contingency pca example- pakistan · web view03-08-2017 · unicef and entering into a...

PCA Reference No:___________ANNEX 1Narrative

Joint Proposal

UNICEF Programme: Maternal and Child Health Care (MCHC) Program, Sindh

AWP Reference No: Output 1.1.12 (MYWP 2011-12): Community Management of Acute Malnutrition (CMAM) interventions established for prevention of malnutrition for the target population in emergencies.

I. Summary

Project Name: Community Based Management of Acute Malnutrition (CMAM) incorporating “Infant and Young Child Feeding” (IYCF)

Project Location: District: Jacobabad, North SindhTaluka: Jacobabad, Garhi Khero and ThullUCs: Jacobabad-I (Soomra Mohalla), Jacobabad-II (Lashari Mohalla), Jacobabad-III (Shah Ghazi Mohalla), Jacobabad-IV (Family Line), Jacobabad-VII (Jaffarabad Mohalla), Jacobabad-VIII (Dastagir Colony), Garhi Chand, Rind Wahi, Khuda Abad, Muhammad Pur, Joungal, Toj, Tajo Khoso, Logi, Thull-1, Thull-2, Thull Nao, Ranjhapur

Project Duration From: 15th October To: 31st March 2013

Implementation Partner: XX

UNICEF Contribution( Supplies+ Cash

Total = xx Cash = xxSupplies = xx

Implementation Partner Contribution:

PKR Cash: = Nil

Total Budget: PKR: xxUSD: xx

IP Project Manager: Name:Address:

Telephone No.E-mail Address

xx

UNICEF Focal Person

Name:

Address:Telephone No.E-mail Address

xx

II. Executive Summary:

1

UNICEF and entering into a contingency Project Cooperation Agreement (PCA) with partners to facilitate collaboration in the event of a disaster in Pakistan for an immediate Nutrition response. On the basis of the PCA’s effectiveness during the IDP and Floods response and during the 2010 and 2011 flood response, the contingency PCAs were activated to provide immediate relief assistance to flood affected communities in flood affected districts.This contingency PCA will valid from 15th of October till 31, March 2013( Depends upon availability of funds in 2013 .It will provide a framework for immediate collaboration, thus enhancing the capacity of both parties to respond rapidly and effectively to emergency situations with a focus on life saving activities in the 6 months of a response.

This agreement shall be signed for a 06 months period, and reviewed annually.Activation of this agreement shall take the form of a short summary Note for Record co-signed by the Representative for UNICEF and the country director for The partner. Efforts will be made to ensure this is co-signed as soon as possible following the onset of the emergency, preferably within 48 hours.The agreement is designed to allow each agency access to combined resources, both in terms of funding from UNICEF and in terms of contingency stocks, thereby saving valuable lives, time and minimizing possible delays attributable to paperwork.The PCA shall remain dormant outside of any emergency except for the collaboration between parties regarding planning, specification, planning for prepositioning, replenishment and management of contingency stocks.

Each organization shall be fully responsible for storage and management of respective contingency stocks and human resources, the content of which shall be reviewed jointly and biannually to ensure complementarities. Through individual stock ownership, the independence of Partner shall remain intact and Partner shall retain the freedom to act independently with their own resources where appropriate, without reference to the other agency outside of any agreed emergency. However, once this agreement is activated consultation would be expected prior to the distribution of contingency stocks. Ideally, this will take place within the Nutrition Cluster mechanism, but shall be achieved bilaterally if deemed appropriate. This agreement shall not be limited to contingency supplies and funding support but shall extend to all resources available at the start of the agreed emergency including of technical personnel and provision of funding as appropriate.

Any resources accessed from another party shall, under this agreement, be fully utilized and accounted for, and returned to the owner if unused. The reporting format shall be as defined by the provider, and submission is the responsibility of the user within a maximum 3 month reporting period. The proposed project ensure integrated lifesaving nutrition services CMAM, IYCF, multi-micronutrient supplementation & Nutrition, health and hygiene education in the affected population. The proposed cooperation is in line with UNICEF Pakistan country program (2009-12) mandate; focusing on supporting Pakistan in reaching the Millennium Development Goals 1,4&5 and UNICEF core commitments for children (CCCs) in emergencies. Moreover commitment to improve maternal and child nutrition status remain a key priority in the framework of “One United Nations” initiative contributing to the accomplishment of Pakistan Integrated Nutrition Strategy (PINS). The partnership will significantly contribute towards reduction of under-five mortality and prevention of malnutrition by providing effective nutritional services that meet national and internationally recommended minimum standards of care for population affected by emergency.

The package of services agreed between UNICEF & The partner is designed to rapidly respond to the urgent nutritional needs of the affected population & also focus on the early recovery aspects of the nutrition program. The project activities will focus on addressing prevailing acute malnutrition amongst children under five years and pregnant and lactating women in the target locations. It will also look at promoting appropriate infant and young child feeding practices especially in the emergency context, addressing micronutrient malnutrition through multi micronutrient supplementation and community awareness regarding improved nutrition, health & hygiene practices.

The integrated nutrition services will be established in selected health facilities of the Department of Health (DoH). All health facilities will provide The partner screening services for assessment of nutritional status and management

Revised April 2011 2

of identified cases of malnourished children and PLW through establishment/operationalization of nutrition sites [OTP/SFP/IYCF/mm-supplementation sites] in the target health facilities and ensuring timely referrals and follow-ups of complicated cases of severe acute malnutrition to the stabilization center’s supported by UNICEF/WHO/DoH Operational cost (cash) for the project will be provided by Partner. Anthropometric equipment’s, multi micronutrient supplements, all medicines as per CMAM protocols and Ready to Use Therapeutic Foods (RUTF i.e. Plumpy nuts) will be provided by UNICEF while Fortified Blended Food, Oil and Ready To Use Supplementary Foods (RUSF i.e. Supplementary Plumpy) will be provided by WFP.

To achieve the proposed objectives of the project, The partner will work in close coordination with the office of EDO Health, LHWs program, UNICEF, WFP and WHO for ensuring effective service delivery and sustainability of the project. For this purpose, the project will utilize the space in the established health facilities and engage at least two healthcare providers from each health facility (MO/LHVs/MTs/FMTs) and facility In charge in the project activities, so that they may go through the process and adopt it as standard CMAM practice in future. Capacity building of the DoH staff and active involvement of the trained LHWs in the The partner screening campaigns, field activities and IYCF will ensure transfer of skills to the real owners of the healthcare system.

The following union councils will be targeted.

S.No: TALUKA/TOWN NAME OF UC POPULATION

1

Jacobabad

Jacobabad-I (Soomra Mohalla) 17,2232 Jacobabad-II (Lashari Mohalla) 18,7043 Jacobabad-III (Shah Ghazi Mohalla) 17,0134 Jacobabad-IV (Family Line) 16,9925 Jacobabad-VII (Jaffarabad Mohalla) 11,6336 Jacobabad-VIII (Dastagir Colony) 16,2227 Garhi Chand 18,0748 Rind Wahi 20,2929

Garhi KhairoKhuda Abad 19,642

10 Muhammad Pur 20,19011

Thull

Joungal 20,64412 Toj 19,15813 Tajo Khoso 16,07614 Logi 18,19715 Thull-1 19,71216 Thull-2 17,14017 Thull Nao 19,26018 Ranjhapur 18,964

325,136

Beneficiaries to be covered upto 60% population


Total target Population 325,136

# of total proposed 60% population to be covered in 18 UCs of 1 District of Sindh 195,081.60# of children from 6-59 months screened for malnutrition 23,410# of malnourished SFP children treated for malnutrition 4,343# of malnourished OTP children treated for malnutrition 2,298# of malnourished SAM Children with complications are referred to Stabilization Centre 406 #of Children dewormed 19,508# Children supplied with MM supplementation 10,729# of PLW screened for malnutrition 15,607# of PLW provided with MM supplementation 15,607# of malnourished women treated for malnutrition 4,779 # of women and adult girls delivered health and hygiene sessions 21600# of IYCF sessions delivered in 18 UCs. 1,296

III.Situation Analysis:

The contingency PCA will be activated at the onset of an emergency situation (manmade or natural) in Pakistan on certification at that time by both parties as above. The main focus of activities through this PCA will be the provision of an integrated response for up to 100 thousand population people for the first six months of that emergency. Scale of the response will be decided on mutual agreements between the two parties subject to access, NOC from local authorities, HR and supplies available.

The activation of the PCA would enable both partners to have instant access to contingency stock of The partner and funding from UNICEF. On the onset of the emergency the PCA will be activated within forty-eight hours.

Technical support shall be made available by both parties. The partner will be responsible for maintaining and replenishing their contingency stocks in coordination with UNICEF. The contingency stock provided will be reviewed every month by both partners or after each emergency deployment and will be shared with UNICEF. If required, stock will be updated /adjusted to respond to changing circumstances. The nature of the emergency may demand considerable flexibility on the part of both partners to achieve the Nutrition related results for women and children. In case of emergency, The partner may be asked by UNICEF to deliver any of the interventions foreseen in the PCA for provision of Nutrition services to emergency affected population in other locations/districts within Province, at the same rates in the PCA. The changes required will be recorded in writing when and where required.

IV. Strategies , including lessons learned and the propose project :

The project is a contingency agreement only and is aimed at enabling both parties, The partner and UNICEF, to provide a more efficient and rapid lifesaving response in accordance with Core Commitments to Children (CCCs) through access to and sharing of resources in hand. Through this collaboration, unnecessary duplication of contingency arrangements shall be avoided and the interests of beneficiaries better served.


Overall Objectives: The overall objective of the proposed project is to ensure that GAM (Global Acute Malnutrition) rate in the affected area is maintained below the 10% emergency threshold by improving nutritional status through provision of effective nutritional services at the community and facility level; that meet national and internationally recommended minimum standard of care for population affected by emergency.

Specific objectives: In line with the minimum standards (SPHERE) and UNICEF Core Commitment for Children (CCCs) the specific objectives of the proposed project include the following

To provide adequate nutritional care and treatment for children less than five years of age and pregnant and lactating women suffering from acute malnutrition through community and facility based nutritional management approach.

To prevent malnutrition in early childhood through promotion of improved infant and young child feeding, care giving, and care seeking practices at the facility, community and family level.

To prevent and treat micronutrient deficiency disorders in children and women through provision of multiple micronutrient supplementation, Vitamin A and deworming campaigns.

To strengthen local technical capacity and provide appropriate resources to initiate integration of nutrition interventions into Primary Health Care.

The proposed interventions are designed to rapidly respond to the urgent nutritional needs in the immediate run and to focus on the early recovery aspects of the nutrition program. The project will focus on treatment of acute malnourished children and women and prevention of poor nutritional outcomes through rigorous promotion of optimal infant feeding practices, proper hygiene/sanitation and improved maternal nutrition. In addition micronutrients supplementation and nutrition education on locally available and setting up of a robust reporting and monitoring mechanism will be emphasized. The program will be implemented in partnership with the district Department of Health (DoH) and provincial nutrition cell of the DGHS. Partner will report to UNICEF on all activities for this project and will be responsible for implementing activities related to the community outreach component, outpatient therapeutic program (OTP), supplementary feeding program (SFP) and referral/follow-up to stabilization centers as well as improved infant and young child feeding, micronutrient supplementation and nutrition/health and hygiene education.

Community Mobilization (CM): Community Outreach Workers (COWs)/LHWs will be trained in the identification of acutely malnourished children using mid-upper-arm circumference (MUAC), and will be responsible for referring clients to health centers, or to agreed-upon locations for the visits of mobile nutrition teams, on the assigned day of the mobile clinic team visit. In addition to identification of acutely malnourished children, COWs will communicate promotion messages on health and nutrition, will follow-up with defaulters, and will identify pregnant and lactating women for SFP and care during pregnancy and in the immediate postnatal period. Simultaneously, COWs will identify cases of acute malnutrition in the community through active case searches. In each area at village level a nutrition support committee will be formed, and sensitized through regular meetings. In meetings nutrition education sessions will be conducted to prevent malnutrition and adopt healthy behavior in childcare. Behavior change communication through health, hygiene and nutrition promotion is the vital components for sustainability. This endeavor is designed to promote Infant Young Child Feeding (IYCF) practices with more emphasis on exclusive breastfeeding and proper complementary feeding. COWs will work in close association with the community, form committees of female in the community and will conduct sessions to disseminate key messages. Minimum two males and females worker will be deployed for the catchment population of 20,000 affected population staff for the outreach can be increased subject to the affected target areas.


OTP Site/

Taluka UC UC Pop SAM # MAM #

PLW

Health facility #

1 Jacobabad Jacobabad-I (Soomra Mohalla) 17,223 143 237 254

2 Jacobabad Jacobabad-II (Lashari Mohalla) 18,704 136 257 275

3 Jacobabad Jacobabad-III (Shah Ghazi Mohalla) 17,013 141 234 251

4 Jacobabad Jacobabad-IV (Family Line) 16,992 141 234 251

5 JacobabadJacobabad-VII (Jaffarabad Mohalla) 11,633 96 161 172

6 Jacobabad Jacobabad-VIII (Dastagir Colony) 16,222 135 224 238

7 Jacobabad Garhi Chand18,074 150 248 266

8 Jacobabad Rind Wahi20,292 168 279 298

9 Gari Khairo Khuda Abad19,642 164 270 289

10 Gari Khairo Muhammad Pur 20,190 168 278 29811 Thul Joungal 20,644 128 284 303

12 Thul Toj19,158 159 263 282

13 Thul Tajo Khoso 16,076 134 221 23714 THul Logi 18,197 152 251 26815 Thul Thull-1 19,712 144 270 29116 Thul Thull-2 17,140 143 236 25217 Thul Thull Nao 19,260 141 264 28418 Thul Ranjhapur 18,964 158 261 278Total 18 325,136 2,704 4,343 4,779

Supplementary Feeding Program (SFP): Children with moderate acute malnutrition (MAM) identified through community outreach will be registered with SFPs and will be provided fortified blended food (FBF) to take home every month. Every two weeks children in the SFP will present at the health center, or other designated location; where they will have their nutritional status checked, and where they will be provided with FBF, deworming and micronutrient supplementation. Pregnant and lactating women will also be included in the SFP, as per CMAM guidelines. FBF will be provided by World Food Program (WFP). Minimum one SFP assistant will be provided per SFP .


Outpatient Therapeutic Program (OTP): Children with severe acute malnutrition (SAM) with appetite and without complications will be Children less than 5 years of age treated with ready-to-use therapeutic foods (RUTF) and symptomatic outpatient medications in the fixed health centers. The severely malnourished child will come to the health center or designated location every week for a medical examination and treatment, and to receive RUTF. Children without appetite and/or with complications will be referred immediately to inpatient care in Stabilization Centers until they are stable to be discharged. These children then continue treatment at home in the OTP with RUTF and outpatient medications. On discharge from the OTP, children will be referred to the SFP as moderately malnourished children. Through this project one OTP will be functional per 20,000 affected population . Referral services from the community also pertain to lady health workers involvement. In each health facility there will be a SFP and an OTP center. DoH staff will run the OTP Program while partner will appoint one nutrition assistant in each health facility to provide support in SFP activities. Partner staff will be responsible for operationalization of the OTP services as per National CMAM protocols and maintain sphere standards.

Stabilization Centre: Children without appetite and with complications will be treated as inpatients at a Stabilization Centre until they are stable for discharge. The partner will refer clients and will ensure they are treated in the nearest operational stabilization Centre. To the fullest extent possible The partner discharged children will be referred to OTP once they are stabilized.

Expected Outputs: 18 static nutritional sites functional in the targeted health facilities of 18UCs in the district, minimum one

site per 20,000 population affected(Mobile /static/camp site) At least 36 health Care Providers (HCPs) of the Department of Health (DoH) and around 72 from partner

will be trained to implement CMAM and IYCF components.(at least 2 staff of DoH and 4 project staff per site # may vary subject to the scale of response and staff availability).

Around 23,410 children and 15,607 PLW in target areas of The partner screened for assessment of acute malnutrition checking Oedema and MUAC.

At least 4,343 MAM children and 4,779 PLW are enrolled in SFP, 2,704 SAM children without medical complications are treated in OTP and 406 SAM children with underlying medical complications are facilitated to be treated in The partner as per CMAM protocols.

Selective Feeding Program outcome indicators meet minimum SPHERE standards (cure rate >75%, default rate <15% and death rates <3%, and coverage >60% in rural areas).

Around 10,729 children and 15,607 PLW are provided multi-micronutrient supplements for at least three months for prevention of micronutrient deficiency disorders.

At least 21,600 PLW and/or caretakers of malnourished children receive messages on appropriate infant and young child feeding practices.

The wider communities, husbands of malnourished PLWs and mothers-in-law have a better understanding of consequences of malnourishment and the importance of a balanced diet.

Beneficiaries/Participants: Project activities will focus on addressing prevailing acute malnutrition amongst children 6-59 months of age and pregnant and lactating women. Those most seriously affected by the conflict & flood emergency situation are vulnerable groups, such as women and children who also have limited access to quality MCH services due to the lack of quality inputs (qualified female staff and medicines), thus compounding the effects of poor food intake.

Total Population 325,13


6

Coverage 195,01

8 Screening: # of children 6-59 months of age (14% of total population) 23,410 SFP: # of Moderate Acute Malnourished Children (10.9% of 6-59 months children as per NNS 2011) 4,343SAM: # of Severe Acute Malnourished Children (6.6% of 6-59 months children) 2,704 OTP: # of Severe Acute Malnourished Children without complications (85% of SAM Rx as Outpatient) 2,298 SC: # of SAM Children with Medical Complications (15% of SAM for SC as Inpatient) 406 Deworming: # of Children (24-60 months) ( 10 % of total population)-Campaign activity 19,508 MM Supplementation: # of Children (6-24 months, 5.5 % of total population) 10,729 Pregnant/Lactating Women: Screening: # of Pregnant and lactating women-PLW (8% of target population) 15,607SFP: # of PLW at risk of malnutrition MUAC < 21 cm (17.5% of total PLW i.e. as per NNS <5yrs GAM rates for Sindh) 4,779

Lessons Learned:UNICEF in collaboration with department of health and partner I/NGOs is implementing emergency nutrition interventions in-line with its country programme 2009-12 mandate, focusing on supporting Pakistan in reaching the millennium Development Goals 1, 4 &5 (component 21) which appears to be the most challenging to achieve for the country and advocates for strategies focusing on appropriate IYCF practices, micronutrient initiatives and maternal and child nutrition (component 22d). UNCEF country programme document the need for sectoral cluster leadership in the humanitarian community for nutrition besides other emergency areas as a lesson learnt from 2005 earthquake and 2007 floods, hence emphasizing the importance of nutritional interventions in the emergency context.

The introduction of new nutritional supplements and the delegation of different components of CMAM to respective donors need a more coherent delivery approach to ensure that all four components of CMAM remain functional, effectively. The impact and sustainability of the interventions will remain questionable without scientific analysis and long term cost effective upholding measures that suites the protracted emergency context of Pakistan. The available studies1 still suggests that CMAM is highly cost-effective in the ‘base case’ as defined by the World Health Organization and endorses The partner scale up of CMAM within essential health services. However, gaps exist in the effective implementation of appropriate IYCF practices and local production of nutritional supplements, which can considerably reduce the morbidity and mortality, cost effectively in long term.

Proposed Collaboration

Partner will implement the project under the leadership of Health Department in close Collaboration with EPI, LHW Program, Health and Nutrition working group and district management. UNICEF and WFP will provide all the required technical support and necessary logistics and will bear the operational cost of the activities. Report will be regularly shared with all these stakeholders. The project will be monitored by UNICEF, WHO, WFP, EDO health Office and provincial nutrition cell of the DGHS. Coordination mechanism will be developed/ strengthened with other stake holders working in the district. Considering the cultural norms and influence of Ulema in the society, local Ulema will be actively involved at District and UC level. Involvements of Ulema as active partners will be the key to success for this intervention.

Sustainability of results:This intervention will introduce the culture of improved nutrition behaviours to the population and will help in

1 Oxford Journal-Health policy and planning Dec 2010 (shared by GNC)


http://heapol.oxfordjournals.org/content/early/2011/03/04/heapol.czr017.abstract?keytype=ref&ijkey=yZKpjA3rzdTRVyz

demand creation for health among people living in different areas of the district. A referral mechanism will be established where complicated malnourished cases will be referred to the stabilization centres Local capacity will be built through involvement of local communities in project implementation. Involvement of the Imam Masjid will have long term positive implications on the overall development process of the district.

The approach and intention of the proposed project is to work in conjunction with the district health authorities and in consultation with the provincial and national nutrition working groups/clusters and other stake holders, with an aim to strengthen the service provision and to revitalize the district health system to take ownership of the services in long run in the district.

The project is designed based on the strategies of the national nutrition working group co-chaired by the department of health and focusing on the relief approach, delivering services through health care system at the district level. The project proposal endorses the vision of integrated CMAM+PHC approach at health facility and community level, relying on the DoH staff and community resource persons to sensitize the targeted populations and sustain the preventive aspects of CMAM, in long run with a particular focus on dissemination of key information relevant to appropriate IYCF practices. The project will focus on the service providers and DoH staff) and community to sustain the impact of the CMAM interventions by ensuring: Active engagement of the DoH staff in all stages of planning and implementation, encouraging ownership

of the programme. Equip health facilities with anthropometric equipment and necessary supplies for CMAM intervention. Train remaining DoH staff (1st level & managerial) on integrating CMAM and IYCF in the existing

essential health services. At least DoH staff receives refresher training on CMAM/IYCF protocols for the management of acute malnutrition. (On job/formal, subject to National Program Approval.)

Active involvement of the trained LHWs in the The partner screening campaigns, CMAM activities and IYCF in particular.

Identification, training and involvement of community resource persons for ensuring access to information that influence behaviors positively and create demand for services and access to and utilization of quality promote, preventative and curative services.

Advocacy and lobbying with DoH for integration of CMAM in the primary healthcare. Setup a system of monitoring of CMAM services and supply management. Ensure quality data collection, analysis and interpretation. To utilize NIS as a monitoring tool for analysis

of malnutrition trends and respond accordingly. Work in consultation with Nutrition working groups and DoH for preparedness plans and rapid response

plans as part of the contingency plans to come upon unforeseen future emergencies. Engagement of DoH, UNICEF, WFP and Provincial & National nutrition working groups for developing

milestones and guidelines for CMAM exit strategy including early recovery plans to ensure smooth and adequate phase out approach and developing the local health systems capacities.

Cross Cutting issue:Children: The proposed activities will emphasize on the delivery of mother and child health services. To promote the utilization of services by women and children, The partner will ensure that female qualified staff and other specific quality inputs (medicines, equipment and kits) are present in health facilities.

Gender: All planned activities consider gender equity. The mother-child and women health services are targeted towards the most vulnerable of the present crisis. Based on the Gender marker (prepared by ISAC), The partner will aim to reach/achieve at least 2A marker for its nutrition intervention packages which target women and children (the most vulnerable.)

Environment: Environmental aspects are taken into consideration, especially with regards to the implementation of health services and health facilities where these will be delivered (cleanliness of the place,


availability of running water, access to toilets for male and female, respecting the protocols for dealing with body fluids, disposables, used medical items and tools, as well as medical waste). The partner will be responsible to train all staff on waste management which is strictly monitored on each of the monitoring visits.

Human rights and International Humanitarian Law: As part of its core humanitarian principles, The partner recognizes access to healthcare and humanitarian assistance for every individual as a fundamental right.


V. Results Framework

Specific Objective: To reduce the vulnerability for malnutrition in returnees and other affected population in flood affected area with the support of UNICEF ,WFP, WHO, PPHI, NP and Department of Health (DoH).

Sub objectives:In line with the minimum standards (SPHERE) and UNICEF Core Commitment for Children (CCCs) the sub objectives of the proposed project include the following:

To improve the human resources capacity of the DOH to provide effective services to the people in 34 UCs. To strengthen Nutrition service delivery at the health facility level To provide adequate nutritional care and treatment for children less than five years of age, pregnant and lactating women suffering

from acute malnutrition through CMAM. To prevent malnutrition in early childhood through promotion of improved infant and young child feeding (IYCF), care giving,

and care seeking practices at the facility, family and community level. To prevent micro-nutrient deficiencies in children and women through provision of multiple micronutrient supplementations,

Vitamin A, de-worming and promotion of appropriate feeding practices. To strengthen local technical capacity and provide appropriate resources to integrate CMAM into Primary Health Care services.

To contribute to the cause of Polio Eradication through awareness sessions and support to community outreach services of PEI in referral

Programme Result

Project Outputs Indicator Baseline MoV Frequency of Reports

1. CMAM services are available in 05 selected health facilities for the management

1.1 The partner screening/ Register screening conducted and report shared

a. # of UCs where Nutrition Assessment conducted using Oedema and MUAC criteria.

- Current Baseline GAM: 13.4%

- Reports of Rapid Nutrition Assessment

- Nutrition Information System(NIS)

- Weekly (NIS based)

- Periodic: every 3-4 months as a campaign to assess impact.

[1.2] Fixed/transit /mobile a. # of nutrition - # of sites are currently

- Lists of functional

- Weekly (NIS based)

11

Programme Result


of identified acute malnourished children and PLW

sites nutrition sites remain functional for provision of CMAM interventions in the target health facilities/areas

SFP/OTP/IYCF sites established/maintained & are providing CMAM services and IYCF information

b. # of SFP/OTP sites has the necessary anthropometric equipment’s and tools.

functional CMAM sites.- List of CMAM

sites provided with anthropometric equipment’s.

- Monthly

1.2[1.3] Around #36 health care providers (HCPs) (from each health facility) of the DoH and from Partner receive refresher trainings on CMAM/ IYCF protocols for the management of malnutrition.

a. % of HCPs (DoH) identified, trained & involved in CMAM/IYCF activities against set targets.

- Around 50% of the targeted DoH staff already trained.

- Future trainings will serve as refreshers.

- Records of HCPs trained and involved in CMAM

- Records of The partner staff trained & involved in screening.

- Once on conduct of planned trainings

- End of project activity report

1.3[1.4] Trained & equipped COWs continue community mobilization, The partner screening and identification of acute malnourished children, pregnant women and lactating mothers, and follow-up to ensure enrolment.

a. % of target children & PLWs The partner screened for assessment of malnutrition and referred to feeding/treatment centres

b. # of community mobilization sessions conducted by the NPs & CMs.

- The partner screening already completedChildren= 23,410PLW= 15,607

- The partner screening registers & reports of The partner REN (NIS)

- Registration books of The partner

- Records at health centres

- Weekly- Monthly- End of project

activity report


Programme Result


At least 23,410 children and 15,607 PLW are The partner screened in the community using MUAC tape.

- Monitoring/Field visits reports of UNICEF staff

1.4[1.5] HCPs of the DoH and The partner in their respective centres register at least 4,343 MAM children & 4,779 PLW in SFP and 2,704 SAM children in OTP and ensure treatment of around 406 SAM with complications, as per CMAM protocols, in coordination with the community outreach and concerned centres.

a. % of referred children registered in appropriate feeding programs in the health facilities by the trained HCPs

b. % of SAM children with complications facilitated to be treated in MER

c. % of acute malnourished children (SAM & MAM) recovered (>75%)

d. % of acute malnourished children (SAM and MAM) defaulted from treatment (<15%)

e. Average LOS in the program

- SAM Cure rate> 90%

- MAM Cure rate> 90%

- Default rate< 8%

- ALOS:SAM < 70 daysMAM < 60days

- The partner registers and reports of The partner (NIS)

- Registration books of The partner

- Records at health centres

- Monitoring field visits of UNICEF staff


activity report

2. Healthy nutrition behaviours promoted at the facility

2.1 At least 7,803 mothers/ caretakers are educated on importance of early initiation of breastfeeding, exclusive

a. # of HCPs and outreach workers trained on IYCF

b. # of BF corners established &

- 98% Women of CBA reached in the previous project cycle.

- Same numbers

- List of HCPs/CRPs trained on IYCF

- Registration books of The


activity report


Programme Result


and community level for prevention of malnutrition in early childhood

breastfeeding up to six months of age, appropriate complementary feeding, good nutrition during pregnancy and lactation and improved hygiene practices through Behaviour Change Communication (BCC) approach.

2.2 Around 5 Breast Feeding (BF) corners established and functional.

functional, providing SRA, full assessment &referral services for management of lactation failure.

c. # of community mobilization sessions held

d. # of community members who participated in mobilization sessions

e. # of mothers reached with key messages on IYCF & Health education.

of New PLW & CBAs planned for the proposed project

partner and health facilities

- Weekly and monthly activity reports

- Reports of mobilization and nutrition education sessions


3. Micronutrient deficiencies disorders in children & women prevented/ treated in the target population

3.1 At least 10,729 children and 15,607 mothers are provided with multi-micronutrient (MM) supplements

a. % of target children and PLW provided MM sachets and tablets.

b. # of target mothers educated on use of MM supplements

- . - Registration books of The partner at health facilities

- Weekly and monthly activity reports


- Monthly- End of project

activity report

3.2 Around 19,508 children receive de-worming treatment and vitamin A dose as per national guidelines.

a. # of eligible children de-wormed.

b. # of children provided with vitamin-A dose.

- 90% covered through MCH weeks as part of previous project cycle

- Registration books of The partner at health facilities

- Weekly and

- End of project activity report.


Programme Result


monthly activity reports


4. Sustainability of CMAM interventions ensured by strengthening local technical capacity for integration of CMAM into the Primary Health Care system.

4.1 Develop essential capacity of DoH 36 staff for sustaining the CMAM & IYCF services after The partner exit.

a. # of health facilities capable of continuing OTP & SFP services after The partner exit (equipped)

b. # of DoH Staff actively involved in provision of nutrition interventions.

c. # of DoH r refresher training on CMAM/IYCF before The partner . exit.

d. # of monitoring visits made by DoH representative.

- 50% of DoH staff trained in previous project cycle. (Staff absenteeism or vacant positions contributing to lesser achievement)

- 100% of The partner staff received initial training.

- Refresher & training on newly introduced nutritional supplements planned for next phase.

- Program closure report

- DoH Staff list endorsed by EDOH

- Records of Health Facilities that can implement CMAM interventions

- Records of healthcare providers involved in CMAM interventions

- Data recording and computerization

- Project documentation and reporting

- Periodic according to training Save the.

- Monthly- End of project

activity report.


Revised April 2011

I. Management and Coordination Arrangements:

The partner will be responsible for management of the project, both prior to and during implementation.

Management structure The partner will be responsible for managing the programme. The Nutrition Program Manager (PM) and Senior Nutrition Coordinator (SNC) at Provincial level will be responsible for the overall management of the programme: trainings of the staff on CMAM, coordination with DOH at district level , proper liaison with all key stake holders and establishment of CMAM sites. Logistic Assistant will be responsible to monitor storage and distribution of all commodities according to standard protocols. Data received from field will be compiled on daily basis and report will be shared with UNICEF/WFP/DoH through Nutrition Information System (NIS).

Micro planning on weekly basis will be done by Senior Nutrition Coordinator/Nutrition Coordinator and will be shared with UNICEF and DOH. The partner Nutrition Supervisors/ Officers and PM/Coordinator will supervise field teams. The partner has its internal monitoring and evaluation mechanism and teams and the continuous monitoring and evaluation will be done by these teams of each site on weekly basis and feedback will be shared with the senior management of the SC on the program quality and delivery of services.

The PM/SNC supervises the project implementation, coordinates with UNICEF and DoH for the selection and smooth running of OTPs and SFPs. The SNC holds weekly meeting with the staff of each components of the programme to ensure that the activities are put into effect according to the work plan and the work frame. In addition, the SNC pays regular fields visit to monitor the activities. The PM will review monthly project report and conduct a bimonthly project review. The SNC/PM also supervises the supplies and the NIS data compilation and shares the reports on regular basis. OTP / SFP and Outreach staff will work under Pakistan standard protocols of CMAM. They will be supervised by the OTP supervisor and the NC.

Clusters & Working Groups

The partner has an MOU from the DCOs and EDOs to work all the areas. The health department will also be engaged in monitoring activities. Government and PPHI staff will also be offered training on CMAM and encouraged to take part in on-the-job training at the sites.

The partner will co-ordinate its activities with the Provincial Nutrition Cell, National Program, District Health Department, PPHI,UNICEF,WHO, WFP and Nutrition Cluster. The partner will properly coordinate with UNICEF, WFP, WHO, PPHI and Department of health in order to avoid duplication. The partner will also attend the co-ordination meetings and report and discuss the progress of the activities at these meetings.

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VII. Fund Management Arrangements:

Total period under this contingency arrangement is one month, from the date of activation.UNICEF will periodically reimburse The partner in line with the financial documents/vouchers submitted. The partner will ensure that the funds will only be used in accordance with the project cooperation agreement and the detailed line-item budget included in this project submission. The partner will keep and maintain all project records for financial audit purposeUNICEF reserves the right to exclude any component from the remaining project activities and reduce the budget accordingly to the expenditure made prior to this change. The partner will submit progress and financial reports with original vouchers on timely manner to settle accounts. Any discrepancy on use of resources, implementation of programmes, and strategy will be resolved and agreed by both partners and a common ground will be reached amicably based on initial contract. All changes to the PCA will be communicated in writing by both the parties.

Fund Management Arrangements:

The partner will ensure that the funds are spent only for the intended purpose (subject to receive the funds from UNICEF if agreed). It will make efforts to ensure that funds transferred to it under the project are spent in transparent and efficient way ensuring the complete audit trail of the accounting transaction. SC will also ensure proper financial management at field offices. All the financial policies and procedures of head office will be applicable on field office and proper segregation of duties will be ensured.

Tranches ManagementThe tranches are calculated on the basis of three monthly / quarterly activities. For contingency PCA of Six months two budgets with two tranches (for Two months and One month) each are calculated respectively. The financial risk rating of SC is medium risk and an NFR will be made for advance payment .

Funds will be disbursed as per instalments calculated in the attached budget.

SC will request (if required) for advance and report of expenditure using the Funds Authorisation & Certificate of Expenditure (FACE) Form. Subsequent advance will not be given unless the expenditure against the previous advances is reported.

RECORD KEEPING

1. SC shall keep separate record for funds provided by UNICEF if any. Records will be accurate, complete, and up to date in respect of funds received and expenditures incurred for the project, and shows that all disbursement is made in conformity with the project plan and budget. Original bills, invoices, receipts and any other pertinent supporting documentation will be maintained with the vouchers.

2. SC will maintain accurate record of supplies and equipment purchased for the project. Monthly inventories count will be made and updated. SC will ensure proper records for distributions of supplies.

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3. UNICEF staff, including internal auditors and operation officers, and its agents for the United Nations Board of Auditors may review and/or copy the records of SC relating to the project, upon mutual agreement on date and time.

4. SC will make all the payments of salaries through bank transfers directly in the name of employee. No salaries expense in cash or through cheque will be entertained.

5. No payment of more than Rs 15,000/- will be made through cash. In instances where expenses are of recurring nature like training food and supplies, vehicle fuel etc the SC will source supplies on bulk basis and all the payments will be made through crossed cheques. Cumulatively in any one month not more than Rs 200,000/- shall be paid out in cash.

6. Partner will discourage the modality of “Payment break” to remain under delegation limit. Any instances for payment breaks found during the spot checks or audits will be dis-allowed.

7. Manual crossing of cheque will not be accepted only the cheques stamped as A/C Payee by the bank will be eligible for liquidation.

8. TA/DA of more than Rs 3,000 will be paid through cheques.9. SC can vary the expenditure in any line item by 20% provided that the total base line of the

budget is not changed. Refer to clause 27 in the legal document.10. Project funds will not be transferred into personal bank account of employees of the IP for

field level disbursements. In exceptional circumstances, if the funds are transferred to the employee’s personal bank accounts (Operational advance) their personal bank accounts will be under review of UNICEF’s authorities.

Competitive bidding process ( with exact specifications or appropriate terms of reference agreed with UNICEF) must take place for all purchases of goods and services above Rs 25,000/-. At-least three quotations are required. The competitive selection process should be clearly documented.

VIII. Monitoring, Evaluation and Reporting

The partner professional team of Monitoring & Evaluation would be regularly observing the area of intervention and report the progress of the project as per following The partner schedule:

Inputs for Strip as and when required Inputs to 3W matrix Monthly Progress Report Project Completion Report

The reports would be prepared to monitor and evaluate the project using measurable indicators stated in the project proposal and the log frame as benchmarks and would be shared with all the stakeholders and the nutrition cluster.

The methodology of M&E would ensure all those mechanisms involving inspection during and after the completion of project activities. Specific Monitoring formats would be used to regularly assess the progress of the each and every proposed project activity separately e-g M&E format (Weekly M&E Formats would indicate all the locations and quality of work separately for each health facility established in the district and for each activity). The formats will comprise of the tables to collect data on weekly intervals and comparison with the results of baseline surveys. Quality of the work would be


ensured so as to meet all the SPHERE standards in all the propose project activities.

In addition to the monitoring and evaluation system developed by The partner for this project, following the new PCA arrangements, UNICEF’s field office will also conduct regular monitoring visits to ensure that the project implements the activities according to the agreement, within timeframe and budget. The concerned UNICEF staff members will carry out spot-checks to verify the progress reported by The partner. UNICEF staff members will also assess the financial management of The partner including records of expediters, and details of vouchers and invoices. The FACE form will be verified (or otherwise) based on findings of the monitoring visits. The evaluation, if planned in the PCA, will be conducted in accordance with the UNICEF evaluation guidelines. The relevant government authorities, third party/independent field monitors and concerned donors agencies can also conduct monitoring visit and assess the progress of the project against the planned activities and results.

UNICEF and The partner will conduct programmatic monitoring and where possible use approaches that involve community and enable women and children to benefit from the process. Since The partner has demonstrated low risk in financial micro assessment, therefore UNICEF will carry out one spot checks and 10% programmatic monitoring (expressed as monitoring of activities costing the indicated % of the annual amount transferred to The partner, and should include monitoring of at least one activity in each Key result Area.

The partner will also ensure existence of a proper monitoring and evaluation system which guarantees the completion of activities as planned and achievement of results verified by objectively verifiable indicators and authentic sources of information mentioned in the result framework of the PCA.

Results for children are the basis for programme performance assessment. UNICEF programme is part of Government of Pakistan’s overall strategy. The partner is accountable to UNICEF for producing the results agreed in the PCA. The quarterly report shall reflect the progress with regard to achievement of results verified by the agreed indicators in PCA. For improved project management, The partner will ensure the following:

Issues arising from the interventions should as much as possible be documented using more than one medium (photos, record testimonies etc.)

Use data to reflect evidences and as basis for analysis and reporting Report on use and effect of supplies. The partner must keep an inventory of supply purchased

with funds from UNICEF. The FACE form is used for reporting on expenditures and a financial progress should also be

submitted annually Show accounts received and expenditures incurred Ensure compliance with PCA rules about financial management, reporting and procurement

Retain all original bills, invoices, receipts & any other relevant document for at least five Reporting

SC will report to UNICEF on weekly, monthly basis on the results achieved and implementation of the activities against the work-plan. UNICEF’s responsible program officer will give feedback to SC on monthly reports within one week of its receipt. UNICEF’s responsible program officer will ensure that activities of the project are on track according to the work-plan.

Within 3 weeks of the signing of the PCA SC will report to UNICEF about the Resource Mobilization


Report on the standard format provided by UNICEF. This report will give the deployment status of human resources and other infra structural resources mentioned in the PCA.

With every FACE Form a standard programmatic progress report will be submitted to UNICEF.

SC will produce Reports of all the activities undertaken in the PCA. These activity reports will be for SC record purposes and will be provided to UNICEF upon request.

A final report will be shared with UNICEF with 3 months of the close of the PCA as mentioned in the legal clause xx of the PCA legal format,

SC Performance Evaluation

At the end of the PCA the responsible program officer in UNICEF will prepare a project close out report and also asses the performance of SC in term of over-all program implementation. The said report will be endorsed by the respective section chief. This report will be referred in case of future partnership with The partner

Assurance Activities

The level of assurance is dependent on the financial risk rating of the SC. According to the HACT Assurance Framework the following activities will be carried out at minimum:

- Financial Spot Checks ( Mention frequency according to financial risk rating)- Monitoring( Mention frequency according to financial risk rating) (expressed as monitoring of

activities costing the indicated % of the annual amount transferred to the SC (if any), and should include monitoring of at least one activity in each Key result Area- refer to assurance plan).

Scheduled Audits( Mention frequency according to financial risk rating) Third party monitoring, including APEX will be part of the overall monitoring of the project. SC will be required to provide all information & support as required by Third Party field Monitors to undertake monitoring of UNICEF supported DoH nutrition interventions.

Results and experience sharing The partner will coordinate with the district and provincial health authorities, UNICEF team, and other relevant stakeholders to ensure that lessons learned and risk-mitigation steps taken by SC are disseminated, so that all stakeholders may benefit from the experiences of The partner and vice versa.

Revised April 2011

IX. Work-Plan and Budget (2 or more pages)

Work plan is attached

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