| Afghanistan 2012 |
| Appealing Agency | Save the Children (SC ) |
| Project Title | Integrated Community-Based Management of Acute Malnutrition (CMAM) and Nutrition Education Rehabilitation Sessions (NERS) project |
| Project Code | AFG-12/H/45736/R |
| Sector/Cluster | NUTRITION |
| Refugee Project | No |
| Objectives | 1. To treat malnourished children in therapeutic feeding sites located in health facilities and reach in remote and hard to reach areas through outreach programme to increase coverage and access;
2. To prevent malnutrition through promotion of optimal infant and young child feeding (IYCF), health and hygiene and caring practices and nutrition education
3. To inform future programming strategy for addressing acute and chronic malnutrition from evidence based and lessons learned from integrated CMAM/NERS approach.
|
| Beneficiaries | Total: 13,165 direct beneficiaries (and approx 107,875 indirect) Female: 4,348 Children (under 18): 8,816 |
| Implementing Partners | Save the Children in Collaboration with BPHS |
| Project Duration | Jul 2012 - Dec 2012 |
| Current Funds Requested | $320,471 |
| Location | Bamyan |
| Priority / Category | A. HIGH |
| Gender Marker Code | 2b - The principal purpose of the project is to advance gender equality |
| Subset of Appeal | |
| Contact Details | Mohammad Akbar Sabawoon MD, mohammadakbar.sabawoon@savethechildren.org, +93 0700250542 |
| Enhanced Geographical Fields | | Central Highland - Bamyan |
|
| Cash Based Intervention | | Is any part of this project cash transfer programming (including vouchers)? | No | | Conditionality: | | | Restrictions: | | | Estimated percentage of project requirements to be used for cash/vouchers: | 0 |
|
Needs
Afghanistan remains one of the poorest countries in the world (one in three Afghans lives in absolute poverty). An additional 37% are situated only slightly above the poverty line. The country experienced prolonged winter and low cumulative rainfall during 2011. For a rain fed country, this has led to significant wheat crop losses, underperforming irrigated crops, and poor pastures. This will lead to increased vulnerability of households (HHs) to nutrition, food and livelihood insecurity. The drought, acute food and water shortages and high food price have an immediate impact on both the quality and quantity of the diet of people living in worst affected areas. Families will either reduce their intake of food or they will be forced to switch to cheaper, less nutritious alternatives. Doing so dangerously undermines children’s fragile immune systems and makes them more prone to malnutrition, sickness and death from infections and disease.
The recent data collected by nutrition cluster shows an increase in the number of admissions in the rehabilitation programmes and other data used as surveillance shows a high rate of malnutrition in most of the districts in the northern and central provinces of Afghanistan. Nutrition Clusters are also very concerned about diarrhoea surveillance data reported in the DEWS mainly due to severe water shortages and poor sanitation situation. This will have a further impact on the nutritional status of the most vulnerable groups of the population, most importantly children under five years of age.
The recent nutrition survey by Oxfam Novib in some of the drought affected provinces indicate that the prevalence of global and severe acute malnutrition were 13.3 % and 3.6 % respectively. Prevalence of acute malnutrition in pregnant and lactating based MUAC measurements less than 23 cm was 30.7% and iron supplementation was 35%. Globally it is well known that malnourished women have an increased risk of delivering LBW babies who have suffered IUGR.In order to provide immediate response to the high rate of malnutrition, prevent further deterioration of nutrition status, prevent deaths among children and based on Save the Children’s prior CMAM / NERS experience, we propose a comprehensive and integrated intervention comprising of Community Management of Acute Malnutrition (CMAM) and Nutrition Education Rehabilitation Sessions (NERS). Save the Children will coordinate with UNICEF regarding the supply of RUTF for its NERS sessions.
Activities
Outpatient treatment for children 6 59 months with SAM without complications using RUTF/medical treatment through the establishment of OTP sites in existing health facilities to ensure they are accessible to community members.
• Stabilization Centers will initially be established in district hospitals. Children with SAM and complications (anorexia, high fever, intractable vomiting, severe dehydration, respiratory infection, severe anemia) and infants <6 months will be treated in inpatient care according to WHO/IMCI protocols and according to the MoPH nutrition guidelines.
• Communities will be sensitized to the issue of malnutrition and the purpose of the CMAM/NERS program. This will be done through information sharing and discussions with key community and religious leaders including shura e sahee or community health committees and, where available, the full engagement of women action groups will be encouraged.
• In collaboration with WFP’s, a Supplementary Feeding programme (SFP) will be implemented to treat moderate acute malnutrition (MAM) among children as well as providing supplementary feeding to pregnant and lactating women.
• In order to prevent further deterioration of nutritional status among children 0 59 months, Save the Children will conduct health and nutrition practical education at community level using NERS approach and mother to mother support systems in the community in their houses to prevent acute malnutrition and change behavior.
• Both male and female staff of BPHS implementing NGOs and the MoPH will be trained to increase their capacity on CMAM and sustainability of programme and all of the CHWs including male and female will be trained on case finding and referral of malnourished children using MUAC and follow up.
• Infant and young child feeding practices will be promoted through different approaches, including using midwives, CHWs, Family Health Action Groups, mothers’ support groups and peer counselors all trained in breastfeeding support.
• Save the Children will conduct a rapid assessment survey and collect disaggregated data including sex and age.. This will form the baseline data for planning and implementation of the CMAM program. Implementation of project Including establishment of OTP, SC, SFP sites and community mobilization activities will be started before the findings of the survey.
• Save the Children will use the monitoring and evaluation system that clearly describes the purpose, indicators, performance standards, frequency of data collection, sources of information, data collection tools, and quality measurement tools and tools for assessing health facility and CHW performance.
Outputs
•Treatment of 2386 children 6 59 months with SAM, 6430 children with MAM and 4348 pregnant and lactating women
• 35 staff of health facilities trained on management of SAM and MAM
• 297 CHWs trained on case finding, referral and follow up
• 175 Shura members oriented on CMAM/NERS
• Community-based practical nutrition rehabilitation and education sessions (NERS) based on positive deviance approach. An estimated 500 mothers trained to ‘actively’ feed their children using local energy dense menus.
• Health education will also benefit approximately 53937 indirect beneficiaries
• Documented and disseminated experience of CMAM and the impact of an integrated approach of CMAM and NERS in Afghanistan
• A nutrition assessment will be conducted to collect base line data for planning and implementation of programme
• In addition following indicators will be measured:
1. >75% recovery rate (SPHERE)
2. <15% exits defaulted (SPHERE)
3. % mothers who know that exclusive breastfeeding is essential for children 0 6 months of age
4. % mothers who know that breastfeeding should be initiated within one hour after delivery
5. % mothers who know breastfeeding should be continued for at least 24 months
6. % of mothers who know complementary feeding for children 6 24 months of age
7. % of mothers who know that sick children (6 to 24 months) must receive appropriate complementary feeding (during and after illness)
8. # of CHWs who know how to use MUAC correctly and refer malnourished children
9. # of CHWs with knowledge of danger signs; importance of referral; and home care
RPM Activities and Indicators
| Save the Children (SC ) |
| Original BUDGET items | $ |
| Human Resources | 188,647 |
| Programme Costs | 308,379 |
| Programme Support Costs | 111,486 |
| Indirect Programme Costs | 32,433 |
| 0 |
| 0 |
| 0 |
|
| Total | 640,945 |
| Save the Children (SC ) |
| Current BUDGET items | $ |
| Human Resources | 94,323 |
| Programme Costs | 154,189 |
| Programme Support Costs | 55,743 |
| Indirect Programme Costs | 16,216 |
| 0 |
| 0 |
| 0 |
|
| Total | 320,471 |
ACTIVITY DETAILS
NO