Action Against Hunger Sudan (ACF)
The violence that erupted in South Sudan in mid-December 2013 led to a humanitarian crisis involving a massive displacement of over 1.5 million people nationwide. The conflict, and associated displacement, had a significant impact on food security and, consequentially, the prevalence of malnutrition. While famine was averted in South Sudan in 2014, the July 2014 Integrated Food Security Phase Classification (IPC) correctly projected that food security would deteriorate for displaced populations and host communities in 2015. The SET team led by ACF but representing the Nutrition Cluster and Nutrition Information Working Group has a mandate to conduct emergency nutrition SMART surveys in the most vulnerable areas identified by the Nutrition Information Technical Working Group (NIWG).
There was a significant need to help provide assistance to the SET team with finalizing the data analysis, report writing, etc. of the December 2015 Panyijar SMART survey, writing the survey protocol and planning the Leer County SMART survey, as well as to increase technical validation capacity within the NIWG pertaining to survey validation. As a result, a request was made to the Tech-RRT Consortium for assistance. On Jan 3rd the Tech-RRT Nutrition Assessment Advisor (NAA) was deployed to Juba, South Sudan.
Bentiu Protection of Civilians (POC) site in Unity State was currently the largest Internally Displace Population (IDP) camp in South Sudan. It was established in early 2014 in response to the large influx of displaced people as a result of fighting in the wider area of Unity State commencing in late 2013. In mid-2015, a new purpose-built camp was established on an organized grid with better drainage and planning. Due to the ongoing influx of new arrivals, however, even this new site remains extremely cramped, and the risk of illness and malnutrition is high. A SMART survey undertaken in August 2015 revealed an extremely high level of Global Acute Malnutrition (GAM) 34.1 % C.I (31.1 – 37.2) according to Weight for Height (WHZ) <-2 and/or oedema) and Severe Acute Malnutrition (SAM) 10.5% C.I (8.5 – 12.9) according to WHZ <-3 and/or oedema). Both are clearly above international thresholds for a serious emergency. The same survey revealed low levels of diet diversity and exclusive breastfeeding and a Knowledge Attitude and Practice (KAP) and Water Hygiene and Sanitation (WASH) survey conducted in April suggests open defecation is still widely practiced while hygiene knowledge and practice remain suboptimal in a population of more than 20,000 residents.
The Tech RRT SBC Advisor was deployed to develop a practical strategy and action plan for promoting priority health, hygiene and nutritional practices that will have the quickest positive impact on the prevention and treatment of malnutrition and illness in children and pregnant women that encompasses both the POC and the evolving settlements in Bentiu town.
Action Against Hunger Sudan (ACF)
The violence that erupted in South Sudan in mid-December 2013 has led to a humanitarian crisis involving a massive displacement of over 1.5 million people nationwide. The conflict, and associated displacement, has had a significant impact on food security and, consequentially, the prevalence of malnutrition. While famine was averted in South Sudan in 2014, the July 2014 Integrated Food Security Phase Classification (IPC) correctly projected that food security would deteriorate for displaced populations and host communities in 2015. The 2015 conflict in Unity state, and associated displacement, had also impacted Guit county, having a significant effect on food security and, consequentially, the prevalence of malnutrition. At the moment, INGO’s do not have bases in Guit county, though an Inter-Sector Rapid Need Assessment/Response (IRNA/R) Mission was conducted from February 20th to 24th by UNICEF, World Relief, Nonviolent Peace Force, Norwegian People Aid and Concern Worldwide. . However, no SMART survey had been conducted in all of Guit County (access permitting) since 2013.
Given the background situation which set Emergency IPC levels of GAM for Guit County for the period January to March 2016, there was a need to provide the Nutrition Information technical Working Group (NIWG) with an up-to-date estimate of undernutrition prevalence for programming purposes.
Nutrition Cluster Coordination Sudan (NCC)
In South Sudan, the 2013 civil war has resulted in widespread insecurity and instability. Conflict and insecurity across South Sudan resulted in a breakdown in community structures, food insecurity, poverty, poor health and nutrition status. According to the Integrated Food Security Phase Classification, a famine was declared in Unity State from February till June 2017. Although the famine has been denounced, currently an estimated 1.7 million people are likely to be facing a food security emergency (IPC Phase 4) – one step below famine on the IPC scale. Currently it is estimated that six million people (50 percent of the population) are expected to be severely food insecure. Acute malnutrition remains a major public health emergency in several parts of South Sudan. Over 1.1 million children are estimated to be acutely malnourished. A total of 22 SMART surveys were conducted between January and June 2017 by numerous organizations. Twenty of the surveys showed global acute malnutrition prevalence above the emergency threshold of 15%.
The Tech RRT Advisor was deployed to South Sudan to support the nutrition cluster to conduct an independent review of routine nutrition activities and provide recommendations and corrective actions to strengthen the nutrition activities. The support focused on Monitoring all routine nutrition activities implemented, specifically CMAM and IYCF activities, by all partners.
Ministry of Health South Sudan (SSD)
The population of South Sudan in 2018 was 11, 261, 51. More than 3.9 million South Sudanese have been forced to flee their homes, and 1.9 million internally displaced persons and over 2 million refugees. The Demographic Health survey shows that less than 20% of pregnant women were able to have at least one Antenatal Care Visits (ANC) by a skilled attendant and just around 11% delivered in health facilities. At the same time, Mother to child transmission of HIV reached worrisome levels and lacked appropriate interventions. Both acute and chronic malnutrition were serious with stunting above 30% and wasting above 20%.1 Poor Infant and Young Child Feeding practices are one of the key causes of child malnutrition. The protracted conflict further exacerbated the rates of acute malnutrition due to the reduced ability of children under five, chronically ill persons, and pregnant and lactating women to meet their nutritional needs because of displacement and increased morbidity caused by disease outbreaks, lack of access to clean water, sanitation facilities and basic health services.
The Ministry of Health with the support of the Nutrition Cluster requested Tech RRT support to improve both CMAM and the Maternal Infant and Young Child Nutrition situation in the country.
Inter cluster working group
The Global Inter-Cluster Nutrition Working Group (ICNWG) identified limited capacities of humanitarian partners and clusters for multi-sectoral nutrition-sensitive programming among the main barriers to effectively achieving nutrition outcomes in humanitarian settings. To address this barrier a three-days training package “Integrated Inter-Cluster Training Package for Nutrition Outcomes” was developed to support in-country cluster coordinators and partners in applying integrated nutrition-sensitive approaches to achieve a better nutrition outcome across sectors, with a specific focus on: nutrition, food security, health, WASH, education, and protection. The specific objectives of the workshop were as follows:
Nutrition Cluster Coordination (Sudan)
Many aspects of infant and young child feeding were far from optimal, mainly initiation of breastfeeding, continued breastfeeding at one and two years as well as introduction of semi solid foods. The majority of deaths during the first year of life are often associated with inappropriate feeding practices. To address this, and also support optimal mental development, UNICEF and MoH developed Maternal Infant and Young Child Nutrition (IYCN) Strategy and Guideline documents to focus comprehensively on the preventative lessons and key areas of concerns including the components of essential nutrition services with the rollout of infant and young child feeding program to improve the feeding practices for children across all former
The nutrition Cluster required further guidance on how to implement recommended actions within humanitarian response as such the Tech RRT was requested to fill the gaps and provide practical and realistic plans for prioritizing MIYCN actions.