Nearly two months after a 7.2 magnitude earthquake rocked southwestern Haiti on 14 August 2021, humanitarian and early recovery needs remained immediate and pressing, particularly in the severely impacted departments of South, Nippes and Grand’Anse. Figures showed that about 40 per cent of the population in the three departments (at least 800,000 people, including 340,000 children) were affected by the earthquake, which left more than 2,246 dead and more than 12,763 people injured.
The earthquake has worsened the already difficult humanitarian situation in the country with 4.4 million people in need of humanitarian assistance (HRP 2021), including 2.2 million children, a deepening socio-political crisis and escalating gang violence causing more than 19,000 internally displaced people (IDPs) as well as raising insecurity and the incidence of kidnapping.
Request for IM support
The GNC received an urgent request for in-country information management (IM) support by UNICEF Haiti country office on 31 August, 2021 for a six-week deployment. The main priority for the Technical Support Team’s Magnat Kavuna was to provide technical assistance for Nutrition Coordination in strengthening the overall emergency nutrition response with a focus on improving Nutrition Information Management. The request was to work collaboratively with other members of the Cluster/ Sector/ Working Group to contribute to the planning and implementation of needs assessment and analysis, and to enable information flow between cluster members through data analysis, particularly in the identification of geographic and programmatic gaps.
“Since my last deployment in Haiti five years ago [in support to the Hurricane Matthew response with the Child Protection Area of Responsibility led by UNICEF], there had been some improvements in systems for collecting information, though these were not being well capitalized – but at least the system was in place.” Nutrition data is collected using the “Systeme d'Information Sanitaire Unique (SISNU)” platform, and was adapted to Nutrition Cluster requirements using the agreed 4W (WHO does WHAT WHERE and WHEN) template by the Haitian Civil Protection General Directorate (DGPC) for operational presence analysis. Part of the IM assignment included building national capacity for extracting data from SISNU via the creation of step-by-step guidance and training to ensure a transfer of knowledge.
SISNU provides detailed information on different indicators, including screening and admissions for Severe Acute Malnutrition (SAM). However, information on Infant and Young Child Feeding (IYCF) is currently missing from the system. This is of particular concern in Haiti since feeding practices for infants and young children had been highlighted as sub-optimal and impacting nutritional status even prior to the earthquake. According to the Haiti Demographic Health Survey (DHS) 2016-17, only two out of five infants under six months of age (40 per cent) are exclusively breastfed and at four to five months, this percentage is much lower (15 per cent). In addition, 25 per cent of children are bottle-fed. Among children aged 6 to 23 months, only 11 per cent received a minimum acceptable dietary intake in terms of diversity and frequency of feeding.
Building IYCF-E capacity
Given this situation, the Nutrition Cluster Coordinator submitted a request to the GNC Technical Alliance for in-depth support to develop the Infant and Young Child Feeding in Emergencies (IYCF-E) response. The Technical Support Team (TST) identified Claude Sabwa (from Save the Children, TST IYCF-E lead) who was able to start work quickly. Whilst travel-related obstacles did not allow for his immediate deployment, Claude was able to provide critical support remotely, before spending two weeks in-country (in mid-September, 2021).
The first task included developing and implementing a capacity assessment of actors in Haiti as well as for the response as a whole. This meant determining the IYCF-E capacity of implementation partners, and understanding what policies and procedures were already in place, or perhaps not in place, but had been developed previously (for example, during the Hurricane Matthew response in 2016 and 2010’s earthquake). Based on these findings, an IYCF-E Technical Working Group (TWG) was established and an action plan developed.
When in-country, Claude supported partners to establish the TWG, and strengthen their capacity in IYCF-E. This entailed developing the TWG terms of reference and delivering a three-day orientation for 18 participants. The orientation targeted TWG members, comprising mainly staff from the Ministry of Public Health and Population (MSPP) and other UN and NGO nutrition partners. The session equipped participants with the basic and technical knowledge necessary to protect, promote and support the appropriate and adequate feeding of infants and young children in emergency situations and to prepare participants for a continued response following the TST support.
Other achievements included updating the national IYCF-E operational guidelines, the publication of a Joint Statement on the appropriate use of breast milk substitutes (BMS), and developing both a BMS donations management system and a three-day IYCF-E training for frontline staff.
Key achievements for the IM deployment were developing IM tools and setting up the interactive dashboard. Magnat also supported the HNO/HRP 2022 exercise with calculations for the Population in Need (PiN) and severity using the Nutrition Humanitarian Needs Analysis and with guidance from the GNC Nutrition Information Systems (NIS) and Nutrition in Emergencies’ (NiE) colleagues.
Benefits of in-country support and lessons learned
Both TST deployments were in-country but there were challenges with travel due to COVID-19 restrictions and the current security situation around the national capital, Port-au-Prince.
“It was my first in-person deployment since the start of the pandemic,” said Magnat. “Although some of the meetings were still held online when I was in Haiti, it was really helpful to discuss issues face-to-face with OCHA colleagues. I was also able to visit one of the mobile health clinics, where I met with Government colleagues and explained the process of data collection in the field.”
Lessons learned included the need to further engage with the “Unite de Coordination du Programme National d'Alimentation et de Nutrition (UCPNANu)” led by Dr Marhone, the Nutrition Cluster lead housed within the Ministry of Public Health and Population, to add the new IYCF indicator during the next update of the platform. This will also strengthen the existing mechanism and avoid creating parallel reporting systems.
Both TST deployments provided vital support at the start of the response. Magnat helped in establishing the IM system and contributed to strengthening the nutrition response with the development of IM tools and the interactive dashboard. Claude helped set up a comprehensive and sustainable IYCF-E response that could be delivered by partners following his deployment. Both have also provided ongoing support to the Haiti cluster coordination team. Whilst capacity and systems have been strengthened by GNC support, capacity is still low in the country therefore further IYCF-E and cluster monitoring and evaluation is required to ensure an optimal response.
Photo credit: UNICEF/Juan Haro/2021