A proposal from Action Contre la Faim France, represented by Action Against Hunger UK, to the Department for International Development (DFID)
For:
EMERGENCY INTERVENTION IN NUTRITION AND MENTAL HEALTH for CYCLONE NARGIS AFFECTED POPULATION,
AYEYARWADDY DVISION, Union OF MYANMAR
Submitted on 24/05/2008
From 24.05.08 to 23.11.08
A. Basic Data Sheet
A.1. Name of the organization:
Action Against Hunger UK
First Floor, rear premises, 161-163 Greenwich High Road, London, SE10 8JA
Partnerships and Programmes Manager: Mariana Merelo Lobo
+44. (0)208 293 6198
Executive Director: Jean-Michel Grand
+44. (0)208 293 6190
Action Contre la Faim France:
Andrew Mitchell, Desk officer
Tel: 00 33 1 43 35 88 03
Laurent Campigotto, Programme Officer
Tel : 00 33 01 43 35 86 02
Action Contre la Faim Myanmar:
Felix Leger, Head of Mission
No. 11, Bawdi Yeik Thar, Bahan Township, Yangon, UNION OF MYANMAR
Tel: 00 95 1 503 391 / 00 95 1 244 052
Fax: 00 95 1 510 130
A.2. Name of the project:
Emergency intervention in nutrition and mental health for cyclone Nargis affected population, Ayeyarwaddy division, Union of Myanmar
A.3. Project cost:
Total project cost: 100955 GBP
Contribution requested from DFID: 100 955 GBP
Other contributions:
Dates: from 24/05/08 to 23/11/08 2008
Duration: 6 months
A.4. Grant payment details:
Bank Name: HSBC Bank
Bank Postal Address: City of London Branch 60 Queen Victoria Street London EC4N 4TR
Name of Account: Action Against Hunger
Bank Account Number: 21587986
Sort Code: 40-05-30
Currency of Bank Account: Sterling
IBAN number: GB74MIDL40053021587986
SWIFT number: MIDL GP 22
ABA or BIC Number: MIDL GB 2141W
A.5. Problems addressed:
The project addresses urgent needs in nutrition and mental health following the devastating impact of Cyclone Nargis on May 2nd in the worst hit areas of the Ayeyarwaddy division of Myanmar. Information collected from the field by ACF-F emergency assessment and response team has enabled ACF-F to identify the following priorities for its intervention:
A real risk of deterioration of the breastfeeding and infant care practices:
· A major part of the population was subject to extreme shock and bereavement
· Basic humanitarian aid is slow to reach the survivors
· Reports of unmonitored distribution of breast milk substitutes
· A high risk of difficulties in mental health of the population, impacting on child care practices, including breastfeeding
· Possible needs for the adults and the women in particular to have to search for food and survival instead of taking care of the infants and children
· Death or disappearance of the usual caregivers
· Extremely precarious environmental conditions non conducive to optimal infant health
A real risk of arising of mental health problems:
· High death toll with little possibility for usual cultural practices for burial and mourning
· Major risk of shock due to cyclone, abrupt loss of close ones and loss of assets
· Displacement, difficult living conditions, with little access to relief and no vision of the future
A real risk of deterioration of the nutritional situation:
· A poor food security situation, with no full coverage of food assistance on day 20 after the cyclone
· A high risk of increase in diseases such as diarrhoea, malaria and pneumonia and compounded by poor access to health care
· A high risk of difficulties in mental health of the population, impacting amongst others on child care practices as well as the need to adapt the usual feeding and care practices to the current situation
· A limited number of NGO’s with capacity and expertise in treatment of severe acute malnutrition
According to the most recent information received from Bogale Township, Bogale is one of the 3 most affected areas with Laputha and Maulamyaimekyun Townships. Pyapon area is also heavily affected, and faces gaps in intervention areas.
A.6. Project Summary:
The objective of the project is to reduce morbidity and mortality related to acute malnutrition and poor infant feeding practices, which are most likely among other related to mental health problems and necessity to adapt to the present situation. The activities are to assess the mental health of the cyclone affected population of Bogale and Pyapon Townships, Ayeyarwaddy Division and its impact on child care, to provide support and care to infants and their mothers among that population, as well as to participate in training partner NGO’s in the treatment of severe acute malnutrition. The project outputs will be as follows (note that these are indicative and the number of beneficiaries, the proportion between all the activities, the geographical location may vary according to the actual situation on the ground as assessments are still on going and the full picture of the damage is not yet available):
1/ The impact of the cyclone and its consequences on the mental health of the population is known:
- One mental health assessment is carried out
- Programme recommendations are made
- Interventions are done in correlation with the optimization of the available resources and with the care and feeding practices
2/ 600 infants and their mothers receive appropriate breastfeeding counseling and psycho-social support:
- The arising of inappropriate breastfeeding practices after this event are prevented
- The negative effects of unsolicited and unmonitored distribution of breast milk substitutes are reduced
- Care for mothers and infants with psycho-social problems is given
- The nutritional and psychological status of pregnant and lactating mothers is improved
- The unmonitored distribution of breast milk substitutes is tackled and documented
3/ The access to treatment of severe acute malnutrition is increased:
- The theoretical capacity of nutrition cluster partners on the treatment of severe acute malnutrition is increased
- The operational capacity of one partner on the treatment of severe acute malnutrition is improved
- What is the likely scale of the project (duration, beneficiaries, staff)
This project is intended to last for a period of 6 months and will provide approximately 500 infants and their mothers appropriate breastfeeding counseling and psycho-social support in Bogale and PyaponTownship, Ayeyarwaddy division, as well as increase the capacity of nutrition partners in the treatment of severe acute malnutrition.
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B. Logical Framework
Objectives / Measurable indicators / Means of verification / Important assumptionsThe malnutrition, mortality and morbidity among the cyclone-affected population is reduced.
PURPOSES
Assistance in infant feeding and psycho-social support is provided to the cyclone-affected infants and their mothers (including pregnant women) of Bogale and Pyapon Townships Ayeyarwaddy Division, Union of Myanmar; and access to treatment of severe acute malnutrition is increased in the cyclone affected areas. / The mental health of the affected population is assessed
Up to 600 infants and their mothers receive:
-Breastfeeding counselling
- Care practices support
-Psycho-social support
Up to 4 partners NGO’s receive theoretical training on treatment of severe acute malnutrition.
One partner NGO improves its operational capacity for treatment of severe acute malnutrition / Assessment report
Activity Reports
Nutrition Assessment and Surveys / -Visas continue being delivered to ACF international staff
-International and national staff have access to the affected area
-International freight remains possible
-Supplies are available on the local market
-Fuel is available for road transport
-Climate does not impede access (heavy rains).
OUTPUTS
1. The impact of the cyclone on the mental health of the population is known / - One mental health assessment is carried out
- Recommendations and types of interventions correlated to the care practices is proposed. / - Assessment report / - Expert expatriate is given a working visa
- Expert expatriate access to the field is possible
- Assessment team is allowed to interview the affected population
2. 600 infants and their mothers receive breastfeeding counselling and psycho-social support / - The arising of inappropriate breastfeeding practices is prevented
- The negative effects of unsolicited and unmonitored distribution of breast milk substitutes is reduced
- 300 mothers and infants with psycho-social problems are cared for
- 600 lactating mothers receive high energy biscuits to improve their nutritional status
- 1000 households receive a baby kit
- The unmonitored distribution of breast milk substitutes is tackled and documented / - ACF-F activity reports
- Nutrition cluster meeting reports
- Rapid breastfeeding assessment report / - Physical access to program sites is possible for ACF-F team
- Expertise can be provided on-site in case expatriate access id not possible
-Materials are available
- Mothers can access services regularly
3. Access to treatment of severe acute malnutrition is increased / - The theoretical capacity of nutrition cluster partners on the treatment of severe acute malnutrition is increased
- The operational capacity of one partner on the treatment of severe acute malnutrition is increased / - ACF-F activity reports
- Nutrition cluster meeting reports
- Partner NGO activity reports
- Partner NGO and UNICEF nutritional surveys and assessments / - Physical access to partner programme
ACTIVITIES
1. Mental health assessment
- Execution of one mental health assessment, led by a psychologist
- To make programme recommendations and interventions according to the needs
2. Access to breastfeeding and psycho-social support
- Set up of 6 Baby Friendly Tents, spaces where breastfeeding mothers can breastfeed, as well as receive breastfeeding counseling and psycho-social support
- Distribution of Baby kits to 1000 infants
- Outreach breastfeeding counseling in remote villages
- Co-ordination and lobbying with partners and the nutrition cluster on Infant Feeding in Emergencies.
3. Training of partner NGO’s
- Oorganization of one theoretical training of trainers on management of severe acute malnutrition for interested cluster partners in Yangoon, in collaboration with UNICEF
- Organization of field training of one partner on the management of severe acute malnutrition
Pre-Conditions
-Minimum access to the affected area is possible
-Climatic conditions remain stable
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C. Organisation Background
ACF-F has a team of 14 international humanitarian experts and approximately 50 national staff already involved in relief operations on the ground and has not met obstructions with the authorities. All expatriates have working visas.The team is currently present in Bogale Township, organizing Food (rice) and WASH essential items distributions as well as performing a rapid nutritional assessment. Another team is being recruited to run the same activities in Pyapon Township (first employees will arrive on the 24th or the 25th of May). ACF-F has a good knowledge of the Ayeyarwaddy division, having conducted a full WASH and Disaster Risk Reduction assessment in the zone in February 2008. Recent contacts with the assessment team mention a population in camps in Bogale dowtown of 20,000 Internally Displaced People and immense needs as the region is devastated. Sanitary risks are high and the number of dead bodies seen is important. Large areas are completely flooded and many people are simply living outside without adequate shelter.
Furthermore, ACF-F has been present in Myanmar since 1994, operating in the fields of emergency and recovery in the sectors of nutrition, care practices/psychosocial, WASH and food security. ACF-F also has a valid Memorandum of Understanding (MoU) with the government and had submitted an extension to the MoU in November 2007 that does include Ayeyarwaddy. This had gone through the internal process, and we were contacted prior to the cyclone that we would be invited to sign this with the government. This was put on standby because of the cyclone. ACF-F is in process to see if this signature meeting can take place again, but obviously this is not the priority of the government. ACF-F had permission to access Ayeyarwaddy Division Feb-March to carry out the WASH-DRR Assessment, based on the favourable progress of our extension, with documentation provided by the MoH. ACF-F has signed an agreement with Population Services International, toformally attach our emergency operation to this organisation. They have a signed an MoU to access Ayeyarwaddy.
Operations have started in the Ayeyarwaddy division and several convoys with relief items have already been sent to the affected area.
ACF-F has intervened in several emergencies in Asia and South East Asia in the recent past. These include an emergency response in both Sri Lanka and Indonesia after the 2004 Tsunami, Emergency interventions in Indonesia following floods, earthquakes in Java, Aceh and Jakarta. In November 2007, ACF-F intervened in emergency in Bangladesh following the devastating effects of Cyclone Sidr. The interventions in post-Tsunami Sri Lanka and post-Java Earthquake in Indonesia included a breastfeeding and psycho-social assessment and intervention. ACF International has experience with other specific breastfeeding support programmes in Macedonia, Kosovo, Tajikistan, Sri Lanka, North Caucuses, Afghanistan, Liberia and Pakistan.
ACF International is a long time active member of the Emergency Nutrition Network and is a member of the Infant Feeding in Emergencies (IFE) group. Additionally, ACF France is one of the leading agency in the newly created Management of Acute Malnutrition in Infants group (MAMI) with ENN and the Institute of Child Health (London) and has a strong knowledge as well as expertise in breastfeeding and infant feeding support.
In Myanmar, ACF-F has an expertise in addressing psycho-social problems, as ACF-F is deepening out the psycho-social component in link with its nutritional programmes in the three bases of the country. Internationally, ACF has been active for the redaction of the IASC psychosocial guidelines in emergencies and is part of the group.
ACF-F is a member of the nutrition cluster at the global level and is engaged with the Myanmar nutrition cluster and has been nominated to take the lead for therapeutic feeding.
D. Project Description
D.2. Needs assessment
A category 3 Cyclone Nargis struck Myanmar on 2nd May. The cyclone made landfall in the Ayeyarwaddy delta region, approximately 250 km southwest of Yangon.
The latest total death toll is estimated to be between 50,000 and 100,000. In the affected areas, several hundred thousands are estimated to be Internally Displaced and over a million persons are estimated to be severely affected by the cyclone. Final death toll casualties and damages could be even higher. The worst human and material damages are inventoried in three Townships of Ayerarwaddy division which are Laputha, Bogale and Maulamyainekyun. In Bogale Township, 10,000 people are reported dead.