Friday, February 9, 2018

Somalia Nutrition Cluster Geo-tagging: Capacity Assessment


Executive Summary
The Somalia Nutrition Cluster commissioned Forcier to geo-tag nutrition services delivery sites and assess their capacity across Somaliland, Puntland and central and southern Somalia. The main objective was to validate the operational status of the sites and identify gaps in service delivery to strengthen the existing capacity of emergency nutrition units and improve their emergency response preparedness.

The findings show that across Somaliland, Puntland and central and southern Somalia, the concentration of fixed nutrition sites varies within regions and districts. In Somaliland, many sites are in the capital, Hargeysa, while the eastern regions remain vastly underserved. In particular, Sool emerges as the region most lacking basic services, supplies and infrastructure at fixed nutrition sites. Similarly, in Puntland, the majority of fixed nutrition facilities are found in Garowe, while the rest of Nugaal and districts in Bari have a lower concentration of sites, to a worrisome degree. In central and southern Somalia, Banadir has the highest concentration of sites and implementing partners, while insecurity impedes humanitarian access to other regions.

Across the three zones, mobile teams play a key role in delivering nutrition services in remote and isolated areas. Unfortunately, limited personnel and resources prevent them from visiting the same village more than twice monthly. In an emergency, such infrequent visits cannot guarantee adequate service provision to affected communities. In contrast, the fixed sites are open much more often but are out of the reach of the most isolated rural communities.
The results highlight the need to focus on the quality of nutrition services provided, specifically training personnel to provide nutrition services in an emergency. Positively, medical staff, including nurses, emerge as the most highly trained staff across the three zones. However, there is a critical shortage of training in Nutrition in Emergency (NiE) in many regions.

In the short-term, priorities should focus on plugging this gap for all medical staff. In the medium term, however, it will be necessary to restructure the system and to implement pedagogic activities linked to hiring policies to ensure the skills of the personnel do not compromise the quality of the service offered.
While most nutrition sites have access to most conventional nutrition services, there is a lack of services focusing on prevention. The most commonly offered services are outpatient therapeutic treatment (OTP) and the targeted supplementary feeding programme (TSFP). Moreover, mid-upper arm circumference (MUAC) screening and community conversation services are provided in most fixed sites and by most mobile teams. However, the relatively low percentage of sites offering the blanket supplementary feeding programme (BSFP) and multi-micronutrients (MMN) is of concern, given that more attention should be given to prevention in the lead-up to, and during, an emergency.

The findings show that most fixed and outreach sites lack access to basic medicines that can save lives in an emergency. Most sites are adequately supplied with admission and referral cards and technical tools. However, both fixed and outreach sites across the three zones are severely undersupplied with medicines, particularly amoxicillin (250 mg.), vitamin A (10,000 IU) and mebendazole. In crisis contexts, the use of unsafe water sources and the consumption of unhygienic food can cause the spread of bacteria and diseases. Diseases are more easily transmitted among individuals whose immune system is already weakened by the dire life conditions caused by the emergency. Therefore, in an emergency, an adequate supply of basic drugs can be a life-saving tool in the fight against malnutrition and endemic illnesses.

The condition of the infrastructure of the nutrition sites varies greatly between the zones and type of site. Fixed sites are well-supplied in terms of sanitation and hygiene. However, outreach sites in Somaliland and Puntland lack access to improved sanitation and hand-washing facilities, while sites in central and southern Somalia are much better equipped. Waste disposal follows a similar pattern. Of concern is the fact that many sites across Somaliland use unimproved water sources. And across the three zones, a third of fixed sites lack incinerators. This can be extremely harmful to the hygienic conditions of the site because a vast portion of the waste material is not biodegradable.

Source: ReliefWeb


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