Mobile Health and Nutrition Teams Providing Crucial Services for Pastoralist Mothers As They Cope with Drought

By Rebecca Beauregard

GASHAMO, SOMALI, 15 February 2017 – Mutas does not look at his mother. He is not looking anywhere, rather he lays still, his unfocused pupils covered occasionally by heavy eyelids. While we talk, his mother, Bedra Dek, keeps her eyes entirely on him. Her one-year-old son is suffering from severe acute malnutrition (SAM) and despite the food and water shortage and her two other children, she explains that all her thoughts are focused on him improving.

“When your child is well, spiritually you feel happy. This is what I am waiting and hoping for. Nothing else is in my mind except this,” Bedra speaks softly, her eyes never wavering from her son.

About six months ago, Mutas became sick with a cold. Since then, he has fought that illness and intermittent diarrhoea while they lived in remote rural areas. Living in remote areas means even farther than where we are now, which is over 300 km from the regional capital and 63 km off the paved road through desert sand – no roads. Bedra walked yet another 15 km to the settlement just outside Al-Bahi kebele (sub-district) after hearing that there was a mobile health and nutrition team (MHNT) providing lifesaving services. She knew Mutas was not improving, and indeed, shortly after her arrival, he had become lethargic and largely unresponsive.

MHNT in Somali drought 2017
Bedra Dek, 21-years-old, looks at her one-year-old Mutas Abdulahi, who is ill from malnourishment. ©UNICEF/2017/Tesfaye

At 21-years-old, Bedra has 7- and 4-year-old daughters in addition to Mutas. They are a pastoralist family, living in a rural village and often traveling vast kilometres in search of water and grazing land for their livestock.

While the semi-arid Somali region is often dry, the drought brought on by the negative Indian Ocean Dipole (IOD) in the past few months is beyond anything Bedra has experienced. Her family’s herd of over 200 goats and sheep is now down to four, and their physical appearance is too poor to sell in the market.

Upon arriving in Al Bahi, she went to the MHNT, which has temporarily set up as a static clinic in the site to service the hundreds of families in the area. MHNTs were initially set up over a decade ago in this region as a unique and necessary component of the emergency health service delivery system to reach nomadic families such as Bedra’s. They respond to disease outbreaks, provide routine immunizations and basic healthcare including treatment of common illnesses, conduct screening and manage uncomplicated cases of malnutrition as well as refer to higher levels of care as necessary. Here, the team has encountered high levels of malnutrition and the majority of children have low immunization status. The team is both responding to emergency care needs as well as conducting mass immunization and other preventative measures to ensure that a temporary settlement like this does not create further disease and suffering.

Once a child is diagnosed with SAM, they are provided with ready-to-use-therapeutic-food (RUTF) and medications which should help them to quickly improve. To ensure progress, mothers are instructed to come weekly to have their children checked. We meet Bedra, as she waits with Mutas for his weekly check.

MHNT in Somali drought 2017
The homes of pastoralists gathered at the temporary Al Bahi site starting from December 2016, in Gashamo woreda, Somali region. ©UNICEF/2017/Tesfaye

UNICEF continues to support the GoE’s MHNTs through vehicle provision, transportation allowances, emergency supplies and technical guidance. UNICEF emergency health and monitoring consultant, Kassim Hussein, was present when Mutas was referred. When asked about his role, he explained how he roves around the region providing technical support. “During emergencies, things may be done in a haste, there may be staffing or technical knowledge gaps, or the situation may reach extreme levels and the team is too busy to report. I make rounds to all the teams, providing technical support and ensuring standards of care and supplies are available at adequate levels. I then report back to UNICEF and the regional health bureau,” explains Kassim.

Now Mutas is being seen by Mohammed Miyir, the team leader of the MHNT in Al-Bahi temporary settlement. Originally, he diagnosed Mutas with SAM; now his condition has developed medical complications, making him unable to receive fluids or medicine. This development signals the need for him to be sent to a stabilization centre (SC) at the Gashamo woreda (district) health centre, where he will receive in-patient advanced care until he reaches a minimal level of improvement in his responsiveness and weight.

Bedra is perplexed. Just minutes before they told her this news, she had said she wanted anything for him to improve. Now that it may happen, a new reality hit her. Her two daughters will need to be left behind – there is no room in the MHNT car. This is often an issue mothers out here face. With husbands caring for the grazing livestock, if they need to go to a SC for further treatment, who will take care of their other children? Some find neighbours to watch their kids, other mothers choose to stay and hope for the best, concerned about finding their children again as people are so mobile.

For Bedra, she has another 10 minutes to decide until the car will be ready for her.

Severe Water Shortage No More

 Project Taps into Existing Groundwater to Bring Sustainable Water to Community

By Ayuko Matsuhashi

SHINILE, SOMALI, 17 January 2017 – Munasib Omer, Chief of Bisle kebele (sub-district) in Shinile woreda (district), tells how excited the community is about the ongoing drilling work of a borehole in the kebele. “Thank you! Thank you to those who are providing the water to this kebele.”

Harshim Town Fafan Zone Somali region
Chief of Bisle kebele, Munasib Omer Maydhane, explains how Bisle has not had sustainable water while standing in front of an abandoned reservoir. ©UNICEF/2017/Tsegaye

He continues, “Since I was born, there has been no sustainable water supply in this community. We are entirely dependent on rainfall and travel 15 km one way to get water from a dried river bed. Here, we can use our hands to dig through the sand and find some water. But in the last 10 years, we have suffered from water shortage. NGOs and the government have been providing water through trucking but this is not enough and not predictable as the road condition is so difficult for trucks to access. Our primary problem has been always water.” He points to the road from which the UNICEF car arrived. “As you may have seen, there are many empty houses [along the way]. People left because of the water shortage.”

A mother of four children, 32-year-old Fadumo Ali talks about how difficult it is to raise children without a secure water source. “Sometimes there is no water to give to our children. We cannot wash them.”

UNICEF’s implementing partner, Hydro, began drilling a borehole in November 2016 at a location 1.5 km outside the Bisle community, which has a population of 11,000 people. This crucial drilling work is made possible by the DFID emergency fund. While it is difficult to find water by drilling in lowland areas due to the nature of the hydrogeological complexity in the Somali region, water was found at a depth of 210 meters and the drilling was completed at depth of 299 meters. According to a pump test, the borehole is providing more than 30 litres per second. The post-drilling construction is planned to be completed by March 2017. This news has brought hope for a better future to the Bisle community.

Pump test
People from Bisle kebele play with the water during a successful pump test of the borehole. ©UNICEF/2017/Godfrey

Fadumo is now looking forward to the day that she will no longer need to worry about water. She will have a few extra hours per day once the borehole is functional as she will not travel in search of water. “When I have regular water and more time, I want to do more about sanitation and hygiene for my children. I will clean my children more often.”

Through the generous contribution of donors, UNICEF will continue to support regional water bureaus across the Somali region to implement similar sustainable interventions that will support children and their families.

 

 

 

UNICEF commits to speed up its efforts to end the violent practice of Female Genital Mutilation/Cutting (FGM/C) 

Addis Ababa, 06 February 2017 As the world observes International Day of Zero Tolerance on Female Genital Mutilation/Cutting (FGM/C), UNICEF Ethiopia commits to accelerate its efforts to end the violent practice of FGM/C through strengthened partnerships with key actors in support of the national theme, “Let us keep our promise and fulfil our commitment by ending FGM/C.”

“FGM/C is a harmful practice inflicted on girls which deprives them of their rights to sexual and reproductive health, endangers their health by causing complications during delivery and even untimely death,” said Gillian Mellsop, UNICEF Representative to Ethiopia. “In order to fast-track the elimination of the practice once and for all, we need to work at grass roots level, at scale and hand in hand with communities – boys and girls, women and men, and most importantly, traditional and religious leaders who are influential communicators with the potential to reach the hearts and minds of millions of people. We also believe that it is equally important to address health and psychological complications caused by FGM/C- by providing the necessary health services for survivors to help them lead a healthy life.” 

According to the 2016 Ethiopian Demographic Health Survey (EDHS), FGM/C among the age group of 15-49 is most prevalent among the ethnic groups of Afar and Somali regions (98 per cent and 99 percent, respectively), followed by Welaita and Hadiya (92 per cent for both). In addition, 54 per cent of urban women have experienced FGM/C as compared to 68 per cent in rural areas. FGM/C is less prevalent among women with higher education and those in the highest wealth quintile. The 2016 EDHS shows a decreasing trend in FGM/C nationwide with the prevalence in 15-19 year olds down to 47 per cent as compared to 65 per cent in the 15-49 age group.

UNICEF supports the Government’s efforts through enhancing capacity to implement both preventive and responsive programmes at scale, and strengthening coordination mechanisms at different levels. UNICEF works with the National Alliance to progress ongoing roadmap development to end FGM/C and Child Marriage. It also, supports the involvement of faith based, traditional and community leaders, as communities usually link this harmful traditional practice to cultural and religious norms. In this regard, UNICEF signed a Memorandum of Understanding (MoU) in August 2016 with major religious institutions in the country to improve the lives of children, women and adolescents by promoting positive behaviour and social norms and to bring about the necessary societal shifts in communities.

UNICEF supports the Government in the health sector in the Afar and Somali regions to address FGM/C related complications by providing training to health workers; raising the communities’ awareness on health risks caused by FGM/C; identifying girls and women affected by FGM/C; developing training materials; recruiting gynaecologists and equipping selected hospitals with basic FGM/C care equipment.

UNICEF Ethiopia seeks US$110.5 million in emergency assistance for 9.2 million children and their families

Malnutrition poses “silent threat” to children, agency’s 2017 appeal says 

NEW YORK/GENEVA/ADDIS ABABA, 31 January 2017 – 48 million children living through some of the world’s worst conflicts and other humanitarian emergencies will benefit from UNICEF’s 2017 appeal, which was launched today.

From Syria to Yemen and Iraq, from South Sudan to Nigeria, children are under direct attack, their homes, schools and communities in ruins, their hopes and futures hanging in the balance. In total, almost one in four of the world’s children live in a country affected by conflict or disaster.

“In country after country, war, natural disaster and climate change are driving ever more children from their homes, exposing them to violence, disease and exploitation,” said UNICEF Director of Emergency Programmes, Manuel Fontaine. 

UNICEF’s Humanitarian Action for Children sets out the agency’s 2017 appeal totaling $3.3 billion, and its goals in providing children with access to safe water, nutrition, education, health and protection in 48 countries across the globe. 

An estimated 7.5 million children will face severe acute malnutrition across the majority of appeal countries, including almost half a million each in northeast Nigeria and Yemen.

“Malnutrition is a silent threat to millions of children,” said Fontaine. “The damage it does can be irreversible, robbing children of their mental and physical potential. In its worst form, severe malnutrition can be deadly.”  

The largest single component of the appeal is for children and families caught up in the Syria conflict, soon to enter its seventh year. UNICEF is seeking a total of $1.4 billion to support Syrian children inside Syria and those living as refugees in neighbouring countries.

In total, working alongside its partners, UNICEF’s other priorities in 2017 are:

  • Providing over 19 million people with access to safe water;
  • Reaching 9.2 million children with formal or non-formal basic education;
  • Immunizing 8.3 million children against measles;
  • Providing psychosocial support to over two million children;
  • Treating 3.1 million children with severe acute malnutrition.

In the first ten months of 2016, as a result of UNICEF’s support:

  • 13.6 million people had access to safe water;
  • 9.4 million children were vaccinated against measles;
  • 6.4 million children accessed some form of education;
  • 2.2 million children were treated for severe acute malnutrition.

UNICEF Ethiopia’s 2017 Humanitarian Appeal for Children (HAC) is for US$110.5 million, which includes US$17.3 million required to provide assistance to refugees.  Together with the Government of Ethiopia and humanitarian partners, UNICEF Ethiopia aims to reach 9.2 million children and their families with access to safe water and hygiene, nutrition, health and protection services and give hope for the future by providing education in emergencies.

Aysha Nur a mother of four is receiving a medical treatment for her child
Fatuma Ahmed 4 is checked for malnutrition by a mobile health extension officer at Lubakda Kebele of Kori Woreda in Afar Regional state. Lubakda, a remote site served by one of Afar’s 20 Mobile Health and Nutrition Teams (MHNTs), is 4km from the nearest health post and 30km from the nearest health centre. ©UNICEF Ethiopia/2016/Tesfaye

“In 2017, UNICEF Ethiopia prioritizes humanitarian needs of those affected by the Horn of Africa drought while continuing to support development initiatives to ensure all children and their families have clean water, adequate sanitation as well as access to nutrition and health services. Additional priorities are to support education for children facing emergencies and to protect children against violence and abuse,” said Gillian Mellsop, UNICEF Representative to Ethiopia. “Our ability to respond adequately to the needs of millions of children contributes to future growth and stability in Ethiopia. Through linked humanitarian and development programming, the Government of Ethiopia, UNICEF and our partners’ investments helps build families’ and communities’ resilience against future emergencies.”

While the funding will be critical to UNICEF’s ability to respond to immediate needs, it will also be used to take appropriate action to strengthen preparedness, improve early warning systems and reduce vulnerability as well as contribute to more resilient communities. 

In 2016, UNICEF raised US$108.7 million to provide around 7 million children and their families with life-saving humanitarian assistance to mitigate the impact of the El Niño-induced drought. With severe water shortages, malnutrition and disease outbreaks, the anticipated humanitarian need in 2017 has reduced only slightly, from 9.7 to 9.2 million people.

Though an adequate 2016 ‘kiremt’ rainy season was recorded in many areas of the country, drought conditions and residual effects from the El Niño emergency continue to cause water shortages, malnutrition, disease outbreaks and related protection and education issues, including the closure of hundreds of schools in drought-affected areas.

A new drought expanding across the lowland areas in the Horn of Africa, induced by another weather phenomena, the Indian Ocean Dipole (IOD), is further exacerbating humanitarian needs in the south and south eastern regions of Afar and Somali, as well as parts of Oromia and SNNP. Neighbouring country Somalia is also severely affected, causing 1,325 refugees crossing into the Ethiopian Somali region in the first 17 days of January. Ethiopia is already one of the top refugee-hosting countries in Africa, with 783,401 refugees as of November 2016 hailing from South Sudan, Somalia, Eritrea and Sudan.

KfW provides vehicles to support Mobile Health and Nutrition Teams in Somali region

By Somali Region Mass Media Agency

mhnt1
Mr. Hassan Ismail, Head of Ethiopian Somali Regional Health Bureau ©2016/Mukhtar Mohamed

JIGJIGA, SOMALI REGION, 13 December 2016– In partnership with UNICEF, the KfW Development Bank, which administers Germany’s financial cooperation in developing countries, provided 15 vehicles to support the Mobile Health and Nutrition Teams (MHNT) across the Somali region.

Regional officials and UNICEF staff attended the handover ceremony in Jigjiga, the capital town of the Somali region. Hassan Ismail, Head of the Ethiopian Somali Regional Health Bureau, emphasizing the benefits of the15 vehicles for MHNT services, said, “The vehicles will contribute for the success of MHNTs to reach vulnerable women and children with basic health and nutrition services in drought-affected pastoralist areas.”

The mobile teams conduct outreach services and targeted campaigns, such as the Enhanced Outreach Strategy (EOS) that provides children vitamin A supplementation, treatment for intestinal worms, and screening for acute malnutrition in far-reaching pastoralist areas.

Fartun Mahdi Abdi, Head of the Water Bureau and representing the Vice President of the Somali region at the ceremony, also reiterated the contribution these vehicles will have to reducing maternal and child mortality as well as strengthening the quality of health services.

 Fartun Mahdi Abdi, left, Head of the Water Bureau, receives keys to the 15 vehicles from Dr. Marisa Ricardo of UNICEF Ethiopia.  ©2016/Mukhtar Mohamed
Fartun Mahdi Abdi, left, Head of the Water Bureau, receives keys to the 15 vehicles from Dr. Marisa Ricardo of UNICEF Ethiopia. ©2016/Mohamed

With the support of donors such as KfW, UNICEF Ethiopia provides the Government of Ethiopia with medicine and other supplies for MHNT operations. As a result, 362,815 medical consultations took place between January and October 2016 across Somali and Afar regions. Forty seven per cent of these are children.

UNICEF Ethiopia, through the generous support of KfW, provided an additional five vehicles to MHNTs in Afar for the same purpose.

Prolonged drought and intermittent flooding has gravely affected these areas in recent years, first caused by the effects of El Niño weather in 2015, and currently from effects of the Indian Ocean Dipole, another climatic phenomena.

Government of Ethiopia and Humanitarian Partners Release 2017 Humanitarian Response Planning Document

ADDIS ABABA, 11 January 2016 – The Government of Ethiopia has released the Joint Government and Partners’ Humanitarian Document, an initial humanitarian response planning document for 2017 while the comprehensive Humanitarian Requirements Document (HRD) is being finalized. Based on the early warning data and modelling undertaken by partners such as UNICEF, the document reflects the joint humanitarian response planning and provides a shared understanding of the crisis, including the most pressing humanitarian needs.

While Ethiopia battles residual needs from the El Niño-induced drought, below average rains in the southern and eastern parts of the country caused by the negative Indian Ocean Dipole, another climatic phenomena, have led to new symptoms of drought. It is anticipated that 5.6 million people will need emergency food assistance in 2017, in addition to those still suffering from effects of El Niño. Ongoing assessments for the HRD will provide total figures of those in need for 2017.

In 2016, international donors contributed US$894 million toward the humanitarian response efforts and from that figure, UNICEF raised US$108.7 million to support the Government of Ethiopia and partners to reach around seven million people with access to health and nutrition care, education, safe water, sanitation and hygiene services, and protection support. At least 73 per cent of those reached were children.

The total anticipated financial requirements for the 2017 HRD is US$1.1 billion, of which, the UNICEF Humanitarian Action for Children (HAC) appeal for Ethiopia is US$110.5 million. This includes US$13.6 million to respond to the new influx of South Sudanese refugees in the Gambella region. While the funding will be critical to UNICEF’s ability to respond to immediate needs, it will also be used to take appropriate actions to strengthen preparedness, improve early warning systems and reduce vulnerability, contributing to more resilient communities.

Immediate responses have already taken shape from regional governments allocating funds to water trucking and fodder provision in the south and south eastern regions, those most affected by the below average rainfall. In 2016 and years prior, UNICEF has supported such emergency interventions, in addition to child health and nutrition, sustainable water and sanitation, quality education for boys and girls, and the protection of children from violence and exploitation. UNICEF Ethiopia looks forward to continuing this support with the Government of Ethiopia and partners in 2017, for every child and their family.

Ethiopia: Vital events registration launched

By Nikodimos Alemayehu and Marie Angeline Aquino

ADDIS ABABA, Ethiopia. August 2016 – Ethiopia launched throughout the country on 4 August 2016 a permanent, compulsory and universal registration and certification of vital events such as birth, death, marriage and divorce.

Vital events registration kicks off in Ethiopia
(L-R) Ms. Gillian Mellsop, UNICEF Representative to Ethiopia , H.E Ms Elsa Tesfaye, Director General of Vital Events Registration Agency (VERA), H.E Dr Mulatu Teshome, President of the Federal Democratic Republic of Ethiopia and H.E Mr Getachew Ambaye, Attorney General holds a symbolic certificate for birth registration. ©UNICEF Ethiopia/2016/Ayene

The inauguration ceremony took place in the presence of the Ethiopian President Dr Mulatu Teshome, UNICEF Representative Gillian Mellsop as well as representatives of other ministries and development partners.

“The Government of Ethiopia has given great emphasis to vital events registration across the country by putting the appropriate policies in place, establishing a system up to the lowest administrative level and deploying massive resources in this endeavor,” said Teshome at the ceremony. “I am confident that, with the collaboration and commitment of all stakeholders, we will succeed in the operationalization of the system, just like we have succeeded in other development sectors in the country.”

Mellsop underscored in her address the importance of the registry in protecting children and combatting child trafficking.

‘’With no proof of age and identity, Ethiopian children become a more attractive ‘commodity’ to a child trafficker, and will not even have the minimal protection that a birth certificate provides against early marriage, child labour, or detention and prosecution of the child as an adult.”

Ethiopia ranks among the lowest in sub-Saharan countries on birth registration with less than 10 per cent of children under the age of 5 with their births registered.

The issue is especially urgent because 48 per cent of the 92 million-strong population is under the age of 18 – 90 per cent of whom are unregistered. The Government has committed itself to reaching at least 50 per cent of children with registration and certification services over the next two years.

UNICEF’s support to Ethiopia’s national civil registration is based on a recognition that birth registration is an important element of ensuring the rights and protection of children.

For children, being registered at birth is key to other rights such as access to basic social services, protection, nationality and later the full rights of citizenship, including the right to vote. Moreover, not only is vital events registration essential for compiling statistics that are required to develop policies and implement social services, it is also, as Mellsop points out, “a pre-requisite in measuring equity; for monitoring trends such as child mortality, maternal health and gender equality.”

Inaugural ceremony of National Vital Events Registration in SNNPR capital Hawassa
One-month child Samrawit at a birth registration centre in Southern Nations, Nationalities and People’s Region (SNNPR) capital Hawassa August 6, 2016. ©UNICEF Ethiopia/2016/Ayene

UNICEF has supported the Government in putting in place a decentralized registration and certification system, which is informed by a legislative framework promulgated in August 2012.

UNICEF is a catalyst in creating this new system with support that includes the reform of the legislative framework, the development of a national strategy and its implementation across the country.

An important element of the Civil Registration and Vital Statistics (CRVS) system is its interoperability with the health sector. On this aspect, UNICEF has worked in collaboration with the Ministry of Justice and Ministry of Health in its efforts to formalize the interoperability, culminating in the signing of Memorandum of Understanding (MoU) between the two ministries.

The important of involving the Health Ministry is because it already has its own well organized and decentralized network stretching across the country. This arrangement allows the health facilities found in nearly every community to manage notifications of births and deaths.

The actual registration and certification of all vital events started on 6 August 2016 at the lowest administrative level of the kebele (sub-district).

With Ethiopia’s new conventional vital events registration system in place, there are better opportunities for accelerating vital events registration in Ethiopia, and realizing one of the fundamental rights of children – the right to be registered upon birth.