NAME OF PROGRAMME: Humanitarian Support to Vulnerable Populations in Pakistan LOCATION: Kohat District, Pakistan DATE OF INVESTIGATION: June 2014 AUTHOR(S): Trenton Dailey-Chwalibóg, Lenka Blanárová TYPE OF INVESTIGATION: SQUEAC, program coverage assessment TYPE OF PROGRAMME: OTP for SAM IMPLEMENTING ORGANISATION: ACF-International CONTENTS CONTENTS .................................................................................................................................................. 2 FIGURES ..................................................................................................................................................... 4 TABLES ....................................................................................................................................................... 5 ACKNOWLEDGEMENTS ............................................................................................................................. 6 ABBREVIATIONS ......................................................................................................................................... 7 EXECUTIVE SUMMARY .............................................................................................................................. 8 CONTEXT .................................................................................................................................................... 9 OVERVIEW OF THE AREA ...................................................................................................................... 9 DESCRIPTION OF THE POPULATION .................................................................................................... 9 NUTRITIONAL SITUATION .................................................................................................................... 10 DETAILS OF HEALTH AND NUTRITION SERVICES: ............................................................................ 10 INVESTIGATION PROCESS ...................................................................................................................... 11 STAGE 1 ................................................................................................................................................. 11 QUANTITATIVE DATA ........................................................................................................................... 11 GLOBAL ADMISSIONS: TRENDS AND NEED MET ........................................................................... 11 OTP ADMISSIONS .............................................................................................................................. 14 SC ADMISSIONS ................................................................................................................................ 14 OTP PERFORMANCE INDICATORS .................................................................................................. 16 COMPLEMENTARY QUANTITATIVE DATA .......................................................................................... 18 ADMISSION MUAC ANALYSIS ........................................................................................................... 18 DEFAULT MUAC ANALYSIS .............................................................................................................. 19 DISCHARGE MUAC FOR CURED SAM CASES ................................................................................ 20 LENGTH OF STAY BEFORE DISCHARGE AS CURED ..................................................................... 20 LENGTH OF STAY BEFORE DEFAULT ............................................................................................. 21 DISTANCE-TO-TRAVEL: ADMISSIONS & DEFAULTING .................................................................. 22 QUALITATIVE DATA .............................................................................................................................. 24 DATA TRIANGULATION ........................................................................................................................ 26 BBQ TOOL .......................................................................................................................................... 26 STAGE 2 ................................................................................................................................................. 27 SMALL AREA SURVEY ...................................................................................................................... 27 FORMING THE PRIOR ........................................................................................................................... 30 STAGE 3 ................................................................................................................................................. 32 WIDE AREA SURVEY ............................................................................................................................ 32 RESULTS ............................................................................................................................................ 33 BAYES COVERAGE ESTIMATE ............................................................................................................ 35 2 DISCUSSION AND RECCOMENDATIONS ............................................................................................... 37 ACTION PLAN ........................................................................................................................................ 38 ANNEX ....................................................................................................................................................... 42 ANNEX 1: LIST OF PEOPLE TRAINED.................................................................................................. 42 ANNEX 2: QUESTIONAIRES ................................................................................................................. 43 Works Cited ................................................................................................................................................ 45 3 FIGURES FIGURE 1. Plot of OTP admissions and defaulting over time (with and without smoothing) (September 2013 – April 2014);. ............................................................................................................................. 11 FIGURE 2.Total admissions per OTP site (September 2013 – April 2014) ................................................. 14 FIGURE 3.SC admissions (Sept 2013 – April 2014) ................................................................................... 15 FIGURE 4. Total percentage of total admissions in OTP/SC (Sept 2013 – April 2014). .............................. 16 FIGURE 5. Evolution of performance indicators over time (September 2013 – April 2014) ......................... 17 FIGURE 6. MUAC at admission (September 2013 – June 2014) ................................................................ 18 FIGURE 7. Default MUAC (September 2013 – June 2014) ........................................................................ 19 FIGURE 8. Discharge MUAC for cured children (September 2013 – June 2014). ....................................... 20 FIGURE 9. Length of stay before discharge as cured (September 2013 – June 2014). .............................. 21 FIGURE 10. Length of stay before default (September 2013 – June 2014) ................................................ 22 FIGURE 11. Distance to travel for admissions (September 2013 – June 2014). ......................................... 23 FIGURE 12. Distance to travel for defaulters (September 2013 – June 2014) ............................................ 24 FIGURE 13. Small-area survey barriers to access; Kohat District, KPK, Pakistan 2014. ............................ 28 FIGURE 14. Priori probability density, Distribution = Beta(19.0, 15.7), Mode = 54.8% (95% CI ≈38.5%; 71.2%) ................................................................................................................................................. 32 FIGURE 15. Wide-area survey barriers to access ...................................................................................... 35 FIGURE 16. Wide-area survey referral mechanism .................................................................................... 35 FIGURE 17. Beta-binomial conjugate analysis. .......................................................................................... 36 4 TABLES TABLE 1. OTP performance indicators (June 2013 – April 2014) ............................................................... 17 TABLE 2. BBQ tool legend ......................................................................................................................... 25 TABLE 3. Main barriers and boosters ........................................................................................................ 25 TABLE 4.Small-area survey village selection criteria ................................................................................. 27 TABLE 5.Small-area survey results............................................................................................................ 28 TABLE 6.Small-area survey results............................................................................................................ 29 TABLE 7.Prior probability calculation ......................................................................................................... 31 TABLE 8.Shape parameter calculation .....................................................................................................