Ethiopia invests US$ 31.4 million on innovative next-generation solar refrigerators for vaccines

Addis Ababa, 18 July 2018 –The Federal Ministry of Health has procured over 6,000 Solar Direct Drive (SDD) refrigerators for health posts and woreda (district) health offices in areas without reliable electricity. The devices will store vaccines at health facilities which will help keep millions of children alive and healthy. The Federal Ministry of Health fully funded the procurement of these solar refrigerators at a total cost of US$ 31.4 million. The procurement was supported by UNICEF given its global expertise in handling such large-scale purchases in a short time.

Prequalified by WHO, the SDD refrigerators are expected to expand immunization coverage in Ethiopia through significantly reducing the time and resources required for vaccine transportation. The devices will ensure the availability and safety of vaccines in remote areas where the country’s most vulnerable children live.

Solar Direct Drive (SDD) refrigerators Programme Launch
Enter H.E Dr Kebede Worku, State Minister of Health addressing media during the Solar Direct Drive (SDD) refrigerators programme launch. ©UNICEF Ethiopia/2018/Mulugeta Ayene

The procurement follows a unique bundled procurement services approach which includes warranty, delivery of spare parts, and training of supply chain and immunization focal persons both at federal and regional levels. In addition, a project management team led by the Ministry of Health and UNICEF will regularly review the progress and efficiency of operations.

At the ceremony, H.E Dr Kebede Worku, State Minister of Health, said, “The Government of Ethiopia underlines its commitment to equip all health posts, health centres and hospitals with optimal cold chain equipment to ensure quality and improve access of the immunization programme.”

“The Solar Direct Drive devices we are being rolled out are the successful outcome of the strong partnership built between the Ministry of Health, UNICEF and other health partners to ensure that no child is left behind on immunization,” said Ms Gillian Mellsop, UNICEF Representative to Ethiopia.

Solar Direct Drive (SDD) refrigerators Programme Launch
Ms Gillian Mellsop visits a display during Solar Direct Drive (SDD) refrigerators programme launch. The SDD refrigerators are expected to expand immunization coverage in Ethiopia through significantly reducing the time and resources required for vaccine transportation. ©UNICEF Ethiopia/2018/Mulugeta Ayene

Immunization is one of the most cost-effective health investments. By protecting children against vaccine preventable diseases, immunization plays a central role in ending preventable child deaths. Despite significant improvements over the past decades, in Ethiopia, only 38.5 per cent of children between 12 and 23 months receive all basic vaccinations. There are also great disparities in terms of access to vaccination services between rural and urban areas.

One of the key strategies to improve access and utilization of immunization services is to improve the cold chain system, especially at health post level. Therefore, the Ministry of Health invested in solar powered refrigerators which are more cost effective and sustainable than refrigerators using gas or kerosene, in remote areas where there is no electricity.

Ethiopia’s Health Sector Transformation Plan (HSTP) has set ambitious goals to improve equity, coverage and utilization of essential health services at all levels by 2020. Achieving these goals will require significant investments, including in innovative technology.

While it remains important to achieve high coverage rates of essential health services, such as immunization of mothers and children, continued efforts are required to provide quality health services to all citizens regardless of differences in socio-economic status or geographic location.

UNICEF signs annual workplans with the Government of Ethiopia worth US$ 56 million

By Metasebia Solomon

Addis Ababa, 9th July 2018: UNICEF signed annual workplans with the Government of Ethiopia for the Ethiopian Fiscal Year 2011. The workplans were signed by Mr Admasu Nebebe, State Minister in the Ministry of Finance and Economic Cooperation (MoFEC), Ms Gillian Mellsop, UNICEF Representative to Ethiopia and heads of Regional Bureaus of Finance and Economic Cooperation.  UNFPA also attended the signing ceremony, as one of the UN agencies signing annual workplans with the Government of Ethiopia under the UN Development Assistance Framework (UNDAF 2016-2020).  UNFPA was represented by Mrs. Bettina Maas, UNFPA Country Representative to Ethiopia.

AWP signing ceremony
UNICEF Representative to Ethiopia, Gillian Mellsop, Admasu Nebebe, State Minister, Ministry of Finance and Economic Cooperation and Bettina Maas, UNFPA Country Representative to Ethiopia, shake hands after signing the annual workplans. ©UNICEF Ethiopia/2018/Zerihun Sewunet

The workplans will create a platform for the implementation of integrated child-focused development interventions in Ethiopia’s regional states and city administrations. This year, with support from MoFEC, UNICEF has managed to reduce the number of work plans from 143 to 89 by integrating related programmes that are currently being implemented by different implementing partners. The reduction will strengthen collaboration and coordination among implementing partners and will contribute to efficient utilization of resources by reducing operating costs and facilitating joint programme implementation, monitoring and evaluation.

In his remarks, Mr. Admasu Nebebe said the continued support and resources mobilized by UNICEF and UN agencies in the past decades has been valuable to Ethiopia’s development. In particular, he singled out the participatory process used to develop the workplans as a key to enhance mutual accountability and ownership of programmes.

Ms. Gillian Mellsop said UNICEF highly values its partnership with MoFEC and the Regional Bureaus. Appreciating the fact that the vast majority of resources are allocated to the regions, Ms. Mellsop said UNICEF is grateful for the support and collaboration of the regional government partners to deliver results for children and women in general and to reach the most disadvantaged and vulnerable children in particular.

The workplans will be implemented by more than 140 regional and federal government partners covering 12 programme areas that include health, nutrition, water, sanitation and hygiene, education, early warning and disaster preparedness, violence against children, ending child marriage and FGM, birth registration, child rights, communication, public finance for children, evidence generation, and programme coordination, monitoring and evaluation.

Helping health workers save Ethiopia’s youngest children

By Demissew Bizuwerk

Kejelo, Tiro AFETA, Oromia, 14 June 2018: Inside the small room of Kejelo health post, health extension worker Amelework Getachew carefully monitors her stock of medicines stacked on a small wooden shelf. She checks to make sure that an Oral Rehydration Salt (ORS), a fluid replacement used to prevent and treat diarrhoea, Amoxicillin Dispersible Tablet and Gentamicin injection, antibiotics used to treat children with pneumonia and serious bacterial infections, are available in good quantity. She cross checks the numbers on each bin card and the actual quantities on the shelf. “I can’t afford to run out of these medicines,” says Amelework, pointing towards a stock of sachets of ORS and packs of amoxicillin tablets and gentamicin injections. “They are lifesaving.”

After Amelework is done taking inventory, she collects her essential job-aids for home visits and attends to five-month-old Aziza in her home as part of her routine house-to-house visit. This way, Amelework makes sure that pregnant women and newborn babies get health follow-ups.

When Aziza was only 45 days old, she suffered from pneumonia, the common killer of infants in Ethiopia. “I was so worried when my child was sick,” says Rawda, Aziza’s mother. “She was struggling to breathe and had it not been for ‘doctor’, my child would not have survived.”

“I was so worried when my child was sick. She was struggling to breathe

Amelework, whose name also means “a golden character,” is a committed health worker. Her nine-year journey as a health extension worker started in a remote village of Kereyu Dodo when she was given the daunting task of changing people’s attitudes on a range of health-related misconceptions.  It wasn’t easy for her to convince people to dig toilets or use bed nets to keep them safe from malaria. “They used to call us names like the ‘toilet controllers’ or ‘bed net checkers,” she remembers.

CNBC Jimma, Oromia
Amelework examines five months old Aziza. When Aziza was 45 days old, she suffered from Pneumonia. But now she is growing up healthy. ©UNICEF Ethiopia/2018/Demissew Bizuwerk

But Amelework is now dubbed ‘doctor’, a name bestowed to her out of love and respect by the village women.  She is key to the livelihoods of the community, saving mothers and newborns including little Aziza in the small village of Kejelo.

Although Ethiopia has managed to significantly reduce its under-five child mortality, newborn deaths have declined at a much slower pace.  Twenty-nine newborn babies die out of every 1,000 live births from preventable causes such as complications due to prematurity, birth asphyxia, and infections like sepsis, and pneumonia[1]. Newborn deaths also account for a greater and growing share of all deaths among children under 5; almost 44 per cent.

Supported by UNICEF, the Government of Ethiopia introduced the Community Based Newborn Care (CBNC) strategy in 2012. CBNC aims to empower health extension workers, such as Amelework, with skills to provide maternal and child health services during pregnancy, childbirth and postnatally. Heath extension workers are also trained to identify and treat newborns with severe bacterial infections or sepsis where referral is not possible. They provide treatment for sick children both at the health post and in houses during their regular visits.

“The treatment we are providing is free of charge,” says Amelework. “This is encouraging mothers to bring their children early when they are sick.  It is also helping us to save young children from serious illnesses like pneumonia.”

Amelework is trained to provide CBNC services by JSI Research & Training Institute, Inc/ The Last Ten Kilometers Project (JSI/L10K), which is implementing the programme with technical and financial support from UNICEF.  She also gets constant support and follow-up from the CBNC supervision team who regularly visit her health post to make sure that she is applying the standard operating procedures.

CNBC Jimma, Oromia6658
Wosen Darge, the CBNC Regional Technical Officer from JSI/L10K supports Amelework with regular visits to her health post. ©UNICEF Ethiopia/2018/Demissew Bizuwerk

“We train and support Amelework to deliver her very important work by effectively identifying sick children in the village during her regular immunization outreach work and when she is providing house-to-house postnatal care,” says Wosen Darge, the CBNC Regional Technical Officer from JSI/L10K.  “We also monitor and evaluate her records to ensure key information is recorded and stored in the treatment book.”

Amelework is also provided with guidance and support on supply management. She keeps track of her medical supplies to avoid shortages of crical drugs that she needs for immediate use.

“Nothing is more fulfilling than seeing a mother’s happy face when her child is recovering from such illnesses”

UNICEF is supporting the scaling up of CBNC services with funds from the Margaret A. Cargill Foundation. Working in coordination with the Ministry of Health, it is expected that the positive experiences observed in villages like Kejelo will be expanded to pastoralist areas.

CNBC Jimma, Oromia
Amelework is the indispensable medical person for Kejelo village mothers and children. She is dubbed ‘doctor’ by the local women for saving their children. ©UNICEF Ethiopia/2018/Demissew Bizuwerk

A humble hard worker such as Amelework embodies Ethiopia’s hope to end preventable newborn and child deaths within this generation. “Nothing is more fulfilling than seeing a mother’s happy face when her child is recovering from such illnesses,” she says, “I am a mother myself and I know the feeling.”

Aziza is growing up healthy, her mother’s wish is to see her daughter becoming a ‘doctor’, like Amelework. “She [Amelework] saved my child’s life and I want my daughter to also do the same when she grows up,” says Rawda, with eyes full of hope to see a bright future for her baby daughter.

[1] EDHS 2016

Mass distribution of mosquito nets to South Sudanese refugees in Ethiopia

By Dorosella Bishanga and Bisrat Abiy

Kule Refugee Camp, Gambella, Ethiopia, 29 May 2018: Nyaluak Kun, 24, is a refugee at Kule Refugee Camp in Gambella, western Ethiopia. Originally from South Sudan, the mother of six has just received three long-lasting insecticide treated mosquito nets for her family. She says malaria has been a threat to her health and that of her family since the rainy season started.

“I am happy to receive these mosquito nets. I hope this is the right time that we have received the mosquito nets. Several times I have been sick with malaria. There was no solution for me. I get medicine, after a few weeks, I get sick again because of mosquito bites.”

Distribution of mosquito nets - Gambella
Nyaluak Kun and her child at Kule Refugee Camp in Gambella, Ethiopia. ©UNICEF Ethiopia/2018/Dorosella Bishanga

For Nyaluak, the mosquito nets will not only keep the family safe from mosquito bites but also from other poisonous insects that enter homes during the rainy season.

Malaria is endemic to the Gambella Region and is one of the top three causes of sickness and death across all the refugee camps.  The epidemic occurs mostly from April to June and September to November every year. Mosquito nets, in-door and out-door residual spraying, and environmental management are the most recommended malaria prevention and control interventions.

The standardized expanded nutrition survey of 2017 indicates that the proportion of households with access to at least one mosquito net is below 50 per cent in all the refugee camps, except for Kule at 54 per cent and Pugnido II at 60 per cent. With inadequate mosquito nets, malaria is rampant: last year alone, 128,520 cases and 33 deaths were recorded, 25 of them children under the age of five.

Distribution of mosquito nets to vulnerable groups, such as under five and malnourished children, pregnant and lactating women, and newly arrived refugees, is ongoing in all the refugee camps of Kule, Tierkidi, Nguenyyiel, Jewi, Pugnido I, Pugnido II, and Okugo.

However, the 2018 blanket distribution, targeting 386,000 refugees, started on 29th May in Kule Refugee Camp. It was combined with general food distribution using lists obtained from UNHCR population and household databases. With the overall coordination of the Administration for Refugee and Returnee Affairs (ARRA), UNHCR and UNICEF, refugees received mosquito nets at distribution centres managed by MSF-Holland, an implementing partner. Upon presentation of a mosquito net coupon obtained at the food registration centre showing the family size, the refugees would receive a mosquito net free of charge based on the UNICEF standard of one mosquito net for every two individuals.

UNICEF monitored the distribution exercise and conducted awareness and demonstration on slinging the mosquito nets. The awareness was done by Community Outreach Agents. Special messages with visuals were developed for under five children and pregnant and lactating women. The monitoring team also conducted interviews with refugees to ascertain their knowledge levels on utilisation of mosquito nets.

Distribution of mosquito nets - Gambella
Nyaluak Kun after demonstrating how to hang the mosquito net. ©UNICEF Ethiopia/2018/Dorosella Bishanga

Nyaluak says the demonstrations were important although the refugees faced difficulties in fixing the nets because of the type of housing and beddings they had.

In all, 163,000 mosquito nets were distributed. They were procured by UNICEF with funds from the European Commission (ECHO) under a project to provide lifesaving and resilience-building health and nutrition interventions for South Sudanese refugees and host communities in Gambella.

In Ethiopia, Community-Based Approaches Help to Improve Nutrition among Women and Children

By Victor Chinyama and Tiguaded Fentahun

South Gondar Zone, Ethiopia: Enalem Asnakew (40) had no idea why her one-year-old son Misganaw Asmare would not stop vomiting. His arms, legs, and abdomen were swollen and his appetite was failing. After about a month, she had had enough and decided to bring him to the local hospital.

“He was put on blood transfusion for three days,” she says in a barely audible voice.Then, they administered [therapeutic] milk through his nostrils in addition to [intravenous] medicine. The nurses frequently visited my child and now, after nine days, the swelling has disappeared, the vomiting is almost gone, and my child takes therapeutic milk orally.”

Misganaw was diagnosed with severe acute malnutrition, a serious but entirely preventable and treatable condition which the WHO estimates accounts for 35 per cent of deaths among children under five globally. Typically, severe acute malnutrition is treated in a hospital but the advent of ready-to-use therapeutic foods has enabled children like Misganaw to be treated at home if they have no underlying medical complication requiring hospitalization.

In general, Ethiopia has made strides in reducing undernutrition in children, with stunting in particular dropping from 58 per cent in 2000 to 38 per cent in 2016. However, the number of children with severe acute malnutrition spikes up during the ‘lean’ season between June and August, the period when most households will have exhausted their food stocks as they await the next harvest beginning September. Prolonged and chronic humanitarian crises, such as droughts and floods, also contribute to increased malnutrition in children.

Inadequate food however is not the only cause of malnutrition. Multiple factors, such as the child’s size at birth and the mother’s weight, predispose a child to malnutrition. Acute illnesses and poor feeding practices are other contributing factors. The key to preventing malnutrition therefore lies in improving the nutritional status of the mother, ensuring the child has access to an improved and diverse diet, providing safe water and sanitation, improving hygiene, and building a strong and supportive system at community level.

In 2011, with a US$ 50 million grant from the Government of Canada, UNICEF embarked on a project to improve nutrition in children and women in 100 food insecure districts in the Amhara, Oromia, and SNNP regions of Ethiopia. The six-year project, later extended for another year, was to improve the use of health and nutrition services by children, adolescent girls, and breastfeeding mothers, and increase the availability of water and sanitation services. The project focused on the community level, where efforts were made to increase the scope and coverage of nutrition activities. These included multi-media campaigns, education of mothers and caregivers on nutrition, promotion of breastfeeding, and increasing production of local complementary foods. Wells were drilled to supply safe water to communities and households were encouraged to construct their own improved latrines.

To improve service delivery, 2,000 community-based health extension workers responsible for mobilizing people and agriculture development agents were trained in nutrition. Water was supplied to health posts and committees to oversee water, sanitation, and hygiene activities were established at kebele level (smallest administrative unit in Ethiopia).

Students line up to receive deworming tablets at Gurumu Koysha Primary and Secondary School in the SNNP Region of Ethiopia. Deworming of adolescents became a national programme after being introduced through the Canada-funded project.
© UNICEF Ethiopia/ 2016/ Meklit Mersha

In total, the number of community-based nutrition activities doubled and 24 per cent more households cultivated a garden (the largest increase was observed among the poorest households). Nutrition knowledge among health workers and health extension workers increased from 51 to 80 per cent while exclusive breastfeeding increased from 71 to 80 per cent. The proportion of mothers stating that water should not be given to babies under six months of age increased from 61 to 78 per cent.

The project also marked a milestone as the first ever in Ethiopia to target nutrition for adolescents (children aged between 10-18 years). Deworming of adolescents was first introduced under the project as a pilot but was subsequently scaled up to national school deworming campaigns, reaching 3.9 million school children.

These results were achieved against a backdrop of unforeseen challenges, such as the civil unrest of 2016 which limited travel and access and the El Nino drought in 2016 which shifted attention and resources.  Notwithstanding, a survey at the end of the project showed that stunting among children had declined from 40 per cent to 35 per cent and the prevalence of underweight children from 22 per cent to 17 per cent. Put differently, the odds of children in the 100 districts being stunted or underweight had been reduced by 19 per cent and 20 per cent respectively.

The education, mobilization, and support given to the 100 districts in Amhara and the other two regions will ensure that mothers like Enalem will never have to wonder again why their children are vomiting, or why their abdomen and limbs are swollen. They will also ensure that children like Misganaw can grow up healthy and strong, free from dangerous yet preventable conditions like malnutrition.

Ethiopia inaugurates model water supply and waste management project

26 May 2018, WUKRO, Tigray region – Today marks another major milestone in the Water Supply, Sanitation and Hygiene (WASH) sector in Ethiopia with the inauguration of a model water supply, sanitation and waste management system in Wukro Town, Tigray Region. Part of the One WASH Plus programme, the system integrates innovative and resilient solutions to provide WASH services to 73,000 people, including 35,000 children under the age of 15, residing in the town and its satellite villages.

Attending the inauguration were His Excellency Dr. Negash Wagasho, State Minister of Water Irrigation and Electricity, Dr Christian Rogg, Head of the UK’s Department for International Development (DFID) in Ethiopia, Ms. Gillian Mellsop, UNICEF Representative in Ethiopia, officials from the Tigray Regional Government and Wukro Town administration officials.

“Ethiopia’s rapid urbanization and population growth has resulted in increased water stress,” said Dr. Negash Wagasho. “The development of adequate, resilient, sustainable and inclusive WASH services is therefore a must to ensure sustainable development of rapidly growing towns. Thus, what we are seeing today is what can be achieved when we put our concerted efforts together.”

“The UK is the largest bilateral donor in the Ethiopian WASH sector and we are proud to fund the excellent work taking place in Wukro, which is supplying vital water and sanitation services to the town and its surroundings,” said Dr Rogg. “I hope the progress in Wukro can serve as an example to be emulated on a national scale.”

UNICEF Representative Gillian Mellsop said the project was one of the greatest achievements of the One WaSH Plus programme and stands as a testament to the tremendous good that can be achieved when everyone pools their resources together towards one common purpose.

“Investments of this nature, both in Wukro and elsewhere in Ethiopia, are not just improving access to essential services but are changing entire lives,” said Dr. Samuel Godfrey, Chief of WASH at UNICEF. “Women and girls no longer have to walk long distances and spend many hours fetching water. Girls can go to school and attend to their schoolwork while mothers have enough time to spend with their children and engage in other productive activities. For communities, a safe and clean environment means fewer disease outbreaks.”

The Wukro project involved expanding the capacity of the town’s existing system to supply water to the town and five satellite villages, integrating it with a “full chain” system for managing liquid sludge and waste (from containment to recycling), improving water and sanitation in institutions such as schools and health facilities, and establishing a business model for managing the facility comprising the local administration and private operators. The low-cost technology deployed in treating domestic liquid waste in selected social housing developments in the town was sourced through a partnership with the Government of Brazil.

The One WASH Plus programme, fully funded by DFID, is implemented by UNICEF in collaboration with the Ministry of Water, Irrigation and Electricity, regional sector bureaus, and the Water Resource Development Fund. The programme also works with the Ministry of Health, the Ministry of Urban Development and Construction, and respective Sector Regional Bureaus, as well as town administrations and town water supply and sewerage utilities.

The programme, which began in 2013, will benefit 250,000 people in eight small towns and surrounding rural villages in Amhara, Oromia, Somali and Tigray regions with a total investment of some US $36 million by targeting communities living in towns and in peri-urban areas. Models such as the one in Wukro, some large and others medium sized, are now a key component of the One WaSH programme across more than 1,000 towns in the four regions in Ethiopia.

Ethiopia’s rapid urbanization and urban development has resulted in increased water stress and high potential for disease outbreaks. The development of adequate, resilient, sustainable and inclusive WASH services is therefore a must to ensure sustainable development of the rapidly growing towns to meet the targets set in the SDGs.

Linking One WASH National Programme and Water Resources Management: UNICEF Ethiopia’s Leverage in the Sector

By Kaleab Getaneh and Jorge Alvarez-Sala

There is a high interdependence between Water, sanitation and hygiene (WASH) services and Water Resources Management. A sustainable supply of good quality drinking water highly depends on how properly the water sources are managed. Similarly, if WASH services provision is not sustainably managed it will have a huge negative impact on the water resource.

The UNICEF and USAID supported project to strengthen the Water Sector Working Group (WSWG) Secretariat started in July 2015 with the aim of establishing a well-functioning platform for the water sector consisting of the WASH and Water Resources Management (WRM) subgroups that contribute to the sustainable development and management of the water resources in the country.

The project has been supporting the reactivation of the WRM Sub Group and the organization of the first-ever Joint Technical Review (JTR) for the WRM sub-sector. The main purpose of the JTR is to bring various stakeholders together and ensure a sustainable coordinated development and management of water, land and related resources in order to maximise the economic and social welfare of the population. This is the basis for the ongoing and future water sector interventions in general and One WASH National Programme in particular.

Developing climate resilient sustainable WASH services under the umbrella of One WASH National Programme require looking into the bigger water resources management picture, including the protection of water sources and the overall water governance issues. To this end, the reactivation and capacitation of the WRM subgroup and the launching of the JTR is significantly contributing to the development of a clear and common agenda for the water resources sector in Ethiopia.

The WRM sub-group has been able to bring together three concerned Ministries: Ministry of Water, Irrigation and Electricity (MoWIE); Ministry of Agriculture and Livestock Resources (MALR); and Ministry of Environment Forest and Climate Change (MoEFCC) and key development partners (DPs), academia and civil society organizations (CSOs).

The priorities established by the WRM sub-group include: 1.Irrigation for growth; 2.Legislation of groundwater use; 3. Conflict resolution; 4. Communication/Management Information System; 5. Institutional and Human Capacity; 6. Water quality; and 7. Water Charges/Tariff and Scheme Sustainability. Following the identification of the priority areas, six WRM technical working groups have been established to further pinpoint key bottlenecks and gaps.

Opening speech by H. E. Ato Kebede Gerba, the state Minister of MoWIE. © UNICEF Ethiopia/2018/Jorge Alvarez-Sala

On the 19th April 2018, the WRM JTR kick-off meeting was successfully held by involving more than 85 participants from academic institutions, CSOs, development partners, basin authorities, concerned federal ministries, and regional bureaus of water, environment and agriculture. The workshop was attended by H.E. Ato Kebede Gerba, the state Minister of MoWIE and H.E Ato Kare Chewicha, the state Minister of MoEFCC. It has laid the foundation by bringing the three ministries (MoWIE, MoEFCC and MoANR) together to talk about water resources management in the country.

 

Currently, the six working groups are actively organizing a field mission to review the state of WRM in three selected river basins (Awash River Basin, Rift Valley Lakes Basin and Abay River Basin) and come up with high impact implementable actions. The findings of the field mission will feed into the upcoming Multi Stakeholders Forum, which will bring both WASH and WRM subsectors together for the first time.

The whole process of JTR and MSF is expected to culminate in the preparation of a National WRM Programme document, which is currently being developed with technical and financial support from UNICEF.

UNICEF’s support to the Water Sector Working Group (WSWG), and its sub-groups is possible thanks to the generosity and support of USAID. The JTR kick-off meeting was also financially supported by JICA and the Italian Cooperation Agency.