1. Women, Adolescent and Young Child Spaces:
Experience from Typhoon Haiyan
During an humanitarian emergency, men and women are exposed to the same events; however women face unique needs. During emergency situations, women and children are often the target of abuse and are most vulnerable to exploitation and violence because of their gender, age and status in society. These issues call for a dedicated place where women affected by crisis would receive gender-responsive services to address their specific needs. World Vision calls this place Women, Adolescent and Young Children friendly spaces or WAYCS , an MNCH model during emergency response. We implemented such spaces during the Haiti earthquake, following the Pakistan floods, in Syria, in Uganda for South Sudanese refugees,and in the Philippines after Typhoon Haiyan, and would like today to share our experience using WAYCs following Typhoon Haiyan.
World Breastfeeding Conference 2016
Colleen Emary, World Vision International

2. Source: https://youtu.be/t6EGn1tFQqU

3. Context Nov 8, 2013, Category 5 hurricane, affecting 9 provinces
6,000 dead, 4 million displaced
800,000 pregnant and lactating women in need of nutrition assistance
60% of health facilities destroyed
50% of health staff impacted
- MIRA assessment conducted on November 2013 by more than 40 agencies in 9 provinces covering 92 municipalities and 283 barangays to better understand the impact of Typhoon Haiyan on affected population
-800,000 PLW in need of nutritional assistance (OCHA)
-health staff were not reporting to work in the most affected areas

4. Context Over-crowding, lack of privacy, fear for personal safety.
PLW and U5s identified as ‘at risk’ – prioritized for assistance
Pre-crisis IYCF – predominantly breastfed, some mixed feeding.
WV response: multi-sectoral (food security, livelihood, health, WASH, education, shelter)
From the emergency to rehabilitation phase, the response covered four areas -- North Cebu, Panay, West Leyte and East Leyte serving 566 villages in 48 municipalities considered to be Haiyan’s hardest-hit areas according to inter-agency damage assessments and
government reports. 789,816 were reached in the emergency response phase (Nov 2013 – Feb 2014).

5. Women, Adolescent and Young Child Spaces (WAYCS)
Set up in initial phase of an emergency response to address unique needs of women, adolescents and young children
Services provided: support for IYCF, offering privacy; assessment of health/nutrition needs-referral for higher care; recreational/social space
Each space is contextualized to the community and disaster event
14 WAYCS established post-typhoon
Some additional interventions can include
1. Promotion of adequate nutrition for women, children and adolescents
2. Support for pregnant women
3. Promotion of good health and hygiene
4. Support for young mothers and families
5. Family planning, emergency contraception and support to survivors of gender based violence (GBV)
6. Provision of a safe recreational space that benefits women and infants
7. Encouraging men to support women’s and infant’s health and nutrition
8. Psychosocial Support to families
9. Information and support around protection issues
10. Support to adolescents (girls and boys with priority to girls)
WAYCS is a dedicated space women can access at all times in sufficient privacy to mainly breastfeed their babies, as they might not feel comfortable doing so in crowded evacuation area and might ending up ceasing to breastfeed, exposing the children to ill-health and nutrition status
The WAYCS were aimed at contributing to the overall goal of the response which is to strengthen the resilience and self-recovery of typhoon-affected communities, families including children.

7. WAYCS activities post-Typhoon
IEC sessions on nutrition, health, hygiene topics
Breastfeeding and relactation support
Health and nutrition screening and referral
Psychosocial support
Capacity building of public health workers and community volunteers
Distribution of baby kits, breastfeeding kits, clean delivery kits, baby carriers, high energy biscuits
Services were provided to 1740 women, 665 adolescent girls, over 2300 children 0 to 59 months of age, 145 volunteers

8. Timetable Example Time Monday Tuesday Wednesday Thursday Friday
Saturday
10:00 to 11:00
EXCLUSIVE BREASTFEEDING (group 1)
PRE & POSTNATAL CHECK-UP by health department
COMPLEMENTARY FEEDING (group 1)
IMMUNIZATION- tent available to health dept./midwife
IYCF IN EMERGENCIES
(group 1)
ADOLESCENT COUNSELLING for group 1
11:00 to 12:00
Discussion and feedback with mother
GROUP DISCUSSION on healthy eating/ balanced diet for children 6 to 24 months
Discussion and feedback with mothers
Bahasa healthy cookery session
GROUP DISCUSSION on women’s health
12:00 to 13:00
LUNCH BREAK
13:00 to 14:00
EXCLUSIVE BREASTFEEDING (group 2)
Playing time for children under 5
COMPLEMENTARY FEEDING (group 2)
(group 2)
ADOLESCENT COUNSELLING for group 2
14:00 to 15:00
COUNSELLING on breast feeding re-lactation
Free time for women
PREPARATION FOR THE NEXT SESSION
15:00 to 16:00
PLAYTIME FOR CHILDREN

9. Evaluation
Qualitative evaluation conducted after 4 months of implementation (March 2014)
Objectives:
Assess change associated with WAYCS from beneficiary and community perspective
Assess how target groups benefitted
Identify challenges and areas for improvement
Evaluation Objectives:
Understand the contribution to change, positive or negative, associated with the WAYCS intervention from the perspective of individuals and communities;
Assess how the target groups have benefitted; and
Identify challenges encountered in the course of the implementation and areas for improvement which is of specific interest with the WAYCS being the first time to be initiated by World Vision in the Philippines
From the 14 WAYCS, 5 were selected from all the response areas- North Cebu, East Leyte, West Leyte and Panay (one each in the provinces of Aklan and Iloilo)- covering a range of dates of establishment

10. From the 14 WAYCS, 5 were selected from all the response areas- North Cebu, East Leyte, West Leyte and Panay (one each in the provinces of Aklan and Iloilo)- covering a range of dates of establishment with preference to those which were to be handed over to the community in about a month’s time.

11. Methods
Methods: document review, key informant interviews, focus group discussions with 127 individuals in 5 villages
FGDs: mothers, health workers, community volunteers
KIIs: husbands/males, community leaders, rural health units
Standardized interview guides and questionnaires used
Participants of the FGDs with women/mothers were selected at random from the list of those who have attended the WAYCS sessions in the sample barangays while those with volunteers and BHWs, everyone who was available during the data gathering was welcome to participate. Purposive sampling was adopted for the KIIs with community leaders and RHU representatives given the relevance of their positions in the selection. On the other hand, husbands were selected based on their willingness and availability.

12. Evaluation Findings Women
Self reported improved emotional well-being and increased knowledge and practice of appropriate infant/child feeding and caring.
Distribution of breastfeeding kits and baby kits freed up resources for other needs, and were an incentive for attendance
Men
Notable improvement in emotional state of wives
Wives applied new learned practices at home (shifting to EBF from mixed feeding)
-Helped their wives in the process of coming to terms with what happened (the typhoon) resulting in having/regaining happy disposition
-Improved their relationship as a couple - that better communication and improved emotional state somewhat contributed to the improvement of their relationship as a couple
-applying practices at home: avoiding common illnesses, preventing malnutrition and proper breastfeeding

13. Female participant in FGD in Ormoc City, West Leyte
“It was a nice experience. It provided an opportunity for interaction—even sharing with fellow mothers about our problems. Stress comes with motherhood; the sharing helped ease up our emotional burdens and in having peace of mind. It got better and better as the days went by.”
Female participant in FGD in Ormoc City, West Leyte

14. Evaluation Findings Community Leaders
Established a strong peer-support mechanism
Reduced time for ‘vices’, such as gambling
Noted long-term benefit ‘healthier children = healthier future’
Rural Health Units
Complemented the services commonly provided by health centres such as pre-natal care and immunization.
Improved monitoring of malnourished children
Built capacity of staff and volunteers in psychological first aid, infant feeding and assessment/monitoring of child health status
RHU – this was particularly helpful in areas where health facilities where heavily damaged.
In the FGDs with the volunteers and BHW, it was mentioned that their involvement in WAYCS helped develop their self confidence assured that they were sharing the right information to the mothers. Some noted that their communication skills have improved allowing for a more effective interaction with the mothers/caregivers. They considered such improvement valuable in carrying out their role as volunteers and BHW doing public service.

15. “During the sessions, we encourage mothers to share about their worries and concerns. This helps lighten up their burden and effective in preventing wrinkles, too.”
Participant in the FGD for volunteers and BHW in Brgy. Bobonon, East Leyte
BHW – Barangay Health Workers

16. Challenges
Location of WAYCS – far for some (requiring transport), lack of easily-accessible toilets
Insufficient space, overcrowded due to high interest
Some confusion over beneficiary selection in the early weeks of response
Interviewed barangay officials in East Leyte said that the number of participants in their area grew considerably as those from the neighbouring barangays also came.
Overcrowding issues were addressed by dividing the groups and offering repeat sessions
BHW – Barangay Health Workers

17. Recommendations Provide ongoing capacity building to HW and volunteers
Invest in capacity building for mothers, so they can teach their peers who were unable to attend
Vary teaching methods – more practical exercises
Utilize a vary of media for education sessions
More durable and larger space needed, including a separate space for play
FGD participants and key informants provided several recommendations on how to improve future implementation of WAYCS
To utilize audio-visual presentation in discussing the topics. To have more flipcharts, posters and other visual aids and to have a
space (e.g. board) where such can be put up for participants to copy from (some said that they refer to their lecture notes
from time to time)
Bigger space, and establish a separate section for babies and children to play since they tend to be noisy during sessions making it difficult for the participants to focus

18. Recommendations Identify opportunities for more engagement with men
Participatory planning – taking into account caregiver responsibilities when setting schedule for WAYCS; ensure beneficiary selection processes/criteria are understood by all stakeholders
Include livelihood training
Include monitoring and reporting of outcome indicators
It is generally recognised that the best results for MCHN occur when there is participation and interest from men
Solicit the views of the mothers/caregivers in coming up with regular schedules for the sessions so their daily routines can be taken into consideration and not be in conflict with their time for fulfilling tasks at work or home like attending to preparations for their children who go to school as mentioned by some of the women. This will also ensure that the schedules do not stand in the way of the participation of the target individuals/groups.
World Vision WAYCS guidelines provide a M&E framework which includes outcome level indicators.

19. Acknowledgements
Eureka P. Fuentes, Health and Nutrition Specialist, World Vision Philippines
Claire Beck, Director, Global Technical Team, Humanitarian and Emergency Affairs, World Vision International
Download World Vision WAYCS Guidance: