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2008_Sept_25_Kenya lessons learned Annexes

VIEWS: 26 PAGES: 95

									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
                                               □
        6.4.3.1 Normal deliveries
                                               □     □          □            □               □
    6.4.3.2 ANC
                                               □
     6.4.3.3 Emergency
                                               □     □          □            □               □
obstetric care
     6.4.3.4 PMTCT
                                               □     □          □            □               □
      6.4.3.5 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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