CONCEPT
PAPER
MOYALE
COMMUNITY-BASED
THERAPEUTIC CARE (CTC)
MAY –
OCTOBER 2006
Successive rain failures in
The Community – based Therapeutic Care (CTC) will provide treatment and nutritional therapy at the community level. Its underlying aims are to maximise coverage and access. Community mobilisation techniques will be used to engage the population and maximise coverage. This program will build on local capacities and existing structures and systems, with the aim of equipping communities to deal with future periods of vulnerability.
A nutrition survey to evaluate the effectiveness of the CTC program is planned for September 2006.
The CTC intervention is targeted to reach approximately 6,865 beneficiaries including malnourished children under five ears, pregnant and lactating women and 300 needy elderly persons. The project implementation period is May to October, 2006.
2.
BACKGROUND AND RATIONALE
Moyale district
is located in Eastern province in the Northern region of
In January 2006, a joint food security assessment by the Government of Kenya (GOK), UN and other agencies classified Moyale district as one of the ten most affected and food insecure districts. In March 2006, a two stage (30x30) cluster nutrition survey conducted by UNICEF found high rates of malnutrition indicating an emergency situation. The prevalence of Global Acute Malnutrition was 18.1% with Severe Acute Malnutrition of 3.1%.The WFP/UNHCR guidelines for Supplementary Feeding Programs in Emergencies classify as ‘serious’ a situation in which more than 15% of children are wasted, which is currently the case in Moyale and other parts of northern Kenya.
The district livestock officer reported a
loss of up to 80% of the livestock, the highest experienced in the last two
decades. Many more cattle are reported to be dying with the start of the rain
season either because of diseases or are too weak. At
the time of the assessment done by Concern Worldwide that coincided with the
UNICEF survey, one
pastoralist reported to have lost 54 additional heads of cattle at the start of
the rains. While the 2006 long-rains season has now begun, pastoral food
insecurity remains extremely severe. Pastoral households have lost a
significant proportion of their livestock and livestock mortalities
continue. As a result, it is expected the recovery period will be
difficult, even if the long-rains season establishes. Livestock births and milk production is reported to be minimal as
most of the pregnant animal succumbed to death during the drought. It will be
at least another 10 months before milk availability can be realised. Relief food remains the main
source of food for most families in the district for the time being.
For the lesser percentage of the population
that practices agriculture, planting was limited due to lack of seeds and weak
oxen. There is also a reported
infestation of cereal crops by dingy caterpillar which is expected to
significantly affect crop yields.
The high levels of acute malnutrition in Moyale coupled with the dire food insecurity situation presents an urgent need to respond and treat acute malnutrition and prevent further deterioration of nutritional status.
The project aims
to address acute malnutrition through community-based therapeutic care (CTC)
approach for treating severe malnutrition. The CTC approach aims at treating a
majority of the malnourished population at home rather than in the traditional TFC
institution set ups, using existing health structures through collaboration,
training and ongoing support, rather than establishing a parallel service
delivery system. The three components of the CTC intervention are:
- Supplementary Feeding Programme
(SFP)
- Outpatient Therapeutic Programme
(OTP)
- Stabilisation Centres (SCs)
4. Goals and objectives
The goal of this program is to improve the health and nutritional status of 7729 drought affected population, including children, pregnant and lactating women and elderly persons, in Moyale district of Kenya.
Specific objectives include:
- To treat and rehabilitate 376 severely acutely malnourished children through provision of outpatient therapeutic care (OTP) and admission to stabilisation centres for children with medical complications.
- To treat and reduce prevalence of moderate malnutrition in the primary target group of 1,833 under fives through provision of a high energy, micronutrient fortified supplementary food ( CSB)
- To treat and prevent malnutrition in 445 pregnant and lactating women through provision of CSB
- To address malnutrition in 300 elderly persons
- Establish a referral system between communities and health facilities using local community networks
- Build capacity of MoH and local structures to respond to malnutrition in future emergencies
In order to achieve the stated goal and objectives, activities will be carried out as follows
5.1 Supplementary Feeding Program (SFP)
The supplementary feeding
component of the CTC program will support moderate acutely malnourished
children without medical complications
as well as those with special nutrient requirements by providing a dry
take - home ration of CSB at 9 kg per person per month. Children with severe medical
complications, characterised by anorexia and life-threatening clinical
illnesses, will be referred to an inpatient facility for stabilisation. Health and nutrition education will be
provided during the SFP distributions. The SFP program will be implemented
through partnership with CIFA, a local based NGO in Moyale district.
Given the high GAM rates ,
>15% , and to prevent further deterioration in nutritional status, Concern
Worldwide proposes to do a blanket distribution of CSB for the initial three
months (May- July) at a ration of 9 kg per person for month. This ration provides
1518 k calories per day and will be given to all children less than 5 years
old, pregnant and lactating mothers up to 6 months postpartum. However, for Central division
that is not currently covered for General Food Ration, only malnourished
individuals will be provided with CSB at the same ration of 9kg per person per
month.
In the second phase, the SFP
program will be narrowed to Targeted Supplementary Feeding Program (TSFP) to
specifically focus on malnourished individuals and allow for closer
monitoring. The target group will be
moderately malnourished children, pregnant women in the third trimester and
lactating women up to 6 months post partum. Beneficiaries of this targeted
supplementary feeding program will receive, bi-weekly, a monthly ration of 9kg
CSB.
Beneficiaries enlisted in the targeted SFP program (malnourished children and lactating women) will receive systematic treatment of Vitamin A, Iron- folic acid and mebendazole as required.
Registration for the SFP beneficiaries is ongoing and actual
distribution are planned to start on the 30th May.
5.2 Outpatient Therapeutic Program (OTP)
The OTP will provide home based treatment and rehabilitation of severely acutely malnourished children who have appetite and are free of medical complications. Around 85-90% of the severely acutely malnourished children are expected to be treated in the OTP. Children admitted in the OTP will be treated with routine medication and given Ready to Use Therapeutic Food (RUFT) to eat at home. They will attend the OTP weekly for medical check up, to receive additional medical treatments if required and to collect their one- week supply of RUTF. All OTP children will receive soap (250 grams/ person/ month) for hygiene promotion and Insecticide Treated Nets (ITNs) to prevent malaria.
The Outpatient Therapeutic Care
will be provided on a mobile service in 23 sites by two teams, east and west of
the district. Eleven of these sites are MoH dispensaries. This program will be
implemented in partnership with the Ministry of Health (MoH) Moyale and CCM
Italy. The MoH will run the mobile service in 13 sites (OTP East) on the
eastern part of the district while CCM- Italy will cover 10 sites on the
western part of the district (OTP West). Concern Worldwide will provide
technical support and training necessary for the implementation of this
program.
The initial phase of the program will involve sensitising the community and partners to promote understanding of the program objectives and methods. Training and on-job capacity building will be provided for the OTP mobile teams on treatment severe malnutrition using the CTC approach.
This program s planned to commence on the 22nd May, 2006.
5.3
Stabilization Centres (SCs)
In order to provide intensive inpatient care for severely acutely malnourished
children with complications two stabilization centres (SC) will be set up in
partnerships with the Ministry of health and CCM- Italy. One of the centres
will be set up at the
6. Number of Beneficiaries and Commodity Requirements for the CTC Intervention
Beneficiary calculations are based on a
reference estimated population of 61,476 and the UNICEF nutrition survey
results for Moyale (GAM 18.2% and SAM 3.1%)
An estimated 376 severely acutely
malnourished children will be treated in the outpatient therapeutic program
(OTP). About 10% of these children will be admitted in to the stabilisation
centres (SCs). This will require 6.2 MT (452 cartons) Plumpy nut, 83 kg (10
cartons) F75 therapeutic milk, 3.6 Kg (11 cartons) F100 therapeutic milk.
For the initial phase of the Supplementary
feeding Program (SFP) – May to July- Concern Worldwide proposes to do a blanket
distribution for the three divisions (Uran, Obbu and Golbu) and targeted
distribution for Central division. For the second phase, August to October,
targeted distribution will be done for malnourished individuals only.
The total number of SFP beneficiaries to be
served in the initial phase of three months is 7,729 (6,629 under fives, 800
mothers and 300 elderly persons). The calculations are based on blanket SFP for
three divisions at an estimated coverage of 80% and percentage malnourished
(18.2% for children and 29.3% for mothers) for central division. This is
approximately a total of 5,447 under
fives and 565 pregnant and lactating mothers for Uran, Obbu and Golbu division
and 1,182 under fives, 235 mothers, for
central division. This will require 208.7 MT of CSB.
The second phase of the SFP, the target SFP,
has a total estimate of 2,278 beneficiaries (1,833 under fives and 445 pregnant
and lactating women). This will require 61.5MT of CSB.
Thus the total tonnage requirement of CSB
for the entire 6 months duration of the program is 270
7. Coordination and Partinerships
Concern
Worldwide will work with and through local partners namely the Ministry of
Health (MoH), CIFA, CCM and the Diocese. The MoH and the Catholic Diocese,
through which CCM supports the Sololo hospital, are addressing primary health
care needs in the four geographical divisions in the district. Concern
Worldwide will work with them to identify areas of collaboration with regard to
addressing emergency malnutrition and building the capacity staff at health
centres. Concern Worldwide will take part in the district health coordination
meeting in Moyale as well as the overall district steering group.
A district CTC
Nutrition taskforce was set up during a health and nutrition planning meeting
convened by Concern Worldwide in Moyale. The members of this taskforce are
drawn from all stakeholders involved in health and nutrition activities in the
district namely the MoH, Concern Worldwide Worldwide, CCM –
At a national
level, Concern Worldwide will coordinate with the other actors involved in
nutrition such MSF F, MSF B, and World Vision. Concern Worldwide will
participate in the Health and Nutrition Working group in
Concern
Worldwide will also exchange information with other NGOs involved in CTC in the
country such as Merlin in order to share experience.
In order to
monitor the programme and assess impact, indicators shown in the logical
framework will be collected on a monthly basis. Indicators for monitoring the
emergency nutrition program will be based on standard SPHERE indicators for
nutrition feeding programmes and will include percent coverage, number of
re-admissions; percent cured defaulters and death cases.
Results of the
nutrition surveys conducted in March will provide baseline data for comparison
with a nutrition survey planned for in September 2006 to evaluate the
effectiveness of the CTC program.
- Security situation in Moyale will remain stable.
- Road are passable for community
access
- There will no major disease
epidemic that will negatively affect the targeted population.
- Basic/staple food and general
ration will continue to be available and accessible to most the
population.
- There will be effective
collaboration with other actors involved in health/nutrition in
Moyale.
- Health authorities in Moyale and
at the national level will accept CTC as an alternative method to treat
malnutrition
- The target population will accept
CTC.
- Adequate supply adequate of RUTF (plumpy
nut).
- WFP and UNICEF will continue to
supply food ration and milk respectively.
- Most of the district will be
accessible through out the program implementation period.
Budget preparation is on going; it is
anticipated to be complete end of the second week of May, 2006
11. organisational & logistics summary
We are holding meetings with MOH, CCM in
Nairobi this week and with MOH, CIFA and other partners in Moyale from April 28th-May
3rd. The proposed organizational and logs summary may be revised
following these meetings. The essence of what we are trying to achieve is an
effective and speedy response, utilizing current capacities in Moyale and
building local health organizations understanding of and capacity to implement
CTC now and in the future.
Roles and
Responsibilities are shares as follow as follows:
|
Organization |
Roles and Responsibilities |
|
MOH Moyale |
Operating SC from Moyale district Hospital Dispensary staff be present for OTP
consultations and follow up on OTPs Base
and running of team (East) |
|
CCM & Diocese |
Operating SC from Sololo hospital Providing some training and support to Running one of the OTP teams (west) OTP team uses CCM established outreach
clinics during OTP rounds Assign transport Some funding ?? |
|
CIFA |
Recruit all non technical staff Implement the blanket distribution program Referral from blanket to OTP (CIFA recruiting
a nurse) Hosting Concern Worldwide nutritionist and program
support person in CIFA offices Assign one car to the program Admin and logistical support to the program |
|
Concern Worldwide |
Overall design of the program Nutrition and CTC training for implementing
partners Quality control and program monitoring Deployment of two nutritionists (one
permanently based in Moyale, one part-time) Deployment of one program support person(
admin/log/finance) Provision of initial supplies of plumpy nut and CSB and other program goods Access DEC funds Assign two cars Participate on national Health and Nut
technical group Support the establishment of the District
Health & Nutrition working group |
|
MOH National |
Deploy 1 nurse- Nutritionists for the SCs in Sololo Mission hospital-
verbal agreement |
|
UNICEF AND WFP |
Provision of CSB and PLUMPYNUT and nutrition
equipment. Both UNICEF and WFP have current shortages and have asked that
Concern Worldwide front load the operation and they will allocate supplies as
they become available (June). |
