Coordination mechanism: Sector
Year of activation: 2008
NCC: UNICEF P4,FT
IMO:UNICEF NoB TA
UNICEF lead, FMOH co-lead 8 sub-national coordination hubs
January to June 2021
Despite humanitarian interventions, malnutrition in Sudan remains at an alarming rate with estimates of three million children suffering from acute malnutrition of which 570,000 are diagnosed with severe acute malnutrition (SAM). Moreover, approximately 883,000 pregnant and lactating women (PLW) are described to suffer from acute malnutrition annually. 15 out of the 18 states reported extremely high global acute malnutrition (GAM) rates in 2020 including high levels of malnutrition in nearly 95 localities.
Drivers of malnutrition can be characterized as; (i) economical, such as income poverty and high food prices which contribute to inadequate food intake and dietary diversity at household level; (ii) displacement due to conflict or flood contributing to destruction of food commodities and disease outbreaks; (iii) COVID-19 pandemic leading to disruption in health and nutrition services; and (iv) prevailing inappropriate feeding practices due to cultural norms and illiteracy. These have contributed to affect essential early childhood development and growth among vulnerable children.
Most vulnerable communities live in areas ranked as severity four and five in terms of malnutrition – sensitive indicators for food security, clean drinking water and low social protection coverage. According to the latest IPC report, around 7.1 million people are severely food insecure. Furthermore, micronutrient deficiencies are prevalent with only 7.6 percent of households use iodized salt (S3M II Survey). Scaling up maternal nutrition services remains a concern with approximately 647,623 PLW in of need moderate acute malnutrition (MAM) management services to attain adequate diet. One million mothers need appropriate infant and young child nutrition (IYCN) counselling services
Standard Expanded Nutrition Survey (SENS) conducted among refugees in White Nile, East Darfur, South and West Kordofan indicate ‘critical’ rates of GAM (>15 percent) and SAM (>3 percent) among children between six to 59 months of age. The survey also indicates high rates of anemia (>40 percent) among children and women (aged 15-49 years), as well as low Vitamin A supplementation coverage for refugees in all above mentioned refugee-hosting states.
Only 40 percent of the 3.2 million acutely malnourished children under five were targeted for 2020, due to limited resources and capacity among humanitarian actors. Globally, 45 percent of all child deaths are associated with undernutrition. In the context of Sudan, this infers approximately 40,000 child deaths annually. Thus, scaling up nutrition response to address the significant gap is essential to mitigate the susceptibility to morbidity and mortality.
Persistent high levels of household food insecurity and deteriorating macroeconomic situation in Sudan are exacerbating nutrition insecurity for all Sudanese, particularly for the most vulnerable families and children. Sudan’s food and nutritional security are eroding, deepening the crisis already affecting 14 percent of the population. An estimated 3.6 million children are suffering from wasting annually. Based on available data (S3M II 2018), 36.6 percent of children under five are stunted. The national prevalence rate of Global Acute Malnutrition (GAM) has been recorded at 14.1 percent; however, several states are above the emergency threshold of 15 percent according to the WHO criteria.
Over 1,600 Outpatient Therapeutic Programmes (OTPs) and 1000 Targeted Supplementary Feeding Programmes (TSFPs) aim to reach 330,000 children suffering from Severe Acute Malnutrition (SAM) and 1.1 million Moderate Acute Malnutrition (MAM) respectively. A nationwide inpatient admission target for SAM with medical complications will be 50,000 children through 144 Stabilization Centers (SCs) in 2021. Micronutrient supplementation will target 430,000 children (aged 6-23 months) who have nutritional deficiencies and about 7.5 million children with vitamin A supplements.
Despite scaling up of nutrition services, over 574,000 children require treatment for SAM, 85,631 require treatment for SAM with medical complications and an additional 2.2 million children need MAM treatment. Over the years, provision of nutrition services was prioritized to conflict-affected states. However, 52 percent of Sudan’s acutely malnourished children are living in nine non-conflict affected states. Therefore, response needs to be scaled-up in these areas as well.
The 2021 Nutrition Sector Strategic Objectives:
Strategic Objective 1: Sector partners will provide timely, multi-sectoral, life-saving assistance to crises affected people to reduce morbidity and mortality. Partners will aim to support 500,000 people with basic survival and immediate assistance.
Strategic Objective 2: Sector partners will focus on building communities’ resilience to recurrent shocks and improving vulnerable people’s access to basic services. Efforts to bridge the humanitarian and development gap with durable integrating and rebuilding solutions to address chronic malnutrition (stunting). Existing inter-ministerial platform and cross sectoral coordination will ensure social protection integration with nutrition programming.
Strategic Objective 3: Multi-sectoral approach to cross-cutting issues and linkage with protection services. Sector partners will adopt community-based livelihoods interventions targeting lowering malnutrition levels and alleviating protection risks.
Response Strategies and Modalities:
The sector will focus on addressing underlying causes of malnutrition through multi-sectoral approaches comprising health, nutrition, WASH, food security, education and protection to achieve optimal SPHERE standards for nutrition. A centered approach, with vulnerable host residents, IDPs, and returnees at its core, the Nutrition sector will ensure equitable access to essential assistance target the highest severity of needs. The sector aims to scale up nutrition services in rural and urban setting of at least 50 percent and 70 percent respectively with emphasis on eastern states. Interventions contributing to the prevention of malnutrition will include blanket supplementary feeding for approximately 85,323 people including children (boys and girls) and PLW and the promotion of infant feeding for approximately one million PLW including those in emergency settings. Sector partners will conduct SMART surveys to strengthen monitoring.
Adoption of participatory people-centered approach improves understanding of affected population key issues, along with feedback mechanisms will promote prompt and focused responses. Investing in capacity building of local partners on key components of nutrition response, assessment and analysis raises the awareness of specific nutrition requirements of different segments of community.
Attention will be paid to gender, protection, disability main-streaming and environmental risks. Liaising with protection sector for GBV and child protection services including screening Nutrition services users for protection issues and appropriate referral appropriate. Women, children, elderly and people with disabilities will be assured equitable access to services. Sector to support environmental standards for appropriate waste management and disposal methods to prevent water contamination and reduce vector borne disease.
Deteriorating macroeconomic situation has affected the operations of humanitarian interventions corresponding to a sizeable increase of project costs attributed to hyperinflation and extreme devaluation of local currency. Increasing food prices, disruption of markets and livelihood activities negatively impact household purchasing capacity.
IPC Phase 3 (and above) outcomes are expected among poor households, particularly IDPs, conflict-affected households, and pastoral and agropastoral households in South Kordofan, Darfur, Blue Nile, Kassala, Red Sea, and North Kordofan states. WFP estimates an additional 1.1 million people are food insecure this year. The continued influx of Ethiopian and South Sudanese refugees further stretches the resources.
Despite efforts made to scale up nutrition services, a gap remains between the coverage of CMAM services and actual needs. An estimated 3.6 million children are suffering from wasting annually, nutrition sector partners collectively were able to reach only 11% of the target in which MAM prevention and treatment services need an immediate attention. Sudan received only 8.1% funding against the Humanitarian Response Plan.