Nutrition Information Management in South Sudan Experiences on progress and challenges 2014-18 Ismail Kassim – SSD -Nutrition Specialist –UNICEF

Outline of Presentation Description and analysis of South Sudan nutrition information system before 2014 conflict Key actions taken by UNICEF/cluster to improve the nutrition information system in South Sudan Key achievements Opportunities and Challenges Lessons learnt Key questions

Nutrition and FS situation at a glance Nutrition Situation IPC- September 2018 (A) SEPTEMBER 2018 6.1 million people (59% of population) facing severe food insecurity 4.3 million in Crisis; 1.7 million in Emergency; 47,000 in Catastrophe (B) OCTOBER – DECEMBER 2018 4.4 million people (43% of population) facing severe food insecurity 3.4 million in Crisis; 960,000 in Emergency; 26,000 in Catastrophe (C) JANUARY – MARCH 2019 5.2 million people (49% of population) facing severe food insecurity 3.7 million in Crisis; 1.5 million in Emergency; 36,000 in Catastrophe Slight improvement-no county reporting extreme critical levels (GAM above 30%) 31 counties reported ‘Critical’ (GAM (WHZ) 15.0 – 29.9%) levels of acute malnutrition 20 counties -‘Serious’ (GAM (WHZ) 10.0-14.9%) levels of acute malnutrition. Central and Western Equatoria recorded ’Alert’ (GAM (WHZ) 5.0-9.9%) and ‘Acceptable’ (GAM (WHZ), <5.0%) levels of acute malnutrition.

New admission trends for Children with SAM 2016-2018

New admissions trends for Children with MAM 2016- 2018

Nutrition Information prior to conflict Nature of Crisis Rapid onset, 740,400 individuals displaced (OCHA, Jan 31st 2014) – fluid population, IDP camps (PoC) Livelihoods & access to basic services impacted Pre-crisis: Only SMART surveys, weak and unsophisticated data collection with delayed validation of results. Information gaps: Limited access to population and funding, lack of HR capacity (both CLA IM and data collection/management). Catalysts: Introduction of IPC and IPC for AMN -demand for information, increased use of evidence based planning

Action taken to fill the gaps Capacity and HR Dedicated nutrition information staff both at cluster and CLA External support – ACF and CDC technical support Advocate for strengthening of Cluster/NIWG Conduct training needs and SMART trainings and establishments of sub-sub WGs- NIS, survey tools etc Scope and sources of information Integration nutrition indicators in FSNMS Prioritize counties with highest information gaps and Rapid SMART surveys in areas of insecurity Active participation in the IPC analysis and introduction of IPC for acute malnutrition Reporting Robust program reporting tool-develop, evaluate, pilot, train and use Annual plan and Funding Annual SMART surveys plan and advocacy for funding

Sources of Nutrition Information South Sudan SMART surveys Food security and nutrition monitoring Systems (FSNMS)- 2 rounds per year Program data- NIS- Reported by all partners routinely (monthly) In depth assessments- causal studies, Urban assessments etc IPC analysis and IPC for Acute Malnutrition Evidence Generation Other Studies- causal analysis, urban assessment Program data Surveys/ Assessments/IPC SMART surveys- County based assessments 50-55 surveys annually Undergoes rigorus review and validation process Conducted by many nutrition partners Food security and nutrition monitoring Systems (FSNMS) State level representative (2 rounds per year) Data quality improved to provide national estimates of all nutrition indicators Last round included anthropometry for 0-59months Funded by FAO/WFP/ UNICEF Supported by all partners of FS and Nutrition Over 10,000 children assessed Program data- NIS- Reported by all partners routinely (monthly) In depth assessments- causal studies, Urban assessments etc

Annual Survey plan and identification of priority areas Partners develop survey plan for the next year using NIWG matrix Survey plan consolidated Based on the most recent IPC analysis priority areas identified both in terms of severity and information gap Survey plan matrix updated with the priority counties For counties identified as priority not captured by partners are included in the plan and partner identified Ad hoc surveys in areas of displacement, IRNA reports etc Partner also indicate in house capacity or use of consultants to do the survey Matrix updated twice a year

Funding / Implementation in 2017

UNICEF role on assessments as CLA Provision of dedicated staff on Nutrition Information Funding of assessment (over 40%) Evidence generation is a key output of nutrition section Chair the NIWG Resource mobilization Use of evidence based in partner agreement Member of the IPC TWG and lead in the IPC for Acute malnutrition Mobilization of partners on analysis and reporting Data storage and access- Cluster and UNICEF Outcome Improved and equitable provision of evidence-based nutrition interventions for children, and for women of child-bearing age, including pregnant and lactating women Output 1 Provision of quality of IMSAM Output 2 IYCF Output 3 Evidence Based Nutrition Intervention Output 4 Nutrition EPRP

Role of NIWG and MOH Role of MOH Chair the meeting Members MOH/RSS, UN agencies and NGOs, Chair – MOH and Co-chair and secretariat – UNICEF Criteria for Membership All Nutrition partners are eligible if the staff meets the criteria Key nutrition information technical expert from nutrition cluster partners Trained on nutrition assessments (SMART, SQUEC, KAP…) Proven experience in Information management and/or statistical background Specific Role of the TWG Planning Nutrition information guidelines Capacity building of partners Quality assurance Technical support Liaison and Coordination Information Management Advocacy Role of MOH Chair the meeting Participate in the deliberations Organise for meeting Arrangements at the Ministry Provide final approval letter addressed to the State and county Government Meetings Meeting every other Thursday Held MOH/ UNICEF

Nutrition cluster contribution to the IPC analysis and IPC Acute in South Sudan Generate malnutrition and mortality data needed for the IPC Cluster partners support FSNMS Mobilization of partners to attend IPC analysis and IPC TWG members (UINCEF, CARE, SC etc ) Resource mobilization for assessments with donors/partners Collates the monthly reporting program data Makes nutrition information as a top agenda in cluster meeting

Challenges of nutrition information management Lack of national nutrition survey - last survey was done in 2010 Widespread insecurity – affect assessments Lack of data beyond nutrition Data quality concerns on FSNMS Ever changing countrywide situation- frequent assessments, ad hoc High turn over of members of NIWG Lack of NIWG functions in TOR of partner NIWG members Possible potential of conflict of interest Too many surveys Capacity gap as most surveys are conducted by consultants which is expensive Mortality in emergency where standard assessment is not possible

New initiatives Improve FSNMS data quality Looking at few partners (max 3) with surveillance capacity doing assessments Support capacity building of Government staff- deploy staff in the next country program Linking NIS with the DHIS2 is currently under discussion Update of NIS SMART Capacity building Improve FSNMS data quality and scope through Use FSNMS for national and State level estimates of most nutrition indicators increased support from nutrition partners Separate Nutrition TOT training conducted in Juba TOT used to conduct state level training in order to standardize training Use of Mobile phone enabled real time quality checks Quality control introduced on phones SMART Capacity building Trained about 25 participants with half being from MOH Requested to delay certificates until the participants participates in one survey at any level Partners contributing to cost of training

What do we learn from South Sudan experience Absolute need for the management of nutrition information Unlike Somalia where there is a unit in FAO that does nutrition information management all other counties do not have such arrangement In many counties there is no clear lead of nutrition information management Dedicated nutrition information management staff is key starting point in setting a robust information management system Establishment of GC nutrition information function to supports countries establish systems The cluster need to advocate for Government/Cluster or CLA to take the lead in nutrition information management Use of consensus evidence based planning Resource mobilization for assessments Unhindered access on nutrition information for internal and international level use

Key questions What leadership/capacity is needed by the CLA and partners to improve on nutrition information systems? What are the predictable arrangements needed at global level for agencies specialising in nutrition information systems? What does the CLA need to put in place at country level? How can humanitarian agencies build capacity/strengthen government systems within humanitarian programming in complex contexts like South Sudan? Are there further examples of this? Where does funding for this come from, e.g. Pool fund, CERF, bilateral donor funds?