Download a PDF of this issue - Field Exchange - Emergency ...

More documents

Recommendations

Info

Field article Figure 5: Deterioration in the nutrition situation from Deyr 2006/07 to Gu 2011 Deyr ‘06/07 Gu ‘07 Deyr ‘07/08 Gu ‘08 Deyr ‘08/09 Gu ‘09 Deyr ‘09/10 Gu ‘10 Deyr ‘10/11 Gu ‘10 Source: FSNAU website. Note: To see the detail, download from http://www.fsnau.org/downloads/Prgrogression_of_Estimated_Nutrition_Situation_Deyr_06_10_to_Gu_11.pdf period, median rates of GAM have remained at serious (10 to
Field article Nutrition outcomes are not yet included in sectoral policies and programmes but the Somali Nutrition Strategy is trying to highlight nutrition issues at policy level. Somali specific IMAM guidelines were developed through the Nutrition Cluster in 2010 and a Basic Nutrition Services Package (BSNP) has been defined and encouraged, also through the Nutrition Cluster. However, whilst many agencies are adopting the approach and include it within activities outlined at proposal level, many organisations find it difficult to conceptualise or lack the capacity to deliver. MOH systems and structures – where nutrition fits After twenty years of conflict, the health care system in Somalia remains underdeveloped, poorly resourced, inequitable and unbalanced. The public health care delivery system operates in a fragmented manner, maintained largely by medical supplies provided by UNICEF and other agencies. In the absence of an efficient and adequate public health system, the private sector has flourished but remains unregulated with poor quality of services and poor access to the rural population. Over half of the estimated health workforce is unskilled and unsupervised and staff are paid a below subsistence wage. Most public facilities operate at a level far below their intended capacity and are poorly organised, with very low utilisation rates (estimated as on average, one contact every eight years 6 ). In Somaliland there is a functioning MOH and political will exists. Nutrition has been identified as a key priority area by the Minister of Health and the nutrition focal person within the ministry is motivated and active. Key staff have been appointed at Hargeisa level, and at regional and district levels. Thus a ‘traditional’ MOH structure is in place but remains financially dependent on support from UNICEF and other agencies. In Somaliland, 34 outpatient therapeutic programmes (OTPs) and four stabilisation centres (SCs) are delivered through government health facilities. In Puntland, political will and support is present to a lesser extent, with health receiving a greater focus than nutrition, primarily due to the qualifications and background of the nutrition focal person. There is willingness to work with UNICEF support on nutrition and government will respond if funding is available. Ten OTPs operate through government health facilities. In SCZ, the MOH recognises nutrition and ‘allows’ UNICEF and its partners to implement programmes but the public health structure and functioning is largely confined to Mogadishu. Delivery of IMAM programmes through government health facilities is limited to one SC in Mogadishu where hospital staff support the implementation of an otherwise independent centre. Where OTP services are operating through government health facilities, the services are delivered by MOH staff but they are given financial incentives by humanitarian players. Where MOH is implementing with little staff support, reporting is provided by MOH alone. Where greater levels of support are provided, reports are provided by the supporting NGO. Whether reporting is conducted by MOH or a humanitarian agency, reports are generally delayed. Efforts are currently underway to train staff to strengthen reporting. Implementation of IMAM in Somalia The implementation of all four components (community mobilisation, SCs, OTP and targeted supplementary feeding programme (TSFP)) of programmes for the management of acute malnutrition in an integrated way is not always feasible in Somalia. Existence of and access to SCs is limited, such that the ideal programme set up of OTP with SC services available (either attached to a hospital or stand alone) are usually only seen in towns in Somalia. The more common set up is a network of several OTPs with limited possibility of referring complicated cases to SCs. The lack of SC services may be due to distance to the nearest facility, or due to lack of access for other reasons (e.g. transport, clan issues, inability to leave the family for a full week or insecurity). OTPs may or may not be integrated with SFP. In some areas, SFPs are implemented in the absence of OTPs or SCs. In these cases, the centres may admit all malnourished children regardless of their severity. During the initial expansion of IMAM, programmes were implemented according to operational guidance developed by Nutrition Cluster partners in 2005. In 2010, new guidelines were developed and endorsed by the Nutrition Cluster. These guidelines, initially promoted by UNICEF and the Somali Nutrition Cluster, have been written in consultation with all organisations, departments and agencies implementing programmes to manage acute malnutrition in Somalia. This was done with the intention of capitalising on best practices and experiences, so that lessons learnt by one can be applied by all partners. The guidelines intend to facilitate the process of training new staff and to help with the opening of new centres. These guidelines try to take specifics of the Somali context into account, whenever possible, and give practical suggestions for often difficult circumstances e.g. lack of SC referral site. Field cards have been developed with the aim of being laminated for use in the field. So far, the application of the 2010 guidelines has been limited due to problems in the process of translation into Somali. Some sections have been translated for training purposes. Some of the specific challenges that IMAM faces in Somalia are: • Conflict • High insecurity • High mobility of population (including health staff) • Spread of the population, with long distances and isolation • Difficult transport and communications • Population displacement (and the inability of IDPs to access services in some host areas) • Regular migration among pastoralists • Difficult social environment related to complex clan structure • Specific conflicts between clans 6 Rossi and Davies, 2008. Rossi L and Davies A. Exploring Primary Health Care in Somalia: MCH Data 2007. UNICEF Somalia Support Centre Report 8. L Matunga/UNICEF, Somalia, 2012 A child who has been rehabilitated in the programme Figure 6: Scale up of UNICEF support to nutrition services, 2006 - 2011. 450 400 350 300 250 200 150 100 50 0 2006 2007 2008 2009 2010 2011 SC OTP SFP Map 1: Nutrition services, September 2007 Map 2: Nutrition services, July 2011 30
Page 1 and 2: July 2012 Issue 43 ISSN 1743-5080 (
Page 3 and 4: The overall aim of the Addis Ababa
Page 5 and 6: Editorial Éditorial A note on term
Page 7 and 8: Editorial Éditorial Haile Gebrsela
Page 9 and 10: Editorial Éditorial governance). S
Page 11 and 12: Editorial Éditorial incorporated b
Page 13 and 14: Editorial Éditorial the MoH and in
Page 15 and 16: Editorial Éditorial Filling RUTF j
Page 17 and 18: Field Article percentage points per
Page 19 and 20: Field Article sion for relevant sta
Page 21 and 22: Field Article anisms, especially fo
Page 23 and 24: Field Article Health and nutrition
Page 25 and 26: Field article Table 2: Number of he
Page 27 and 28: Field article MOH, Ghana MUAC measu
Page 29: Field article Box 1: Outline of the
Page 33 and 34: Field article feeding (IYCF) practi
Page 35 and 36: Field article other cluster activit
Page 37 and 38: Linear programming to design low co
Page 39 and 40: Research reporting rate sometimes r
Page 41 and 42: Field article Through twice yearly
Page 43 and 44: Field article Table 2: Chronology o
Page 45 and 46: Field article The following assessm
Page 47 and 48: Field article Brief history and bac
Page 49 and 50: Field article France and UNICEF sup
Page 51 and 52: Field article Table 3: Facility-bas
Page 53 and 54: Field article Article de terrain Ba
Page 55 and 56: Field article Article de terrain th
Page 57 and 58: Field article Article de terrain Fi
Page 59 and 60: News UNICEF/NYHQ2008-1649/Pirozzi,
Page 61 and 62: News specialists, CMAM programme ma
Page 63 and 64: News Integration of the management
Page 65 and 66: Conference on Government experience
Page 67 and 68: News Update on Minimum Reporting Pa
Page 69 and 70: Field Article Table 1: Nutrition si
Page 71 and 72: Field Article Table 5: Experience f
Page 73 and 74: Field Article six mobile teams were
Page 75 and 76: Field Article different programmes,
Page 77 and 78: Field Article (IYCF) issues, Target
Page 79 and 80: Field Article term sustainability.
Page 81 and 82:
Field Article from UNICEF, using th
Page 83 and 84:
Field Article spearheaded by UNICEF
Page 85 and 86:
Evaluation absence of pre-service t
Page 87 and 88:
Field Article (58% of the global to
Page 89 and 90:
Table 4: Proportion (%) severely un
Page 91 and 92:
Field Article ACF, Yobe State, Nige
Page 93 and 94:
Field Article team, comprised of (O
Page 95 and 96:
is also to create a more meaningful
Page 97 and 98:
Field Article District training in
Page 99 and 100:
Professional profile Dr Nadera Haya
Page 101 and 102:
People in aid CMAM Conference, Addi
Page 103 and 104:
Invite to submit material to Field
show all

Download a PDF of this issue - Field Exchange - Emergency ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?