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Initial Rapid Assessment tool (IRA) - Lessons learned from implementation during post-election violence in Kenya Introduction • IRA was developed as a tool for assessing needs in the early phases of a crisis. It is the product of a process involving 3 clusters, Health, Nutrition and WASH, to develop a common tool that covers the essential needs in an emergency. An analysis would result in the mapping of needs and gaps, which would form the basis of decision-making to address these. • Late December 2007, disputed election led to eruption of violence which had roots in unresolved land issues- mass displacement of an estimated 600,000 people, political crisis which lasted for months. • In this context, needs assessments were carried out- lots of different tools, sector- specific, agencies not sharing information (no mechanism for this to happen) • IRA was recently available in a draft version, which was shared with Nairobi- did not arrive in early stages, but about 1 month after crisis began, a training was held on the IRA by UNICEF and UNFPA. However, this was not particularly productive, mainly because no-one running training had any experience with IRA • Subsequently, different agencies adapted tool in isolation and without guidance, so that WHO had one version, UNICEF Nutrition had another, and UNICEF WASH used a third version. This negated much of the benefit of having a common tool, which was comparability across sites and cluster agreement and communication. This did not happen • OCHA received a multitude of assessments, but these could not be transferred into a WWW tool and gap analysis. • Assessment fatigue due to lack of coordination which meant that there was a constant stream of interviewers from different agencies arriving and asking similar questions on a weekly basis- proves the need for a common tool. • After IRA data collection, majority of forms were not returned to WHO. UNICEF kept track of their forms, but there was no information sharing, common analytical processes, and report writing. The Health assessment report remains unfinished • In late March, I arrived in Nairobi to conduct trainings and run field assessments using IRA, to see how appropriate the tool is to crisis setting and to identify problems and suggest solutions to these. • By this time, was in chronic phase of crisis, and much had already been established to cater for needs of IDPs. IRA was somewhat inappropriate to this phase, but valuable lessons were still learned. Problems with the survey tool • It is supposed to be for non-specialists, but much of it needs specialist training and knowledge. • It is supposed to be for rapid assessment, but is too long and needs training and local adaptations that delay implementation by several days. o Develop a shorter form of the IRA with only core questions, how they are to be analysed, and closed-questions response options. o Needs definition of the period when tool is to be used- 72hrs, 14 days, monitoring…? • It does not facilitate the drawing of analytical outcomes. Questions are informative, but it is not clear how some of this information is to be used, and how it is useful for decision-making purposes for rapid response. o We should initiate a new process whereby clusters return to basics, and consider what information is actually used to make decisions, and limit tool to just this. Or at least open discussions on this- how do different actors feel about IRA, are we all on the same page regarding it's purpose- I think this needs to be clarified before moving forward o Maybe separate out sections- have initial core section for decision-making purposes, and a longer tool for monitoring and evaluation purposes in the subsequent weeks (and which is built upon the core questions) • Information elicited is often very subjective. It is a mix of questions that require both quantitative and qualitative answers- this undermines comparability across sites not done by same team. o Wherever possible, offer a closed selection of answers, not open-ended- o Where it says 'other observations', is this necessary? If so, guidance needs to be provided on the type of information to include o Some of problem questions can be dealt with by making an electronic system, but is this unfeasible? This stage must wait until the tool is much improved anyway, before field testing again… a bit of a Catch-22 • Ordering of the questions makes a certain logic on paper, but not in the field- interviewer skips from questions directed at camp manager, to IDPs, to observation. o These should be grouped together in a practical fashion by informant, not by subject domain • Secondary data were very difficult to collect in the midst of the Kenya crisis o needs to be established before, with designated person (IRA country leader?) regularly (yearly basis) updating, and this person knowing it is their responsibility- clear responsibilities is essential for IRA to work rapidly and smoothly • Despite guidance to the contrary, is not really appropriate to assess needs of IDPs integrated into host communities (and what about other emergency settings, not involving IDPs?). Indeed, this was identified by HPG as an area in need of special attention, as other assessments had overlooked their needs- "The fate of the displaced not residing in camps is unclear- accurate data does (sic) not exist and there has been a failure to implement a coherent mechanism to identify, locate and assess their needs and intentions" o Guidance on limited use among these groups needs to be strengthened Tool Structure: • Summary section is a strength- overall picture plus ranking of severity, but again depends on quality of team • Population description and Shelter sections are fairly good- could be adjusted somewhat, but generally short and quantitative • WASH and Health sections are reasonably short and clear, but could still be improved by trimming unnecessary questions • Nutrition section seems to need most work, according to field staff- much seems superfluous to need (depending on what need is), and causes people to back away from the tool o Summary - 2 sheets o Section 1 - 1 sheet o Section 2 (Pop description)- 2 sheets o Section 3 (Shelter)- 3 sheets o Section 4 (WASH)- 4 sheets o Section 5 (Nutrition)- 10 sheets o Section 6 (Health)- 3 sheets o Section 7 (Health facility)- 4 sheets • Guidance is needed on adaptations- Myanmar, Kenya, Bangladesh and South Africa (CAR?) all demonstrate that adaptations will occur, so we should try to control this process by providing guidance, suggesting core elements to include unchanged. A part of this process is probably to improve the tool, so that there is less need to adapt in emergency situation. Training • It is optimal to have multi-disciplinary teams present in order to share knowledge and advise on areas outside their expertise • Need for team leaders who have been identified and sensitised in the use of IRA prior to crisis- at the least, each team leader must be present at pre-deployment training and be comfortable with conducting training when meets with other team members • Where to conduct the training, and with which staff, is an important issue- at capital level or field level. There are advantages and disadvantages of each o Capital- is probably centrally located, served by decent transport links, is the easiest place for groups from the field to congregate but, one difficulty is language- capital staff may not speak the appropriate language for the field site, is difficult and impractical to take field staff away from the site to capital and back again. o Field- Speak local language and understand context/rely on already established confidences. Can maintain presence in longer term than capital staff Impracticalities of trainers moving from site to site over time o NB. Might depend on context of emergency- if concentrated in one area, might be more sensible to conduct trainings in field, where staff come from dispersed area, more sensible to conduct in (provincial) capital • Finances and logistics- these must be established beforehand- who will be conducting training, who will identify team members, who will organise training and transport, who will cover costs, security clearances, etc. • Guidance on local adaptations established and necessary changes made before training- who is to be involved in this process, how quickly should this be done. Needs to be done before crisis hits in the most part, and if context calls for further adaptations, these must be done as quickly as possible by as few people as necessary o In Kenya, this process took 1 day for adaptations to be made, and 2 weeks for agreement on the tool and the changes- this is far too long, so mechanisms must be in place to make this a smooth, quick process Implementation • Major concern expressed was lack of clarity in tool itself- what exactly is being asked by certain questions? o Can it be simplified in language and made clearer? o Need for well-planned and comprehensive training module to be developed, which can be rapidly adapted to local context • Major difficulty is structure of questionnaire- it does not flow when in the field- questions range from those needed to be asked to camp managers, to IDP focus groups, to NGOs working in the field, in a haphazard fashion. In practise, much time is lost by each interviewer going through the tool several times trying to locate relevant questions- adds a lot of time and fatigue o more practical would be to arrange the questions according to who one is speaking to at the time, to cover everything in one go. Also, add a key to each question that indicates who to get info from, rather than always referring to the matrix in the front section • Open ended questions difficult- most often, these are left blank because interviewers feel uncomfortable dealing with these, esp. if not in area of expertise. o Short, close-ended questions should be the rule in this tool, with space for comments and impressions at the end of each section • Method of data collection is long-winded- guidance suggests letting people speak and using tool to guide topic areas, but in practice that meant spending a lot of time with each interviewee- is this practical in crises? o Would be much more so if this can be limited to those sections where is most appropriate, and questions to target audience are grouped together as described above • Lack of central co-ordination one of biggest problems- Getting IRA adapted and agreed upon was difficult and lengthy process, as was getting teams out to the field and getting forms back again o this is likely to be improved if IRA has been agreed upon beforehand, adaptations made, and most crucially, central co-ordination in place • Lack of guidance on adaptations- different groups selected sections and adapted freely, defeating much of the purpose of having common tool. o WHO- heavily adapted all sections to a much shorter version o UNICEF- Nutrition adapted only Nutrition section- also made much shorter, plus added an infant/young child feeding section N.B. they commented that the IRA section of their own tool was the most useful and clear- it was the only section that was consistently completed o Training- was conducted in haste- 3 hrs, of which very little was actual training, was more a talk on assessments. Feedback was quite negative on quality and usefulness • Local language not spoken by some interviewers recruited at capital level • Unreliable team leader resulted in one teams results never coming back to HQ level o Careful selection and orientation of team leaders as part of emergency preparedness Analysis, reporting and dissemination of results • Retrieving completed forms was major problem, both in 1st round (Jan/Feb) and 2nd round (April)- no central co-ordination in first case (who is where, who is responsible for collecting forms, who is responsible for ensuring they get there, who is keeping track of this), unreliable team leader in second case • Findings are out of date very quickly o in early phase, tool should be shorter to answer key questions. Think about utility of tool for monitoring at a later stage o Can IRA be used to consolidate data from already collected assessment forms at a later date? Could be a use of tool in the 'chronic' stage of crisis • Qualitative nature of much of questionnaire means less straight-forward to enter, analyse, and present data. This is not necessarily a bad thing, as long as mechanisms are identified for processing large amounts of qualitative data and transforming this into useable information to inform decision-making o Make close-ended questions wherever possible • No clear plan of analysis. Once this data is collected, how is it to be used? The tool at present is a collection package, but it should be a collection and analysis package. o Need to develop data entry system, a template for presenting results, guidance on how to compare data across camps/regions, an indication as to what most important factors are to include in report, and improve communication between clusters to facilitate appropriate analysis and interpretation. o Plan an exercise with 2 steps 1. using data from the field, ask each cluster to analyse data and produce results from it 2. ask how useful that analysis is- can this be used to make any decisions? If not, can we cut? • No clear plan for who is doing dissemination, where to disseminate to, how the interpret results, how to make decisions based on results. o Cluster co-ordination is necessary here, or else each will analyse their section alone. • For the large sections where information is site-specific and cannot be used to describe situation broadly (on district level), the possibility exists to present this as appendices/matrices- these are quite time-consuming to produce and may not be high priority early in a crisis, but can be useful later to describe situations and for monitoring purposes Annex I: Draft report on IRA findings IASC Inter-Cluster Partnerships Initial Rapid Assessment Report on the findings from implementation in Kenya Context: Internal displacement following post-election violence Overview of needs assessment • Population are generally coping well and being adequately served • Shelter needs must be continually addressed, e.g. replacement of deteriorated collective shelters • Important gaps exist in essential non-food items • Sanitation and hygiene need to be addressed • Food security and nutrition need monitoring to ensure situation does not deteriorate • Health of populations in this area are well-provided for, no urgent action to be taken Eldoret Kitale Kakamega Keroka Ekerenyo Manga Overall Population and demographics 2 3 3 2 2 2 2.3 Sites and shelter 3 3 1 2 2 3 2.3 Essential non-food items 2 1 2 1 1 1 1.3 Water supply 3 3 3 2 2 1 2.3 Sanitation 3 2 2 2 2 1 2.0 Hygiene 3 2 2 2 1 3 2.2 Food security 2 3 2 2 1 2.0 Nutrition 3 2 3 3 2 2.6 Health status and health risks 3 3 3 3 3 3 3.0 Health facilities and services 3 3 3 3 3 3.0 Key: 1 Severe situation- urgent intervention required 2 Situation of concern- further assessment and/or surveillance required 3 Relatively normal situation- no further action required N.B. The lower the overall score, the more severe the situation for that sector across the region Overview of needs assessment cont'd • situation disaggregated by location (to be used as baseline for monitoring purposes) Eldoret Kitale Rank Problems Recommendations Rank Problems Recommendations Tensions between hosts Maintain security 2 and displaced presence 3 3 3 Provide clothing, Poor lighting at night- blankets, bedding and 2 security issues Provide lighting 1 Exposure to elements firewood 3 3 Presence of faeces & 3 2 household waste Improved lighting 3 2 Lack of soap Provide soap x 2 No food stocks x 3 3 3 3 3 Kakamega Keroka Problems Recommendations Problems Recommendations 3 2 Overcrowding Need more tents Overcrowding, lack of 1 shelters Provide more shelters 2 Rain getting into tents Lack of items, little Lack of matresses and 2 protection from elements Provide supplies 1 clothes Urgent need 3 2 Lack of clean water Treat and protect water 2 Few toilets More latrines 2 Poor sanitation More toilets needed Lack of soap + places to 2 wash hands 2 Lack of sanitary towels Urgent need Lack of sufficient food 3 2 stuffs Urgent need 2 Lack of diversity 3 3 3 x 3 Ekorenyo Manga Problems Recommendations Problems Recommendations Proper tracing records 2 Overcrowding Need more tents 2 Returnees are scattered should be kept Urgent replacement of 2 Rain getting into tents tents 3 Lack of blankets, NGOs should provide 1 matresses, clothes Urgent need 1 Items in short supply more Water source poorly Presence of unprotected 2 protected Treat and protect water 1 spring Water to be treated Empty latrines, build new 2 Latrines are filled Empty latrines 1 Latrines in poor condition latrines 1 Lack of sanitary towels Urgent need 3 2 Low food ration Increase ration 1 Shortage of food aid Increase food aid 3 2 Shortage of food aid Increase food aid 3 3 3 3 Key: Red- Severe situation. Urgent intervention required Orange- Situation of concern. Further assessment &/or surveillance Green- Relatively normal situation. No further action required Introduction: Widespread violence broke out across Kenya following disputed results of the election which took place on 27th December 2007. More than 1000 people were estimated to have been killed, and up to 600,000 displaced. During April 2008, a series of rapid assessments of the needs of IDPs living in camps and among host communities was carried out by two multi-disciplinary teams consisting of field staff from a number of agencies- Kenya Red Cross, UNICEF, WHO, Merlin, and Health and Water Foundation. Team members included professionals with expertise covering several major sectors- Health, Nutrition, Water and Sanitation, Shelter, and Protection. A one-day training was organized and held in Nairobi on . Due to nation-wide rioting that commenced in the early hours of the morning, most of the participants were unable to attend this training, greatly reducing its utility. One of the key objectives of the training was to create inter-sectoral collaboration and a sense of familiarity with all aspects of the IRA tool, so that any member of the team would feel comfortable conducting any part of the IRA. Despite this drawback, those members that did attend the training responded well and felt comfortable taking the lead in carrying out assessments in the field. The assessments proceeded successfully, but unfortunately only one of the two teams delivered back the completed assessments, despite repeated requests. This was a problem which arose during initial use of the tool in Jan/Feb 2008, when fewer than half the completed forms were returned to WHO for analysis and reporting. Based on the 6 forms which were returned, the following information was gathered and used to create this report. Due to the nature of IRA, which is a mix of both quantitative and qualitative, open-ended and closed questions, subjective and objective reporting, the report is divided into two parts- the first describes the more quantitative and generalizable results (to the district), and the second the more qualitative and specific points (to the camp or community). This represents a first attempt at extracting data from IRA and making conclusions about districts as a whole, and basing recommendations on these findings. It is probable that other attempts would be able to produce more information, especially if carried out by experts in the relative fields. However, what is clear is that a large proportion of the IRA tool does not yield usable information in terms of decisions that must be taken in the first hours and days of a crisis. The lessons learned paper attached (Annex I) details further some of the concerns about the utility and appropriateness of the IRA, and recommendations based thereon. Section 2- Population description Movement to and from site each week • The larger camps, located more centrally in the area are generally more stable with regard to population movements in and out of camps. The smaller camps close to Rift Valley have higher rates of influx and outflow, with IDPs returning nearer to farmlands Name of camp Total size in camp # (%) arriving # (%) leaving Period previous week previous week Eldoret 13050 700 (5) 140 (1) 22- 29/03/08 Kitale 5889 500 (8) 267 (5) 24- 31/03/08 Kakamega 404 15 (4) 0 (0) 25- 01/04/08 Keroka 427 100 (23) ? 10-17/04/08 Ekerenyo 1393 700 (50) 1400 (101) 10-17/04/08 Movements of IDPs to and from camps over one week period 14000 12000 10000 8000 6000 4000 2000 0 Eldoret Kitale Kakamega Keroka Ekerenyo Total # arriving previous week # leaving previous week People dead, missing or injured during last 7 days 80 70 60 50 40 30 20 10 0 Dead Injured Missing # 36 68 57 % of total population 3 7 5 • Mortality rates are low, approx. 0.14/10,000/day, which is well below the baseline for sub-Saharan Africa • Many injuries have been reported, these are referred to the district hospital o Need to provide ambulances for referrals Section 3: Shelter and essential non-food items Access to, and quality of, shelter Percentage of population with access to each type of shelter 9% 1% 90% Temporary shelter Collective shelter Without shelter • Majority of IDPs living in temporary shelters provided by UNICEF and UNHCR, or constructed by themselves. Approx. 9% live in collective shelters, which are usually overcrowded and house unrelated individuals together. A small number of IDPs are without shelter, and their needs must be addressed urgently • The temporary shelters generally provide adequate protection from the elements. Some people expressed a lack of privacy and security, but the poor protection from fire is a danger in this context- little covered space for household activities including cooking results in people cooking with open fires close to tents Quality of temporary shelters 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Protection from the Privacy Security Protection from fire Covered space for elements essential household activities Acceptable Somewhat poor Very poor Access to essential non-food items (NFIs) • There is a general lack of access to essential NFIs o In the larger, more centrally located camps, the population have sufficient clothing, blankets and bedding cooking utensils and plastic sheeting o In the smaller camps, these resources have not penetrated as well. These camps tend to report a lack of NFIs. This should be addressed by improving communication and co-ordination between camps, so that surpluses can be transferred to other camps o No camps have adequate artificial lighting, creating potential for security and sanitation/hygiene problems Proportions of households with access to essential non-food items 100% 90% 80% Proportion of camps 70% 60% 50% 40% 30% 20% 10% 0% Sufficient clothing Sufficient blankets Cooking utensils Plastic sheeting for Tools for Artificial lighting for protection from and bedding for temp. shelter construction of the elements protection from the shelter cold <25% 25-50% 50-75% >75% Section 4: Water Supply, Sanitation and Hygiene • Most camps have an adequate supply of clean water o 60% have piped water, while the remaining have both protected springs and unprotected open wells o Most camps report >75% of households have at least 1 narrow-necked container, but these were mostly absent in 1 camp (Ekorenyo) o In Ekorenyo and Manga, animals and humans use the same water source- need for water bladders to be re-filled regularly as are left unfilled for many days at a time Proportion of camps with water supply according to different needs 70% 60% 50% 40% 30% 20% 10% 0% Piped water Unprotected open Protected spring Piped water Unprotected open Not applicable well well Human consumption Animal consumption Section 5: Nutrition and food security Eldoret Kitale Kakamega Keroka Ekerenyo Manga Overall Cereals 1 1 0 1 1 1 0.8 Roots and Tubers 0 0 1 0 0 0 0.2 Pulses and legumes 1 1 1 1 1 1 1.0 Oils and fats 0 1 0 0 1 0 0.3 Meat, fish and eggs 0 0 0 0 0 0 0.0 Vegetables and fruits 0 0 0 1 1 0 0.3 Dairy products 0 0 0 0 0 0 0.0 Food aid commodities 1 1 1 1 1 0 0.8 Key: 1 Present in diet 2 Absent from diet • There has been a dramatic reduction in the variety and availability of food groups in all settings. All IDPs reliant on food aid distributions, few have access to products available on the market. Market prices have increased dramatically (200- 300%) • In most places, food distribution needs are being met o In some camps, beneficiaries and ration sizes need to be increased, and in Manga, food aid needs to provided o In most places, malnutrition is being managed adequately, but no provisions are being made in Manga Eldoret Kitale Kakamega Keroka Ekerenyo Manga Overall General food distribution needed? 1 1 1 1 1 1 1.0 - increase beneficiaries? 0 0 1 0 0 1 0.3 - increase ration size? 0 0 1 1 1 1 0.7 - change distribution logistics? 0 0 1 0 0 1 0.3 Supplementary feeding programme? 1 1 1 1 1 1 1.0 - increase beneficiaries? 0 0 1 0 0 1 0.3 - increase ration size? 0 0 1 1 1 1 0.7 - change programme logistics? 0 0 1 0 0 1 0.3 Management of acute malnutrition - management of SAM (children) 1 1 1 1 1 0 - management of SAM (others) 1 1 1 1 1 0 - management of GAM (children) 1 1 1 1 1 0 Urgent interventions- <5 yrs feeding 0 0 0 0 0 0 0.0 Key: 1 Yes 2 No Section 7: Health facility assessment • The majority of health facilities are well-stocked with essential drugs and equipment o Need for delivery kits and oxytocin o Preparedness for cholera/dysentery outbreaks is weak and should be supported Proportion of health facilities with essential drugs 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Antibiotics for Antibiotics for Vit. A, Zn, & Anti-Malarials Delivery kits Oxytocin Mg Sulfate pnemonia dysentery & ORS cholera Available Missing Functioning of sub-sectors and services: • Subsectors functioning well in all camps o Attention may need to be paid in the long-run to non-communicable diseases programmes and environmental health in Keroka Eldoret Kitale Kakamega Keroka Ekerenyo Manga Overall General clinic services 3 3 3 9 3.0 Child health 3 3 3 9 3.0 Nutrition 3 3 9 3.0 Communicable diseases 3 3 3 9 3.0 STI & HIV/AIDS 3 3 3 9 3.0 Maternal & Newborn health 3 3 3 9 3.0 Sexual violence 3 3 3 9 3.0 Non-communicable diseases 3 1 1 9 1.7 Environmental health 2 1 3 9 2.0 Key: 1 Not functioning 2 Decreased 3 Normal 9 Does not apply Camp site - Ekerenyo Section Current status Recommendations Population description • Men underrepresented in this population • 25 unaccompanied minors • Return of IDPs prevented because of loss of land • Economic activity in the form of selling tea leaves and handicrafts • Population wholly reliant on supplies from agencies Shelter and essential non-food • Overcrowding- Temporary shelters with 6 Provide more shelters items people per tent, collective shelters with 14 people per tent • Tents are leaking rainwater when it rains Replace existing shelters when worn out • Majority of IDPs without mattresses, blankets NGOs and local churches to • Lack of clothing for protection from cold organise provisions • Insufficient firewood for cooking, inadequate cooking utensils Supplies of fuel needed • Main water supplies are unprotected open well and protected spring. Spring water is treated reliably • Human and animals share the same water Water supply, sanitation and source hygiene • Lack of jerry cans for collecting and storing Water containers should be water provided • Latrines are close to full Empty latrines and dig new ones • Substantial presence of human faeces, solid Adequate lighting is needed waste and stagnant rainwater close to the shelters Nutrition and food security • Poor lighting- people defecate in the open after dark • Lack of toilet paper and hand-washing Provision of hygiene items facilities urgently needed • Inadequate staff for management of SAM NGOs should provide extra staff for supplementary feeding programmes • Extra food aid needed Increase food ration • Danger of food shortages due to presence of high numbers of IDPs in local community • Allegations of equity imbalance based on Involve women in delivery of gender- men collect food rations on behalf of food rations all Health risks and health status • Low measles vac. Rate (25%) Initiate measles vacc. campaign • Shortage of medical personnel NGOs/MoH to make provisions for extra doctors and nurses Annex IIa- IRA report from 1st round teams INITIAL RAPID ASSESSMENT FOR INTERNALLY DISPLACED PERSONS IN TRANS-NZOIA DISTRICT INITIAL RAPID ASSESSMENTFOR IDP CAMPS IN TRANS- NZOIA DISTRICT CAMPS: TRANS NZOIA WEST – PEFA CHURCH, GOSPEL EXPLOSION, SIKHENDU CATHOLIC CHURCH, ASK-SHOW GROUND, WAMUINI TRANS –NZIA EAST- KACHIBORA, EDEBES, MAKUTANO, KESOGON Date of Assessment – 29th January 2008 Assessment Team A.PEFA Church Kiminini Name Organization 1. Dr. Bernard Olayo UNICEF 2. Jacklyne Atieno KRCS 3. Joachim Oreko DHRI/MOH B. MAKUTANO IDP CAMP Name Organization 1. Ben Mullah MOH 2. Vincent Hamisi MOH 3. Daniel K. Tanui MOH 4. Zipporah Nyakang’o KRCS C. GOSPEL EXPLOSION FELLOWSHIP Name Organization 1. Zakayo Kimuge MOH 2. Elmi Mohamed UNICEF 3. Jane Bauni IMC D. NAIGUM (KACHIBORA) Name Organization 1. Gladys Gathoni MOH 2. Dr. Abdi Maalim WHO 3. Mildred Palapala KRCS 4. Leah Jelagat Ampath /IRD 5. Elizabeth Kipkosiom MOH E. SIKHEDU (CATHOLIC CHURCH ) Name Organization 1. Daniel Wekesa MOH 2. Lukas Wanyoyi MOH 3. Bornface Onyango KRCS F. A.S.K SHOW GROUND Name Organization 1. Lucy Wachira MOH 2. Tabitha Toroitch MOH 3. Mukanda Rophine KRCS 4. Dr. Abdi Hassan W.H.O 5. Philip Bett MOH G. ENDEBESS Name Organization 1. P.O Lutta MOH 2. Rose Rono APATH/IRD 3. Samuel Rotich MOH 4. Joseph Chepkuto MOH 5. Allan Lodenyo KRCS EXECUTIVE SUMMARY OF IRA TRANS-NZOIA DISTRICT Date: January 31, 2008 Introduction This assessment was jointly carried out by the Ministry of Health supported by partners including WHO, UNICEF, AMPATH/IRD, Kenya Red Cross Society and IMC as a follow to the post election clashes that affected the district. Trans-Nzoia East and West Districts are two of the 27 districts of Rift Valley province. The greater Trans-Nzoia borders it borders Uasin Gishu and Marakwet to the East, Bungoma and Lugari to the South, West Pokot to the West and Uganda to the West. Kitale town is the headquarter of the district is also the second largest commercial centre in the North Rift and is approximately 370km North West of the Kenya’s capital Nairobi. IDP Situation The current situation in the district is calm but fluid. The total number of IDP camps in the district currently stands at 9 with the major ones being ASK Show ground Kitale, PEFA and Gospel Explosion Churches Kiminini, Kachibora,Makutano, Endebes and Shikhendu Catholic Church. The situation is however constantly changing as some camps are merged. The North Rift region in which Trans-Nzoia falls has approximately 150,000 IDPS resident in various camps and neighboring host communities. All camps have established management structures and registration of new arrivals is ongoing. Food and Nutrition In all the camps food distribution was on going carried out by Kenya Red Cross and other partners. There are however concerns on the quality of food since it is not balanced. Nutritional assessment has not been done in most camps; however there are concerns of high levels of malnutrition emerging among children in the camps. In short term, there in need to post nutritionists to the camps to carry training on preparation of special feeds and concurrent nutritional assessments. Feeding centers to provide both supplementary and therapeutic feeds need to be established at all major camps Water and Sanitation Overall, attempts have been made at all camps to provide toilets and clean water. The number of toilets in most camps however remains low with an average of more than 100 persons per toilet. Solid and liquid waste management remains problematic in all camps. It is recommended that more pit latrines should be constructed and additional waste disposal pits be dug in all camps. In some cases exhaustion of filled up latrines could help relieve the stress in short term. Water storage facilities at camps and at house hold level are inadequate and should be increased. Finally basic hygiene commodities such as soap and sanitary pads should be provided in adequate quantities. Health Services All the IDP camps are currently receiving some basic level of health services. Some have static temporary facilities while others rely on outreach services. There have been no disease outbreaks reported in any camps but the risk remains high due to poor sanitation. All camps should establish disease surveillance mechanisms. Most of the HIV/AIDS patients who are on ARVS are currently being tracked to ensure the treatment is not disrupted. Patients with other chronic illnesses however remain underserved. All health facilities should provide health services to all IDPS free of charge as stipulated by the Ministry of Health. There is need to develop effective interventions, services and coordinated community responses to sexual violence against women (SGBV) and trauma counseling services. Key Health Recommendations • There is need for better coordination of all the health response activities under the leadership of the Ministry of Health • Provide Cold Chain infrastructure for Trans-Nzoia East District • Running water should be connected to Cherangany Health Center • Provide regular outreach services to IDP camps and host communities with difficult access to functional health facilities. • Mass immunization should be carried out in all the camps. During this exercise Measles and Polio vaccines should be administered to all under fives together with deworming and Vit A supplementation • Strengthening of disease Surveillance teams with specific early warning systems activated at each camp. • The DHMT should be facilitated with additional funds and tools to enable them respond appropriately to the crisis including regular Supervision and M&E • HMIS tools are inadequate in most health facilities in the districts. Urgent efforts should be made to avail these tools to end users including all partners for the purposes of standardization • Assessment and training on SGBV issues to be conducted 1. Introduction Trans-Nzoia District (Recently divided into Trans-Nzoia East and West) is one of the 27 districts of Rift Valley province. It borders Uasin Gishu and Marakwet to the East, Bungoma and Lugari to the South, West Pokot to the West and Uganda to the West. Kitale town is the headquarter of the district is also the second largest commercial centre in the North Rift and is approximately 370km North West of the Kenya’s capital Nairobi. The district has 26 health facilities as follows: The GoK health facilities in the district include 3 Hospitals, 7Health Centers and 16 dispensaries. Additionally, there are a number of faith based and private health facilities. 2. Background Violence erupted in various parts of the district following the Kenya General elections in December 2007, resulting in injuries, deaths and displacement of human populations. Election related violence occurred in the district in 1992, 1997 and 2002 but the current violence is by far the worst, leading to loss of life, property and displacement of many people. These displaced populations live in nine IDP camps with the three major ones being Kachibora, Endebes and PEFA Church Kiminini. The situation is still fluid the number of the camps and population in each of the camps change daily. Settlement in camps may face several challenges including: • high population densities, • inadequate shelter, • poor water supplies and sanitation, • And a lack of even basic health care. In these situations, there is an increased threat of communicable disease and a high risk of epidemics The Top 4 health Priorities in complex emergencies such as this one are; A. Conducting rapid health assessment to Identify main disease threats, including potential epidemic diseases Identify priority public health interventions Identify the lead health agency Establish health coordination mechanisms B. Prevent communicable diseases Select and plan sites Ensure adequate water and sanitation facilities Ensure availability of food Control vectors Implement vaccination campaigns (e.g. measles Provide essential clinical services Provide basic laboratory facilities C. Set up surveillance/early warning system Detect outbreaks early Report diseases of epidemic potential immediately Monitor disease trends D. Control outbreaks Preparation o outbreak response team o Stockpiles o Laboratory o standard treatment protocols Detection o Surveillance/early warning system Confirmation o Laboratory test o Management Response o Investigation o Control measures In view of the above priorities, the Ministry of Health with support from its partners decided to carry out Initial Rapid health Assessment (IRA) in the IDP Camps in all the districts affected by the post – election crisis. Objectives of the IRA To assess how the populations have been affected by emergency. Who is most vulnerable? Estimate the number of IDPs To establish whether interventions are necessary to prevent further harm or loss of life. If so define the type and size of interventions and priority activities; To establish whether there are continuing or emerging threats that may escalate the emergency. If so What resources are already present (infrastructure and institutions) that could assist in the response To disseminate the findings among partners to assist with planning and resource mobilization .3. Methodology All camps registered with the DMOH at that point and which were not targeted for relocation were considered for the assessment. These were ASK Show ground Kitale, PEFA and Gospel Explosion Churches Kiminini, Kachibora, Makutano, Endebes and Shikhendu Catholic Church. Assessment teams consisting of 3-5 members were formed. Each team had at least a DHMT member who was the team leader. The other members were drawn from the partners in the district These teams were then taken through the IRA tool Once in the camp, teams reported to site office or management, following protocol as necessary. Data was collected by o Interviewing key informants o review of existing information, o Visual inspection of the affected area Interviews were conducted with key personnel in the camps and with members of the affected population. These included: o IDP camp management leaders o health workers o personnel from local and international emergency response organizations o individuals in the affected population After completing collection of the data, each team met to wrap-up information for the site. This information was summarized for each section of the tool in each camp using a format prepared by the WHO and adapted by the partners. These summaries were then brought together from which priority interventions were drawn for respective camps and district 4. Findings 1. Camp information: Name of Div/Dist. Source of info. Existence of management Registration of new camp structure in the camp arrivals PEFA Kiminini Division Bishop Isaiah Lukasa IDP Committee in place Registration of all CHURCH Trans-Nzoia west persons in the camp on-going Gospel Div, -Kiminini JAMIN WAFULA & Isaiah IDP Committee in place Registration done Explosion Dist –T/NZOIA WEST odhiambo regularly Fellowship 0722594284/0727737820 Church Kachibora Fred nyaborora – asst chief, Camp committee headed Registration done Centre Div, -Cherangany pastor by chairman of IDPS regularly Dist –T/NZOIA East Joseph mwangi – chairman Sikhendu Kiminini Div, Chrisanthus Wamela Wanyama Yes, the committee in place The of IDPS is on Catholic T/Nzoia West District going Church Makutano Kaplamai Division Francis Njuguna – Welfare Host There is a committee in Registration of IDPS Camp Dist –T/Nzoia East place at the camp is ongoing ASK Show Div, -Central Makokha Khaemba – chairman of There is a committee in Registration of IDPS ground Dist –T/NZOIA WEST the camp place at the camp is ongoing Endebess IDP Div, -endebess D.O – George Matundura There is a committee in Registration of IDPS Camp Dist –T/NZOIA EAST place composed of IDPS at the camp is (Cell phone – 0723 624 and partners ongoing 603) Population Profile in the Camp: Name of Total Women Male <5yrs No. of Youth Vulnerable Elderly camp pop. pregnant person(s) women PEFA 2300(total) 329(in 1398 573 Women not not Known Not known CHURCH camp) Known not Known Gospel 355 112 111 132 4 Not known Not known Not known Explosion Fellowship Church 13,754 7495 6259 3392 Women not not Known Disabled -158 not Known Kachibora Known Centre Sikhendu 1579 921 249 409 16 not Known Elderly -39 6 Catholic Church Makutano 450 not not not Known not Known not Known not Known Not known Camp Known Known ASK Show 1030 215 348 470 15 not Known Blind-5 Not known ground Orphans -4 Endebess 4647 938 811 1516 100 1382 not Known Not known IDP Camp 2. Organizations and partners in the district and/or camp Name of camp partners in the district and/or camp PEFA CHURCH catholic church, red cross ( KRCS), MOH Gospel Explosion Fellowship Church Catholic Church, Red Cross ,MOH Kachibora Centre Catholic Church, Red Cross, MOH, MSF, UNICEF, WFP Sikhendu Catholic Church Catholic church, Red Cross ,ACK Church, UNICEF Makutano Camp Catholic church ,Red Cross, PCEA Church, MSF ASK Show ground Catholic church ,Red Cross, ACK Kitale Diocese Endebess IDP Camp Catholic church, Red Cross, MSF, AMPATH, HANDICAP, IMC, LFBO 3. Sanitation and Hygiene. Name of camp Presence and number Human or animal Stagnant water Waste Piped water supply of functional toilets fecal matter in in the camp disposal/refuse (Municipal) to Camp around the site pit exist in the exist. camp. PEFA CHURCH - 4 functional toilets -No human or - substantial -A waste -the supply is not enough -> 100 persons/toilet( animal fecal matter presence of disposal/refuse pit but the quality is good 175/toilet ) in around the site stagnant water exist in the camp - Storage at camp is -In good condition but two 50Mtrs from the but is already full satisfactory but at are almost filling up. shelter household level not sufficient Gospel -Access and conditions of - No human or - substantial - There is one - Water source is about 1 Explosion toilets fair and they are animal fecal matter presence of rubbish pit km away Fellowship digging one more at the site stagnant water - Storage at camp is Church -> 100 persons/toilet( less than satisfactory but at 177/toilet ) 50Mtrs from the household level the IDPs shelter have got 720 liters for storage. Kachibora - >20 toilets, in poor -Yes , Human or Present Waste - Storage facility at camp Centre condition animal fecal matter substantially disposal/refuse pit and at house hold level is -Person/toilet –? in around the site less than 50mts exist in the camp Satisfactory. Access and conditions of from the shelter and it is full. -Water supply is toilets is poor insufficient Sikhendu - > 100 persons/toilet(--- Human or animal - No substantial -Waste . Catholic Church /toilet ) fecal matter in presence of disposal/refuse pit - Water supply is - Toilets are in poor present around the stagnant water exist in the camp inadequate conditions but accessible. site - Storage facilities at house hold level adequate Makutano Camp -4 functional toilets - No presence of -No stagnant - Waste - Poor water supply. - > 50-100 persons/toilet(- Human or animal water around disposal/refuse pit - Storage facility at camp -- /toilet ) fecal matter around the camp exist in the camp and at house hold level - toilets are accessible the camp but not in good not adequate - condition ASK Show -15 functional toilets - Presence of -No stagnant -There are 8 -wholesome water ground - > 100 persons/toilet(69 Human or animal water around rubbish pit almost available at the camp /toilet ) fecal matter around the camp full -Available & regular - Toilets not accessible at the camp -Distance of water about night 200m away -10 pit latrines almost full. -All the 15 pit latrines not well cleaned & maintained. Endebess IDP -14 functional toilets - Presence of - No presence -Inadequate -Inadequate (supply Camp - persons/toilet(429 /toilet Human or animal stagnant water disposal pits. 18,000ltrs but require ) fecal matter around around the 120,000 per day) - Toilets accessible the camp camp -inadequate water supply during day but at night at camp & households need light - Basic maintenance, cleaning & disinfection not available Name of Households’ Obstacles to hand Priorities expressed by the Recommendation(s) on camp posses soap. washing after population concerning water, water and sanitation in this defecation include: sanitation and personal hygiene camp; PEFA - 50% of the - no place for -Need for more Water storage -Provision of bathrooms CHURCH households washing hands containers at household level -Provision enough water posses soap - Water inadequate - Treat jiggers and conduct -Disinfectants and detergents for health education and hygiene cleaning toilets -Digging up of waste disposal -Exhausting filled up latrines pit. -Covering up the filled refuse pit -Exhausting the filled up latrine Gospel -50% of population -No hand washing -Inadequate latrines -Enough supply of clean water Explosion possess soap facility - No bathrooms -Proper waste disposal to be Fellowship -No water for -No proper disposal bins put in place Church cleaning - Exhaust the filled toilet -More toilet facilities be -Only 6,000 liters is provided available and no -Drainage of stagnant water piped water Kachibora All people given -No hand washing -Water inadequate - Enough supply of clean water Centre soap facilities -Poor sanitary disposal -Proper waste disposal to be -no water at the -poor sanitary use of toilets put in place moment -water not sufficient -More toilet facilities be -Shortage of sanitary -dusty environment provided towels -Drainage of stagnant water -Exhaust of filled up toilets - Additional water storage -All people have - More toilets. - Enough supply of clean water Sikhendu soap -no place for washing - Health education on personal hygiene - Proper waste disposal to be Catholic hands -Toilets are inadequate put in place Church -No bath room - More toilet facilities be -No proper disposal pins provided - Drainage of stagnant water Makutano - One quarter of - No place for -Two more pit latrines to be dug. - Enough supply of storage Camp the population washing hands -More bathroom and refuse disposal container. posses soap -No water for pits - Proper waste disposal to be cleaning -Lack of water containers put in place - Need for Health education - More toilet facilities be provided ASK Show - All the people - No place for -Additional water storage -Enough supply of clean water ground posses soap washing hands -Provision of more pit latrines -Proper waste disposal to be - Distance to the -Exhaust the filled toilet put in place water point -Regular cleansing of the pit latrines -More toilet facilities be -Provision of disinfectants & equipments provided for cleansing. -Drainage of stagnant water -Provision of new compost pits. -Put in place organized cleansing programme -Health education -Issuance of sanitary towels & proper disposal of the same Endebess IDP -All the people -No place for -Household storage too small - Build adequate bathrooms, Camp posses soap washing hands -Repair borehole available to facilitate - remove domestic animals -No water for supply of enough water from camp. cleaning -No bathrooms available - Provide more water storage facility for camp and household. - Repair the borehole at market centre and upgrade the health facility 4. Nutrition and food security Name of Source of Nutrition Organizations Limitations Availability Recommendation(s) on camp information assessment supporting of Secondary nutrition in the camp done or not nutritional data done activities in this camp PEFA Bishop Isaiah - Nutrition -KRCS -Special diet not - No -Mobile nutrition services Church Lusaka assessment -Catholic church available secondary to be provided not done -Lack of data available - Need for supply of unimix supplementary on nutrition and Soya milk feeding for children - Nutrition assessment to less than five years be carried and lactating and pregnant mothers Gospel Florence Tata Nutrition -Catholic church -Special diet not -No nutrition -establish feeding center Explosion assessment -Kenya Red available assessment - undertake Nutrition Fellowship not done Cross -Supplementary has been assessment Church feeding for special done. -health promotion talks groups in place -screen for anemia in -mothers lack pregnancy training on feed preparation Kachibora Wilson Nutrition -Catholic church -Transport Secondary -establish feeding center Centre chirchir assessment -Kenya Red -Personnel Funds data - undertake Nutrition done --- by Cross -Fuel/firewood available assessment whom? -MSF -health promotion talks -WFP -screen for anemia in -WOH pregnancy Sikhendu Chrisanthus Nutrition -Catholic church -lack of enough No nutrition -establish feeding center Catholic Wamela assessment -Kenya Red supplies/funds assessment - undertake Nutrition Church Wanyama not done Cross -Lack of has been assessment -UNICEF organization at site done. -health promotion talks -screen for anemia in pregnancy Makutano Francis -Not available -Catholic church -Lack of supply of -No nutrition --establish feeding center Camp Njuguna -Kenya Red food items. assessment - undertake Nutrition Cross -Lack of enough has been assessment -PCEA Church staff. done. -health promotion talks -screen for anemia in pregnancy ASK Show Joseph -Not available -Catholic church -cooking utensils -No nutrition -Provision of cooking ground wafula -Kenya Red not adequate assessment utensils. K.R.C.S Cross has been -Collection of secondary -Catholic done. data to be carried out in Dioceses of Kitale the camp Endebess William -not done -all faith based -Lack of firewood -No nutrition -Provide adequate nutrition IDP Camp Walucho, organizations -Cooking space assessment supplement e.g. Soya KRCS -Kenya Red -Lack of cooking has been -Provide vegetables & Cross facility done fruits -Provide firewood 5. Health profile, status and risks Name of Source of Prese Health outbrea Sexual Chronic Psychosocial Existen Recommendation( camp information nce of profile at ks and illnesses needs ce of s) on health health camp gender morbidi services at the servic Main health based ty and camp es in concerns violence mortalit this y camp surveill ance PEFA Bishop none Malaria, ARI, -None -None -None Need counseling -Non - improve outreach Church ISAYA Diarrhea and -Some IDP services LUSAKA Vomiting display lost hope, - introduced sorrow bitterness disease and violent surveillance behavior. Gospel Bishop -Non Malaria, ARI, -None -None -None Need counseling -Non - improve outreach Explosion ISAYA Diarrhea and services Fellowshi LUSAKA Vomiting - introduced p Church disease surveillance Kachibor Miriam -None Malaria, ARI, -None -None Yes -Non -Non - Introduce disease a Centre Lagat Diarrhea and surveillance 0710729136 Vomiting Sikhendu Chrisanthus -None Malaria, ARI, -None -None -Yes -They feel -None -Increase no of Catholic Wamela Diarrhea and ,Asthma insecure, mobile health Church Wanyama Vomiting stressed & services. isolated -Introduce disease surveillance Makutano Francis - -Childhood -None -None -Yes, HIV lack of sleep, -None - Introduce disease Camp Njuguna outrea Diarrhea & & TB talking to surveillance Tel: 072 7 ch vomiting him/herself 403 968 availa ble ASK Joseph -None Diarrhea & -None -None -None - need for a - - free health Show wafula- vomiting in counselor Existing services for IDPS ground K.R.C.S children - Provide drugs and other supplies. Endebes Simiyu PHO - - Malaria , -None Yes as Yes ,done - Temperament , - None - Need for health s IDP (cell outrea ARI,D/Vomitin they fled by MOH confusion & education Camp phone;0722 ch g depression awareness 423 055) availa - Need for mobile ble clinics 6. Health Facility Assessment Name of Source Particular Accessibilit Infrastruc Main shortages Demand and Recommendation( camp of s of y ture expressed by informant utilization of S) on referral informa facility services health facility for tion this camp PEFA Sr. Bala Kiminini -Accessible -Good -Essential equipment -significantly -So far the referral Church n/o I/c cottage available increased number of system is in place. (tel:0720 hosp(cath - Essential drugs enough patients 107113/ olic for one month 0723644 Sponsore - The consumable and 555) d) other supplies are in short supply Gospel Sr. Bala Kiminini -Accessible -Good -Essential equipment -The health facility is -So far the referral Explosion n/o I/c cottage available seeing high number system is in place. Fellowshi (tel:0720 hosp(cath - Essential drugs enough of patient and there p Church 107113/ olic for one month requires more staff 0723644 Sponsore - The consumable and 555) d other supplies are overstretched Kachibor - Miriam Cheranga -Very -Good Essential equipment: - -The health facility is - So far the referral a Centre Lagat ny Accessible centrifuge, fridge, cooking seeing high number system is in place. HC(MOH), facility & sterilizer. of patient and there -The essential drugs requires more staff available are enough. Sikhendu Chrisant Sikhendu -Accessible -Good. Essential equipment: - - The facility is -So far the referral Catholic hus medical 1/2km from none seeing many system is in place Church Wamela clinic(priva the camp. Essential drugs:- patience Wanya te partly available ma Consumables and others: partly available Makutano -Francis Location, -Accessible -Good Essential equipment: -The facility is -So far the referral Camp Njuguna Kapsara with The facility is well seeing many system is in place District obstacles equipped. patience Hospital (5KM away) Essential drugs: partly (MOH),Di: available. Kaplamai, Consumables and District:T/ others: partly available Nzoia East, ASK -Medical -District -Accessible -Good Essential equipment: - Very high -So far the referral Show superint Hosp, available but inadequate utilization of system is in place ground endent Transnzoi Essential drugs:- services a west rift available but inadequate valley Consumables and province others: available but inadequate Endebes - - -Accessible -Good Essential equipment: - -The health facility is - Referral available s IDP Endebe Endebess adequate. seeing a high but irregular Camp ss Sub – Div,T/Nzoi Essential drugs: -party number of patients District a East available and they require Hosp District Consumables and more staff others: gauze, strapping, detergents, cotton wool & antiseptics Summary of priority interventions per section per camp Camp Camp profile Sanitation & Nutrition & food Health status and Nearest Health facility hygiene security risks assessment PEFA CHURCH -Provision of - Need for -Provide health - Drugs for chronic conditions - Improve registration of detergents and nutritional services in the - Extra staff (nurses and IDPs and new arrivals disinfectants assessment - camp nutritionist) for outreach for better demographic -Provision of Feeds for special - Provide services profiling additional water groups. counseling - Provide essential drugs storage at camp - Health talks on services in the and HH level Nutrition camp. - strengthen disease surveillance Gospel Explosion - Improve registration of - More toilets - Need for - Improve - provide essential drugs Fellowship IDPs and new arrivals needed and at nutritional reproductive - initiate mobile outreach Church for better demographic accessible points assessment health services -Equip the facility profiling - Exhaust the filled -post nutritionist to - Provide up toilets camp psychosocial -Provide - Health talks on support bathrooms Nutrition - Strengthen -More water tanks - There is need for disease needed screening for surveillance - Proper waste anemia in disposal to be put pregnancy in place. Kachibora Centre - identify camp - Provide sanitary - Need for - introduce disease - Provide centrifuge, fridge, Naigum management structure towels nutritional surveillance cooking facility & sterilizer - Improve registration of - initiate proper assessment in - provide essential drugs IDPs and new arrivals waste disposal camp for better demographic system - Health and profiling - More toilet facility nutrition education to be provided to be provided -Exhaust of filled up toilets Sikhendu - identify camp - Increase number - Needs for - increase number - Provide sterilizer to the Catholic Church management structure of toilets and nutritional survey of mobile health facility, - Improve registration of bathrooms - Mobile nutrition service - Supply MOH drug ration kit IDPs -Waste bins service to be - Provide - Supply more Ant-malarials needed. provided Counseling and disinfectants - Provide Health - Health talks on services. - supply x-ray film promotion talks Nutrition - Strengthen - Supply dressing materials, - Provide enough disease water surveillance Makutano - identify camp - Increase number -carry out - increase number -provide additional drugs and management structure of toilets and nutritional of outreach non-pharm. Supplies - Improve registration of bathrooms assessment services - Provide free health services IDPs -Waste bins -establish disease to IDPs needed. - post nutritionist to surveillance - Provide Health camp promotion talks - Provide enough water Endebes - identify camp - Increase number -carry out -counseling - improve supply of essential management structure of toilets and nutritional services at camp drugs and consumables - Improve registration of bathrooms assessment - improve security at the health IDPs -Waste bins - provide additional - disease facility needed. cooking fuel surveillance at - additional funds for - Provide Health - provide training camp emergency operations promotion talks on food - Provide enough preparation water ASK Show - identify camp - Increase No. of -carry out - provide outreach -provide free health services Ground Kitale management structure toilets and nutritional services to the IDPs - Improve registration of bathrooms assessment -establish disease IDPs and new arrivals -Waste bins - provide cooking surveillance for better demographic needed. utensils profiling - Provide Health - promotion talks - Provide enough water storage at HH level Priority Interventions for Trans-Nzoia Districts Camp Profile Improving camp management and registration of IDPs Sanitation and Hygiene Increase no. of toilets and bathrooms Improve water capacity at camp and house hold level Provide soap and other detergents Improve waste management Nutrition and Food Security Carry out nutritional survey Establish supplementary and therapeutic feeding Hire more nutritionist Coordinate nutritional services Health Risks and Status Clarify roles and responsibilities with MoH taking the lead to improve coordination. Establish integrated health services (static and mobile) at camps Ensure access to health services for host communities Measles vaccination Provide counseling services Maintain regular supplies of essential drugs (incl. drugs for chronic conditions such as TB, HIV/AIDS, DM, HTN) and consumables Establish disease surveillance systems within the camps Health Facility Provide basic equipment such as examination couches, BP machines Provide theatre materials and supplies Provide lab. services Provide essential drugs and other consumables Strengthen referral system Hire extra staff where necessary Ensure security of health workers 2. Strengthen coordination mechanism at district level Establish routine meetings Prepare matrix indicating who does what and where Share MOH protocols and WHO guidelines with all partners, organize joint task forces on specific problems 3. Strengthen information management i. Strengthening the information base, conducting field assessments supporting and integrating IDSR with Nutritional surveillance ii. Disseminating information to support the right decisions: Weekly IDSR and Nutritional surveillance/Weekly ME 4. Building capacity of the health staff Train DHMTs/Health Workers and partners in the district on emergency preparedness, response and monitoring Share best practices and lessons learnt 5. Filling identified gaps Support DMOH to respond to crisis effectively o Hiring additional staff o Transport cost for supervision and mobile services o Health workers allowances o Accelerated vaccination activities o Communication (air time) o Printing/photocopy of reporting tools- growth monitoring tools o Support in providing essential additional drugs, equipment and supplies Annex IIb- IRA report from 1st round teams INITIAL RAPID ASSESSMENT FOR INTERNALLY DISPLACED PERSONS IN UASIN GISHU DISTRICT INITIAL RAPID ASSESSMENTFOR IDP CAMPS IN UASIN- GISHU DISTRICT TARGET AREAS: TURBO/NYS, ASK SHOW GROUND, MUNYAKA PCA CHURCH AND BURNT FOREST/CATHOLIC CHURCH Date of Assessment – 23rd January 2008 Assessment Team A. Munyaka PCEA NAME ORGANIZATION. Rose Kogo MoH U/Gishu Michael Mwasame MoH U/Gishu Abdi Hassan WHO John Kibet AMPATH Tabitha Njoroge KRCS B. ASK SHOW NAME ORG. TITLE PENINAH KIPKOGEI MOH DPHO MOHAMMED ELMI UNICEF H/SPECIALIST HENRY CHEROP MOH DCO JOSEPH RUGUT MPATH/IRC FIELD CO-ORD. DAISY KOSGEI RED CROSS VOLUNTEER GLADYS KOECH MOH DHEO LANGAT BERNARD MOH PTLC C. TURBO NAME ORG. TITLE Dr. S. C. Bii MOH Dr. D. A. Maalim WHO/EHA David Maina KRCS Joash O. Nyang’ao MOH Nutritionist Eunice Rotich MOH PHO Wilfred kiprono AMPATH/IRD Clinical Officer C. BURNT FOREST/ST. PATRICK’S CATHOLIC CHURCH NAME ORG. TITLE Caleb Otichilo- MOH/U/Gishu Nancy Esavwa- MOH “ Laban Kiprop- MOH “ Rose Kioko- AMPATH/IRD Senewa Montet-Timayio IRD Consultant EXECUTIVE SUMMARY OF IRA UASIN –GISHU DISTRICT Date: January 30, 2008 Introduction This assessment was jointly carried out by the Ministry of Health supported by partners including WHO, UNICEF, AMPATH/IRD, Kenya Red Cross Society and IMC as a follow to the post election clashes that affected the district. Uasin Gishu District is one of the 27 districts of Rift Valley province. It borders Transnzoia in the north, Marakwet and Keiyo districts in east, Koibatek to the south east, Kericho to the south, Nandi north to the south west, Nandi south to the west, and Lugari to the North West .the district has a total area of 3,327.8 km2. The total population of the district as of 2007 is projected at 777,337. The district headquarter is in Eldoret, which is located approximately 300 kilometers North West of Nairobi. IDP Situation The current situation in the district is calm but fluid. The total number of IDP camps in the district currently stands at 11 with the major ones being ASK Show ground, St. Francis Catholic Church Burnt Forest, Matharu and Burnt Forest. This is however constantly changing as some camps are merged. The North Rift region where Eldoret falls has approximately 150,000 IDPS resident in various camps and neighboring host communities. Food and Nutrition In all the camps food distribution was on going carried out by Kenya Red Cross and other partners. There are however concerns on the quality of food since it is not balanced. Nutritional assessment had been done but the process was not completed and is ongoing. There are however concerns of malnutrition emerging as a major concern in the camps. As a result, plans are complete to establish supplementary and therapeutic feeding centers at the main camps. This will largely be supported by UNICEF donated CSB/UNIMIX and nutritionists hired by MOH/UNICEF. Water and Sanitation Overall, attempts have been made at all camps to provide toilets and clean water. The number of toilets in most camps however remains low with an average of more than 100 persons per toilet. Subsequently, solid waste management remains problematic. It is recommended that more pit latrines should be constructed and additional waste disposal pits be dug in most facilities. In some cases exhaustion of those filled up could help relieve the stress in short term. Water storage facilities at camps and at house hold level should be enhanced. Finally hygiene commodities such as soap and sanitary pads should be provided in adequate quantities. Health Services All the IDP camps are currently receiving some basic level of health services. Some have static temporary facilities while others rely on outreach services. There have been no outbreaks reported in any camps. Notably, normal health services have been disrupted with several clinics closed and a number of health workers displaced. Most of the AIDS patients who are on ARVS are currently being tracked to ensure the treatment is not disrupted. There is however a need for better coordination with the MOH taking a lead in most of the processes. Some essential services were lacking in most camps especially PEP kits and Condoms. There is need to develop effective interventions, services and coordinated community responses to sexual violence against women (SGBV). Key Health Recommendations • Arrangements should be made to restore normal services by reopening all the closed facilities • There is need for better coordination of all the health response activities under the leadership of the Ministry of Health • Mobile/outreach services will be jointly conducted by all the partners with the MOH doing the central coordination of the activities. • Efforts should be made to ensure the other communities other than theIDPs should access health care services. • Mass immunization should be carried out in all the camps. During this exercise Measles and Polio vaccines should be administered to all under fives together with deworming and Vit A supplementation • Strengthening of disease Surveillance teams with specific early warning systems activated at each camp. • The DHMT should be facilitated with additional financial resources and other tools to enable them respond appropriately to the crisis • HMIS tools are lacking in most health facilities in the district. Urgent efforts should be made to avail these tools for use by end users e.g. the road to health card, EPI, Nutritional assessment tools. • Assessment and training on SGBV issues to be conducted 1. Introduction Uasin Gishu District is one of the nineteen districts of Rift Valley province. It borders Transnzoia in the north, Marakwet and Keiyo districts in east, Koibatek to the south east, Kericho to the south, Nandi north to the south west, Nandi south to the west, and Lugari to the North West .the district has a total area of 3,327.8 km2. Eldoret, the headquarters of the district is also the largest commercial centre in the North Rift and is approximately 300km North West of the Kenya’s capital Nairobi. The district has 114 health facilities as follows: 10 Hospitals 23 Health Centers 81 dispensaries Health indices The Infant Mortality Rate as of 2007 is estimated at 54/1000; fertility rate of 7 2. Background Violence erupted in various parts of the district following the Kenya General elections in December 2007, resulting in injuries, deaths and displacement of human populations. Election related violence occurred in the district in 1992, 1997 and 2002 but the current violence is by far the worst, leading to loss of life, property and displacement of many people. This displaced population lives in four major camps but the situation is still fluid the number and population of these camps change daily. Resettlement in camps may entail; • high population densities, • inadequate shelter, • poor water supplies and sanitation, • And a lack of even basic health care. In these situations, there is an increased threat of communicable disease and a high risk of epidemics The Top 4 Priorities in complex emergencies such as this one are; A. Conducting rapid health assessment to Identify main disease threats, including potential epidemic diseases Identify priority public health interventions Identify the lead health agency Establish health coordination mechanisms B. Prevent communicable diseases Select and plan sites Ensure adequate water and sanitation facilities Ensure availability of food Control vectors Implement vaccination campaigns (e.g. measles Provide essential clinical services Provide basic laboratory facilities C. Set up surveillance/early warning system Detect outbreaks early Report diseases of epidemic potential immediately Monitor disease trends D. Control outbreaks Preparation o outbreak response team o Stockpiles o Laboratory o standard treatment protocols Detection o Surveillance/early warning system Confirmation o Laboratory test o Management Response o Investigation o Control measures In view of the above priorities, the Ministry of Health with support from its partners decided to carry out Initial Rapid health Assessment (IRA) in the IDP Camps in all the districts affected by the post – election crisis. Objectives of the IRA To assess how the populations have been affected by emergency. Who is most vulnerable? Estimate the number of IDPs To establish whether interventions are necessary to prevent further harm or loss of life. If so define the type and size of interventions and priority activities; To establish whether there are continuing or emerging threats that may escalate the emergency. If so What resources are already present (infrastructure and institutions) that could assist in the response • To disseminate the findings among partners to assist with planning and resource mobilization . .3. Methodology All camps registered with the DMOH at that point and which were not targeted for relocation were considered for the assessment. These were Munyaka PCEA; ASK Show ground, St Patrick’s Catholic Church - Burnt Forest, and Turbo Police station. Assessment teams consisting of 5-6 members were formed. Each team had 2 DHMT members one of them the team leader. The other members were drawn from the partners in the district These teams were then taken through the IRA tool Once in the camp, team reported to site office or management, following protocol as necessary. Data was collected by o Interviewing key informants o review of existing information, o Visual inspection of the affected area Interviews were conducted with key personnel in the camps and with members of the affected population. These included: o IDP camp management leaders o health workers o personnel from local and international emergency response organizations o individuals in the affected population After completing collection of the data, each team met to wrap-up information for the site. This information was summarized for each section of the tool in each camp using a format prepared by WHO and adapted by the partners. These summaries were then brought together from which priority interventions were drawn for respective camps and district 4. Findings 1. Camp information: Name of camp Div/Dist. Source of info. Existence of management Registration of new structure in the camp arrivals MUNYAKA/ Munyaka Estate, Eldoret Pastor Simon Maina IDP Committee in place Registration of all PCEA. Municipality, approx. 4km from persons in the camp town centre along Eldoret-Iten on-going Road ASK SHOW Kapseret location Lydia Kwamboka - KRCS IDP Committee in place + Yes by KRCS Kapseret division. partners with red cross as lead agency TURBO Turbo Esther Wati- DPR Red Cross OCPD, OCS Done by red cross Elizabeth & Jane- Nurse, RCO MOH Camp committee headed by George Ngarau – Community, chairman of IDPS Chairman -IDP RED CROSS – DPR officer BURNT Ainabkoi, Francis Wainaina-Patron Yes, the committee has seven The situation is very FOREST/ST. Uasin Gishu Ndirangu Wanjohi-Secretary members’ two women and five fluid with IDPs high in PATRICK’S S. Waweru, B. Karanja, A. Njoki, T. men. . and out flows. CATHOLIC Wangari-members CHURCH -Gachichu Ngero- PHT, Population Profile in the Camp: Name of camp Total Women Male <5yrs pop. No. of Youth Vulnerable person(s) Elderly pregnant women Munyaka/ 3,000 741 1005 Women not 7 girls Not known PCEA (24.7%) (33.3%) Known ASK Show 13,551 8,131 4,753 1,254 677 Not known Not known Turbo 4094 1,800 1,471 50 9 26 Burnt Forest/St. 5,858 607 2,066 1041 81 1,792 100 171 Patrick’s Catholic Church 2. Organizations and partners in the district and/or camp Name of camp partners in the district and/or camp MUNYAKA/ KRCS PCEA Open Arms (FBO) ASK SHOW GOK (MOH,WATER,PA,MEN), KRCS/ICRC,AMPATH, IOM, UNICEF, CRS, IRD and others TURBO Red Cross, WFP, UN, UNICEF, ICRC, MOH/AMPATH/IRD, MOH/APHIA II, MSF BURNT FOREST/ST. PATRICK’S CATHOLIC CHURCH Catholic church, AMPATH/IRD, Red Cross, UNICEF, MSF, Deliverance Church 3. Sanitation and Hygiene. Name of camp Presence and number of Human or animal Stagnant water Waste Piped water supply functional toilets fecal matter in in the camp disposal/refuse pit (Municipal) to Camp exist. around the site exist in the camp. MUNYAK/ PCEA -9 Functional toilets (4 -No human or animal -No substantial -A waste -No storage tanks the camp reserved for women) fecal matter in around presence of disposal/refuse pit -< 25% of households have -> 100 persons/toilet the site stagnant water in exist in the camp but water storing containers & -Access – easy (lights the camp is already full average household water available at night) storage capacity is l< 10 liters Cleaned twice a day ASK SHOW -Access and conditions of -YES esp. outside the -No. -YES, 20 bins,1 -Piped water, 4 points with @ toilets fair latrines waste disposal pit, 6 taps -Obstacles to hand washing crude burning - Storage at house hold level after defecation 25 liters container, 1 main tank approx. 10000lts TURBO POLICE -14 toilets, 2 full -Yes. -None -Collected by NYS -Piped water stored in tank STATION/NYS -Person/toilet –:319/1 and burned. (10,000 lts), 2 taps for -Far from most of the people -Camp was fairly community from the tank -Inaccessible at night, No clean -Long queues doors, Foul Smell, Other source - spring & river -About half the population not treated defecate in bush -Storage at hold level – 10L Name of camp Human or animal Stagnant water Waste Water Supply fecal matter in in the camp disposal/refuse pit around the site exist in the camp. BURNT - 15 pit latrines & 2 -human waste and -At Water point & No disposal pit, no - Army and Municipal supply FOREST/ST. bathrooms animal waste visible washing areas waste collection and water to one storage tank, PATRICK’S -390 per toilet especially behind because poor waste are disposed 5000 liters and households CATHOLIC - The services are charged toilets, building and drainage system behind buildings and issued with 20ltrs jerrican by CHURCH 1-2/= for toilet access and tents. tents. UNCEF. 3/= for bathroom. Name of camp Households posses Obstacles to hand Priorities expressed by the population Recommendation(s) on water soap. washing after concerning water, sanitation and and sanitation in this camp; defecation include: personal hygiene MUNYAKA/ - Less than 25% of -Lack of soap -Need for high volume Water storage tank(s) -Provision of bathrooms PCEA the households -Adequate water at -Need for more Water storage containers at -Provision of sanitary towels and posses soap household level household level disposal bins -Disinfectants and detergents for cleaning -Provision of detergents and toilets disinfectants -Exhausting filled up latrines -Digging up of waste disposal pit. Bathrooms -Covering up the filled refuse pit -Exhausting the filled up latrine ASK SHOW -supply of1 bar NO hand washing -Inadequate latrines, latrines almost full, - Improvise hand washing cans, soap/household/--2 facility at latrines more water points. -provide exhauster/digester weeks but chemicals/ cont’d health talks inadequate TURBO All people given -No hand-washing -Water inadequate -More toilets needed and at soap facilities -No bathrooms – 6 being constructed accessible points -Shortage of water -Few toilets – 6 pit latrines being constructed --More water points needed -Most defecate in bush -Latrines far -More water tanks needed ---Disinfectants needed -More storage facilities for families Burnt Not available was System and water not -adequate and safe water -Bathrooms needed urgently Forest/St. given during the first Available. -adequate storage materials -Waste bins needed. Patrick’s week. -Disinfectants for cleaning Catholic -H/E personal and environmental hygiene Church -provision of sanitary pads for ladies -increase the number of toilets - stop charges for toilet use 4. Nutrition and food security Name of Source of Nutrition Organizations Limitations Availability of Recommendation(s) on camp information assessment supporting Secondary data nutrition in the camp done or not nutritional activities done in this camp Munyaka Grace Munohi, - Nutrition KRCS - Inadequate feeds for - No secondary - Need for nutritional PCEA Kevin Githinji assessment special groups data available assessment in this camp and Simon done but no (infants, aged & sick) on nutrition - Provision of cooking utensils Maina data available - No fuel to cook food - Provision of cooking fuel - Lack of utensils - Feeds for special groups Burnt Forest Committee - Done by - KRCS through - Staff shortage - not available - Needs for nutrition survey. Catholic members KRCS & MOH. UNICEF and MOH - Information Sharing to avoid Church AMPATH - Severe 10 - AMPATH duplication. Moderate 30, - Improve f coordination. - MUAC, Wt/Ht -Capacity building was used as -increase supply of non-food data collection. items Eldoret ASK Jackline Akinyi Assessment - KRCS, - Inadequate quantity, -Available - Need proper nutritional Showground done - MOH, - lack therapeutic 10-15% mod. & - Establish - UNICEF, - preparation-powder 5% severe nutritional/therapeutic centers - AMPATH /IRD milk and care centers, Walnut. in <5 - increase food ratios. -Projected 11% - inadequate staff rise & Risk - is 45% Turbo NYS Esther Wati – Assessment KRCS, WFP, ICRC, A lot of population Not Available. Nutritionist needed in camp Camp Red Cross done by MoH GOK movement into and Vit A given to - Need for data on nutritional NO DATA out camp <5 assessment in camp 5. Health profile, status and risks ASK- UASIN- BURNT FOREST MUNYAKA TURBO GISHU Source of Lydia Kwamboka MOH-Ms. Beatrice Waweru, Grace Munohi Elizabeth Mulinga – Nurse 0722297192 Information AMPATH-Hosea Some Jane Markoko Presence of Health Static dispensary MOH and AMPATH services 500 No health services exist 2 facilities, one in camp run by MOH/Red Cross services in the meters from the camp in this camp other at NYS camp managed by NYS staff camp Turbo Health Facility used for referral Health profile at Both facilities are understaffed (burn out) camp Basic Lab services lacking (malaria and stool) RH services lacking (delivery couch) Essential drugs and dressing materials available Main health ARI, Diarrhoeal Diarrhoeal, RTI, Malaria Diarrhea in children URTI, Clinical malaria, Diarrhoeal diseases concerns diseases, malaria, Malaria injury Acute respiratory inf. Outbreaks none Diarrhoeal due to poor sanitation No Outbreaks reported No concerns of outbreaks and lack of water in this camp. Sexual and gender None reported 2 cases of rape report and expect 6 year old girl sexually None/ not addressed based violence an increase. assault by her father Chronic illnesses Diabetes, Asthma, diabetes, asthma, HIV, Asthma, Hypertension ( Hypertension, Diabetes HPT, HIV/TB Hypertension Diabetes (1), HIV/AIDS (Community believes that TB and HIV are there (3) but they have not come out in the open) Psychosocial Counselors diabetes, asthma, HIV, No counseling services Yes a lot of depression needs available Hypertension exist in this camp Existence of No deaths occurred in The first 2 weeks there were 2 deaths reported by morbidity and No- MOH 1 suicide (stress), 2 other causes this camp in the last the community to the police, query pneumonia mortality one week. reported???, for the last seven days no death surveillance have been have reported surveillance in this Yes-MOH YES, by the MOH AMPATH, Red Cases/incidents No surveillance done camp Cross. reported to the Pastor’s office Specific mortality No No reported deaths rates ASK- UASIN- BURNT FOREST MUNYAKA TURBO GISHU Recommendation(s MOH to take - Operationalize the catholic clinic -Provide health services Need for a nutritional survey ) on health services leadership. - Mobile clinic to cover the people in the camp Need for disease surveillance for this camp who can not access the camp - Provide drugs for More staff needed facilities due to insecurity. patients with chronic Improve on reproductive health services - Improve security for the people to illnesses including ARVs Provide basic lab services e.g. stool, malaria, access the MOH clinic. - Facilitate obstetric Provide psychosocial support - Avail Nutrition supplements in the services in the camp. clinic. - Provide counseling - Address the issues of MOH staff services in the camp. displacement. - Provide maternal child - Counseling services e.g. health and FP, and psychosocial services. HIV/AIDS prevention - Supply drugs for Chronic disease services Summary of priority interventions per section per camp Camp Camp profile Sanitation & Nutrition & food Health status Nearest Health facility hygiene security and risks assessment Munyaka PCEA - identify camp management -Provision of bathrooms - Need for nutritional -Provide health services - Antibiotics (Adults and children) structure -Provision of sanitary assessment in this camp in the camp - Analgesics - Improve registration of IDPs towels and disposal bins - Provision of cooking - Provide drugs for - Drugs for chronic conditions and new arrivals for better -Provision of detergents utensils patients with chronic - Minor Theatre supplies and materials demographic profiling and disinfectants - Provision of cooking illnesses including ARVs - Laboratory reagents and supplies -Digging up of waste fuel - Provide counseling - Extra staff (nurses and nutritionist) for disposal pit. - Feeds for special services in the camp. outreach services -Covering up the filled groups. - Provide maternal child refuse pit - Health talks on Nutrition health and FP, and -Exhausting the filled up HIV/AIDS prevention latrine services - Provide Health - strengthen disease promotion talks surveillance Turbo - identify camp management - More toilets needed and - Need for nutritional - More staff needed - provide suction machine structure at accessible points assessment in camp - Improve reproductive - provide oxygen to referral facility - Improve registration of IDPs --More water points health services - supply antibiotics and analgesics and new arrivals for better needed - Nutritionist needed - Provide basic lab - improve security for staff demographic profiling -More water tanks in camp services in referral facility - improve security so that host community needed - Health talks on Nutrition - Provide psychosocial can use facility -More storage facilities support - mobile outreach if above not possible for families - Strengthen disease - Provide Health surveillance promotion talks . Burnt Forest - identify camp management -Bathrooms needed Needs for nutritional - Operationalize the - Provide sterilizer to the facility, structure urgently survey. catholic clinic - Supply MOH drug ration kit - Improve registration of IDPs -Waste bins needed. - Information Sharing to - Mobile clinic for host - Supply more Anti-malarial drugs and and new arrivals for better - Provide Health avoid duplication. community unable to disinfectants demographic profiling promotion talks - Improve coordination of access Camp clinic due - supply x-ray film response to insecurity. - Supply dressing materials, -increase supply of non- - Improve security for the food items. people to access the - Health talks on Nutrition MOH clinic. - Provide Nutrition supplements in the clinic. - Address the issues of MOH staff displacement. - Provide Counseling services. - Supply drugs for Chronic disease - Strengthen disease surveillance ASK Show - identify camp management - Provide hand washing - Nutritional survey - MOH to take - MoH to take lead role structure facilities near latrines - Establish nutritional or leadership. - provide examination couches - Improve registration of IDPs - Exhaust filled up therapeutic centers - improve patient privacy and new arrivals for better - Strengthen Disease latrines - Health talks on Nutrition - Improve referral demographic profiling - Provide Health surveillance promotion talks 1. Priority interventions to address the crisis in the district 1. Address camp specific identified priorities i. Improving camp management and registration of IDPs ii. Promote camp and personal hygiene Increase no. of toilets and bathrooms Improve water capacity at camp and house hold level Provide soap and other detergents Improve waste management iii. Nutrition and food security Carry out nutritional survey Establish supplementary and therapeutic feeding Hire more nutritionist Coordinate nutritional services iv. Health status and risks Clarify roles and responsibilities with MoH taking the lead to improve coordination. Establish integrated health services (static and mobile) at camps Ensure access to health services for host communities Measles vaccination Provide counseling services Maintain regular supplies of essential drugs (incl. drugs for chronic conditions such as TB, HIV/AIDS, DM, HTN) and consumables Strengthen Disease surveillance v. Nearest Health Facilities Provide basic equipment such as examination couches, BP machines Provide theatre materials and supplies Provide lab. services Provide essential drugs and other consumables Strengthen referral system Hire extra staff where necessary Ensure security of health workers 2. Strengthen coordination mechanism at district level i. Establish routine meetings ii. Prepare matrix indicating who does what and where iii. Share MOH protocols and WHO guidelines with all partners, organize joint task forces on specific problems 3. Strengthen information management i. Strengthening the information base, conducting field assessments supporting and integrating IDSR with Nutritional surveillance ii. Disseminating information to support the right decisions: Weekly IDSR and Nutritional surveillance/Weekly ME 4. Building capacity of the health staff i. Train DHMTs/Health Workers and partners in the district on emergency preparedness, response and monitoring ii. Share best practices and lessons learnt 5. Filling identified gaps Support DMOH to respond to crisis effectively o Hiring additional staff o Transport cost for supervision and mobile services o Health workers allowances o Accelerated vaccination activities o Communication (air time) o Printing/photocopy of reporting tools- growth monitoring tools o Support in providing essential additional drugs, equipment and supplies Recommendations One page executive summary Merge introduction and background sections of above Nutrition- incorporate nutrition assessment data that is available by 29th January, 2008 Comment on how the normal services have been affected – 6 clinics closed, numbers of staff that have been moved, some clinics functioning at suboptimal level Comment on IDPS who are not on Annex III- Health Report generated using completed IRA forms as basis Kenya Initial Health Assessment Draft: February 6, 2008 Data used dated: February 5, 2008 Introduction Following the national presidential and parliamentary elections on December 27th 2007 Kenya has experienced post election violence. Mainly six provinces have been affected by the violence that has resulted in people being internally displaced. The Provinces affected are: Nairobi, Central, Rift Valley, Nyanza, Western, and Coast. In order to assess the health services for and health status of people in IDP camps and host communities the Ministry of Health (MoH) in collaboration with partners adapted the United Nations Inter-Agency Standing Committee Initial Rapid Assessment Tool. In addition, an assessment tool, Health Facility Report Form, was developed to assess the status of the health services available for the affected communities. The purpose of the Initial Health Assessment is to provide an overview of the emergency situation in order to identify the immediate impacts, estimate needs of the affected populations, and define priorities for action. Methodology To support the PMOs to facilitate the assessment UNICEF and WHO sent officers to the six affected provinces. The target for the assessment was the registered IDP camps, the camps nearest health facility and the health facilities in the affected areas. Field teams consisting of 3-5 members from MoH and partners went to the IDP camps and the camps nearest health facility assessing the situation using the Initial Rapid Assessment Tool aiming to assess all IDP camps and their nearest health facility, while DMOs were asked to fill in the Health Facility Report Form for the affected district. Data was collected using interviews with key informants, review of existing information, and visual inspection of the affected area. Key informants identified were IDP camp management leaders, health workers at the camp, personnel from local and international emergency response organizations, and individuals in the affected population. Due to the fluid situation and the changing security situation the data collection was conducted on different dates. Rift Valley: 19th of January 2008 to the 23rd of January 2008. Nairobi: not included in the results yet Central: 24th to 28th of January 2008 Coast: Not conducted since the camps have been closed down Western: Not conducted due to security issues Nyanza: Not conducted due to security issues The number of camps in the provinces at the time of data collection was (data from the Presidents National Operational Center for information as of Jan 25th 2008): Rift Valley: 132 Nairobi: 2 Central: 12 Coast: 0 Western: 21 Nyanza: 25 Total: 192 The districts in which the Initial Health Assessment was conducted are: Province District No of camps Rift Valley Kipkelion 4 Nakuru 5 Uasin Gishu 8 Central Kiambu 5 Results The following describes the initial results of the assessment Response rate 22 of the 192 camps have been assessed so far giving an overall response rate of 11.5% for the Initial Health Assessment. A total of 17 of 132 camps equal to 12.9 % were assessed in Rift Valley. In Central Province 5 out of 12 camps were assessed giving a response rate of 41.7 %. Population in camps The total IDP population in the assessed camps was estimated to be 55,065 of which 7115 were under five years old and 6964 were pregnant. Other vulnerable groups identified in the camps were: People on ARVs, people with physical and mental disabilities, people who are ill, elderly, young people, orphans and widows. Water and sanitation Sanitation 6 (27.3%) out of the 22 camps reported that a number of people, out of 10, on average, currently use “the open, not in a defined and managed defecation area” for defecation: Average number of people No of camps 1 1 2-3 3 4-5 1 >5 1 4 (18.2 %) camps reported that a number of people, out of 10, on average, currently using “a defined and managed defecation area” in the four reporting camps are: Average number of people No of camps 1 0 2-3 1 4-5 0 >5 3 Other places to defecate are Public toilets (pit latrines, pour-flush latrines, flushing toilets etc) and family toilets and shared family toilets. The numbers are Average number of people No of camps defecate are No of camps family toilets Public toilets (pit latrines, and shared family toilets pour-flush latrines, flushing toilets etc) 1 0 1 2-3 1 0 4-5 1 0 >5 8 2 It thus looks like public toilets is the most used place for people to defecate. The average number of users per functioning toilet/latrine at the camps (21 camps reported) calculated using the number of functional toilets and the no of IDP in the camps: Average number of users per No of camps (% of camps functioning toilet reporting) <=20 3 (14.3) 21-50 2 (9.5) 51-100 4 (19.0) >100 12 (57.2) When looking at the district it is Kipkelion, Nakuru and Uasin Gishu that has the most users per functioning toilet. The presence of human faeces on the ground and around the site was recorded by 7 (31.8 %) of the camps. Worth noticing is that none of the camps in Kiambu has human faeces on the ground. Human faeces present No of camps (% of all camps) Yes 7 (31.8%) No 11 (50.0%) Not recorded 4 (18.2%) Solid waste management The presence of solid waste including household waste, building rubble, animal carcasses and animal faeces on and around the site, the proximity of solid waste shelters as well as the no of pits per population were also assessed. Out of the 22 camps 13 (59.1%) camps had solid waste including household waste, building rubble, animal carcasses and animal faeces on and around the site. 12 out of the 13 camps recorded that the waste was within 50 m of the shelters. 3 (13.6%) camps did not have solid waste including household waste, building rubble, animal carcasses and animal faeces on and around the site. 6 (27.3%) camps did not respond to this section. The number of waste disposal pits in the camp was recorded by 18 (81.8) of the 22 camps. Worth noticing is it that the camp with more than 2 waste disposal pits had four pits, however, solid waste was still visible on the ground. The number of people pr disposal pit can explain this, as 75 % (9) of the camps reporting to have a pit have more than 200 people per pit. No of waste disposal pits No of camps (% of camps reporting) 0 6 (33.3) 1 11 (61.1) >2 1 (5.6) Average number of people No of camps (% of camps per disposal pit with pits reporting) (n=12) <=50 0 (0.0) 51-100 1 (8.3) 101-200 2 (16.7) >200 9 (75.0) The proximity of stagnant wastewater to shelters and water sources were reported by 9 and 7 camps respectively out of the 22 camps: Proximity of stagnant No of camps (% of camps wastewater to shelters reporting) Substantial, LT 50 m 4 (44) No substantial presence 5 (55) Proximity of stagnant No of camps (% of camps wastewater to water sources reporting) Substantial, LT 50 m 1 (14.3) No substantial presence 5 (71.4) DNK 1 (14.3) Hygiene The proportion of households possessing soap was reported by 20 (90.9%) of the 22 camps. Proportion of households No of camps (% of camps possessing soap reporting) ¼ 7 (35) ½ 1 (5) ¾ 4 (20) All 8 (40) The average total capacity of water containers per family (camps=18): The average total capacity of No of camps (% of camps water containers per family reporting) (liters) 0-10 7 (38.9) 11-20 6 (33.3) 21-40 2 (11.1) >40 3 (16.7) Of the districts Kiambu has the best water capacity per family as all three camps with a capacity over 40 liters are located in Kiambu. In addition, none of the camps in Kiambu has an average total capacity less than 11 liters per family. Uasin Gishu and Nakuru have the camps with the lowest average total capacity of water containers per family, as 7 out of 10 camps in the two districts have a capacity of 0-10 liters. Nutrition and food security Nutritional and food aid programs The nutritional programs ongoing in the camps are: Initial nutritional screening, MUAC for under 5’s, supplementary and therapeutic feeding, food aid, and vitamin A supplementation. The key challenge for the nutritional programs is staff shortage. Vitamin A distribution was reported as ongoing by 7 (31.8%) out of the 22 camps. Food aid programs are done by well-wishers, Kenyan Red cross, WFP, Catholic diocese of Nakuru, and GOK. Nutritional assessment and acute malnourishment A nutrition assessment has been reported done by 9 (40.9%) camps. 10 (45.5%) of the camps have reported that a nutritional assessment has not been done. 3 (13.6%) camps have not reported on this issue. See figure 1. Figure 1 Missing 14% Yes 41% No 45% 4 camps reported acute (moderate and severe) malnutrition in children under 5: Camp % children under 5 years of age with acute malnutrition (moderate and severe) Kunyank 25 Victoria Monast 17 Eldoret ASK showground 20 Turbo police station 12 Health risks and health status Health services at the camps 13 (59.1%) camps out of the 22 camps reported having health services. Type of Health service No of camps (% out of reporting camps) Static health facility 3 Outreach services 8 Both static and outreach services 2 Disease control programs are reported to exist in camps, however, 9 (40.9%) camps report that no programs exist in the camps. One camp (Kandutura, Nakuru) reported that all programs existed in the camp. Disease control program No of camps providing the service (% out of all camps) Immunization 7 (31.8) TB 4 (18.2) Malaria 6 (27.3) HIV 7 (31.8) Control of Diarrhoeal diseases 6 (27.3) Family planning and ANC 6 (27.3) Deliveries 2 (9.1) Nutritional supplementation 9 (40.9) Of all programs nutritional supplementation has the widest coverage in camps (40.9%) whereas only 9.1% of the camps have safe deliveries. Main health concerns The top three health concerns in the camps are: 1. ARI including URTI 2. Diarrhoea 3. Fever including Malaria Sexual and gender based violence Three camps (Kirathimo, Burnt Forest catholic church, and PCEA Munyaka) reported cases of sexual and gender based violence. In all three camps, two cases reported. Chronic diseases 16 (72.7%) out of the 22 camps have reported that there are patients suffering from chronic diseases among the affected population. The diseases identified are: Hypertension, HIV and AIDS, Asthma, Diabetes, and TB. Psychosocial needs Manifestations of psychosocial need identified in the camps are: Anger, violence, anxiety, miscarriages, depression, headache, not talking, and stress. Mortality The existence of mortality surveillance in the camps are shown in the table below: Existence of mortality surveillance No of camps (% of all camps) Yes 4 (18.2%) No 14 (63.6%) Not recorded 4 (18.2%) Because of the low rate of existing mortality surveillance there is no substantial information on the number and causes of death. Indications does however show, that burns, clashes and injuries are the main causes of deaths with pneumonia being ranked as the second highest cause of death. Analysis Discussion Annex IV- IRA Report from 2nd round teams Report on Initial Rapid Assessment for Ekerenyo, Keroka and Kitutu Central Preamble The exercise was conducted by four Research Assistants from Merlin, Health and Water and Kenya Red Cross. The exercise took two days, with the first day going through the guideline for data collection. The assessment tool was too detailed which actually needed a very detailed training to understand the tool well. All the same the RAs acquainted themselves with the tool for one day and work commenced on the second day which took three days. The assessment was intended to be done at the initial of the crisis, but since it was overtaken by event. The team was to do the assessment in three camps in Nyamira and Masaba/Manga Districts Nyanza province. Summary of the camps visited 1. Ekerenyo Camp The work started with assessment in Ekerenyo IDP camp. The camp is the largest camp in the greater Kisii District. It accommodated 1,393 Internally Displaced Persons staying within the camp, although some are staying with the host community. There were 82 tents and the tents are of different sizes. There are family, communal and special cases tents. The family tent was accommodating 4-5 people. The communal tent was accommodating 14-21 people. Stakeholders on site The RAs met the various agencies assisting the IDPs in the camp as shown in the table below; NGO Support Kenya Red Cross Food, shelter, medicine Merlin Medicine, water container, ITNs, mattresses, water treatments kits, sanitary towels Health and Water Foundation Family Kit, sanitary towels, tents, water treatments kits ADRA Kenya Cloths, medicine, kitchen sets, blankets, food Young Women Christian Association Clothes, food African Girl Child International Clothes, food APHIA II Nyanza Water tanks World Vision Mobilets, water tanks, clothes, sanitary towels Unicef Food, ITNs, drugs Medicine San Folunteer (MSF-F) Drugs Churches/Well Wishers/Community Food, clothes and spiritual nourishment Situation analysis The Ekerenyo camp is the largest camp in the greater Kisii District with a large population. The camp is very much congested and has many issues to be addressed as indicated below; Sanitation This is not very well attended to due to the large population; the management of the camp is poor. The solid waste disposal is poorly managed hence there are avenues of a disease outbreak. The latrines are few compared to number of users (IDPs). The digging of latrines every after one has been filled up poses a big danger as there is limited land. The drainage system within the tents was not well done; this might be a breeding habitat for mosquitoes. Water The water source for drinking and cooking was from a spring and the drainage is poor. However, water fetched from the spring is treated by the Kenya Red Cross staffs who are manning the camp. There are latrines built near this spring which are a health hazard to the water users. There is an open river which being used by IDPs for bathing, washing clothes/utensils and the community also use this river for animal consumption. The river is also used for car washing. This poses a big risk of contamination and possible outbreak of a waterborne disease to the community and the IDPs. Health Status The RAs visited the health facility which serves the IDPs. They found out that some NGO’s are assisting within the Health facility i.e. Merlin in collaboration with MoH has set up the clinic within the health facility which is servicing only the IDPs, Red Cross which is also is supporting the drugs and allowances to the health volunteers offering the work in the facility. They also assist with the ambulance in case there are emergencies in the facility. Otherwise the health facility was well managed by the clinical officer who was also in charge. Market The RAs found that some the IDPs are the ones doing trading in the nearby market though every trader was complaining that the price of the commodities have gone high which is not avoidable to the community and the IDPs. Though the team managed to list done the prices of the products found in the market. (Found in assessment tool). Conclusion There is need for the IDPs to be trained on Health matter since the team found that most of them hygienically were poor. There was scarce of food 2. Keroka IDPs Camp Situation analysis This camp was not as big has the other camps, it was much organised as compared with other camps, when the team tried to assess the situation around the camp is perfectly managed in other word the camp was clean and everyone was responsible in taking all the roles given by team leader, never the less, the Kenya Red cross team leader together with the camp chairman was well coordinated. Although the camp lacked clinic inside the camp but Merlin promised them twice a week mobile clinic. Food distribution was well done and everyone in the camp was satisfied. Although the IDPs requested to return back to their homes if possible very soon as the government promised them. Sanitation This well attended to and they had a team who are responsible in managing the sanitation but they were worried of the of the latrines since they were almost full how they will be managed the land for digging the latrines was limited the local authorities who accommodated them, it was found as a big challenge in the camp. The camp was sprayed to control mosquitoes. Water The IDPs are getting water from the spring which in the 1 kilometres from the camp site, it is well protected and also inside the camp the water they are using for cooking and drinking is well treated by the Kenya Red cross and all issues of water is well catered by the Kenya red cross Health volunteer. The team noticed that in this camp there is less risk of diseases. Health Status The team went through the health facility the area found that it’s also well managed by Red Cross and Merlin in terms of distributing hence that all the IDPs from the camp are treated free. Market The RAs went to the market around the camp; it was the largest market in the area and is served by many communities around. Though there few IDPs who were trading in the market. The team managed to talk to IPDS, selling boiled eggs, second hard clothes doing crafting of Jikos selling the to the community. Household The household assessment was done at Kitutu Central (Kiogutwa) IDP camp. The RAs went through some households and found out that the returnees who are accommodated in the host community are congested in the homes with no food and one house was accommodating 17 people. Sanitation was poor since latrines were in open place and were not well covered. The spring were they draw water from is not protected and this is the same spring which is being used by animals. The team took four days to collect this data since there was heavy rainfall in this district. Conclusion The exercise was an eye opener for any future emergency in the country. The assessment could have been done at the initial or at the beginning of the crisis. Annex V- Adapted version of IRA by UNICEF/UNFPA/WHO INITIAL HEALTH AND NUTRITION CLUSTER RAPID ASSESSMENT TOOL: FIELD ASSESSMENT FORM SECTION 1 IDENTIFICATION INFORMATION 1.1 PLACE AND DATE: 1.1.1 Name and location of site being assessed. (Note administrative/district boundaries, and which government authorities should be involved. Note estimated size of site and attach map if possible.) 1.1.2 GPS Coordinates and satellite system: P-Code if available 1.1.3 Date(s) of the visit: 1.1.4 Main contact at this site: 1.2 ASSESSMENT TEAM: Name Institution Title / position 1.3 Population Source of information: Name:_______________________ Title:________________________ Total population (Approximate or estimate): ______________ Number of displaced people:_____________ Estimated sex ratio of current adult population:_____________% women Estimated number of children < 5 years:_________ OR estimated % of total population < 5 years__________ Estimated number of pregnant women: ____________________ Are there other especially vulnerable population groups in the area (OVC’s): ________________________________________________________________________________________ _______ IRA FORM SECTION 6: HEALTH RISKS AND HEALTH STATUS 1 2.1 SANITATION: 2.1.1 Number of people, out of 10, on average, currently using each of the places listed below to go to defecate In the open, not in a defined and managed defecation area In a defined and managed defecation area In public toilets (pit latrines, pour-flush latrines, flushing toilets etc.) In family toilets and shared family toilets (pit latrines, pour-flush latrines, flushing toilets etc.) □ DNK Check that this column adds up to 10 2.1.2 Average number of users per functioning toilet □ > 100 □ 51 – 100 □ 21-50 □ ≤ 20 □ DNK 2.1.3 Number of functional latrines 2.1.4 Presence of human faeces on the ground on and around the site Yes / No 2.1.5 Presence of solid waste, including household waste, building rubble, animal carcasses and animal faeces on and around the site 2.1.6 Number of waste disposal pits □ substantial presence □ substantial presence, less than 50 m from generally more than 50 m shelters from shelters □ substantial presence □ substantial presence, less than 50 m from water generally more than 100 sources m from water sources 2.1.7 Presence of stagnant wastewater or rainwater on and around the site □ substantial presence □ substantial presence □ no substantial presence □ DNK less than 50 m from less than 100 m from shelters shelters □ substantial presence □ substantial presence □ no substantial presence □ DNK less than 50 m from water less than 100 m from sources water sources 2.1.8 ADDITIONAL COMMENTS CONCERNING SANITATION AT THIS SITE . IRA FORM SECTION 6: HEALTH RISKS AND HEALTH STATUS 2 3.0 HYGIENE 3.1 Proportion of households 1 possessing soap □ ¼ □½ □¾ □ All □ DNK 3.2 Proportion of households possessing at least one narrow-necked water container (e.g. jerrycan) for storing drinking water □¼ □½ □¾ □ All □ DNK 3.3 Average total capacity of water containers per family (litres) □ 0-10 litres □ 11-20 litres □ 21-40 litres □ >40 litres □ DNK 3.4 ADDITIONAL COMMENTS RELATED TO HYGIENE AT THIS SITE E.G. ANY SPECIFIC OBSTACLES TO HYGIENE (PARTICULARLY HANDWASHING AFTER DEFECATION OR HANDLING FAECES OF CHILDREN AND SICK PEOPLE AND BEFORE FOOD HANDLING) NOT MENTIONED ABOVE, ANY PARTICULAR GROUPS WHO ARE EXCLUDED FROM ACCESS TO RESOURCES AND FACILITIES FOR HYGIENE: 3.5 WHAT ARE THE PRIORITIES EXPRESSED BY THE POPULATION CONCERNING WATER SUPPLY, SANITATION AND HYGIENE? SECTION 4 NUTRITION AND FOOD SECURITY 4.1 RESOURCE PERSONS AND OTHER INFORMATION SOURCES: 1 Household for our purposes is a group of persons eating from the same pot. IRA FORM SECTION 6: HEALTH RISKS AND HEALTH STATUS 3 4.2 EXISTING CAPACITIES AND ACTIVITIES: Organisation or person(s) Normal / current activities Limitations to capacity or responsible performance (lack of staff, materials and equipment, funds, access etc.) 4.2.1 Nutrition programs 4.2.2 Infant and young child feeding programs 4.2.3 Food aid programs 4.2.4 Food security/ livelihoods programs 4.2.5 Yes No If yes, specify by whom and when. Has a nutrition assessment been done? 4.3 SECONDARY DATA AND OBSERVATIONS FROM SPECIALISTS ON NUTRITIONAL STATUS: SUMMARY OF REPORTS AND OBSERVATIONS BY HEALTH AND NUTRITION SPECIALISTS ON NUTRITIONAL STATUS: 4.3.1 Reports and observations on current situation with acute malnutrition (moderate and severe) in children under 5 years of age: (Note the % children, age range, how malnutrition was measured) Source: 4.3.2 Reports and observations on the likely evolution of the acute malnutrition situation (moderate and severe) in children under 5 years of age over the next month: Source: 4.3.3 Summary of reports or observations of acute malnutrition in adults (especially pregnant or lactating women) or adolescents: Source: SUMMARY OF SECONDARY DATA FROM THE CAMP ON NUTRITIONAL STATUS: 4..3.4 Vitamin A distribution in the last 12 months for □ YES □ NO □ DNK □ Other (specify) children 6-59 months of age: Source: 4.3.5 Is Vitamin A distribution ongoing? □ YES □ NO Source: 4.3.6 Percent of children 6-59 months with wasting (insufficient weight for height): (Note whether total or severe, how it was measured) Source: 4.3.7 Percent of children 6-59 months with stunting (insufficient height for age): (Note whether total or severe, how it was measured) Source: 4.3.8 Percent of children 6-59 months with underweight (insufficient weight for age): (Note whether total or severe, how it was measured) Source: 4.3.9 Percent of pregnant women with BMI <18.5: Source: IRA FORM SECTION 6: HEALTH RISKS AND HEALTH STATUS 4 4.3.10 Percent of pregnant women with anaemia: Source: SECTION 5 HEALTH RISKS AND HEALTH STATUS 5.1 INFORMATION SOURCE, TITLE, NAME AND CONTACT: 5.2 WHICH OF THE FOLLOWING SERVICES ARE AVAILABLE IN THE CAMP? STATIC FACILITY - NO OF STAFF AND TYPE OUTREACH SERVICES – FREQUENCY, ORGANISATION Existence of special disease control programmes in the camp? □ Immunisation □ TB □ Malaria □ HIV □ Control of Diarrheal diseases □ FP, ANC □ Deliveries □ Nutritional supplementation 5.3 HEALTH PROFILE: Morbidity (disease in population) 5.3.1 Main health concerns reported (rank) 1 2 3 5.3.2 Have there been any confirmed or unconfirmed reports of any outbreaks or unusual increases in illness? □ No □ Yes (Specify) 5.3.3 Have there been reports of trauma or injury? □ No □ Yes (Specify 5.3.4 Have there been reports of sexual and gender based violence (SGBV)? □ No □ Yes (Specify) 5.3.5 Are there patients suffering from chronic diseases among the affected population? □ No □ Yes (Specify) 5.3.6 Have there been reports of non-infectious agents (such as cold, heat, poisons or toxins)? □ No □ Yes (Specify) 5.3.7 What are the main manifestations of psychosocial needs among the affected population? IRA FORM SECTION 6: HEALTH RISKS AND HEALTH STATUS 5 5.3.8 Other causes of morbidity? (Specify) Mortality (deaths) 5.3. 9 Existence of mortality surveillance? □ No □ Yes (Specify) 5.3.10 Number of deaths of people over-5 in the last seven days (specify among how big a population) Source: 5.3.11 Number of under-5 deaths in the last seven days (specify among how big a population) Source: 5.3.12 Was there a change in the mortality pattern since the beginning of the crisis? □ No □ Yes (Specify) Source: 5.3.13 Causes of mortality (rank)? 1. SECTION 6 HEALTH FACILITY ASSESSMENT (fill one for each health facility visited) 6.1. HEALTH FACILITY 6.1.1 Name and place: 6.1.2 Facility type: 6.1.3 District 6.1.4 Province 6.1.5 Who manages that facility? □ Ministry of Health □ Other (specify) 6.1.6 Access to nearest health facility (check one): □ Easy Distance in km: □ With obstacles (Explain) □ Very difficult (Explain) 6.1.7 Who else provides health care services for the community? □ Community health worker □ Traditional healer □ Traditional birth attendant □ Other (specify) IRA FORM SECTION 6: HEALTH RISKS AND HEALTH STATUS 6 6.2. RESOURCES 6.2.1 Infrastructure (e.g. buildings, water, sanitation, waste disposal, electricity): □ Intact/functioning Main shortages: □ Damaged/malfunctioning □ Destroyed / not functioning 6.2.2 Essential equipment: □ Available/functioning Main shortages: □ Partly missing/malfunctioning □ Missing/destroyed 6.2.3 Supplies – essential drugs: □ Available □ Partly available □ Missing 6.2.4 Supplies – other essentials: □ PEP kits □ TB drugs □ ARV’s □ Emergency contraception □ PMTCT supplies 6.2.5 Supplies – EPI vaccines: □ Available Main shortages: □ Partly available □ Missing 6.2.6 Supplies – consumables (e.g. syringes, dressing material): □ Available Main shortages: □ Partly available □ Missing 6.2.7 Human resources: (provide numbers per category) : □ Doctors No.: Main shortages: □ Nurses No.: □ Midwives No.: □ Others (specify) No.: 6.2.8 Present external support to resources: IRA FORM SECTION 6: HEALTH RISKS AND HEALTH STATUS 7 6.3 ACCESS TO THE HEALTH FACILITY 6.3.1 Referral mechanism: □ Defined/regular □ Ad hoc/irregular □ None 6.3.2 Limits to access to health services (e.g. financial, geographical, cultural, security): 6.3.3 Post-crisis change with regard to access: IRA FORM SECTION 6: HEALTH RISKS AND HEALTH STATUS 8 6.4 FUNCTIONING OF SUB-SECTORS AND SERVICES functioning Decreased Does not Normhal Increase apply Not Observations : Sub-sectors and services 6.4.1 General clinic services (outpatient and, □ □ □ □ □ where applicable, inpatient services) 6.4.2 Mother-and-child health □ □ □ □ □ 6.4.3 Reproductive health □ 22.214.171.124 Normal deliveries □ □ □ □ □ 126.96.36.199 ANC □ 188.8.131.52 Emergency □ □ □ □ □ obstetric care 184.108.40.206 PMTCT □ □ □ □ □ 220.127.116.11 Management of victims of sexual □ □ □ □ □ violence 6.4.4 Emergency surgery □ □ □ □ □ 6.4.5 Mental health □ □ □ □ □ 6.4.6 HIV/AIDS □ □ □ □ treatment □ 6.4.7 HIV/AIDS Prevention □ 6.4.8 Nutrition □ □ □ □ □ 6.4.9 Expanded program □ □ □ □ of immunizations □ (EPI) 6.4.10 Communicable □ □ □ □ □ disease control 6.4.11 Health □ □ □ □ □ education/promotion 6.4.12 Community health □ □ □ □ □ services 6.4.13 Epidemic □ □ □ □ □ preparedness 6.4.14 Laboratory □ □ □ □ □ 6.4.15 X-ray □ □ □ □ □ 6.4.16 □ □ □ □ Dispensary/pharmac □ y IRA FORM SECTION 6: HEALTH RISKS AND HEALTH STATUS 9 6.4.17 Other (specify) □ □ □ □ □ 6.4.18 Other (specify) □ □ □ □ □ 6.4.19 Other (specify) □ □ □ □ □ 6.4.20 Comments on sub-sectors and services: 7.0 HUMANITARIAN INTERVENTION: 7.1 Current humanitarian interventions Organization : Main activity: 1 2 3 IRA FORM SECTION 6: HEALTH RISKS AND HEALTH STATUS 10 Annex VI- IRA short form used by UNICEF WASH during early phase of crisis Initial (72 hrs) Rapid Assessment Check List 1.1. Date visit (dd/mm/yyyy) |___|___|___|___|___|___|___|___| 1.2. Name leader assessment team________________________ 1.3. Agency (1) _______ 1.4. Name leader assessment team (2) _________________________ 1.5. Agency (2) __________ 2. LOCATION/ACCESSIBILITY/SÉCURITY 2.1.Country (Admin 1) ___________ 2.2 Admin 2 _________ 2.3 Admin 3_____________ 2.4 Admin 4______________ 2.5 Name of location _________ 2.6 Type of location Town Village Hamlet Camp Bush Other (specify) ______________ 2.7 Code P_____________ 2.8 Longitude N |___|___|, |___|___|___|___|___| 2.9 Latitude N |___|___|, |___|___|___|___|___| 2.10 Is the location accessible ? Yes No 2.11 What is the distance to the closest inhabited centre ? ___________ km 2.11.Are there any security problems ?? Yes No 2.12. if yes, what types of problems are there ? Fighting Demonstrations Mines Bandits Border incursions Other(specify) __________ 3. POPULATION Estimated host population : Estimated affected* population 3.9 If the IDP/refugee population is unknown, what is the % vis-à-vis the the host population ? 3.1 Persons 3.3 Persons < 10% 10-25% 25-50% 50-75% >75% 3.10. Place of origin 3.2 Households 3.4 Households % pop % pop % pop 3.5 Children < 5 yrs _______ 3.6 Children <18 yrs _______ Admin2 Admin2 Admin2 3.8 Women 15-49 yrs _______ Other estimated IDP/refugee population Admin3 Admin3 Admin3 3.11 Persons 3.12 Households * local/IDP/refugee Initial (72 hrs) Rapid Assessment Check List 4. SHELTER AND NON-FOOD ITEMS 4.1. Destruction of pubic and private buildings 4.2. Shelter Conditions Type Number i. Types of shelter: hard semi hard ground plastic sheeting no shelter No. without shelter ___ ii. Condition of the roof Good Average With holes Totally dilapidated iii. Type of roof : Plastic sheeting Hay Bamboo Other__________________________ 4.3. Non-food items i. Sleeping conditions On the ground mattress mats plastic sheeting ii. Blankets none 1 x bed 1 x person insufficient iii. Plastic sheeting none 1 x household insufficeint iv. Cooking items none 1 x household insufficient Recommended interventions for shelter & non-food items 4.8 What the priority needs identified by the community? 4.8.1.__________________ 4.8.2.______________________ 4.8.3__________________________ 1. ______________ 2. ______________ 3._______________ 5. FOOD SECURITY/FOOD AID 5.1.i. Does the majority of households have access to their land ? Yes No Accessibility problem ? (Assessment team) 5.1.ii. Is there access to markets? Yes No Yes No 5.2. i. Does the majority of households have food stocks ? Availability problem ? (Assessment team) Yes No Yes Non 5.2.ii. Is it possible to purchase main food items on the market since the crisis? Yes No 5.3.i. Has the number of meals consumed x day changed ? Yes No Utilisation problem? (Assessment team) 5.3..iiIf yes, how many meals were consumed before ? ____ Yes Non 5.3.iii. If yes, many meals are consumed now ? ____ 5.3.iv. Has the quantity of food consumed x day changed ? Yes No Initial (72 hrs) Rapid Assessment Check List 5.3.v. Has the type of main staple consumed changed ? Yes No 5.3. vi. Type of main staple consumed before________________ Type of main staple consumed now___________ 5.4. Main source of food? What is the number/% of people whose food security Stock Purchase Gift Assistance Loan situation has been affected by the crisis ? No.__ % ___ 5.5. What the priority needs identified by the community? 5.5.i.__________________ 5.5.ii. ______________________ 5.5.iii.__________________________ Severity of food security Recommended food situation ? security/food aid Moderate_______________ interventions Severe ______________ 1._______________ Very 2. ______________ severe_______________ 3._______________ Initial (72 hrs) Rapid Assessment Check List 6. WATER AND SANITATION 6.1 Current sources of water 1= used the most 2= less used 3= not used Pump Well Traiditonal Source Source Tap Fountain Use aménagé well aménagée non- aménagé A.Drinking/cooking B. Washing/Bathing 6.2 Condition water points : Not functional No/% not functional ____Deteriorated No/% deteriorated___ Good condition Lack of/insuffucient fuel 6. Is the quantity of water available sufficient? Yes No 6.4 Estimated quantity of water used x day (l/ps/dd) 0-5 6-10 11-15 >15 6.5. What type of container is used to collect/conserver water : open basin/bucket covered basin/bucket Jerrican Other (specify) 6.6 Estimated number of people x water source ___________ 6.7 Sanitation practices (% pop) Open on Pit latrine Traditional Improved VIP latrines Other ground direct drop latrines Traditional (specify) latrines 6.8. Conditions of latrines/sanitary facilities % functional ____ % not functional ____ % deteriorated _____ 6.9 Estimated number of persons/latrine Recommended priority wash 6.10 Is the soil suitable for the construction of latrines? Yes No Partial Unknown interventions 6.11Does the population have access to soap ? Yes No ___________ 6.12. Are waster disposal services functional ? Yes No 1._______________ 6.12 What are the priority needs identified by the community? 6.12.1.__________________ 6.12.2______________________ 6.12.3.__________________________ 2. ______________ 3._______________ Initial (72 hrs) Rapid Assessment Check List 7. HEALTH AND NUTRITION 7.1 Main causes of injury, illness and death since the crisis 7.2 Shortage of medical & sanitary supplies CHILDREN <5 YRS POPULATION > 5 YRS Essential drugs Cause #1 : # deaths? Cause #1 # deaths? Antibiotics Injuries ? Injuries ? Drugs for chronic illnesses ARVs Cause #2 : # deaths? Cause #2 # deaths? VCT test kits Injuries ? Injuries ? PEP kits Essential supplies (gauze, plasters etc) Cause #3 : # deaths? Cause #3 # deaths? Vaccines Injuries ? Injuries ? Vit A Immunisation equipment PREGNANT WOMEN COMMENTS ? (Try to assess women vs Surgical equipment Cause #1 : # deaths men, those under 18, elderly, etc.) Cause #2 : # deaths Obstetrical equipment Cause #3 : # deaths Cold chain equipment Delivery kits COMMENTS : Therapeutic milk Therapeutic food Impregnated bed nets Blood bank Operating blocks Electricity Latrines Running water Other (specify) : ______ 7.3 Health centre available : Central hospital Hospital Admin 2 Hospital Admin 3 Health centre Health post Mobile clinic Private treatment 7.4. 3 m ain causes of admissions 1. __________________ 2. ___________________ 3. ____________________ Initial (72 hrs) Rapid Assessment Check List Equipment and supplies for treating injuries? 7.5 Main barriers with access to health or nutrition 7.6 Malnutrition cases centres : (specify if Health Centre HC or Nutrition Centre NC) 7.6.1. No. cases of marasmus observed ____ 7.6.2. No. cases of oedema/kwashiorkor observed ____ Access to services_______________ 7.6.3. Signs of thinning amongst children ? Yes No ___________ Lack of services ___________ 7.6.4. Screening recommended ? Yes No ___________ Poor quality treatment _____ Local/IDPs//refugees Host Pop Number of personnel _________ * No. moderate cased Trained personnel __________ * No deaths moderate cases Cost of consultations __________ Cost of drugs __________ * No. severe cases Lack of drugs/supplies ________ * No deaths severe cases Cues/excess patients ________ TFC. No. Admissions Language problem ___________ TFC No. deaths Gender barriers _________ Other (specify) ________________ SFC No. Admissions SFC No. deaths * Source : health personnel Priority health/nutrition 7.7 What are the priority needs identified by the community? interventions recommended 7.7.1._____________ 7.7.2._____________________ 7.7.3.______________________ 1. ____________ 2. ______________ 3._______________ Initial (72 hrs) Rapid Assessment Check List 8. PROTECTION 8.1. Impact of the security situation on the population : Risk to life/limbs Limited freedom of movement Loss of shelters Reduced access to livelihoods Reduced access to health centres Reduced access to water sources Reduced access to schools Arbitrary detention Mistreatment during detention Other (specify ________ 8.2. No. of separated 8.3. No. of unaccompanied 8.4. No. orphans children children 8.5. Main causes of separation : Death of parents Flight of children Evacuation of children Liberation/flight from institutions Other (specify) _____________________________________________________________________ 8. 6. Who looks after the separated children ? : Parent Brother/sister Older child Wider family Neighbours Other families Institutions NGOs Other (specify)______________________________________________________________________ 8.7. Presence of armed forces Yes No Type : National army Police Paramilitairy group Armed opposition group Other (specify) _________ 8.8. Children <18 yrs associated with armed forces/groups ? Yes No (NOTE THIS INCLUDES ADOLESCENTS) 8.9. If yes, what tasks do they undertake? Carrying arms Guards Loading/unloading Domestic tasks Other (specify) : ___________________________________________________________________ 8.10. Are there reports of sexual violence or gender-based violence ? Yes Non Priority protection If yes, # _____ What kind of people likely perpetratotrors?___________________________________________ interventions recommended 8.11. Existence of Kit PEP (health centres) yes no 1._______________ 8.12. Availability of assistance : medical psychosocial legal 8.13. Are safe areas available for recreation and play for boys and girls of all ages ? Yes No 2. ______________ 8.15. What are the priority needs identified by the community? 3._______________ 8.15.1._______________ 8.15.2. ___________________8.15.3. ________________________ Initial (72 hrs) Rapid Assessment Check List 9. EDUCATION 9.1 Are primary schools existing ? yes non If yes, how many ? _________ Are they functioning ? yes no Are they permanent or temporary ? _________ 9.2 How many teachers are present ? Host population : # Men _____ # Women____ # Trained ___ IDP/Refugee Population : # Men _____ # Women ____ # Trained : ___ 9.3 If needed, are there competent volunteers? ___________ If yes, how many ? _____ 9.4 How many school-age children are there ? Boys ___________ Girls ___________ Pre-school : ___________ Primary: ___________ Secondary: ___________ 9.5 Do teachers and pupils have school books and educational ? yes no If yes, % teachers ___ If yes, % (primary school only)_____ 9.6 Do teachers and pupils have access to clean drinking water and latrines within the school premises ? Clean drinking water yes No Latrines yes No 9.7 What are the priority needs identified by the community ? 9.7.1__________________ 9.7.2 ____________________ 9.7.3.___________________ Priority education interventions recommended 1._______________ 2. ______________ 3.
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