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Rohingya Crisis, Cox's Bazar, Bangladesh, November 2017 Report date: 24 December 2017
Contact for Inquiries: Mohammad Mainul Hossain Rony, IMO, Nutrition Cluster Bangladesh, Email: [email protected]
Nutrition Sector Rapid assessment of Nutrition Centres, Dec. 2017
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Contents
Background to the assessment ................................................................................................................................................ 3
Specific Objective: .................................................................................................................................................................... 4
Data Sources: ........................................................................................................................................................................... 4
Birdseye view of the Nutrition Service Centres ....................................................................................................................... 6
Out Patient Therapeutic Programme (OTP) overview: ............................................................................................................ 7
Blanket Supplementary Feeding Program (BSFP) overview: .................................................................................................... 8
Targeted Supplementary Feeding Program (TSFP) overview:.................................................................................................. 8
Stabilization Centre (SC) overview: .......................................................................................................................................... 9
Mother Baby Area (MBA) overview: ........................................................................................................................................ 9
ANNEX-III Assessment Team ................................................................................................................................................. 25
Nutrition Sector Rapid assessment of Nutrition Centres, Dec. 2017
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Background to the assessment
Violence in Rakhine State which began on 25 August 2017 has driven an estimated 620,000 Rohingya refugees across the border into Cox’s Bazar, Bangladesh
1. The majority of the Rohingyas are living in Ukhia and Teknaf Upazilas of Cox’s
Bazar, a district bordering Myanmar identified as the main entry area for border crossing. Those fleeing are putting an immense strain on infrastructure, services and the host population. Pre-existing settlements and camps have expanded with the new influx, while new spontaneous settlements have also formed and are quickly growing. Significant numbers of new arrivals are also being absorbed into the local host community. Along the border regions of Bandarban and Cox’s Bazar, groups have settled in or near no man’s land, presenting additional access challenges with legal and security dimensions.
A total of 28 Collective Sites and 99 locations with dispersed setting in host communities were assessed between 30 September to 11 November 2017. Total of 823,805 Rohingyas were identified in Cox’s Bazar District
2. This figure has also
taken into consideration additional figures collected on a daily basis through NPM Emergency Tracking – Flow Monitoring exercise up to 15 October 2017, updated figures of Rohingya population in refugee camps by UNHCR, and other relevant secondary data sources available.
Rationale:
Preliminary results of a nutrition assessment done in October 2017 in Kutapalong Registered Refugee Camps showed a GAM prevalence of 24.3%) and SAM prevalence 7.5% CI. This indicated a Nutrition Emergency based World Health Organization recommended emergency threshold of 15%. This was of further compounded by high stunting prevalence (40%), poor IYCF practices and high morbidity rates.
The Nutrition Sector in Cox Bazar Coordinates delivery of the Nutrition services by humanitarian actors to address the high prevalence of malnutrition. Nutrition Service delivery is guided by the Community based Management of Acute Malnutrition (CMAM) and Facility based In-Patient management of Severe Acute Malnutrition ( SAM) Guidelines. During a Nutrition Sector meeting held on 23 October 2017, Nutrition service coverage mapping results developed by the Nutrition Sector was presented. The Mapping detailed Who was doing Which Nutrition Service, Where and When(4Ws). The members agreed on the importance of having a verification exercise to physically ascertain presence of the nutrition centres as well as nutrition service delivery based on minimal agreed standards. . The CMAM TWG was assigned to develop the relevant data collection tools for this exercise and to initiate the process. During the CMAM TWG held on 13 November 2017, the CMAM TWG tasked the Cluster Information Management Officer (IMO) to lead the exercise.
Methodology:
Supervisors of the Nutrition Action Week will visit all Nutrition Service Centers and interview service providers. There will be observatory feedbacks. The questionnaire agreed by the technical team will be digitalized to Kobo Toolbox. There were four teams for Data collection. Each team consists of 3 members from different organizations to maintain nutrality. Every team has a team leader and before entering any data, the team has to come to a consensus to avoid organizational biasness.
The whole area is divided into 12 Enumeration Areas. The team posted visible marks in each enumerated centres to avoid double counting.
There was day long training on how to read maps and collect data using the mobile devices. To monitor the data collection process, a monitoring team of Nutrition Sector has oversighted the process. There were team leaders meeting every day evening to administrate the field operation. Sector members provided resources to conduct this assessment (staff/vehicle). The Data collection is done using tab/smart phone with GPS location. Data is being analysed and mapped using GIS map.
1 ISCG Situation Report 2 ISCG NPM 6
th round
Nutrition Sector Rapid assessment of Nutrition Centres, Dec. 2017
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Overall Objective:
To ascertain the physical presence of Nutrition Centers as well as Nutrition Service delivery based on the results of the 4W mapping exercise in order to establish coverage and gaps in service delivery.
Specific Objective:
1. To ascertain the total number of functional Nutrition Services to inform programme scale up.
2. To identify specific the nutrition services being provided in the Nutrition Centers.
3. To establish the overall nutrition stock status.
Expected Results:
1. Physical verification of all existing Nutrition Centers.
2. Potential gaps in service delivery and coverage of Nutrition services identified.
3. Stock position of all Nutrition Centres identified
4. Base information for the phase 3 assessment
Data Sources:
• Primary data collection using Kobo Collect tool through supervisors of the Nutrition Action Week
• Secondary data source is the data provided by the partners.
• Interviews of the Nutrition Centers service providers
• Nutrition Sector 4W Map
Acknowledgment:
We acknowledge support and assistance from Nutrition Cluster Bangladesh, Nutrition Sector (CXB), UNICEF, Care, SARPV, Concern, SHED and ACF.
Key Findings: Summary
Total Service Centres : 92 Functional Centres : 78 = 84% Partly Functional : 08 = 09% Not Functional : 06 = 07% Out of 92 Service Centres, 90 are static and 02 are mobile. Out of 92 Service Centres, 51 established after August 2017.
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Number of Nutrition Centres by Union:
Number of services provided by 86 Functional/ partly functional Centres:
Number of Nutrition Centres by Locality:
Union No. of Centers
Baharchhara 6
Nhilla 9
Palong Khali 35
Raja Palong 15
Sabrang 5
Teknaf Paurashava 4
Teknaf Sadar 4
Whykong 14
Services Number %
Center with 1 Service 22 26%
Center with 2 Services 33 38%
Center with 3 Services 27 31%
Center with 4 Services 3 3%
Center with 5 Services 1 1%
Center with 6 Services 0 0%
Locality type No. of Centers
Host Communities 31
Makeshift Settlements 23
New Spontaneous Site 34
Others 1
Refugee Camp 3
Nutrition Sector Rapid assessment of Nutrition Centres, Dec. 2017
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Birdseye view of the Nutrition Service Centres:
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Out Patient Therapeutic Programme (OTP) overview:
Out of total 58 OTPs, 1 is mobile.
Nutrition volunteer attached to the OTP # of OTP
0 Volunteer 4
1-10 Volunteer 31
11-20 Volunteer 10
21-30 Volunteer 5
31-40 Volunteer 6
40+ Volunteer 2
Stock of RUTF # of RUTF
0 Carton 19
1-3 Carton 10
5-9 Carton 7
10-20 Carton 5
21-30 Carton 9
31-40 Carton 3
40+ Carton 5
Functional OTP, 51
Partly Functional
OTP, 7
No OTP, 34
Centers With OTP
Days operational # of OTP
1 day per week 17
2 day per week 7
5 day per week 14
6 day per week 20
Number of Nurses/ Clinical Officers per OTP
Number Of OTP
0 20
1 23
2 11
3 3
5 1 Numbers of days OTP remain operational
(Measurers, Registrars, Distributors)
Number of Nutrition Assistants per OTP
Number Of OTP
1 - 3 Nutrition Assistants 39
4 - 6 Nutrition Assistants 15
8+ Nutrition Assistants 4
Out of 58 centres with OTP, 30 centres have adequate Nutrition Equipment (MUAC tapes, Weight Scales, Height Board, Bracelets) and 28 OTPs have no or inadequate Nutrition Equipment.
Storage facility for Supply available in the center # of OTP
Available 31
Partly available 22
Not available 5
Medicine for Systematic treatment available
# of OTP
No Medicine 4
Only Amoxicillin 2
Amoxicillin Albendazole 52
Feedback mechanisms on services
# of OTP
Available 12
Not available 43
Partly available 3
Nutrition Sector Rapid assessment of Nutrition Centres, Dec. 2017
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Blanket Supplementary Feeding Program (BSFP) overview:
Targeted Supplementary Feeding Program (TSFP) overview:
MUAC tapes, Weight Scales, Height Board
Opening days in a week # of BSFP
1 day per week 1
2 day per week 3
5 day per week 8
6 day per week 5
Number of Nutrition Workers attached # of BSFP
1-10 Nutrition Workers 10
11-20 Nutrition Workers 4
20+ Nutrition Workers 3
Stock of WSB+ (25 KG Bags) # of BSFP
No Stock 2
1-50 bag 6
51-100 bag 5
100+ Bag 4
Stock of WSB++ (Cartoon) # of BSFP
No Stock 2
1-50 bag 3
51+ bag 12
Opening days in week # of TSFP
1 day per week 24
5 day per week 3
6 day per week 2
Number of Nutrition Assistants attached Column5
0 Nutrition Assistants 8
1-3 Nutrition Assistants 18
4-8 Nutrition Assistants 3
Number of Community Nutrition volunteer are attached to the site # of TSFP
0 Nutrition Assistants 6
1-10 Nutrition Assistants 20
10+ Nutrition Assistants 3
Nutrition equipment available # of TSFP
Available 22
Partly 7
Stock of WSB+ (Bags) # of TSFP
No Stock 15
1-10 bag 10
10-100 bag 3
100+ Bag 1
Nutrition Sector Rapid assessment of Nutrition Centres, Dec. 2017
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Stabilization Centre (SC) overview:
There are 5 Stabilization Centres (SC) were found and among them 4 are functioning and 1 is partly functioning. All SCs are open 7 days of week. All SCs have doctors and nurses attached. No information about the doctor’s orientation for SAM management was collected via this assessment. The SCs don’t have adequate nutrition supplies.
Mother Baby Area (MBA) overview:
Stock of WSB++ (cartoon) # of TSFP
No Stock 18
1-10 cart 8
10+ cart 2
Quantity of Vegetable oil available (Litre) # of TSFP
No Stock 5
1-10 litre 19
10+ 5
Storage facility for Supply # of TSFP
available 13
Not available 2
Partly available 14
Location # of TSFP
Host Communities 25
Makeshift Settlements 2
New Spontaneous Site 1
Refugee Camp 1
Opening days in week # of MBA
1 day per week 5
5 day per week 13
6 day per week 19
Number of IYCFE counsellors # of MBA
0 counsellors 12
1-3 counsellors 23
4+ counsellors 2
Number of IYCF volunteers # of MBA
0 IYCF volunteers 14
1-10 IYCF volunteers 22
10+ IYCF volunteers 1
Sufficient privacy # of MBA
No privacy 7
Partly 5
Proper privacy 25
Nutrition Sector Rapid assessment of Nutrition Centres, Dec. 2017
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IYCF Corner Overview:
Sufficient clean drinking water and cups # of MBA
Not Available 2
Partly Available 6
Available 29
A place to wash cups or other materials # of MBA
Not Available 5
Partly Available 5
Available 27
Close proximity to clean toilets or latrines # of MBA
No 8
Partly 2
yes 27
Opening days in week # of IYCF
1 day per week 2
5 day per week 14
6 day per week 25
7 day per week 1
Number of IYCF-E counsellor # of IYCF
0 IYCF-E counsellor 7
1-IYCF-E counsellor 27
2-IYCF-E counsellor 7
3-IYCF-E counsellor 1
Number of IYCFE volunteer # of IYCF
0-IYCFE volunteer 17
1-5 IYCFE volunteer 19
6-10 IYCFE volunteer 6
Access to safe water # of IYCF
No access 1
Partly access 3
Proper Access 38
IYCF counselling Material # of IYCF
No material 14
Partly 7
Adequate 21
Storage facility for Supply available # of IYCF
Not available 10
Partly available 7
Available 25
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Map A: Overview of Nutrition Sector Rapid Assessment of Nutrition Centers
Nutrition Sector Rapid assessment of Nutrition Centres, Dec. 2017
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Map B: Nutrition Centers in Baharchhara Union
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Map C: Nutrition Centers in Nhila Union
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Map D: Nutrition Centers in Palonh Khali Union
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Map E: Nutrition Centers in Raja Palong Union
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Map F: Nutrition Centers in Sabrang Union
Nutrition Sector Rapid assessment of Nutrition Centres, Dec. 2017
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Map G: Nutrition Centers in Teknaf Paurashava Union
Nutrition Sector Rapid assessment of Nutrition Centres, Dec. 2017
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Map H: Nutrition Centers in Teknaf Sadar Union
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Map H: Nutrition Centers in Whykong Union
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Recommendations
Infrastructure: Most of the infrastructures are made on temporary basis and has limited protection against wind, rain and cold wave.
Geographical addressing: We found after analysis that 15 centres are using wrong address (union name) which need attention for proper planning
Preparedness for natural disasters: Didn’t find much on preparedness against fire or natural disaster.
In-depth assessment of service quality: An In-depth assessment of service quality is required to improve the services and disaster resilience.
Access of enumerators to the Centres: In some centres, access was challenged for the enumerators as the service providers were not allowing enumerators to enter into the centre.
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ANNEX-I Enumeration Area Map
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ANNEX-II Assessment Questionnaire
Nutrition Sector Rapid assessment of Nutrition Centers
Date Auto GPS Auto
Enumerator Name
Nutrition Centre Name
Upazila List
Union List
Mouza Free text
Zone Free text
Block Free text
Organization Name Free text
Overall observation Choose an item.
Available services: (Select multiple)
☐ OTP (Out Patient Therapeutic Program)
How many days per week are is the OTP site open? Choose an item.
Number of Nurses/ Clinical Officers ___
Number of Nutrition Assistants ___
(Measurers, Registrars, Distributors)
Numbers of Community Nutrition volunteers are attached to the site? ___