SINGLE FORM
27/11/2007
DIRECTORATE-GENERAL FOR HUMANITARIAN AID - ECHO
SINGLE FORM FOR HUMANITARIAN AID ACTIONS[1]
1.GENERAL INFORMATION
1.1 Name of Humanitarian Organisation/Country of registration:Action Contre la Faim France (ACF-F)
1.2 Title of the Action:
NutritionHealthprogrammes in South Central Somalia
1.3 Area of intervention (country, region, localities):
Somalia, Benadir/Bay/Bakool/Gedo regions, Mogadishu Town and Wajid district
1.4 Start date of the Action:
01 August 2008
1.5 Duration of the Action in months:
12 months
1.6 Start date for eligibility of expenditure:
1.7 Requested funding modalities for this agreement
100% financing
Co-financing
Multi-donor (for International Organisations)
In case of 100% financing: justify the request
1.8 Urgent actionYes No
If yes:ECHO Primary emergency decision
ECHO Emergency decision
Other ECHO decisionPlease justify:
1.9 Control mechanism to be applied: A P
1.10 Proposal and reports
Initial proposaldate:03-07-08
Revised proposal N°2date:XX-09-08
ECHO reference 2008/00002/RQ/01date:03-07-08
Intermediate reportdate:dd-mm-yy
Final reportdatedd-mm-yy
1.11 [INT]List the supplementary agreements and exchange of letters after signature of the Agreement up to intermediate report stage
1.12 [FIN]List the supplementary agreements and exchange of letters after submission of the Intermediate report up to final report stage
2.NEEDS ASSESSMENT
2.1 Date(s) of assessment; methodology and sources of information used; organisation/person(s) responsible for the assessment
2.1.1Date(s) of assessment;
Nutrition:
- A rapid assessment in Mogadishu, July 2004.
- ACF Nutritional Surveys in Wajid area conducted in January 2006, July 2006, February 2007, October 2007, and April 2008
Health
- WHO epidemiologic surveillance – on-going
Food security
- FSAU monthly food security updates
2.1.2Methodology and sources of information used
Nutrition:
- A rapid assessment carried out by the FSAU in Mogadishu: in IDP camps in Mogadishu: anthropometric measurement with MUAC.
- ACF Nutritional Surveys: Two-stage random cluster sampling following the SMART methodology
- Information from ACF nutrition facilities in 2006-08
Health
- WHO epidemiologic surveillance: Using 13 sentinels site in Mogadishu city.
- Information from ACF health facilities in 2006-07
Food security
- FSAU food security surveillance
- ACF Food security department
2.1.3Organisation/person(s) responsible for the assessment:
ACF international and national senior staff.
2.2 Problem statement and stakeholder analysis
Mogadishu town, Benadir region
On the top of an already alarming humanitarian situation in 2007, the combination of conflict, destruction, inflation, trade limitation and high level of displacement increased vulnerability of Mogadishu inhabitants and worsened the situation in term of basic services hampered by the lack of medical and humanitarian supplies and access to Ingo’s due to the increased insecurity. The impact was immediate on under five year children regarding their health and nutritional status during the first quarter of 2008 with significant increase of beneficiaries in ACF projects.
Wajid district, Bakool region
Wajid area is populated by agro-pastoral rural population that has been relatively uninvolved in the 2006 conflict between TFG and ICU. A severe drought in 2006 (Gu rainy season) left thousands of people without water, crops and livestock. It had a dramatic impact on the vulnerable populations of the region dependent on rainfall regarding their agricultural incomes and was followed by high rates of acute malnutrition over the region. The lack of basic services due to the ongoing 15 years of civil war, added to poor hygiene practices, led to increased waterborne diseases, which have a direct impact on under five nutritional status.
Fields are exclusively rain-fed. This means that the area is reliant upon rains to ensure a good harvest and food security, however poor quality land means that even in good rain seasons the harvest yield may not be sufficient to provide the entire family with food until the next season. Consequently there is usually insufficient food production in the area and families are obliged to supplement their stocks with market-bought produce and ultimately to reduce their food intake.
Regarding health in Bakool region, adding to the lack of basic health services and hygiene practices that already created an alarming situation, an outbreak of acute watery diarrhoea including cholera cases was confirmed in a WHO report in April 2007. The outbreak occured at the time when an influx of IDPs that had fled the conflicts in Mogadishu -where cholera had already broken out-reached the area. Recurrent diseases such as water, Kala azar and and lung infection related have also a direct impact of the nutritional status of these vulnerable populations.
A KAP survey (knowledge, attitudes and practices) carried out by the water and sanitation department of ACF showed poor sanitation facilities, poor hygiene knowledge and practices.
At the time of writing this proposal, the general nutritional situation has further deteriorated following the lack of rains during the last Deyr rainy season (Oct-Nov 2007) and further economical deterioration due to the devaluation of the local currency, increase of imported goods and lack of access to humanitarian organisations. During the last 2 months, ACF has observed a significant increment of admissions of severely acute malnourished children in its centres (almost double). On top of that the last nutritional survey conducted in April-May 2008 highlighted very critical levels of malnutrition (2.5 SAM – 22.4 GAM).
2.3 Summarise findings of the assessment (include full report in annex, if relevant) and link these to the Action
The general situation in Mogadishu is still precarious. Out of the 1.2 million inhabitants in Mogadishu, 250,000 are internally displaced persons (IDP)[2]. The low income of the majority of households, the lack of reliable urban infrastructure and the poor population awareness about health and hygiene care practices, jeopardize the access to primary services (security-education-health and nutrition). Therefore, there is no indication for sensible improvement of the health situation in general.
Concerning nutrition, the last survey conducted by Unicef/FSAU in IDP camps - July 2004 - showed a GAM rate of 15,8% (CI 12.8% - 19.6%) and SAM rate of 3,2% (CI 2.2% - 4.7%) in z-score, representing an alarming situation. From July 2007 until May 2008, ACF nutritional screening through home visitors using MUAC have shown that amongst 16,289 children screened 9,068 (55.6%) were identified as moderately malnourished while 532 (3,3%) as severely malnourished, which is an increase compared to the results of the same activity during 2006.The results show a critical situation linked to poor medical status, poor feeding practices and habits, family food insecurity (spectacular inflation of the local currency led to an increase of the basic commodities prices compared to the steadily limited income generation possibilities), and the growing insecurity all over the country that hampers the regular private trade and the humanitarian aid access.
In Wajid the last nutrition and mortality surveys conducted (April 2008) have shown a very critical nutritional situation[3]. Compared to the last two surveys the current situation has significantly worsened (see Annex 1). The following factors have been identified as having an impact on the nutritional status in Wajid District:
Permanent factors: high dependence of the people on the climatic vagary[4] because of very low agricultural and farming techniques available;exhausted stocks due to several years of lack of precipitations and failed harvests,low level of drinking water quality and sanitation once again depending on the climate;extremely limited access to health services;still limited care and health practices related to almost inexistent education system; chronic political instability;
Additional factors from the last 10-11 months led to a very critical nutritional situation: the rainfalls during the last Deyr season were extremely poor, leading to important cropfailure[5]andrapid stocks exhaustion. Other temporal factors include the countrywide devaluation of the Somali shilling, which resulted to 300-400% of increase of the market prices of the staple foods and other basic commodities, andthe increased insecurity situation that blocks free movement of humanitarian aid and free trade.
ACF intends to contribute to the reduction of mortality and morbidity among the most vulnerable people of Mogadishu and Wajid as follows:
- ACF will ensure detection and treatmentof severely malnourished cases using CBTC approach in both Mogadishu and Wajid and relying on WHO standards. To improve access and enlarge the intervention area, ACF will increase the OTP points network in both locations.
-ACF will reinforce health & nutritional education, and home visiting, and will improve the detection and the community awareness throughthe existing network of community volunteers, especially in Wajid area.
-Based on its 2006 positive experience and to mitigate the high risk of mortality o, ACF will carry a blanket distribution of high-energy food for the under 5 years old during two months in Wajid.
-ACF will continue the immunization through two EPI fixed posts, promoting safe motherhood and health for under five running MCH, and providing free primary health care to IDPs and destitute residents of Hodan District by running an Out Patient Department (OPD).
- ACF will strengthen the partnerships with other actors involved in the nutrition and the health sector.
2.4 [INT]If changes in needs assessment at intermediate report stage, please explain
2.5 [FIN]If changes in needs assessment after intermediate report, please explain
3.HUMANITARIAN ORGANISATION IN THE AREA OF INTERVENTION
3.1 Humanitarian Organisation's presence in the area of intervention: brief overview of strategy and current or recent activities in the country
ACF has been operating in Somalia since 1992 and is currently based in Wajid (since 2003),Mogadishu (since 1992), and in Galgaduud (since 2007), the coordination and support office being in Nairobi, Kenya.
ACF has been for several years now, and will continue in 2008, to substitute non existent public services in order to address the basic needs of the populations, focusing on current areas of intervention: Wajid zone (Bay/Bakool/Gedo), Mogadishuand surroundings, and Dhusamareb (Galgadud).
In Wajid zone (Bay/Bakool/Gedo) and Dhusamareb district (Galgaduud): ACF will continue to substitute non-existent public services in the field of nutrition, water and sanitation and food security with the objective of contributing to the reduction of the vulnerability of the resident populations through the improvement of access to food and creation of conditions of food autonomy and by extending geographically its water points rehabilitation/improvement project.
Mogadishu: ACF will continue to substitute non-existent public services in the field of nutrition (CBTC[6]s), health (EPI, OPD, MCH).
In parallel to the assistance, and considering the strict limits on what can be achieved, all research/information aspects have to be enhanced and given greater priority.
ACF will also continueresponding to the most acute and emergency needs and will work on improving people’s capacity to better cope with future external shocks
Wajid zone (Bay/Bakool/Gedo) and Dhusamareb district (Galgaduud):considering the recurrence of climatic hazards in the region, ACF will remain in alert and will keep the capacity to respond through emergency water trucking, distribution of food and/or seeds, as it did throughout 2006 and 2007 (diversification of the production system, restocking/de-stocking, recapitalisation through cash injection, etc).
3.2 Actions currently on-going and funding requests submitted to other donors (including other EC services) in the same area of intervention - indicate how overlap and double funding would be avoided
The French Government through the Nairobi Embassy has been supporting for several years ACF programmesin terms of food supply. Their contribution for the coming months will cover a part of the high-protein (BP5) blanket distribution. It has been ensured that all contributors are complementary and that there is no financial overlapping.
3.3 [FIN]List other Actions carried out by the Humanitarian Organisation or its Implementing Partners in the same period in that area of intervention and how risks for double funding were avoided
4.OPERATIONAL FRAMEWORK
4.1 Exact location of the Action (include map of project location)
Mogadishu town, South Bakol/ North Bay/ East Gedo area (around 50 km around Wajid, ACF base) Somalia
Please refer to Annex 2.
4.2 Beneficiaries
4.2.1Total number of direct beneficiaries: 69,490
4.2.2Status of the direct beneficiaries (multiple options possible) IDPs Refugees Returnees local population Others (e.g. for Grant Facility, thematic funding, etc.)
4.2.3Specificities of direct beneficiaries (please elaborate, refer to groups as appropriate, e.g. unaccompanied minors, disabled, children, ex-combatants…)
Nutrition[7]Treatment of acute malnutrition
Status / Group / Numbers / Remarks
Mixed target population (both local and IDPs) / Children / 4,350 / Under-five children identified as severely malnourished according to ACF criteria of admission.
Estimated figures:
- Mogadishu: 3,800
- Wajid: 550
Beneficiaries’ household members / 8,300 / - Children with medical complications are first admitted in the stabilization center where they stay with their caretaker. In addition, in 75% of the cases, an extra-child is admitted since the caretaker cannot afford leaving the latter by his/her own. Both benefit from direct ACF support (food, health education, etc) during their stay in ACF centres: around 4,700 individuals.
- Moreover, in order to protect the ration given to the beneficiary in the frame of the ambulatory treatment (OTP) and to support families particularly at stake in Wajid, ACF provides food rations for the family of the beneficiary. For the present operation it represents about 3,600 people.
Capacity building and community volunteers training and support
ACF staffs and community volunteers / 20 staffs and 20 community volunteers / 20 ACF nutrition and medical staffs will benefit of training and workshops (in Somalia and Nairobi)
The network of community volunteers will rise up to 20. They will receive regular training and material support related to their activities.
Emergency distribution of high energy food
Mixed target population (both local and IDPs) / Children / Max 15,000 / Under-five children
Estimated figures: total population 46,523 inhabitants (ACF April 2008 survey),
Under-5 population represents 13,864 (29.8%[8] out of the total).
Estimated eventual population growth and the IDPs influx in 2007-2008: around 1,000
Health
Status / Group / Numbers / Remarks
Mixed target population (both local and IDPs) / All / Max 28,800 / Estimated figures for OPD:
2,400/month, leading to 28,800 in total.
Women / 3,000 / Estimated figures for MCH:
250 new entries/month, leading to 3,000 in total
Children and Women / Max 10,000 / For EPI: Children under 5 years pregnant and childbearing age women
4.2.4Direct beneficiary identification mechanisms and criteria
Nutrition:
Community based therapeutic care (CBTC): weight for height < -3 Z-score (WHO reference population), MUAC < 110 mm, oedema, and BMI[9] for adult only. All children with major medical complications, anorexia and marasmus-kwashiorkor are stabilised first in stabilization centre. One caretaker is admitted with each patient. The patient’s family members benefit from family rations during the treatment.
Health:
MCH/OPD: any patient coming at the OPD or MCH.
EPI: individuals below 5 years depending on their immunisation schedule, as well as the pregnant and childbearing-age women.
Emergency supplementary distribution:
All children under 5 years oldor below 110 cm in height in the zone of Wajid
4.2.5Describe to what extent and how the direct beneficiaries were involved in the design of the Action
In the nutrition centres, systematic interviews are carried out with caretakers and/or beneficiaries in order to better understand the profile and expectations of the patients. Remarks about the quality of welcoming, living conditions in the TFC, or quality of care would be considered to improve beneficiaries and caretakers well being in the centre.
In addition, the home visitor teams, who have the opportunity to discuss with households and community leaders, report needs expressed by the visited communities. Those related to nutrition and health are considered for improvement of ACF facilities and services.
In Wajid, during the blanket distribution the local authorities will be involved in the process. ACF will involve also the community volunteers’ network in the screening and nutrition education activities. All suggestions from those key community persons will be taken into consideration.
4.2.6Other potential beneficiaries (indirect, "catchment", etc.)
In Mogadishu the catchment population is made of the Hodan District population (158,472 people), Karan District population (159,000), Madina District population (109,567), and Abdil Aziz District population (29,878 people) (Source: WHO, 2005) and Daynile District. Out of this total, the under 5 years-old population is estimated at 97,582 individuals (except for Daynile). There is no precise data on the total population of Daynile district, but estimations of other actors (ICRC, MSF-F) are of about 60,000 with 12,000 under 5 years old out of the total.
The Wajid area includes North Bay and East Gedo, which population is estimated at 46,523 people, among which the under-5 population represents 13,864 (29.8%[10] out of the total). It is estimated that around 3,092 children are acutely malnourished (data from April 2008 nutrition survey).
4.2.7Direct beneficiaries per sector:
Sector / Number of beneficiariesNutrition: / 27,690
Health: / 41,800
4.2.8[INT]In case of changes, please explain
4.2.9[FIN]In case of changes, please explain
4.2.10[FIN]Estimate per type of beneficiaries
female:… %, male:… % (total female + male= 100%)
infants (< 5y):… %,children (< 18 y):… %, elderly: … %
[Proposal][Agreement ECHO/…] – version [XX/09/2008]1
SINGLE FORM
27/11/2007
4.3 Objectives, Results and Activities
4.3.1Operational Overview of the Action: Log-frame[11] (max. 3 pages)
Title of the Action / Nutrition & health programmes in South Central SomaliaPrincipal Objective / To contribute to the reduction of mortality and morbidity among the most vulnerable people (with specific focus on children under 5 and pregnant women).
Intervention Logic / Objectively Verifiable Indicators / Sources of Verification / Risks and Assumptions
Specific Objective / Acute malnutrition in Mogadishu and Wajid area and primary health problems in Mogadishu are addressed / A total of 3,270 severely malnourished are cured (420 in Wajid, 2,850 in Mogadishu, 75%[12] of admissions)
28,800 persons receive health treatment and/or consultation in the OPD
3,000 women are admitted and monitored in MCH (30% of them follow three antenatal and one postnatal consultations)
30% of the children <5 and pregnant women are fully immunized
The malnutrition rate amongst children under the age of five in the Wajid area is reduced. / Monthly ACF TFP reports
Monthly ACF OPD report
Monthly MCH reports
Monthly ACF EPI reports
Nutrition survey report
Results / A total of 4,350 severely malnourished children are adequately treated (3,800 Mogadishu, 550 Wajid) / Number of admissions in TFP (OTP + TFC) Mogadishu and Wajid;
ACF nutrition treatment standards are met[13] / Monthly ACF Nutrition reports
20 ACF staff and 20 community volunteers (in Wajid) have improved knowledge on health and nutrition practices / Number of staff attending training sessions;
Number of community volunteers attending the training sessions;
80% of the post-test results are positive / ACF attendance records
Post test results
28,800 consultations in Outpatient Department (OPD) and 3,000 new women visit Mother and Child Health (MCH) centre in Mogadishu / Number of new admissions in MCH
Number of consultations in OPD / Monthly ACF OPD/MCH morbidity reports
10,000 persons attended EPI programme in Mogadishu (7,000 children under 5 and 3,000 pregnant women) / Number of admissions under 5 in EPI
Number of women admissions in EPI / Monthly ACF EPI reports / Regular UNICEF supply with vaccines
15,000 children under five years old in Wajid area have access to complementary food for 2 months / - 95% of the target group receive BP5
- 80% of the target group consume BP5 / Post-distribution monitoring report / ACF advice regarding BP5 consumption is followed (stocking, preparation, consumption).
Hunger gap period does not extend for more than 6 months
[Proposal][Agreement ECHO/…] – version [XX/09/2008]1