Phuong Tran trip notes Niger July 18-27

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					Phuong Tran trip notes Niger July 18-27, 2009
Burkina 27 July- 3 August

Niger Agency/NGO briefings

      WFP Deputy Director Gianluca Ferrera; Nutritionist Rachel Fuli; Communications officer Aline
       Sanu


      UNICEF Deputy Director Dr. Guido Borghese; Nutrition manager Eric-Alain ATEGBO


      FAO Representative Mustafa Cassama; Assistant coordinator of Emergency Unit and Agricultural
       Rehab Norou Macki TALL


      CARE International communications head Ibrahim NIANDOU; Diffa program coordinator Ali Sale
       and outgoing director Bill Stringfellow. Met with technicians and Ali Salé in Diffa for program
       activities. Used to do household vulnerability studies (last one in 2004).

           1. Funds an early warning system in 50 communities (doesn’t seem to be effective. Not get
              many alerts and couldn’t name any that had been acted on in recent years). Train farmers to
              identify illnesses and report them. Amateur vet trainings.

           2. Cereal banks for animals

           3. Has emergency fund for animal health (30 million CFA for Diffa- need to get details on how
              many withdrawals, conditions, beneficiaries, criteria). Mirrors one that exists at regional level,
              which may not be operational. Need to follow up with Diffa Ag regional director.

           4. literacy training for farmers after growing season in about 25 centres. Each centre has about
              20-25 farmers. Need to be literate to participate in early warning system, management, etc.

            Questions: How much spent on early warning training nationwide? In how many communities?
           Get background on cash transfer program and follow up interview with Niamey CARE cash
           transfer expert.

      MSF Swiss Gerard Bedock and MSF Belgium Stephane Heyman. MSF Belgium works in Maradi on
       moderate malnutrition. Because Zinder has more serious malnutrition, MSF Swiss concentrates solely
       on severe malnutrition.

      WHO, Dr. Ambrosio Disadidi. WHO nutritionist is seen as very government friendly and not
       critical/open, all talk and doesn’t participate in group nutrition events (according to MSF). But the
       briefing Aichatou Diawara prepared for me called malnutrition “alarming”- not a lot of apparent
       cover up.

                                               National issues

Malnutrition: Severe acute malnutrition has more than doubled in last year from 0.8 to 2.1%, Diffa has
overtaken Zinder as region with highest level of acute global undernutrition, and overall chronic malnutrition
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has increase six percentage points to more than 46%. In 2008, there were 600,000 tons of surplus cereals
harvested nationwide, but 1427 villages still didn’t produce enough cereal to cover estimated year’s worth of
needs. Delayed and insufficient rainfall previews a bad harvest, which may increase malnutrition/food
insecurity if rain season ends same time it did last year.

Government taking over care of malnourished children: For at least 2 years, government has laid out
plan to integrate care of malnourished children into health centers and cases of severely malnourished
children into their hospitals. Croix Rouge Francais started 2 years ago, Save the Children UK started April
2009, and MSF Swiss in June 2009. Government met with partners working in malnutrition recently and laid
out plan of how it would increase agents in health centers and hospitals to accommodate the increase in
patients, but widespread concern that it won’t find the money to fund human resources, therapeutic
feedings/treatments. Government’s assistant director of nutrition, Aboubacar Mahamadou, said he is
concerned government does not invest enough in health. Gave very very open, frighteningly honest interview
levying criticism at both donors who have not done enough to build government capacity and the
government, which has not done its part to help donors help it.


                          Diffa site visit, 1400km east Niamey, Far eastern region

HIV/AIDS: 2002 national health survey did not even include Diffa, which was included for first time in
2006 (need to check). Official HIV infection rate per national 2006 survey for region is 1.7%, but NGOs,
regional health HIV focal points, HIV patient association and local officials in border area near triangle at
Lake Chad basin area said this number is gross underestimate.

Follow up with Kateri Clement (former CARE director, now US MCC director in Burkina Faso) who wanted
to put me in touch with former CARE HIV expert on nomads. Would be interesting angle on HIV testing in
nomadic communities. She also suggested military base as a reason for high HIV infection (but there are
other military posts where the HIV rate is not as high.) May be contributing factor that aggravates situation.
Need to look into.

Meetings:

   1. Sex worker microcredit group in Bosso commune, Blatoungour village 10km from Bosso. Mostly sex
      workers as well as infected women who are not TS.
   2. Dr. Kiari Fougou L Aïssa, PTME focal point for district health centre in Diffa
   3. Dr. Youssey Nana, trained NGOs for hospital for World Bank 2005-08 HIV grant. She attended
      group meeting with 3 NGOs that participated in grant.
   4. Tawafi (Hausa for discretion, security, protection) HIV patient association of 40 members. Met with
      president Mohamane Issa.
   5. Health centre director Boukar Ousmane Moktar, Centre de Santé Integré in Bosso (border town)
   6. Bosso adjunct chef de post, Abou

             Hospital patients who agreed to testing- pregnant women in Diffa and general patients in
              Bosso health centre- had 3% and 43% rate of infection, respectively. 90% of X tuberculosis
              patients were HIV+ (clarify if this is included in the 169 tested, and how many tb patients)
              About one-third of pregnant women who got pre-counseling through PTME agreed to testing.
              Cultural taboos, fear of stigma, inability to get husbands’ approval account for low testing rate
              (Aïssa)



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            Border region has high migration and a suspected but unconfirmed high rate of HIV infection,
             lots of sex workers, little apparent targeted outreach to sex workers, and resulting low
             knowledge/use of condoms.

            Early/forced marriage in this area leads to divorce, which leaves women cash strapped and
             vulnerable to apparent high demand for sex work. Clients pay up to 15,000 CFAs per sex
             transaction (sex worker group in Bosso).

            As part of World Bank grant, sex workers carried out “HIV education/awareness” activities,
             but none of the former/possibly still active sex workers in the meeting I attended said they had
             been tested. The NGO that created the micro-loan circle with women said that if the grant was
             renewed, the NGO would add criteria that women be tested. Said that in the first round, their
             goal was to get women to abandon sex work. Though women claim to have left sex work
             once they received credit, this cannot be confirmed.

            Region 46km north of Bosso near lake, Gadira and Karamga, is even more affected by spread
             of HIV (chef de poste adjudant)


Animal health: problem of fake meds, untrained /faux vaccinators and counterfeit animal meds on street
market partly responsible for increase in animal deaths. Eleveurs don’t call livestock agent because they do
not have the money to pay for agent to come diagnose/administer vaccine (govt does not provide money for
gas for its agents). Regional livestock ministry can’t quantify animal deaths, but said malnutrition accounts
for most deaths rather than disease. Main diseases are pasteurellose and pirpoplasmose. Follow up with
Organization of Animal Health in Paris for link between unregulated meds and disease- is there resistance?

Animals malnourished because of shrinking pastoral lands, water access problems. Look into FAO animal
feed donations to this area and planned distributions. Animal cereal banks? Issue closely tied to region’s high
malnutrition because of pastoralists’ dependence on animals for subsistence.

Under development= chronic, constant nutrition crisis. Diffa’s percentage of malnutrition surpasses
Zinder in UNICEF’s latest under-five child survey to become the region with highest percentage of chronic
malnutrition (17.4% in 2009 vs 12.6% in 2008 and 19.4% in 2007).

Secretary General Adjoint of Diffa, also president of committee for nutrition crisis management- a
roundtable of actors who meet periodically to coordinate activities- as well as the national government’s
regional rep for the Cellule Crise Alimentaire- said malnutrition is multifaceted problem which has not
elicited a similar response.

Why nutrition is recurrent, deepening and stubborn in face of donor intervention in Diffa:

      Extreme poverty and strong population growth (4.7%, higher than national average)- SGA
      Shrinking cultivable land, shortened growing season, monoculture (SADEL, SGA)
      Water access (donor programs not sustainable, i.e. motorized water pumps that break down (SADEL,
       SGA)
      Lack of coordination between various ag interventions, which confuses beneficiaries (SADEL)
      Donors too ambitious and don’t concentrate on communities, lose gas, time, money spreading project
       thin (SADEL)
      Ag taboos i.e. if plant onions, no rain. Need to change producers’ mentality (SADEL)
      Cuvette/ water sources threatened by advancing sand (SGA)
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        Animal diseases/deaths root cause of human malnutrition because of people’s dependence on their
         animals for subsistence (Diffa regional Ministry of Livestock, village livestock agent in Kindjandi)
        Theory that malnutrition spikes every 5 years in Niger

Future reporting

        North of Diffa in N’guimi, animal health is even more dire according to WFP Zinder, which recently
         returned from mission there. Get debriefing from Djim, WFP Zinder bureau chief who did quick eval.

         Diffa has largest population growth in country - population pressure exerted on an area also under
         environmental pressures. Follow up UNFPA to see how much is due to lack of family planning and
         how much to in migration

        High drop out rate in Diffa, kids go to school and drop out when they go hungry. Need for school
         canteens? Follow up WFP Zinder/Djim and Niamey about WFP opening up office in Diffa.

        Zinder cheaper water pumps financed by UNICEF. Follow up Sandra/Seydou.

        Sex workers in Diffa

        Security/trafficking in east

        Nomads and HIV

Journalist meetings:

Boureima BALIMA, current stringer, Niamey He confirmed interest in reporting on social topics and
pitched following, which we discussed and two of which I commissioned.

   1. HIV story on women kicked out of marriages because of HIV status and their refusal to pursue court
      proceedings to reclaim property (reporting)
   2. analysis of impact if donors curtail funding as result of referendum (filed 3 August)
   3. talibes and changing marabout behaviours (he needs interview with talibes)
   4. to be commissioned: Water access problems in peri-urban areas because of mismanagement, lack of
      connection points and price gouging by middlemen

Ousseini ISSA, potential stringer, Niamey

Journalist at private weekly Le Republicaine and stringer for IPS. Knowledgeable, has interest in social
issues and activism journalism. But he is also overworked, covering for director when he is jailed. He also
strings a lot for IPS. Ousse22fr@yahoo.fr, +227 93 93 89 98

Gossip

    Cash transfers may be good idea because of the high logistical cost of food delivery which
     quadruples cost. MONUC costs $1 million a day. Better if agencies, especially HCR, shut down and
     gave in cash to refugees what they spent on logistics/operations. With a $1000/refugee, the refugees
     could set up businesses and shed refugee status, but then aid workers would be without work.


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 Niger government nutrition people don’t want to ask for aid, but yet depend on it. Don’t know why
  donors trip over themselves to be the first to give money to government reticent to admit problems.
  Government people won’t attend regional coordination meetings if they aren’t paid per diem, paradox
  of not asking, but yet depending on aid.

 Niger government masks nutrition numbers and damned be the one who uses his own statistics rather
  than official ones

 Despite all the money invested through the years, tactics to fight malnutrition are not working.
  Indicators are near 2007 levels again, chronic malnutrition, after dropping in 2008 (46.3%). Need to
  rethink strategy. Donors pour money into sensibilization campaigns with their eyes closed and don’t
  ask if it’s working or not.

 MSF France and ACF grossly and unethically exaggerated their numbers for fundraising purposes.
  Had they not, other NGOs would have stood up for them, but that was not the case. MSF France was
  acting as if it was still 2005 when the government was blindly denying the blatant food crisis, but
  there are now structures, surveillance, and committees in place to address malnutrition. Government
  also at fault, but NGOs were guilty.


                                          Reports for Niger

1. Q&A: why is malnutrition constant? Responses from Kader Bayard- don’t address root causes of ag
   development; SGA Diffa and multifaceted nature of malnutrition; Ministry of Elevage Diffa- animal
   malnutrition overlooked; MSF and breastfeeding; HKI and lack of holistic development; SADEL and
   lack of ag integration; government’s nutrition asst director- emergency programs have led to little
   capacity building or long-term development; get ECHO/OFDA perspective

2. sex workers go untested in border area: lack of resources to carry out testing, education

3. animal health in east: ¼ dying (black market drugs, malnutrition, shrinking pastoral lands)

4. challenges to fighting malnutrition in east (SGA interview)

5. why early warning doesn’t always work (fatalism, lack of SAP in villages, CARE’s interventions,
   village health worker as example of how it can work at most elemental level)

6. integration of malnutrition care into government health services (interview with CSI director in
   Djoum, government’s nutrition asst dir, MSF)

7. when malnutrition hides infectious disease

8. 24-hours in CRENI: profile of intensive care for malnourished children. Clear any MSF comments.

9. how breastmilk saves lives (list village beliefs, maternal malnutrition at CRENI and mother’s
   inability to breastfeed, lack of time to breastfeed because of ag work, medical expert interview, MoH
   focal point)

10. literacy and farmers in Magaria


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   11. search for perfect seed (improved seeds, cultivation and distribution, science article)

   12. Mini dripping their way to new harvest (CRAC, ECHO Jan, Action Aid, get stringer to get quotes
       from school/individuals mini dripping)

   13. case study cash transfer Azga in Tahoua

   14. shortage of zinc? (HKI site visit with CSI medical chief)

   15. Donor drought in Diffa- analysis of donor presence there. Why so few when needs so great?

filed from field: WFP blanket feeding; flood Moa; CDC Ouaga

Notes: Technicians, field staff open (except for MSF jittery beginning, but we got over that) to discussing
malnutrition. May be couched in terms of food insecurity, but people are open. I spoke to a government
nutrition manager, Mahamadou, who prefaced the meeting with “I will be completely honest with you even
though you are a journalist and not hold back.” Not clear his intentions, but the result was a peek into Niger’s
political take on malnutrition (not admit to it out of pride, but actively work to cut it- quietly; political will
not backed with commensurate investments)

I asked some folks a seemingly banal question- why is malnutrition still a problem- and will turn their
responses into a collective Q&A of what has and has not worked, and what has been neglected (animals and
agriculture)

In both countries, I decided to only report on nutrition/food security, partly because of ECHO support, partly
because of our lack of reporting on it and need to build contacts/expertise in that domain. Given the
sensibilities surrounding malnutrition, it took a bit of extra preparation, luck and stamina to get interviews.




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Burkina Faso notes 27 July to 3 August

Agency/NGO meetings

      WFP- Annalissa Conté, Representative and Olga Keïta, Deputy; got update on food voucher
       evaluation. Need to follow up to learn more about the issue Save raised how WFP does not follow
       govt protocol on pre-mixing enriched flour, which Save says is ineffective in fighting malnutrition
       since women don’t know how to mix ingredients.

      UNICEF- met with Biram Ndiaye, head of nutrition program who has been in place since Feb 2008.
       Helpful, knowledgeable, despite the mise-en-garde he had been put under to be wary. Sylvana,
       deputy director, told me that on the morning of my arrival, there was concern expressed on team (I
       think by the head of communications, Jean-Jacques, that IRIN has rogue reporters. UNICEF felt
       burned by report 2 years ago that had repercussions extending to UNICEF New York. I later learned
       from government’s director of nutrition that some people lost their jobs over that article also?
       Stringer Brahima gave me some background. I followed up with an email cc-ing UNICEF Dakar
       addressing this past “crime” and indicating we should all move forward. UNICEF funds plumpy nuts,
       just bought 20 vehicles for the govt to do surveillance, is supporting an interesting breastfeeding
       study, works in all districts of country.

      ECHO- Program assistant Henriette gave me ENIAM study, which is the most recent nutrition study-
       but it has not been verified by govt. Not sure delay. Ask government’s Sylvestre.

      Red Cross Belgium- took me on site visit to Ouahigiyah, 185km northwest of Ouagadougou for
       CREN (Nutrition Education and Recuperation Centre) visit, distribution/weigh in Tanlili village,
       50km from Ouagiyah

      Save the Children Canada- visited community interventions they support in Kaya, 100km northeast in
       Zincko village (18km from Kara). Met with village nutrition health worker in Zincko and
       interviewed head of nutrition, Jean Natembenga.

      Ouagadougou university researchers working on UNICEF-funded breastfeeding study. Team of 20
       researchers- mostly sociologists and some nutritionists- headed by Marcel Daba Bengaly, who
       interviewed about 1000 people (current and expectant mothers, “opinion” leaders, fathers,
       grandmothers/elders, birthing attendants) about their views on breastfeeding to learn why Burkina’s
       exclusive breastfeeding rate is so low, about 6% according to government study.

      Government’s director of nutrition, Sylvestre Tapsoba. Straight talking, say-it-like-it-is guy. As
       soon as I started giving my speech about IRIN, he stopped me and said that he did not want to meet
       with me and would not agreed had it not been for the communications director insisting repeatedly
       that he do so. He said in his shop IRIN had an awful reputation following the 2007 incident in which
       I understand some people lost their jobs? (a needed shake up? The power of journalism to change!)
       Seems Nick had interviewed some people in the government who were critical of nutrition
       programming, but had not apparently given this guy a chance to respond. This director seemed
       brusque, but capable. Has been in position since 2003. Talked at length about a new initiative
       underway, funded with $15 million World Bank seed money, to sub contract nutrition services to
       NGOs. This guy is pro- civil society having a permanent role in nutrition services, govt can’t do it
       alone. Dismissed questions about dependency and sustainability, saying that the govt is kicking in
       more money, not letting donors dictate agenda. Have sub contracted to 21 organizations, training
       NGOs now until end of year. At end of our meeting, when I asked for details about the 2007 incident,
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         he said- “that’s in the past”, so meeting ended on a much warmer note with him talking about how he
         really enjoyed a recent work trip in Vietnam.

Reports:

   1. update/eval of food vouchers
   2. why such low exclusive breastfeeding rates, an ethnographic analysis (part 1/5 in exclusive
       breastfeeding series)
   3. health centre pleas for exclusive breastfeeding unheeded (part 2/5)
   4. low ARV treatment of HIV+ children (commissioned from Brahima)
   5. illegal urban health clinics (commissioned)
   6. village nutrition outreach on motorbike in Kaya
   7. referral CREN in northwest- where the most complicated malnourished medical cases are referred
   8. malaria rapid tests change little in village health care diagnostics
   9. competing for malnutrition rations in Zincko/ fight for freebies hurt children?
   10. urban-rural hunger balance tips in northwest/ urban stigma of malnutrition- intellectuals hide problem
       (Ouahigiyah), with government response/insight.

Met with stringer Brahima Ouedraogo who helped me get Ministry of Health authorization from director of
communications, Rene Segbo, to report on nutrition centers. He took me to food voucher kiosk and will
submit HIV and illegal clinic stories. Need to add stringer fee to one of those stories for his help.

Future reporting

        orphans and malnutrition
        cotton and GMO/ expected low harvest and impact on cotton communities

Notes:

        Biggest expense in Burkina was phone cards- Zain network most expensive, but has the best network
         coverage. Orange in Niger cheaper, but its network is still being set up and there were long stretches
         when I did not have coverage.

        Should have prepared from IRIN info packets, brought more business cards. People really
         appreciated and read the printouts. Very few in the field subscribed or knew about IRIN. (even when
         they had internet access).

        Burkina advanced in drafting of nutrition protocol, 5 year strategy. Nutrition director said political
         will is there and that 1 billion CFAs (US$2.1 million) are being invested per year in nutrition (mostly
         donor budgetary aid and the World Bank $15 million- which was supposed to be a $5 million grant,
         but because they were so impressed with Burkina’s proposal, they upped the amount and turned the
         loan into a grant). Follow up with UNICEF Felicité about Burkina background and growing pains for
         it to get where it is now, with Save the Children UK about analysis it is doing of government
         nutrition strategies in region.

        In two places, I was told that IRIN had misquoted and was not objective in previous nutrition
         reporting. We need to verify quotes and if criticize someone’s handling of ANY issue, give that
         person a chance to respond. Need to review treatment of “whistle blower” or inside-critic interviews.


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Trip planning: Cost-efficient. OCHA Niger plus NGO and US embassy in Burkina Faso = cost savings on
car rentals. ECHO support covered gas in Niger. No stringer fixing fees. (but rural reporting itinerary +
desert travel + 16 long reporting days in field = tiring endurance course)

Office support and Modibo’s help invaluable, the info packets were well received. Thuraya never worked
and I did not have time/occasion to follow directions Marame sent to reconfigure it.

filed from field: Niger day before referendum; 2 breastfeeding Burkina articles

Final tally:

Reports filed from field:    6
Reports to be filed:         28 + 2 sound slides
Days in field:               16
Countries:                   2
In country travel:           4000km




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