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Emergency Nutrition Response in Nepal

13th – 15th October, 2015GNC Annual Meeting, Nairobi, Kenya

DOLPA

MUGU

JUMLA

KAILALI

BARDIYA

HUMLA

DOTI

SURKHET

NAWALPARASI KAPILBASTURUPANDEHI

DANG

BANKE

ACHHAM KALIKOT

SIRAHA

DARCHULA

BAJHANGBAITADI

DADEL-DHURA

KANCHAN-PUR

BAJURA

PARSA

BARA RAUTA-

DHANUSAMAHO-TARI

SARLAHI

DHADING

MAKAWANPURCHITWAN

KASKI

TANAHU

PALPA

SYANGJA

PARBAT

ARGHAKHACHI

GULMI

UDAYAPUR

SINDHULI

ILAM

BHOJ-PUR

PACHETHAR

DHANKUTA

TAPLEJUNG

RAMECHHAP

OKHAL-DHUNGA

TERHA-THUM

KHOTANG

Patan

B

KTMSOLUK-HUMBU

DOLAKHA

SANKHUWA-SABA

NUWAKOTSINDHU-PALCHOK

KAVRE

RASUWALAMJUNG

GORKHA

PYUTHAN

ROLPASALYAN

MYAGDI

DAILEKHJAJARKOT

RUKUM

MUSTANG

MANANG

•Simikot•Darchula

•Baitadi

•Dadeldhura

•Mahendranagar

•Dhangadi

•Dipayal

•Chainpur •Martadi

•Magalsen

•Gularia

•Birendranagar

•Dailekh

•Manma

•Jumla

•Gamgadi

•Jajarkot

•Dunai

•Jumlikhalanda

•Salyan

•Nepalgunj

•Ghorahi

•Liwang

•Jomosom

•Beni

•Baglung

BAGLUNG

•Kusma

•Pyuthan

•Taulihawa

•Sandhikharka

•Tamghas

•Sidharthanagar

•Tansen

•Syangja

•Pokhara

•Chame

•Besisahar

•Damauli

•Parasi•Bharatpur

•Gorkha

•Dhadingbesi

•Dhunche

•Bidur

•Hetauda

•Birgunj•Kalaiya

•Gaur

HAT

•Dhulikhel

•Chautara

•Charikot

•Ramechhap

•Sindhulimadi

•Malangwa

Jaleshwor•Janakpur•Siraha •Ineruwa

•Gaighat

•Diktel

•Salleri

•Okhaldhunga•Bhojpur

•Khandbari •Taplejung

•Phidim•Ilam

•Dhankuta

•Terhathum

EASTERN REGION

CENTRAL REGION

WESTERN REGION

MID-WESTERN REGION

Earthquake Affected 14 Priority Districts

Legend

14 Priority Earthquake affected districts

Nepal Country Context

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Pre-crisis (Nutrition Indicators) Current Situation

Wasting was 11% (DHS 2011) MUAC screening GAM prevalence between 5-7%??

Stunting was 41% (DHS 2011)

Exclusive breastfeeding rates in boys and girls aged between 0 to 5 months of age: 70% DHS 2011

Anemia prevalence (<2 years: 70%, <5 years: 43%) DHS 2011

Access to food/healthcare was a major problem but the female community health volunteers (FCHVs) despite challenges continued the community support group activities

Nutrition sector Coordination Structure

• Government is leading the Cluster (MOHP)• Double hatting National NCC, 2 surge NCCs for

12 weeks• National dedicated IMO, 1 surge IMO for 12

weeks• 28 partners • Two subnational/regional level hubs; • ToR of SAG validated and pending approval• CMAM, IYCF and IM working groups

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Overview of Needs Assessments and AnalysisAssessment and Analysis:• IRA/MIRA and other nutrition assessment wasn’t conducted immediate after

EQ emergencies• However, quick field based information was collected from different partners

and government officials• Secondary data analysis of DHS (2011) - ecological region based data was

used as proxy information for planning

Strategic Planning: • The target number of affected population was set based on the HMIS target

population of MoHP Nepal and coverage estimate was made districtwide • Priorities for interventions identified based on the nutrition cluster operating

guideline, contingency plan etc.• PDNA and district level review recommendations are the basis for nutrition

recovery planning 4

Strategic Nutrition PrioritiesObjective: “to ensure timely and effective nutrition response in Earthquake affected 14 priority districts to minimize mortality and morbidity of Earthquake affected population and increase in malnutrition focusing to children under five, pregnant and lactating women has been prevented”..Key Cluster Interventions (six building blocks)• Promotion, protection and support for breast feeding • Promotion of complementary feeding • Supplementary Feeding Programme (SFP) for prevention and management of moderate

acute malnutrition • Therapeutic Feeding Programme (TFP) for the management of Severe Acute Malnutrition

(SAM)• Micronutrient for children and women (Vitamin A and MNP for children age 6-59 months,• Deworming to children age 12-59 months, IFA for pregnant and postnatal mother

Gaps in Resource Mobilization

Highlight key gaps (max 6 bullet points): Human Resources;

No full time dedicated NCC at national level and at regional/hub level.

NiE technical “thematic” gaps among all partners. Geographically the NC partners are present in all 14 affected districts but gaps exist in the coverage of the six building blocks

Financial: For flash appeal 11 Million USD was required and 9.8 Million USD is funded (89.5%). Flash Appeal expired in September 2015

Supplies were available but some gaps in distribution

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Nutrition Cluster Target Vs. Achievement

SN Intervention Area Cluster Target Achievements (#)

Achievements

(%)

1 Counselling the mother of 0–23 months old children on breastfeeding 168,000 152,697 91

2 Counselling the mother of 6–23 months old children on complementary feeding 126,000 137,719 109

3 Children age 6-59 months screened for identification of their nutrition status 397,211 373,546 94

4 Children age 6-59 months with severe acute malnutrition who were identified through screening 2,500 1,572 62

5 Children age 6 -59 months with SAM who are admitted to therapeutic care 2,500 1,360 54

6 Blanket supplementary feeding programme to the children age 6-23 months 43,256 32,022 74

7Children age 6-59 month who received multiple micronutrient powders to improve their diets and prevent nutritional deficiencies

323,775 326,091 101

8 Children age 6-59 months who received vitamin A capsules 362,000 354,562 98

Challenges in achieving strategic priorities

• Limited capacity with MoHP for nutrition cluster coordination for appropriate emergency nutrition preparedness and response

• Limited capacity for Nutrition cluster information management• Lack of access to the services due to difficult geography in

many districts • Early identification and management 100% SAM cases in the

OTP sue to capacity of community volunteers• Supplementary feeding programme for the management of

moderate acute malnutrition

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