Yemen Nutrition Cluster Call to Action to address malnutrition and way forward Anna Ziolkovska, Yemen Nutrition Cluster Coordinator Ruth Situma, UNICEF

Outline Background Nutrition situation Nutrition coordination Nutrition cluster scale up Call to action Challenges Group work

Background Escalating conflict since March 2015, over 2M IDPs Escalation of conflict in Hodeidah since June 2018 22.2 M (of 27.4M) people in need of humanitarian assistance 17.8 M people (65% of population) food insecure 16 M (59%) people need support to meet basic WASH needs 16.3 M (59%) people require assistance to ensure adequate access to healthcare High levels of malnutrition, both chronic and acute (0.4M SAM, 1.8 M GAM and 1.1M PLW) Ongoing transmission of cholera Escalation of conflict near Hodeidah port (the “lifeline” of Yemen) Steep devaluation of YER Situation is likely to deteriorate further

Global Acute Malnutrition SMART (2018) for Al Mahra, Al Baidha, Abyan, Socotra, Al Jawf, Sana'a, Hajjah, Amran and Dhamar, SMART (2017) for Shabwa, Ibb, Raymah and Lahj, SMART (2016) for Taiz and Sa'ada, and EFSNA (2016) for remaining governorates

Chronic malnutrition WHO Cut-off Values for Public Health Significance of Stunting < 20% = Low prevalence 20-29.9% = Medium prevalence 30 -39.9% = High prevalence ≥ 40% = Very high prevalence SMART (2018) for Al Mahra, Al Baidha, Abyan, Socotra, Al Jawf, Sana'a, Hajjah, Amran and Dhamar, SMART (2017) for Shabwa, Ibb, Raymah and Lahj, SMART (2016) for Taiz and Sa'ada, and EFSNA (2016) for remaining governorates

Anaemia Source: DHS 2013

IYCF practices in Yemen Result Practices 52.7 % % of newborns who breastfeed during the first hour of life 10.3 % % of infant 0 – 5 months who exclusively breastfeed in the last 24 hours 45.9% % of children 0 - <12 months who were bottle-fed during the last 24 hours 6.6% % of infants 0-5 months who are not breastfed 59.7 % % of 6- <9 months who were given complementary foods during the last 24 hours

Nutrition Coordination Country joined SUN movement in 2012 2015: five-year Multi-Sectoral Nutrition Action Plan of 1.2 bn developed, but never implemented due to shifting focus to humanitarian assistance Nutrition Cluster established in 2009, March 2015 L3 emergency declared Co-led by MoPHP and UNICEF 15 INGOS, 19 NNGOS, 5 UN agencies, 1 MoPHP, 6 donors, 2 others 5 sub-national clusters (Aden, Sanaa Saada, Hodeidah, Ibb) SAG, CMAM WG, IYCF WG, Technical Committee on Assessments

SAM scale up

MAM scale up 71% of HF with SAM have MAM

SAM/MAM needs (against population density)

SAM/MAM gap analysis (against target) PLW AM

SAM/MAM gap analysis (against needs) SAM and MAM 2419 55% SAM only 959 22% MAM only 52 1% No SAM and MAM 961 22% PLW AM

Prevention programmes gap analysis IYCF BSFP U2 MNP BSFP PLW

Yemen Integrated Famine Risk Reduction (IFRR) 107 districts prioritized by Health, Nutrition, FSAC and WASH Clusters at highest risk of famine A comprehensive package of interventions at Community, Household and Health Facility levels with inter-sectorial linkages and An operational guidance on how to implement IFRR in Yemen that is being piloted Challenges in receiving multi-cluster funding

Call to Action Vision To reduce all forms of malnutrition in Yemen and save young lives. To help Yemeni children thrive, grow to their full potential and contribute to the development of their communities and country

Call to Action: Commitments & Key Targets ❶Reduce Global Acute Malnutrition (GAM) to pre-crisis levels in all governorates, and in the long-term, aim for rates below the serious threshold of 10% in each of the 22 governorates. ❷Reverse chronic malnutrition prevalence to pre-crisis levels and aim for a long-term annual rate of reduction of 1%. Coming together to save Yemeni lives and future

Conditions for meeting the Key Targets Increased coverage and quality of nutrition programmes Improved access to both preventive and curative services Adequate capacity and commitment among national counterparts

Call to Action: Accountability Mechanism Steering Committee comprised of representatives of call to Action Take stock every year on progress and provide recommendations Design the next phase after the 3 years First meeting organized by DFID in early 2019.

Key discussions from the Call to Action Event Governments, donors and partners were in great support of the Yemen’s  Call to Action   - money, logistics , access,  collaboration, enabling environment etc. Critical enablers discussed: Access/ safety for humanitarian workers  The need for all parties to the conflict to abide to International Humanitarian Law,  Salaries for health and community workers to be addressed, focus on building livelihoods, Ensure continuum of care for children with moderate and severe acute malnutrition  Strengthen inter -cluster coordination and integrated programming, Balance between addressing the now and the future needs. 

What challenges do we need to overcome?

Political challenges A fragile political situation Political impediments with access for UN agencies and NGOs Poverty limiting access of population to health services and high transport cost Devaluation of YER Operational issues with Hodeidah port for import and roads for transport Escalation of the war involving newer areas and difficulty in accessing various areas Dynamic changes in the IDP movements and targeting difficulties

Workforce challenges Non-payment of salaries to the health workers since October 2016 in the North Non-payment of salaries to MoPHP staff in the North Non-standartised incentives rates Limited number of the health workforce available in the country Limited presence of health staff at community level and limited capacity to scale up them quickly (transportation cost, supervision) Overwhelmed health workers who do not have time to train and supervise CHVs Shift of focus of health workers to outbreaks (cholera, diphtheria, etc.)

Financial challenges Most ministries working without any budget for programming thus functioning at minimal level Limited government funding to scale up and sustain nutrition interventions, including CHVs network Gaps in health facility operational/running cost to maintain adequate services Resource gaps in the Health Cluster to fully functionalize the HFs Reluctance to fund integrated programs

Capacity challenges Insufficient focus to implement IYCF-E by partners and MoPHP Slow start for the WFP scale up Limited HR capacity of UN agencies and NGOs in country Difficulties to bring international technical expertise to Yemen (visas, slots) Gaps in continuity of care (geographical, quality, access) Inability to conduct SMARTs in governorates with estimated high caseloads Delays in validating SMART assessments Delayed reporting from GHO/MoPHP

Different working modalities of UN (WHO, UNICEF, WFP) agencies Supply channels Incentives payments and modalities Internal geographic priorities Difference in support modalities

Other challenges Gaps in nutrition-sensitive programming (WASH hygiene education and hygiene kits, GFD/cash/vouchers, health services) Lack of attention on nutrition-sensitive programming among nutrition and non-nutrition stakeholders Focus mainly on humanitarian response with little or no support for developmental activities and capacity development CMAM services are delivered through HFs as no health infrastructure in communities

Conclusions Yemen has scaled up Nutrition in emergencies response significantly in the past years, but more needs to be done given the statistics we shared Multi-sectoral plans have stalled in the face of the humanitarian crisis The nutrition situation remains alarming and is likely to deteriorate further To say that coming together to address malnutrition in Yemen is urgent is an understatement The Call to Action event during UNGA yielded key joint commitments by UN agencies, NGOs and donors to address malnutrition in Yemen Next step: Translate the commitments in the Call to Action by the UN agencies, NGOs and donors to practical actions. We have prioritized critical areas to act on that are feasible to address with those around the table here, framed as questions to donors, UN agencies and NGOs that reflect on the commitments of these stakeholder groups articulated in the call for action.

Group work

Moving forward – donors’ commitments How increase multi-year & flexible funding to implement the multi-sectoral plan for Yemen? Build on cluster experiences of integrated package Nutrition specific & nutrition sensitive How can we secure predictable, sustained payment for health workers and CHV network? Ongoing discussion on a fund for salaries/incentives How do we advocate for increased access of UN and partners in hard-to-reach and marginalized areas to increase operations/programmes addressing malnutrition across the country? Bringing both parties to the discussion table Lead in could be: TO move forward on these areas, it is important to consider what we have tried to date, what has worked and what hasn't.

Moving forward – UN agencies’ commitments What needs to be done to improve the continuum of care for treatment of acute malnutrition? With a focus on a referral system to and between CMAM programmes How to scale up preventative nutrition interventions given the very low performance and link to treatment? SBCC being developed How to address challenges related to the different modalities of UN agencies? Selection of implementing partners Supplies delivery modalities to the HFs Incentives payments Geographical targeting

Moving forward- NGOs’ commitments How to ensure that NGO projects support (rather than replace) health systems? Capacity building and coordination with MoPHP and ownership by MoPHP What are the ways to increase technical capacity of NGOs without bringing international technical expertise to the country? Difficulties with visas and slots for INGOs and travel for NNGOs What are the opportunities to strengthen continuum of care for acute malnutrition? before moving onto the next slide, which introduces the working groups, you could stop here and ask the room (Yemen country team) are there any additional considerations they would add on what has worked and hasn't, that would be helpful to bear in mind on the working groups?

Group work Examine what has been tried, what has worked and what hasn’t for each question Identify clear next steps to take to move forward for each question this is not about dwelling on the challenges but moving forward! Focus should be on coming up with solutions, not adding to the challenges. Please be as specific as possible: who (names), what, by when, how