Nutrition Sector Rapid assessment of Nutrition Centres ... · Nutrition Sector Rapid assessment of...

Rohingya Crisis, Cox's Bazar, Bangladesh, November 2017 Report date: 24 December 2017

Contact for Inquiries: Mohammad Mainul Hossain Rony, IMO, Nutrition Cluster Bangladesh, Email: [email protected]

Abigael Nyukuri, CC, Nutrition Cluster Bangladesh, Email: [email protected]

Photo: Rony, Nutrition Cluster

Bangladesh Nutrition Sector Rapid assessment of Nutrition Centers

mailto:[email protected]

Nutrition Sector Rapid assessment of Nutrition Centres, Dec. 2017

pg. 2

Contents

Background to the assessment ................................................................................................................................................ 3

Rationale: ................................................................................................................................................................................. 3

Methodology: ........................................................................................................................................................................... 3

Overall Objective: ..................................................................................................................................................................... 4

Specific Objective: .................................................................................................................................................................... 4

Expected Results ...................................................................................................................................................................... 4

Data Sources: ........................................................................................................................................................................... 4

Acknowlodgement: .................................................................................................................................................................. 4

Key Findings: Summary ............................................................................................................................................................ 4

Birdseye view of the Nutrition Service Centres ....................................................................................................................... 6

Out Patient Therapeutic Programme (OTP) overview: ............................................................................................................ 7

Blanket Supplementary Feeding Program (BSFP) overview: .................................................................................................... 8

Targeted Supplementary Feeding Program (TSFP) overview:.................................................................................................. 8

Stabilization Centre (SC) overview: .......................................................................................................................................... 9

Mother Baby Area (MBA) overview: ........................................................................................................................................ 9

IYCF Corner Overview: ........................................................................................................................................................... 10

Maps ....................................................................................................................................................................................... 11

Recommendations ................................................................................................................................................................. 20

ANNEX-I Enumeration Area Map ........................................................................................................................................... 21

ANNEX-II Assessment Questionnaire ..................................................................................................................................... 22

ANNEX-III Assessment Team ................................................................................................................................................. 25

ANNEX-IV Assessment Timeline ........................................................................................................................................... 26


pg. 3

Background to the assessment

Violence in Rakhine State which began on 25 August 2017 has driven an estimated 620,000 Rohingya refugees across the border into Cox’s Bazar, Bangladesh

1. The majority of the Rohingyas are living in Ukhia and Teknaf Upazilas of Cox’s

Bazar, a district bordering Myanmar identified as the main entry area for border crossing. Those fleeing are putting an immense strain on infrastructure, services and the host population. Pre-existing settlements and camps have expanded with the new influx, while new spontaneous settlements have also formed and are quickly growing. Significant numbers of new arrivals are also being absorbed into the local host community. Along the border regions of Bandarban and Cox’s Bazar, groups have settled in or near no man’s land, presenting additional access challenges with legal and security dimensions.

A total of 28 Collective Sites and 99 locations with dispersed setting in host communities were assessed between 30 September to 11 November 2017. Total of 823,805 Rohingyas were identified in Cox’s Bazar District

2. This figure has also

taken into consideration additional figures collected on a daily basis through NPM Emergency Tracking – Flow Monitoring exercise up to 15 October 2017, updated figures of Rohingya population in refugee camps by UNHCR, and other relevant secondary data sources available.

Rationale:

Preliminary results of a nutrition assessment done in October 2017 in Kutapalong Registered Refugee Camps showed a GAM prevalence of 24.3%) and SAM prevalence 7.5% CI. This indicated a Nutrition Emergency based World Health Organization recommended emergency threshold of 15%. This was of further compounded by high stunting prevalence (40%), poor IYCF practices and high morbidity rates.

The Nutrition Sector in Cox Bazar Coordinates delivery of the Nutrition services by humanitarian actors to address the high prevalence of malnutrition. Nutrition Service delivery is guided by the Community based Management of Acute Malnutrition (CMAM) and Facility based In-Patient management of Severe Acute Malnutrition ( SAM) Guidelines. During a Nutrition Sector meeting held on 23 October 2017, Nutrition service coverage mapping results developed by the Nutrition Sector was presented. The Mapping detailed Who was doing Which Nutrition Service, Where and When(4Ws). The members agreed on the importance of having a verification exercise to physically ascertain presence of the nutrition centres as well as nutrition service delivery based on minimal agreed standards. . The CMAM TWG was assigned to develop the relevant data collection tools for this exercise and to initiate the process. During the CMAM TWG held on 13 November 2017, the CMAM TWG tasked the Cluster Information Management Officer (IMO) to lead the exercise.

Methodology:

Supervisors of the Nutrition Action Week will visit all Nutrition Service Centers and interview service providers. There will be observatory feedbacks. The questionnaire agreed by the technical team will be digitalized to Kobo Toolbox. There were four teams for Data collection. Each team consists of 3 members from different organizations to maintain nutrality. Every team has a team leader and before entering any data, the team has to come to a consensus to avoid organizational biasness.

The whole area is divided into 12 Enumeration Areas. The team posted visible marks in each enumerated centres to avoid double counting.

There was day long training on how to read maps and collect data using the mobile devices. To monitor the data collection process, a monitoring team of Nutrition Sector has oversighted the process. There were team leaders meeting every day evening to administrate the field operation. Sector members provided resources to conduct this assessment (staff/vehicle). The Data collection is done using tab/smart phone with GPS location. Data is being analysed and mapped using GIS map.

1 ISCG Situation Report 2 ISCG NPM 6

th round


pg. 4

Overall Objective:

To ascertain the physical presence of Nutrition Centers as well as Nutrition Service delivery based on the results of the 4W mapping exercise in order to establish coverage and gaps in service delivery.

Specific Objective:

1. To ascertain the total number of functional Nutrition Services to inform programme scale up.

2. To identify specific the nutrition services being provided in the Nutrition Centers.

3. To establish the overall nutrition stock status.

Expected Results:

1. Physical verification of all existing Nutrition Centers.

2. Potential gaps in service delivery and coverage of Nutrition services identified.

3. Stock position of all Nutrition Centres identified

4. Base information for the phase 3 assessment

Data Sources:

• Primary data collection using Kobo Collect tool through supervisors of the Nutrition Action Week

• Secondary data source is the data provided by the partners.

• Interviews of the Nutrition Centers service providers

• Nutrition Sector 4W Map

Acknowledgment:

We acknowledge support and assistance from Nutrition Cluster Bangladesh, Nutrition Sector (CXB), UNICEF, Care, SARPV, Concern, SHED and ACF.

Key Findings: Summary

Total Service Centres : 92 Functional Centres : 78 = 84% Partly Functional : 08 = 09% Not Functional : 06 = 07% Out of 92 Service Centres, 90 are static and 02 are mobile. Out of 92 Service Centres, 51 established after August 2017.


pg. 5

Number of Nutrition Centres by Union:

Number of services provided by 86 Functional/ partly functional Centres:

Number of Nutrition Centres by Locality:

Union No. of Centers

Baharchhara 6

Nhilla 9

Palong Khali 35

Raja Palong 15

Sabrang 5

Teknaf Paurashava 4

Teknaf Sadar 4

Whykong 14

Services Number %

Center with 1 Service 22 26%

Center with 2 Services 33 38%





Locality type No. of Centers

Host Communities 31

Makeshift Settlements 23

New Spontaneous Site 34

Others 1

Refugee Camp 3


pg. 6

Birdseye view of the Nutrition Service Centres:


pg. 7

Out Patient Therapeutic Programme (OTP) overview:

Out of total 58 OTPs, 1 is mobile.

Nutrition volunteer attached to the OTP # of OTP

0 Volunteer 4

1-10 Volunteer 31

11-20 Volunteer 10

21-30 Volunteer 5

31-40 Volunteer 6

40+ Volunteer 2

Stock of RUTF # of RUTF

0 Carton 19

1-3 Carton 10

5-9 Carton 7

10-20 Carton 5

21-30 Carton 9

31-40 Carton 3

40+ Carton 5

Functional OTP, 51

Partly Functional

OTP, 7

No OTP, 34

Centers With OTP

Days operational # of OTP

1 day per week 17

2 day per week 7

5 day per week 14

6 day per week 20

Number of Nurses/ Clinical Officers per OTP

Number Of OTP

0 20

1 23

2 11

3 3

5 1 Numbers of days OTP remain operational

(Measurers, Registrars, Distributors)

Number of Nutrition Assistants per OTP

Number Of OTP

1 - 3 Nutrition Assistants 39

4 - 6 Nutrition Assistants 15

8+ Nutrition Assistants 4

Out of 58 centres with OTP, 30 centres have adequate Nutrition Equipment (MUAC tapes, Weight Scales, Height Board, Bracelets) and 28 OTPs have no or inadequate Nutrition Equipment.

Storage facility for Supply available in the center # of OTP

Available 31

Partly available 22

Not available 5

Medicine for Systematic treatment available

# of OTP

No Medicine 4

Only Amoxicillin 2

Amoxicillin Albendazole 52

Feedback mechanisms on services

# of OTP

Available 12

Not available 43

Partly available 3


pg. 8

Blanket Supplementary Feeding Program (BSFP) overview:

Targeted Supplementary Feeding Program (TSFP) overview:

MUAC tapes, Weight Scales, Height Board

Opening days in a week # of BSFP

1 day per week 1

2 day per week 3

5 day per week 8

6 day per week 5

Number of Nutrition Workers attached # of BSFP

1-10 Nutrition Workers 10

11-20 Nutrition Workers 4

20+ Nutrition Workers 3

Stock of WSB+ (25 KG Bags) # of BSFP

No Stock 2

1-50 bag 6

51-100 bag 5

100+ Bag 4

Stock of WSB++ (Cartoon) # of BSFP

No Stock 2

1-50 bag 3

51+ bag 12

Opening days in week # of TSFP

1 day per week 24

5 day per week 3

6 day per week 2

Number of Nutrition Assistants attached Column5

0 Nutrition Assistants 8

1-3 Nutrition Assistants 18


Number of Community Nutrition volunteer are attached to the site # of TSFP

0 Nutrition Assistants 6


10+ Nutrition Assistants 3

Nutrition equipment available # of TSFP

Available 22

Partly 7

Stock of WSB+ (Bags) # of TSFP

No Stock 15

1-10 bag 10

10-100 bag 3

100+ Bag 1


pg. 9

Stabilization Centre (SC) overview:

There are 5 Stabilization Centres (SC) were found and among them 4 are functioning and 1 is partly functioning. All SCs are open 7 days of week. All SCs have doctors and nurses attached. No information about the doctor’s orientation for SAM management was collected via this assessment. The SCs don’t have adequate nutrition supplies.

Mother Baby Area (MBA) overview:

Stock of WSB++ (cartoon) # of TSFP

No Stock 18

1-10 cart 8

10+ cart 2

Quantity of Vegetable oil available (Litre) # of TSFP

No Stock 5

1-10 litre 19

10+ 5

Storage facility for Supply # of TSFP

available 13

Not available 2

Partly available 14

Location # of TSFP

Host Communities 25

Makeshift Settlements 2

New Spontaneous Site 1

Refugee Camp 1

Opening days in week # of MBA

1 day per week 5

5 day per week 13

6 day per week 19

Number of IYCFE counsellors # of MBA

0 counsellors 12

1-3 counsellors 23

4+ counsellors 2

Number of IYCF volunteers # of MBA

0 IYCF volunteers 14

1-10 IYCF volunteers 22

10+ IYCF volunteers 1

Sufficient privacy # of MBA

No privacy 7

Partly 5

Proper privacy 25


pg. 10

IYCF Corner Overview:

Sufficient clean drinking water and cups # of MBA

Not Available 2

Partly Available 6

Available 29

A place to wash cups or other materials # of MBA

Not Available 5

Partly Available 5

Available 27

Close proximity to clean toilets or latrines # of MBA

No 8

Partly 2

yes 27

Opening days in week # of IYCF

1 day per week 2

5 day per week 14

6 day per week 25

7 day per week 1

Number of IYCF-E counsellor # of IYCF

0 IYCF-E counsellor 7

1-IYCF-E counsellor 27



Number of IYCFE volunteer # of IYCF

0-IYCFE volunteer 17

1-5 IYCFE volunteer 19

6-10 IYCFE volunteer 6

Access to safe water # of IYCF

No access 1

Partly access 3

Proper Access 38

IYCF counselling Material # of IYCF

No material 14

Partly 7

Adequate 21

Storage facility for Supply available # of IYCF

Not available 10

Partly available 7

Available 25


pg. 11

Map A: Overview of Nutrition Sector Rapid Assessment of Nutrition Centers


pg. 12

Map B: Nutrition Centers in Baharchhara Union


pg. 13

Map C: Nutrition Centers in Nhila Union


pg. 14

Map D: Nutrition Centers in Palonh Khali Union


pg. 15

Map E: Nutrition Centers in Raja Palong Union


pg. 16

Map F: Nutrition Centers in Sabrang Union


pg. 17

Map G: Nutrition Centers in Teknaf Paurashava Union


pg. 18

Map H: Nutrition Centers in Teknaf Sadar Union


pg. 19

Map H: Nutrition Centers in Whykong Union


pg. 20

Recommendations

Infrastructure: Most of the infrastructures are made on temporary basis and has limited protection against wind, rain and cold wave.

Geographical addressing: We found after analysis that 15 centres are using wrong address (union name) which need attention for proper planning

Preparedness for natural disasters: Didn’t find much on preparedness against fire or natural disaster.

In-depth assessment of service quality: An In-depth assessment of service quality is required to improve the services and disaster resilience.

Access of enumerators to the Centres: In some centres, access was challenged for the enumerators as the service providers were not allowing enumerators to enter into the centre.


pg. 21

ANNEX-I Enumeration Area Map


pg. 22

ANNEX-II Assessment Questionnaire

Nutrition Sector Rapid assessment of Nutrition Centers

Date Auto GPS Auto

Enumerator Name

Nutrition Centre Name

Upazila List

Union List

Mouza Free text

Zone Free text

Block Free text

Organization Name Free text

Overall observation Choose an item.

Available services: (Select multiple)

☐ OTP (Out Patient Therapeutic Program)

How many days per week are is the OTP site open? Choose an item.

Number of Nurses/ Clinical Officers ___

Number of Nutrition Assistants ___


Numbers of Community Nutrition volunteers are attached to the site? ___

Nutrition equipment available Choose an item.

(MUAC tapes, Weight Scales, Height Board,bracelets?

Quantity of RUTF available __ Cartons

Medicine for Systematic treatment available Choose an item.

( Anti-Biotic, ORS, Malaria medicine, Albendazole)

Is health promotion/education provided?

Is there referral system between OTP/TSFP/BSFP?

Are mechanisms that to get community feedback on the services provided?

☐ BSFP (Blanket Supplementary Feeding Program)

Frequency of distribution Choose an item.

Number of Nutrition Workers ___


pg. 23

Number of Nutrition Workers ___

Stock of WSB+ ___ Carton

Stock of WSB++ ___ Carton

☐ TSFP (Targeted Supplementary Feeding Program)

How many days per the week is admissions done Choose an item.

Number of Nutrition Assistants ___


Number of Community Nutrition volunteer are attached to the site ___

Nutrition equipment available Choose an item.

(MUAC tapes, Weight Scales, Height Board)

Quantity of WSB++ available ___ Cartons

Vegitable oil ?? cartons

☐ SC (Stabilization Center)

How many days per week is the SC open? Choose an item.

Average Number of Children admitted per day ___

Number of Doctor ___

Number of Nurses ___

Number of Feeding/ Nutrition Assistants ___

Bed Capacity ___

☐ Mother Baby Area

Open for how many days of the week Choose an item.

Number of IYCFE counsellors ___

Number of IYCF volunteer to support ___

Sufficient privacy Choose an item.

Sufficient clean drinking water and cups Choose an item.

A place to wash cups or other materials Choose an item.

Close proximity to clean toilets or latrines Choose an item.

☐ IYCF Corner

Open for how many days of the week Choose an item.

Number of IYCFE counsellor ___

Number of IYCFE volunteer ___

Access to safe water Choose an item.

Service provider present Choose an item.


pg. 24

Type of Structure Choose an item.

Storage facility for Supply Choose an item.

Date of establishment of the center

Click here to enter a date.

Is the service point easily accessible from the catchment area

Choose an item.

Contact person Name Free text

Contact Number XXXXXXXXXX


pg. 25

ANNEX-III Assessment Team

Assessment Coordinator: Mohammad Mainul Hossain Rony, IMO, FSC & NC.

Team – 01

Sl #

Name Designation Organization Mobile Email address

1 Mollah Saukat Hossain (Team Lead)

TC - CB CARE 01712123011 [email protected]

2 Md. Mehedi Hasan

TCN SARPV 01674646564 [email protected]

3 Joshna Akter Community Mobilizer

Concern 01847267972 [email protected]

4 Nur Hossain Siddik

C4D officer SHED 01827292728 [email protected]

Team – 02

Sl #


1 Main Uddin Bhuiyan (Team Lead)

M - Supervision

CARE 01724505647 [email protected]

2 Md. Mahmudul Karim

APO ACF 01811231014 [email protected]

3 G.M. Mehadi Hasan

TM SHED 01838506406 [email protected]

Team – 03

Sl #


1 Md. Sadequl Islam

M - Supervision

CARE 01855226499 [email protected]

2 Sabug Borua OTP

supervisor SHED 01864580000

[email protected]

3 Khaleda Hossain Moon (Team Lead)

TM SARPV 01792024394 [email protected]









pg. 26

Team – 04

Sl #


1 Md. Hasanuzzaman

TC – M&E CARE 01716088639 [email protected]

2 Suraia Akter TCN SARPV 01737552540 [email protected]

3 Giusuddin Community Mobilizer

Concern 01847289567 [email protected]

4 Nurul Amin Sikdar (Team Lead)

APO ACF 01842600944 [email protected]

ANNEX-III Assessment Timeline

04 Dec 2017 Training and field operation planning

Field data collection time line

Date Team Lead Coverage area

5 Dec 2017 Team-1 (Saukat) EA-1

5 Dec 2017 Team-2 Main Uddin EA-2

5 Dec 2017 Team-3 Moon EA-3

5 Dec 2017 Team-4 Amin EA-4


6 Dec 2017 Team-2 Main Uddin

EA-6 6 Dec 2017 Team-3 Moon



7 Dec 2017 Team-2 Main Uddin EA-9

7 Dec 2017 Team-3 Moon

EA-10 7 Dec 2017 Team-4 Amin

8 Dec 2017 Review of Data

9 Dec 2017 Team-1 (Saukat)

EA-11 9 Dec 2017 Team-2 Main Uddin

9 Dec 2017 Team-3 Moon EA-12


10-11 Dec 2017 Data Cleaning, preliminary analysis and preliminary result presentation





Nutrition Sector Rapid assessment of Nutrition Centres ... · Nutrition Sector Rapid assessment of...

Documents

Transcript of Nutrition Sector Rapid assessment of Nutrition Centres ... · Nutrition Sector Rapid assessment of...