Infant and Young Infant and Young Infant and Young Infant and Young Child Feeding in Child Feeding in Dadaab Dadaab: Improving practices Improving practices Improving practices Improving practices in a protracted crisis in a protracted crisis Mary Lung’aho, CARE Mary Lung’aho, CARE on behalf of the on behalf of the interagency interagency Dadaab Dadaab IYCF Team IYCF Team UNHCR, CARE & Partners UNHCR, CARE & Partners October 10, October 10, 2009 2009
Transcript
Infant and YoungInfant and YoungInfant and Young Infant and Young Child Feeding in Child Feeding in
DadaabDadaab::Improving practicesImproving practicesImproving practices Improving practices in a protracted crisisin a protracted crisis
Mary Lung’aho, CARE Mary Lung’aho, CARE on behalf of theon behalf of the
interagency interagency DadaabDadaab IYCF TeamIYCF Team
UNHCR, CARE & PartnersUNHCR, CARE & Partners
October 10, October 10, 20092009
IYCF Support in IYCF Support in DadaabDadaab: an Interagency Effort : an Interagency Effort pppp g yg y
DadaabDadaab IYCF TeamMembersIYCF TeamMembers ObjectivesObjectivesDadaabDadaab IYCF Team MembersIYCF Team Members UNHCR*UNHCR*
CARE*CARE*
ObjectivesObjectives Integrate support for Integrate support for appropriate IYCF intoappropriate IYCF into CARE*CARE*
GTZ*GTZ*
NCCKNCCK
appropriate IYCF into appropriate IYCF into multimulti‐‐sectoralsectoralprogrammingprogramming
NCCKNCCK
IRC*IRC*
p g gp g g
Strengthen capacity of Strengthen capacity of staff/workers and staff/workers and
ACFACF
MSFMSF‐‐Swiss*Swiss*partners to support partners to support IYCF in emergency IYCF in emergency
t tt t* = current* = current contextscontexts
Protracted EmergencyProtracted EmergencyDadaabDadaab Refugee Camps in KenyaRefugee Camps in Kenyag p yg p y
DadaabDadaab CampsCamps
Strengthening the SystemStrengthening the SystemStrengthening the SystemStrengthening the SystemWhat are the key elements?What are the key elements?What are the key elements?What are the key elements?
Orientation for all staff
Rapid assessment of new arrivals
Capacity‐building for staff & volunteers Capacity‐building for staff & volunteers
IYCF support in on‐going programming
Behavior change communications
MonitoringMonitoring
Dadaab IYCF TeamUNHCR Nutritionist CARE IYCF Supervisor
UNHCR—CARE—GTZ—NCCK AAH—Save UK
IYCF Coordinating Team:
CARE IYCF SupervisorGTZ Nutrition Coordinator NCCK
Hagadera Hospital Ifo Hospital Dagahaley Hospital
IYCF Health Post Team
IYCF Officer. Maternity staff Pediatric staff Under five
consultant HIS staff
Health Post
Health Post
Health Post IYCF Community Workers
Health Post Staff ANC consultant Under five consultant HIS staff
SC staff PMTCT etc.
EPI staff SFP and OTP staff
Community Workers CHWs- Community Health Workers TBAs- Traditional Birth Attendants CDWs- Community Dev Workers RHMs- Repro. Health Motivators CPWs- Children Protection Workers
Community Volunteers-IYCF Counselors Mother-to-Mother Support Groups Secondary Targets
Men’s support groups School clubs Youth groups etc etc.
Orientation for all staffOrientation for all staff
IFE: Why it MattersIFE: Why it Matters
Key policy guidance: Key policy guidance: IFE Core Group: IFE Core Group: O G idO G idOps GuidanceOps Guidance
Challenges in Challenges in implementationimplementationimplementationimplementation
Role and Role and responsibilities of allresponsibilities of allresponsibilities of all responsibilities of all sectorssectors
CME for medical staffCME for medical staff CME for medical staffCME for medical staff
Ensure staff have Ensure staff have b i k l db i k l dbasic knowledgebasic knowledge
Rapid Assessment for New ArrivalsRapid Assessment for New Arrivalspp
Identify acuteIdentify acute Identify acute Identify acute feeding and care feeding and care problems needingproblems needingproblems needing problems needing immediate immediate attentionattentionattentionattention
Provide critical Provide critical informationinformationinformationinformation
Link to support Link to support systemssystems
Orientation & CapacityOrientation & Capacity‐‐Building MaterialsBuilding Materials Orientation: interagency Orientation: interagency Ops Guidance & IFE Ops Guidance & IFE Core Group Mod 1Core Group Mod 1
WHO/UNICEF BF WHO/UNICEF BF C lliC lli ( h )( h )CounsellingCounselling course (40 hr) course (40 hr)
IYCF CommunityIYCF Community‐‐Focused Focused and Cand C F Plus (incorporatesF Plus (incorporatesand Cand C‐‐F Plus (incorporates F Plus (incorporates ENA content) ApproachesENA content) Approaches
MotherMother‐‐toto‐‐MotherMother MotherMother toto Mother Mother Support Group: Facilitator Support Group: Facilitator TrainingTraining
Integration of IYCF Support Integration of IYCF Support into CTC/CMAMinto CTC/CMAM
CapacityCapacity‐‐BuildingBuildingIYCF CommunityIYCF Community‐‐Focused ApproachFocused ApproachIYCF CommunityIYCF Community Focused ApproachFocused Approach
Integration of IYCF Support into CTC/CMAM Integration of IYCF Support into CTC/CMAM
Staff & Workers: HandsStaff & Workers: Hands‐‐on Practiceon Practice
Peer Support: Peer Support: MtMSGMtMSG
Camp Blocks showing Mother Support Group LocationsCamp Blocks showing Mother Support Group Locations
BCC ActivitiesBCC ActivitiesTransporting a video between health postsTransporting a video between health postsTransporting a video between health postsTransporting a video between health posts
IEC M t i lIEC M t i lIEC MaterialsIEC Materials
IYCF Support ActivitiesIYCF Support Activities IYCF Counsellors: staff, CHW incentive workers and IYCF Counsellors: staff, CHW incentive workers and mother volunteers (234 CHWs, 214 trained‐to‐date as IYCF Counsellors; 32 Trainers)
Identified Contact Points (facility and community) to visit and counsel pregnant and lactating women
IYCF counselling cards and other job aids for IYCF counselling cards and other job aids for community workers
Mother support groups spread throughout the blocks: currently 658 functioning groups (610 with trained facilitators)Activities to engage community including men; Activities to engage community ‐‐ including men; involve religious leaders
Instructional videos and action‐oriented educational talks in health posts
Feedback to community
Tracking our ProgressTracking our Progressd d ffd d ffHas it made a difference?Has it made a difference?
Monitoring of programme activities Monitoring of programme activities
Age‐disaggregation in UNHCR HIS
Annual nutrition survey
Measures child nutritional status
Provides coverage data
Tracks IYCF practices at population levelTracks IYCF practices at population level using globally‐agreed indicators
St b St GUIDE t C ll ti d Step‐by‐Step GUIDE to Collecting and Analyzing IYCF Data, with Tools
African Countries: African Countries: EBF 0EBF 0‐‐<<6 Months6 MonthsUNICEF State of the World’s Children 2009 UNICEF State of the World’s Children 2009
&&& &
EBF 0EBF 0‐‐<<6 Months in 6 Months in DadaabDadaab: 2005 & 2009: 2005 & 2009Exclusive Breastfeeding 0 <6 months
80
90
100
g
40
50
60
70
10
20
30
0
Djibou
ti
Chad
Cote d'Ivoire
Dadaab 20
05
Gabon
Algeria
South Africa
Sierra Leo
ne
Niger
Somalia
Angola
Zimbabw
e
Kenya
Guine
a‐Bisseau
Nigeria
Congo
Cameroo
n
an Rep
ublic (C
AR)
Nam
ibia
Guine
a
Mozam
biqu
e
Swaziland
Botswana
Sene
gal
Libe
ria
DRC
Lesotho
Mali
Gam
bia
Tanzania
Benin
Burund
i
Dadaab 20
09
Ethiop
ia
Eritrea
Ghana
Cape
Verde
Malaw
i
Ugand
a
Zambia
Madagascar
Rwanda
2424
Central Africa
Global Acute Malnutrition D d b 2005 2009
40 0%
45.0%
50.0%
Dadaab 2005‐2009
25 0%
30.0%
35.0%
40.0%
10.0%
15.0%
20.0%
25.0%
0.0%
5.0%
2005 2006 2007 2008 2009
Percent GAM Dag Hag Ifo
Ongoing ChallengesOngoing Challenges Continued population influx: 134,000 to 289,307 …
Limited diet options
Quality: limited food commodity diversity
Quantity: continued pressure from influx
Concerns for maternal nutrition & care
Post‐training mentoring of workers & volunteersvolunteers
Ongoing staff turnover
Others Others …
This year: transition to UNHCR coordination
ThTh D d bD d b i ti tThe The DadaabDadaab experience suggests experience suggests that IYCF practices can be protected, that IYCF practices can be protected, and even improved, in some and even improved, in some emergency contextsemergency contextsemergency contexts. emergency contexts.
