OCT 2013

AMHARA FIELD OFFICE REPORT

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1. HIGHLIGHTS & CRITICAL ISSUES

2. UTILIZATION PROGRESS
Cash Transfer
Supplies

CMAM and CHD supplies requested and delivered for all zone based on the region request.
The requests for CHD supplies are Vit A and printing Materials for Dec CHD implementation
and Albedazol drugs will come through RHB from FMOH and it is on process.

3. ISSUES PENDING FROM PREVIOUS REPORT (Country Office)

Health, ICCM
Health, MNCH
Nutrition, VAS / DM
Nutrition, Micronutrients

4. PROGRAM PROGRESS REPORT by PCR & IR

PCR 102
102 / 006

Community health & nutrition services

Child Health Days for VAS / DM

(Selamawit Teshome)

Recent developments.

The fifth round CHD was conducted on the first week of October in all zones except South wello zone
with integrated Polio campaign some zonal health office that is South wello zone did not conduct with
polio & their plan was to conduct CHD after polio campaign.
Monitoring activities

More than 5 million ETB that left amount from Quarter 4 allocated for CHD and CMAM activities are
liquidated within a week by supporting RHB and BOFED technically by making with frequent contact
with zone and weredas through telephone. The quarter two budget of 2006 was requested and it is not
processed on the system because of system glitch.
Constraints

Even if the regional nutrition team liquidate the existing unliqudated budget from all weredas but, still
now RHB could not get the requested quarter two budget for the implementation because of the System
glitch
Remedies taken

Inform the problem for the section and program assistant of the region and they are working on it to
solve the problem as soon as possible.
Next month plan

Attended the review meeting of the routine weredas implementation

Supportive supervision of the routine wereda Vit-A supplementation and De-worming

102 / 007

Micronutrients deficiency control

(Wondayferam Gemeda)

Recent developments/Progress made

Monitoring activities
Constraints
Support required from Country Office
Next month plan

102 / 008

Community Based Nutrition Program

(Wondayferam Gemeda)

Progress Made

Capacity Building
Twenty four L10K staffs have got a skill and capacity of utilizing CBN data at woreda level. A
half day training was provided focusing on the basics of under nutrition, data collection,
recording, reporting, analysis and taking doable actions at the community level. The trainees
were well versed with the newly developed GMP registration book, reporting formats, nutrition
monitoring wall charts and woreda database. Participants raised their concern of including other
nutrition information databases (CMAM and CHD) for ease of monitoring and triangulation.
Monthly Meeting with Partners
A monthly meeting was held with L10K Amhara and head office team on how to optimize
monitoring activities in L10K supported CBN woredas in the region.
The below action points have been agreed
o L10K staffs assigned in the woredas should ensure monthly PHCU (HC staffs and
HEWs) meeting conducted regularly and performance based discussion using the
identified nutrition indicators made. The staffs should make maximum effort to attend
the meetings.
o L10K staffs should evenly distribute the selection of the 12 kebeles per month per
woreda for each HCs in such a way that all HC and one or two HPs under each health
center will be supervised. One model HP (GMP participation rate >80%, GUW <10%,
>60% of HDAs trained on complementary feeding demonstration) per each HC should
be established.
o Ensure quarterly review meeting held regularly. The budget sent from UNICEF shall be
shared to L10K staffs by the nutrition officer for follow up of its prompt utilization in
the respective woreda.
o Conduct monthly joint monitoring with team comprising of RHB nutrition focal, L10K
nutrition coordinator and UNICEF nutrition officer.
o Conduct monthly meeting (RHB, L10K and UNICEF)
Donor Visit
Amhara region has hosted two important donor visits on the implementation of Community
Based Nutrition activities. The DFAT-CIDA/UNICEF was a high profile visit encompassing the
president of CIDA, Representative of UNICEF ECO and Section chief of NFS. The visiting
team has got an insight on the overall implementation of Community Based Nutrition from the
briefing provided by the head of Dera W.H.O of South Gonder Zone and HEWs of Gibtsawit
HP of Dera woreda. Besides the visiting team got a chance to visit a household to hear the
services provided by HEWs from the family.

Sensitization Workshop on Local Production of Complementary feeding

As per the agreement between UNICEF and Ethiopian Orthodox Church on production of local
complementary food in five woredas (Basoliben, Awebel, Machakel, Sekela and Bure) of East
and West Gojjam zones, a sensitization workshop was held in the three woredas of East Gojjam
zone (Basoliben, Awebel and Machakel). Nine rural kebeles and one urban kebele had been
selected for the rural and semi-urban model of CF production prior to the workshop. From each
kebele, HEWs, DAs, school directors and kebele administrators attended the workshop. Woreda
participants included delegates from the W.H.O, Agriculture office, communication office and
administrator. At the end of the workshop action plan was designed when;
o To establish the grain bank in each kebele (kebele administrators pledged to provide the
space/centre serving the purpose) and when to start actual implementation.
o HEWs identified under two children
The workshop shall be conducted in the remaining two woredas (Sekela and Bure) of west
gojjam in November 2013.
Monitoring activities
Nutrition monitors recruited through an LTA with a consulting firm have supervised 8 woredas
in 6 zones of the region. Besides the regional coordinator the consulting firm and RHB nutrition
focal have paid a follow up visit in two woredas of S. Gonder and one woreda of West Gojjam.
The major findings of the visit have been shared in a separate report.
Constraints
Due to competing priorities, the nutrition officer couldnt supervise the sensitization workshop
on local production of complementary food.
Recommendations (or Remedies as applicable)
Support required from Country Office

Next months plan.

Following the sensitization workshop on local production of CF in the remaining woredas
Support the RHB in launching workshop of the revised NNP
Programme implementation monitoring.
PCR 308
308 / 006

DRR and emergency response

Nutrition, Coordination, Information Systems (NCIS)

(Mussie Asfaw)

Recent developments

Tentatively planned regional level nutrition cluster coordination training postponed to fourth
week of November,2013 due implementing partner not able access the requested budget in time.
Regional DPFSPCO attended and actively participate in annual review meeting which held
from Oct 21-22, 2013 in Adama of Oromia region. Amhara regional DPFSPCO presented
annual 2005 EFY AWP in detail and re-requesting UNICEF ECO NCIS focal person in
addressing undelivered supplies according the endorsed 2005 AWP.

Targeted zones DPFSPC departments for upcoming BANS prepared zero draft survey proposal
and submitted to RENCU for technical comments with the capacity of last rounds on job
coaching and training on SMART.
Regional DPFSPCO jointly with RENCU produced quarterly early warning bulletin and some
of concerns highlighted are:
Meher 2013 season weather condition was favorable and the distribution of rain was
rated as normal to above normal in most parts except Telemet, Zequala, Abergele and
Dahana woredas.
Agricultural performance of the season is much better compared to recent years
including last year and the reference year. In the current year, it was planned to cover
4,324,500 ha and 4,302,705 ha (99.5%) were covered /planted with different crops
No major disease outbreaks were reported except Typhiod in Tach Gaint and Anthrax in
cases from Waghimra weredas.
Relief food was distributed for 2013 in 5&6 rounds for 557,052 beneficiaries. Out of
total 103,193.98 food allocated arrived 27,779 and has been handed out to targeted
16,005 beneficiaries and not yet finilized
Overall burden of malnutrition status has been increased in last three months particularly
weredas with aggravating food insecurity due the hunger season
Regional health and Nutrition taskforce and EPRP coordination forums were held on Oct. 10
and 11, 2013 at RHB and DPFSPCO respectively. Some of major concerns discussed are:
The new hotspot classification and the need for inception on TSF to the newly included
priority one weredas by WFP, besides the need of communicating those weredas by
RBOH for screening and compiling results including MAM identified beneficiaries were
discussed.
TFP admission trends increased when compared in the last three years in similar season
but mainly due expansion of the service and better community mobilization.TFP
admission increase by 11% in the region on August than last July in 2013 which is
seasonal
Malaria situation relatively decreased than last year, but case increase reports from
(Metema and West Armacho), and seasonal increase in the malaria prone areas in the
region. Preventive measures (IRS operation) and response strengthening (Drug
distribution and surveillance) is currently taking place in the region
Typhoid outbreak was detected in Anista Kebele in Tach gaint and its investigation and
confirmation was done through lab results.
Constraints
RENCU Nutrition officer position vacant for more than year on top of the existing one staffs
switched to DCT modality under government which makes difficult to get full support due
vehicle access challenge.
Remedies
Still waiting an urgent best option in deploying the vacant position.
Next month plan
Facilitate in conducting regional level nutrition cluster coordination training
Preparation and implementation first round 2006 EFY BANS
Provided supportive supervision in regular program implementation.
Disbursement QI & II,2006 AWP funds and also alerting IP in utilization of the released QIV,
2005 AWP fund soon in selected zones.

308 / 007

EPR - Nutrition (CMAM)

(Selamawit Teshome)

Recent developments

The TFP admission has been increasing since July and this has been observed in the previously years as
well (seasonal explanation). The malnutrition is highly correlated with the food security gaps.
Over all TFP admission has increased in September 15% from August and 27% from July. The increase
in September was mainly observed in East Gojam 64%, Oromiya Zone(58%), North Shewa(41%) and
South Gondor (27%).The overall admission increase could also be attributed to CHD, polio campaign
etc which have enhanced community mobilization. TFP admission has increased in August by 11%
from July and the increase was mainly observed in in S wollo, N shewa and N wollo/
The increase in August is most observed in North Shewa, South Wollo and North Wollo
North Shewa
That is 241 Admisions from July to 341 in August (40% increase), however the number of new
TFP sites and their reporting sites have also raised. There are new 34 TFP sites and the reporting
rate also rose from 79% in july to 90 % in August.
South Wollo
There is 32% increase than last month with even lower reporting rate and the higher increase is
observed in Delanta, Leghambo,Mekdela, Tenta , where belg failure has also been reported
(Could associate with the food insecurity)
North Wollo
The increase is 18% and increases were observed in Meket (food insecurity reports as well
coming from this werda), Lasta where reported, But most of all the quality of reporting also
showed improvement.
Therefore the overall increase is mainly due new opening sites but the seasonal food insecurity has also
could have influenced specially in S wollo
Currently house to house polio campaign was conducted in the region and some zones have integrated
it with nutritional screening. For instance, North gondor zone has decided to do house to house
nutritional screening together with this campaign. Though the reports not yet been fully complied, high
number of severely malnourished children was found. This was again highly noticed in all kebeles of
telemt wereda. For example in one of the visited kebele (Negade Meshageria out of totally screened 55
children 22 of them were found to be below 11CM in MUAC i.e. 40% of them are screened to be
MUAC below 11 CM) and some other zones have also planned screening with currently ongoing
meningitis vaccine and we will be expecting a better mobilized screening reports.

Admission Trend Amhara region 2011-2013

Monitoring activities
Building the capacity of nutrition stakeholders at health post, health center and woreda level, to
implement and analyze CMAM program indicators. Additionally and most importantly, the quality
monitoring project has sought to create a health extension worker capable of carrying out, management
of sever acute malnutrition without medical complication at the health post level , our monitoring
achievement record for the months of October is indicated in the below bullet point
11 rural woredas and two town administration have been monitored in six zone in the region
104 health post have been visited to provide supportive supervision and on the job coaching
38 cluster health centers visited and mentored based RHB and UNICEF regional office
direction
8 stabilization centers was also monitored and supported in this reporting period
On the job coaching touched 132 Health extension workers and 77 health workers
Table: Woreda CMAM score classification by zone

CMAM score
# woredas
with <50
score
# woredas
with >50 &
<70
# Woreda >
70 score

North
wollo
0

South
wollo
0

North
showa
0

E.
Gojam
0

S.Gonde
r
0

N.Gond
er
0

Total

Monitored
woreda

13

Constraints

Routine drugs was not given to children in OTP service

OTP cards were not accurately and completely filled during follow up session

Shortage of non-medical items like soap to demonstrate hand washing practice

In majority of the HPs bin card is not practiced for stock balance of drugs and RUTF

Regular supportive supervision is not given from cluster supervisor on CMAM for HEW

TFU sites are open but enrollment of SAM with medical complication is very poor

Lack of red scoop is becoming a big challenge in majority of the inpatient care facility

Remedies taken

Communicated to woreda and zone so that they will be able to distribute medicine to local
health facility
On the job coaching provided the HEW to fix the problems and improve follow skill using the
standard SAM management protocol
Introduced the use Bin card and model in all the visited facility to improve supply
management

Support required from Country Office.

Next month plan

Supportive supervision on screening implementation and the admition status of SAM

cases with Jarco and RHB.