Cameroon: Emergency Response South-West Assessment, Mar. 2019
Cameroon: Emergency Response South-West Assessment, Mar. 2019
The assessments carried out in sub-divisions of Fako and Meme in South West Region and Moungo sub-division in Littoral region served several interlinked objectives, allowing Action Against Hunger to obtain an improved understanding of not only the needs but also the opportunities for response. The principal objective was to assess the needs and priorities for response and to understand the nutrition status of the affected population in the area. In second instance, the data collected also serves to provide information to other actors for the general support of the humanitarian response, which is struggling with data sparsity. Through this initial integrated assessment/distribution phase, Action Against Hunger has aimed to build a network, explore the opportunities for operations and develop a better understanding of the situation on the ground.
The objectives of activities in SW region from Nov. 2018 to Jan. 2019 can be summarized as follows:
- Understanding the opportunities and limits related to access for potential activities in South West region. Based on initial information collected, the initial minimal team collected information on access, while presenting the organization as a new actor in the area.
- Understanding of the humanitarian space and the work required to ensure humanitarian principles are respected. Part of the role of the deployment was to gage the need for reminders on humanitarian principles and set the base for response, and training of future staff.
- Assessment of the needs and understanding of response opportunities. Any possible response needs to be built on sound understanding of needs: immediate or latent (worrisome tendencies). The SW assessment has gathered data on nutrition, health, wash and food security, which has previously been limited (read nihil). Although some nutrition screening was done, no data other than presented in this report is yet available. National SMART survey did not include South West or North West regions. The most recent data for nutrition is the MICS that was conducted in 2014.
With access and insecurities being the main hindrances to data collection, data was collected only in the areas where access was obtained and security of staff could be reasonably assumed. The concrete collection of data took several forms, including informal interviews, household level Rapid Needs Assessments (RNAs) with IDP families, health facility
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assessments and MUAC and oedema screening of children under the age of 5-years-old. The combination of several means of data collection needed to be flexible and adaptable to the volatile context. As a result, not all types of assessments were conducted in each location or in each community to the same extent. The majority of the presented data was collected through direct interactions with the communities visited.
In order to avoid fatigue among local communities and further antagonizing affected communities, assessments were combined with activity implementation. In areas where access was obtained directly to the community, Action Against Hunger distributed basic WASH kits to vulnerable IDP households housing at least one child under the age of 5, or a pregnant or lactating woman. Through this approach rights holders were encouraged to participate in screening and assessments while not being left empty handed. During distributions, the team was also able to identify household sizes as well as origins and duration of displacement, information that will prove useful to feed into any planned response.
Informal interviews were conducted in the field with key informants and community leaders, but were not systematically documented as part of the assessment. The feedback received and relevant inputs do however feed into this report, and other internal reports concerning access, security, programing modalities and operational procedures. In addition to the field activity reports submitted by AAH staff, these interviews provide invaluable insights to the situation on the ground.
Rapid Needs Assessments (RNAs) were conducted with individual members of IDP households attending the WASH kit distributions and screening of children under five. Individual interviews were preferred over grouped discussions due to security concerns, as people were scared of gathering in larger groups. Each interview was conducted using a standard list of questions including primarily closed or multiple-choice questions. The questionnaire was kept short, while also trying to cover a range of areas in order to maximize information gathering but avoid fatigue. Those interviewed were predominantly women, mothers and caretakers of the children, between the ages of 20 and 45 years-old. To avoid attention, interviews were recorded in hard copy rather than through mobile data.
Health Facility assessments were carried out in 3 health centers, two in Tiko and one in Fiko sub-divisions of South West and Littoral region respectively. Additionally, interviews with Health workers, such as the General manager of St. John clinic in Kumba and with an assistant nurse in Penda Mboko supported these assessments with information covering the health district area. All health assessments were carried out by the Nutrition and Health Supervisor, using a standard questionnaire evaluating HR capacities, drug supplies, ambulance services and main tendencies in morbidity and mortality.
MUAC and oedema screening of children under-five was conducted at each of the distribution sites as well as in some localities where distributions did not take place. Caretakers were informed of the importance of their children’s health and asked to allow their children to be screened for malnutrition in order to (a) ensure their child was not malnourished and (b) to provide Action Against Hunger with a better understanding of the nutrition status among children in displaced communities. This assessment systematically involved children from 6 to 59 months who were available for screening for malnutrition (ie children who came to WASH kits distribution sessions with their parents). It should be noted that this screening was carried out by a health nutrition supervisor from AAH with the support of local staff identified locally and trained by AAH.
In a rapid nutrition assessment, the indicators of choice to measure acute malnutrition are MUAC and oedema. MUAC is quick to perform and effectively predicts risk of death in children aged 6 to 59 months. Based on a single measurement, it requires no heavy equipment, uses the same cut-off for both boys and girls, and can be undertaken by low-skilled staff given training and supervisory support.
A broad overview of the situation within the areas assessed highlights challenges faced by the affected population on several fronts. Each locality clearly seems to be having their particular difficulties, with food insecurity being a larger issue in the Kumba region than in Limbe or Tiko, and access to clean water being a priority in Penda Mboko rather than Kumba II. On the other hand, we also observe some over-arching challenges including limited access to healthcare and high levels of morbidity among the assessed populations. When asked point-blank what their primary needs were; households systematically returned the same answers: Food, Health, Shelter, Water, Protection and Education. These self-identified needs were flowingly assessed through the RNA surveys, revealing similar areas of priority needs.
In terms of Malnutrition and Health, the assessment has found that, while the nutrition status is currently still within acceptable boundaries, as per the screenings conducted, aggravating factors, particularly the significant gaps in health coverage, do indicate a possible precarious situation of affected communities. Proxy GAM rates remain well below the emergency threshold of >15%, and while some SAM cases have been identified in 4 out of 7 localities visited, singular cases do not yet warrant alarm. Meanwhile, with close to 90% of the assessed households reporting not being able to access health facilities, and over 75% of households reporting morbidity among the household members in the last month, it seems that morbidity and the lack of services pose a particular challenge across all localities. The assessment confirmed earlier indications by IMC, that government infrastructure is no longer able to ensure adequate coverage, with a decrease in vaccinations, disease surveillance and primary health care.
In terms of WASH, primary water sources and quality vary greatly, with populations residing in more rural areas seemingly unable to provide clean water for the households. Water treatment is not widely practiced, nor are some primary hygiene practices such as handwashing. General observations from the assessment team corroborate these findings and highlight the lack of access to soap and sanitation facilities, as also highlighted by REACH in their recent WASH assessment. Lack of access to clean water and sanitation can raise the risk of disease such as diarrhea or skin infections, an aggravating factor towards malnutrition.
Food Insecurity and diversity of intake, as measured by the HHS and FCS, both show low overall scores in all communities assessed. While household hunger levels are noticeably lower in more urban areas, such as Limbe and Tiko, each locality reported having households suffering some degree of food insecurity with overall, 61% meeting WFP indicator for severe food insecurity. In terms of dietary diversity, only one in five (1/5) households reported consuming 5 or more food groups in the last four weeks. The fast majority therefore reports a diversity of below 4 groups, indicating a low household food diversity score.
At larger displacement sites in Kumba I - Mile I, and in Penda Mboko, the assistant field coordinator took the initiative to briefly ask households receiving WASH kits were also about their origin and duration of displacement, which he noted down. Based on these observations, we have found that, in these two sites, 63% and 74% of the population had been displaced for over 6-months respectively, and less than 20% was displaced in the last 3 months (as of January 2019). It also revealed clear movements from more remote areas and towns to relatively “safer” government controlled areas, near cities and across the divisional border between South West and Littoral regions. Movement map can be found in the Annex.