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

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

3. 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

4. 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

5. Chronic malnutrition
WHO Cut-off Values for Public Health Significance of Stunting
< 20% = Low prevalence
% = Medium prevalence
% = 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

6. Anaemia
Source: DHS 2013

7. 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

8. 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

9. SAM scale up

10. MAM scale up
71% of HF with SAM have MAM

11. SAM/MAM needs (against population density)

12. SAM/MAM gap analysis (against target)
PLW AM

13. SAM/MAM gap analysis (against needs)
SAM and MAM %
SAM only %
MAM only %
No SAM and MAM %
PLW AM

14. Prevention programmes gap analysis
IYCF
BSFP U2
MNP
BSFP PLW

15. 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

16. 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

17. 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

18. 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

19. 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.

20. 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. 

21. What challenges do we need to overcome?

22. 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

23. Workforce challenges
Non-payment of salaries to the health workers since October 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.)

24. 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

25. 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

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

27. 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

28. 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.

29. Group work

30. 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.

31. 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

32. 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?

33. 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