OCT 2013AMHARA FIELD OFFICE REPORT ===================================================================== 1. HIGHLIGHTS & CRITICAL ISSUES 2. UTILIZATION PROGRESS Cash Transfer Supplies CMAM and CHD supplies requested and delivered for all zone based on the region request. The requests for CHD supplies are Vit A and printing Materials for Dec CHD implementation and Albedazol drugs will come through RHB from FMOH and it is on process. 3. ISSUES PENDING FROM PREVIOUS REPORT (Country Office) Health, ICCM Health, MNCH Nutrition, VAS / DM Nutrition, Micronutrients 4. PROGRAM PROGRESS REPORT by PCR & IR PCR 102 102 / 006 Community health & nutrition services Child Health Days for VAS / DM (Selamawit Teshome) Recent developments. The fifth round CHD was conducted on the first week of October in all zones except South wello zone with integrated Polio campaign some zonal health office that is South wello zone did not conduct with polio & their plan was to conduct CHD after polio campaign. Monitoring activities More than 5 million ETB that left amount from Quarter 4 allocated for CHD and CMAM activities are liquidated within a week by supporting RHB and BOFED technically by making with frequent contact with zone and weredas through telephone. The quarter two budget of 2006 was requested and it is not processed on the system because of system glitch. Constraints Even if the regional nutrition team liquidate the existing unliqudated budget from all weredas but, still now RHB could not get the requested quarter two budget for the implementation because of the System glitch Remedies taken Inform the problem for the section and program assistant of the region and they are working on it to solve the problem as soon as possible. Next month plan Attended the review meeting of the routine weredas implementation Supportive supervision of the routine wereda Vit-A supplementation and De-worming A half day training was provided focusing on the basics of under nutrition.H. o Conduct monthly meeting (RHB. o L10K staffs should evenly distribute the selection of the 12 kebeles per month per woreda for each HCs in such a way that all HC and one or two HPs under each health center will be supervised. . 102 / 007 Micronutrients deficiency control (Wondayferam Gemeda) Recent developments/Progress made Monitoring activities Constraints Support required from Country Office Next month plan 102 / 008 Community Based Nutrition Program (Wondayferam Gemeda) Progress Made Capacity Building Twenty four L10K staffs have got a skill and capacity of utilizing CBN data at woreda level. o Conduct monthly joint monitoring with team comprising of RHB nutrition focal. L10K and UNICEF) Donor Visit Amhara region has hosted two important donor visits on the implementation of Community Based Nutrition activities. analysis and taking doable actions at the community level. >60% of HDAs trained on complementary feeding demonstration) per each HC should be established. The budget sent from UNICEF shall be shared to L10K staffs by the nutrition officer for follow up of its prompt utilization in the respective woreda. data collection. o Ensure quarterly review meeting held regularly.O of South Gonder Zone and HEWs of Gibtsawit HP of Dera woreda. Monthly Meeting with Partners A monthly meeting was held with L10K Amhara and head office team on how to optimize monitoring activities in L10K supported CBN woredas in the region. The DFAT-CIDA/UNICEF was a high profile visit encompassing the president of CIDA. reporting. The visiting team has got an insight on the overall implementation of Community Based Nutrition from the briefing provided by the head of Dera W. GUW <10%. L10K nutrition coordinator and UNICEF nutrition officer. Besides the visiting team got a chance to visit a household to hear the services provided by HEWs from the family. reporting formats. The staffs should make maximum effort to attend the meetings. Participants raised their concern of including other nutrition information databases (CMAM and CHD) for ease of monitoring and triangulation. Representative of UNICEF ECO and Section chief of NFS. nutrition monitoring wall charts and woreda database. recording. The trainees were well versed with the newly developed GMP registration book. One model HP (GMP participation rate >80%.. The below action points have been agreed o L10K staffs assigned in the woredas should ensure monthly PHCU (HC staffs and HEWs) meeting conducted regularly and performance based discussion using the identified nutrition indicators made. 2013 in Adama of Oromia region. Coordination. Woreda participants included delegates from the W. Machakel. Amhara regional DPFSPCO presented annual 2005 EFY AWP in detail and re-requesting UNICEF ECO NCIS focal person in addressing undelivered supplies according the endorsed 2005 AWP. o HEWs identified under two children The workshop shall be conducted in the remaining two woredas (Sekela and Bure) of west gojjam in November 2013. From each kebele. communication office and administrator. the nutrition officer couldn’t supervise the sensitization workshop on local production of complementary food. DAs. Regional DPFSPCO attended and actively participate in annual review meeting which held from Oct 21-22. a sensitization workshop was held in the three woredas of East Gojjam zone (Basoliben. o To establish the grain bank in each kebele (kebele administrators pledged to provide the space/centre serving the purpose) and when to start actual implementation. Following the sensitization workshop on local production of CF in the remaining woredas Support the RHB in launching workshop of the revised NNP Programme implementation monitoring. Besides the regional coordinator the consulting firm and RHB nutrition focal have paid a follow up visit in two woredas of S. Constraints Due to competing priorities.Sensitization Workshop on Local Production of Complementary feeding As per the agreement between UNICEF and Ethiopian Orthodox Church on production of local complementary food in five woredas (Basoliben. Agriculture office. Awebel and Machakel).O. Monitoring activities Nutrition monitors recruited through an LTA with a consulting firm have supervised 8 woredas in 6 zones of the region. At the end of the workshop action plan was designed when. . school directors and kebele administrators attended the workshop. PCR 308 308 / 006 DRR and emergency response Nutrition. The major findings of the visit have been shared in a separate report. Nine rural kebeles and one urban kebele had been selected for the rural and semi-urban model of CF production prior to the workshop. HEWs.H. Gonder and one woreda of West Gojjam.2013 due implementing partner not able access the requested budget in time. Awebel. Recommendations (or Remedies as applicable) Support required from Country Office Next month’s plan. Sekela and Bure) of East and West Gojjam zones. Information Systems (NCIS) (Mussie Asfaw) Recent developments Tentatively planned regional level nutrition cluster coordination training postponed to fourth week of November. 779 and has been handed out to targeted 16. Regional DPFSPCO jointly with RENCU produced quarterly early warning bulletin and some of concerns highlighted are: Meher 2013 season weather condition was favorable and the distribution of rain was rated as normal to above normal in most parts except Telemet. Targeted zones DPFSPC departments for upcoming BANS prepared zero draft survey proposal and submitted to RENCU for technical comments with the capacity of last rounds on job coaching and training on SMART.302.500 ha and 4.193.005 beneficiaries’ and not yet finilized Overall burden of malnutrition status has been increased in last three months particularly weredas with aggravating food insecurity due the hunger season Regional health and Nutrition taskforce and EPRP coordination forums were held on Oct. Relief food was distributed for 2013 in 5&6 rounds for 557. but case increase reports from (Metema and West Armacho). it was planned to cover 4. Out of total 103. In the current year. besides the need of communicating those weredas by RBOH for screening and compiling results including MAM identified beneficiaries were discussed.TFP admission increase by 11% in the region on August than last July in 2013 which is seasonal Malaria situation relatively decreased than last year.705 ha (99. Some of major concerns discussed are: The new hotspot classification and the need for inception on TSF to the newly included priority one weredas by WFP. 2005 AWP fund soon in selected zones. Preventive measures (IRS operation) and response strengthening (Drug distribution and surveillance) is currently taking place in the region Typhoid outbreak was detected in Anista Kebele in Tach gaint and its investigation and confirmation was done through lab results.2006 AWP funds and also alerting IP in utilization of the released QIV. 2013 at RHB and DPFSPCO respectively. Abergele and Dahana woredas. . Constraints RENCU Nutrition officer position vacant for more than year on top of the existing one staffs switched to DCT modality under government which makes difficult to get full support due vehicle access challenge. Zequala.98 food allocated arrived 27.324. Remedies Still waiting an urgent best option in deploying the vacant position. Disbursement QI & II. 10 and 11.5%) were covered /planted with different crops No major disease outbreaks were reported except Typhiod in Tach Gaint and Anthrax in cases from Waghimra weredas. TFP admission trends increased when compared in the last three years in similar season but mainly due expansion of the service and better community mobilization. and seasonal increase in the malaria prone areas in the region.052 beneficiaries. Next month plan Facilitate in conducting regional level nutrition cluster coordination training Preparation and implementation first round 2006 EFY BANS Provided supportive supervision in regular program implementation. Agricultural performance of the season is much better compared to recent years including last year and the reference year. For example in one of the visited kebele (Negade Meshageria out of totally screened 55 children 22 of them were found to be below 11CM in MUAC i. polio campaign etc which have enhanced community mobilization. Lasta where reported. high number of severely malnourished children was found. The increase in September was mainly observed in East Gojam 64%. where belg failure has also been reported (Could associate with the food insecurity) North Wollo The increase is 18% and increases were observed in Meket (food insecurity reports as well coming from this werda). Leghambo.The overall admission increase could also be attributed to CHD. . Therefore the overall increase is mainly due new opening sites but the seasonal food insecurity has also could have influenced specially in S wollo Currently house to house polio campaign was conducted in the region and some zones have integrated it with nutritional screening. 40% of them are screened to be MUAC below 11 CM) and some other zones have also planned screening with currently ongoing meningitis vaccine and we will be expecting a better mobilized screening reports. For instance. North gondor zone has decided to do house to house nutritional screening together with this campaign. TFP admission has increased in August by 11% from July and the increase was mainly observed in in S wollo. But most of all the quality of reporting also showed improvement. North Shewa(41%) and South Gondor (27%). Tenta .Mekdela. There are new 34 TFP sites and the reporting rate also rose from 79% in july to 90 % in August. South Wollo There is 32% increase than last month with even lower reporting rate and the higher increase is observed in Delanta. Oromiya Zone(58%). The malnutrition is highly correlated with the food security gaps. This was again highly noticed in all kebeles of telemt wereda. Over all TFP admission has increased in September 15% from August and 27% from July. Though the reports not yet been fully complied.308 / 007 EPR . South Wollo and North Wollo North Shewa That is 241 Admisions from July to 341 in August (40% increase).e. N shewa and N wollo/ The increase in August is most observed in North Shewa. however the number of new TFP sites and their reporting sites have also raised.Nutrition (CMAM) (Selamawit Teshome) Recent developments The TFP admission has been increasing since July and this has been observed in the previously years as well (seasonal explanation). our monitoring achievement record for the months of October is indicated in the below bullet point 11 rural woredas and two town administration have been monitored in six zone in the region 104 health post have been visited to provide supportive supervision and on the job coaching 38 cluster health centers visited and mentored based RHB and UNICEF regional office direction 8 stabilization centers was also monitored and supported in this reporting period On the job coaching touched 132 Health extension workers and 77 health workers’ Table: Woreda CMAM score classification by zone CMAM score # woredas with <50 score # woredas with >50 & <70 # Woreda > 70 score North wollo 0 South wollo 0 North showa 0 E.Gonde r 0 N. to implement and analyze CMAM program indicators.Gond er 0 Total 1 0 1 2 2 2 8 2 2 0 0 0 1 5 0 . management of sever acute malnutrition without medical complication at the health post level . Additionally and most importantly. Gojam 0 S. health center and woreda level.Admission Trend Amhara region 2011-2013 Monitoring activities Building the capacity of nutrition stakeholders at health post. the quality monitoring project has sought to create a health extension worker capable of carrying out. Monitored woreda 3 2 1 2 2 3 13 Constraints Routine drugs was not given to children in OTP service OTP cards were not accurately and completely filled during follow up session Shortage of non-medical items like soap to demonstrate hand washing practice In majority of the HPs bin card is not practiced for stock balance of drugs and RUTF Regular supportive supervision is not given from cluster supervisor on CMAM for HEW TFU sites are open but enrollment of SAM with medical complication is very poor Lack of red scoop is becoming a big challenge in majority of the inpatient care facility Remedies taken Communicated to woreda and zone so that they will be able to distribute medicine to local health facility On the job coaching provided the HEW to fix the problems and improve follow skill using the standard SAM management protocol Introduced the use Bin card and model in all the visited facility to improve supply management Support required from Country Office. Next month plan Supportive supervision on screening implementation and the admition status of SAM cases with Jarco and RHB. .