Madagascar El Niño Drought Humanitarian Situation Report April 2017

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1 Madagascar El Niño Drought Humanitarian Situation Report April 2017 Screening and monitoring in Maroalimainty health center, Ambovombe disctrict UNICEF Madagascar/2017Abela Ralaivita Highlights The improved rainy season and harvest in March and April 2017 may produce a temporary reprieve from the complex nutritional crisis in the south, however pockets of acute malnutrition remain an obstacle to recovery. Preliminary results of the UNICEF-led nutrition SMART surveys show GAM prevalence between 10 and 15 per cent in Beloha and Amboasary districts, within the high prevalence range for wasting, according to WHO standards (10-14 per cent). Since January 2017, UNICEF has provided water access to nearly 130,000 people of the estimated 740,000 living without access to potable water in the eight most affected districts, but 610,000 people remain without access to sufficient safe water. UNICEF is conducting hydrogeological surveys for future water infrastructure construction, water system repair and other temporary water provision interventions to provide access to those still in need. In March 2017, student absenteeism continued to increase in two of three affected regions (Anosy, Androy) after a brief period of improvement in January. The response to meet the needs of 391,000 children in need of humanitarian assistance remains widely underfunded, except for Nutrition and Health, jeopardizing UNICEF s ability to meet its Core Commitments for Children in Humanitarian Action (CCCs). UNICEF s Response with partners highlights (national) UNICEF UNICEF Cumulative results (#) Sector/Cluster Cluster Cumulative results (#) Children 6-59 months treated for severe acute malnutrition (SAM) 35,000* 6,201 35,000 6,201 Caregivers of children in humanitarian situations 0-23 months accessing IYCF 65,000 4,877 65,000 4,877 counselling Children under 5 with pneumonia treated with antibiotics (ARI) 70,620 10,908 People in humanitarian situations accessing water for drinking, cooking and 850,000* 129, , ,900 personal hygiene Children in humanitarian situations accessing psychosocial support** 12, ,000 - Children aged 5-18 in humanitarian situations access basic education 25,000** 62,000 25,000 62,000 (including through temporary structures) Vulnerable households receive cash transfers 20,000 3, ,300*** 43,681 *The estimated caseload of SAM children and lack of water access are calculated for all the country, Out of the 35,000 national figure, 21,750 are estimated to be in the southern regions, and out of the 850,000 in need of water, 740,000 are estimated in the southern drought-affected regions. **This target will be revised shortly. ***Cash transfer is not a cluster itself, but rather a modality of intervention. shows the total actors capacity at this stage to reach beneficiaries with cash. s will change provided that new actors intervene through cash transfers. SITUATION IN NUMBERS As of 30 April ,000 Children in need of immediate humanitarian assistance (46% Total pop in IPC phases 3 & 4) 35,000 Children aged 6 to 59 months in need of treatment for SAM in 2017 (UNICEF estimated caseload 2017 in the Humanitarian Action for children (HAC) appeal) 850,000 People without access to safe water for drinking, cooking and personal hygiene (UNICEF estimated caseload 2017, HAC) UNICEF HAC Appeal 2017 US$ 31.4 million 2017 UNICEF Funding Status Carry forward from 2016: $5.3M Funds received to date: $6.1M 2017 funding requirement: $31.4M Funding gap $19.9M *Funds available includes funding received for the current appeal year as well as the carry-forward from the previous year.

2 Situation Overview & Humanitarian Needs Field reports from March indicate a certain new optimism among drought-affected communities which have reported the best rains and harvest since 2014/2015. Preliminary results of four SMART nutrition surveys supported by UNICEF and conducted by the National Nutrition Office with UNICEF and ACF-Canada, show a prevalence of global acute malnutrition (GAM) ranging from 13.9 per cent in Beloha to 8.1 per cent in Taolagnaro and rates of severe acute malnutrition (SAM) between 2.7 per cent in Beloha to 0.7 per cent in Taolagnaro. While none of the four districts covered by the survey have GAM prevalence above the emergency threshold (15 per cent), two districts (Tsihombe and Amboasary) have rates of GAM above the alert threshold of 10 per cent. These results also show high rates of chronic malnutrition, which ranges from 31 per cent in Beloha to 47.7 per cent in Amboasary. Table. Preliminary results of SMART nutrition surveys in four districts of the Southern regions of Madagascar, March 2017 Districts Global Acute Malnutrition (GAM) as of weight-for-height z-score Severel Acute Malnutrition (SAM) as of weight-for-height z-score Crude mortality rate (#/10,000/day) Beloha 13.9% 2.7% Tsihombe 9.6% 1.7% Amboasary 13.7% 1.4% Taolagnaro 8.1% 0.7% Under 5 mortality rate (#/10,000/day) Field reports indicate that water access will continue to be a major factor of the crisis and response. Relatively high levels of rainfall have paradoxically increased the risks of insufficient safe, potable water for drinking and the aggravated health risks of water and vector-borne illnesses, as families collect water from unsafe sources (puddles and small bodies of water polluted by animals and human waste). Regular monitoring of the situation by UNICEF, in collaboration with the decentralised services of the Ministry of Education, shows that since the beginning of 2017, the rate of absenteeism of pupils in Anosy and Androy has continued to increase, most particularly in Anosy (from 19 per cent in February to 21 per cent in March) and Androy (from 6 per cent in February to 27 per cent in March 2017). Families who are struggling to recover their livelihoods often pull their children out of school so that they can work in the fields or otherwise support their families as a negative coping strategy. In Atsimo Andrefana, there was a small decrease in absenteeism, from 14 per cent to 12 per cent for the same period. Teacher absenteeism in the three southern regions declined from February to March due to the arrival of teachers salaries/stipends, but still remains high: 71 per cent in Anosy, and 43 per cent in Androy. Estimated Affected Population in drought-affected southern districts Total Male* Female* # of people affected by drought 1,140, , ,700 # food insecure (IPC, Oct 2016) 840, , ,200 # SAM Children Under-5 in drought affected districts in the south (based on UNICEF Malnutrition 3,455 1,593 1,862 Screening, February 2017) # MAM Children Under-5 in the drought affected districts in the south (based on UNICEF Malnutrition 19,704 9,157 10,547 Screening, February 2017) # of population without access to safe water in drought-affected districts in the south 740, , ,700 # of women in childbearing age living beyond 5km from health facilities ( pregnancies) 178, ,000 # of children Under 5 living beyond 5km from health facilities 130,990 64,840 66,150 # of people living beyond 5km from health facilities 748, , ,740 *Estimated based on sex 49.5% (M) and 50.5% (F). UNICEF. SITAN. 2014

3 Humanitarian leadership and coordination UNICEF continues its support to the National Office of Disaster Risk Management (BNGRC) and UN-OCHA in the humanitarian response to the drought in the South. Nutrition Cluster: The National Nutrition Office and UNICEF co-lead the Nutrition Cluster response at both district and central levels. Monthly coordination meetings are held to discuss the evolution of the situation and the status of the response: progress, gaps, constraints and ways forward. During the first quarter of 2017, a total of three meetings were held at the national level and 20 at district levels. WASH Cluster: UNICEF co-leads the cluster response with the Ministry of Water, Sanitation and Hygiene at national and regional levels with a focus on data collection and response interventions. The most recent national level cluster meeting was held in April Education Cluster: UNICEF, in collaboration with the Ministry of Education, continues to closely monitor teacher and student absenteeism, drop out statistics and the integration/re-integration of out-of-school children in drought-affected districts in the south. The most recent Cluster meeting was held on 17 March Child Protection: For the current reporting period, UNICEF together with the Ministry of Population, the BNGRC and the Telma Private Foundation developed a package of services for beneficiaries, including an unconditional cash transfer to households and literacy and life skills sessions for both adolescents and their parents. Unconditional cash transfers coordinated by BNGRC and UNICEF, and executed by Telma are expected to start in May. Interventions focus on adolescents, victims or at risk of sexual and economic exploitation, in urban areas where child protection concerns are more acute. C4D in emergencies: UNICEF continued to support the BNGRC to coordinate communication in humanitarian action through the Emergency Communication Network at national and regional levels for Anosy and Androy regions. Social Protection / Emergency Cash Transfer: As co-lead of the cluster, UNICEF has promoted information sharing and coordination among the six partners that are providing support to five types of cash interventions. UNICEF has strengthened national capacity to coordinate emergency cash responses and a specific emergency cash sub-group has been created. UNICEF and the Emergency Cash Transfer subgroup have validated a joint communication strategy to ensure harmonised communication with beneficiaries, local and national authorities. Humanitarian Strategy UNICEF s humanitarian strategy for the drought response includes interventions in the areas of Nutrition: Screening, treatment of SAM, Infant and Young Child Feeding; WASH: Drilling of boreholes, distribution of ceramic filters; water trucking, emergency sanitation and C4D; Health: Case management of children under 5 with diarrhoea and pneumonia and distribution of zinc, Oral Rehydration Salts (ORS) and antibiotics; Education: Provision of catch up classes for children who have dropped out of school; provision of teaching and learning materials; Child Protection: Training of social workers to provide psychosocial support to children and their families; strengthening family tracing and reunification interventions for separated/unaccompanied children; and prevention of negative family coping mechanisms through Emergency Cash Transfers. The 2017 approach is three pronged: i) Continue with current activities, ii) Further develop outreach and integrated activities and, iii) Strengthen documentation and dissemination of evidence-based analysis in all sectors. The humanitarian strategy encompasses early recovery and resilience building. This includes capacity building of public systems as well as community mobilisation and integrated, complementary interventions that improve resilience, especially considering the extreme poverty and structural vulnerability faced by the populations in the south, which have significant long term negative consequences for children. A mother and her malnourished child are cared for by a trained health worker in an in-patient facility in Ambovombe district UNICEF Madagascar/2017/Abela Ralaivita

4 Summary Analysis of Programme response Nutrition: In January and February 2017, UNICEF continued to conduct monthly mass screenings for approximately 250,000 children in five of the eight drought-affected districts of the southern regions for early identification and referral to therapeutic and supplementary feeding programmes. 1 February screening found 3,455 cases of SAM and 19,704 cases of moderate acute malnutrition (MAM), of the 21,750 estimated cases in the South. UNICEF supported the management of SAM cases in eight in-patient facilities in hospitals and 193 out-patient facilities in health centres in the eight affected districts. During January and February 2017, a cumulative total of 6,067 SAM cases were admitted to out-patient facilities in the South, and 134 SAM cases with complications admitted to in-patient facilities, with a 72.4 per cent recovery rate and 0.7 per cent mortality rate. A relatively high defaulter rate of 12.1 per cent is why the recovery rate is slightly below SPHERE standards. UNICEF conducted a study to determine the causes of default and used this evidence to support interventions which provide food for accompanying family members during SAM treatment, and allocated more beds for children in SAM treatment facilities. UNICEF also trained 2,356 caregivers of children in humanitarian situations 0-23 months in infant and young child feeding counselling during the same period. UNICEF has provided therapeutic products to affected districts in support of the Ministry of Public Health since the beginning of the year, including: 4,750 cartons of RUTF, 20 cartons of therapeutic milk, drugs and equipment. UNICEF has also supported the deployment of five mobile clinics for outreach treatment of SAM in the most remote areas in the districts of Ambovombe, Tsihombe and Beloha. UNICEF is currently conducting four additional SMART nutrition surveys in Ampanihy, Betioky, Bekily and Ambovombe districts, the results of which will inform the humanitarian response in the second half the year. Moreover, UNICEF supported the Ministry of Health in vitamin supplementation and deworming activities at the end of April, results will be available in the next report. WASH: With rainfall in the south since mid-december, the use of surface water and rainwater has increased, and the demand for water trucking has reduced. Therefore, the communication component concerning the use of potable water has been reinforced (mass media campaign and messages, sensitization, etc.). During the last two months (March and April), over 19,400 additional people gained access to safe water as a result of ongoing water trucking, rehabilitation of six boreholes, construction of three new boreholes and three new mid-scale water supply system, bringing the total number of UNICEF supported beneficiaries to 129,650 since January This represents 17.5 per cent of the estimated total number of people without access to safe water in the south and 15 per cent of the estimated 850,000 people without access to safe water across the country. The construction of 42 boreholes, four wells and six mid-level water supply systems remains in progress and will benefit an estimated 25,560 additional people. An estimated 44,500 more people will benefit from the rehabilitation of 178 water points by UNICEF and 25 wells rehabilitated by ACF. Hydrogeological and geophysical studies of 50 sites in sedimentary and littoral areas in Androy, Anosy and Atsimo Andrefana regions remain in progress. As of this reporting period, a total of 3,518 families benefited from water cards (1,510 families with SAM children, 454 new mothers giving birth in community health centres and 1,617 pregnant women in health centres). UNICEF also distributed WASH kits to 1,800 families with children identified with SAM to improve their access to sufficient, safe water. Health: Since January 2017, UNICEF has provided Integrated Management of Childhood Illnesses training to 109 health workers, contributing to the diagnosis and treatment of 5,505 cases of diarrhoea, 10,098 of acute respiratory infection (ARI) and 2,332 cases of malaria at community health centres in Androy and Anosy regions. In addition, UNICEF supported trainings updating the competencies of 1,076 community health workers relative to emergency Integrated Community Case Management. To reduce the risk of drug stock ruptures, UNICEF distributed mosquito nets for malaria prevention to 6,200 households (31,000 people), 3,000 rapid tests and treatments for malaria and 20 Interagency Emergency Health Kits (IEHK) with two supplementary kits of essential medicines, supplies and basic medical equipment for three months for 20,000 beneficiaries. UNICEF also made available medicines for treatment of 130,000 children under five with ARI and 120,000 children under five with diarrhoea in community health centres. The creation of obstetric facilities in drought-affected districts continues to be severely underfunded, constraining progress to reduce maternal and infant mortality and morbidity among this extremely vulnerable population. 1 In and out-patient therapeutic programmes are supported by UNICEF and supplementary feeding programmes are supported by WFP.

5 Education: During the reporting period, 438 additional students benefitted from catch up classes and now access remedial classes in public primary schools in affected districts, bringing the total number of out-ofschool students benefiting from UNICEF support as part of the drought response to 5,738. In addition, 1,246 different learning materials (933 school-in-a-box, 155 recreational kits and 158 Early childhood development kits) were delivered to districts in Anosy, Androy and Atsimo Andrefana (two districts) to support the continued quality education of a total of 58,120 pupils. Child Protection: The needs in Ambovombe remain the same since the last report, although the identification of beneficiaries has been completed, and the local committee validated the list of 368 beneficiary households. The identification phase for Beloha, Tsihombe and Amboasary is 70 per cent completed. Priority has been given to households with adolescents between 10 and 18 years who are victims or at risk of sexual and/or economic exploitation, forced to beg, as well as adolescent head of households. For the two regions of Anosy and Androy, at least 1,500 households will benefit a package of services, including unconditional cash transfers to household (around US$ 10 (30,000 MGA) per month until December 2017) and literacy and life skills sessions for both adolescents and their parents. This responds to the needs for socio-economic opportunities such as vocational training and tailored educational options for vulnerable children and adolescents in the Grand Sud. The Ministry of Population and UNICEF jointly implemented the intervention, with the support of Regional Directions of the Ministry of Education and of the Ministry of Youth. Weak capacities and limited geographical coverage of intake services and of referral mechanisms for child victims of violence and exploitation has constrained progress toward response objectives. As a mitigating measure, capacity building interventions were integrated into the response strategy plan. In addition, a newly recruited Child Protection Specialist now monitors and supervises Child Protection interventions in the two regions (Androy and Anosy). Emergency Cash Transfer/Social Protection: An emergency national cash programme, Fiavota, funded through the World Bank and supported technically by UNICEF, aims to alleviate the situation of affected families in communes with high rates of malnutrition. The programme is implemented by the Development Intervention Fund and the National Nutrition Community Programme, in collaboration with the Ministry of Social Protection. The Fiavota programme targets 68,000 households (4,000 funded through UNICEF) with a monthly unconditional cash transfer, a livelihoods-recovery grant and nutrition services for children. For the whole program 50,681 households have been registered, of which 43,681 have received cash. With UNICEF support, 3,227 (out of 4,031) vulnerable households with children below age five have been registered for the programme in the communes of Tanandava Sud and Ifotaka (district Amboasary-Anosy). Of the 4,000 cash transfers funded through UNICEF, 1,439 households (more than 4,320 children) in the commune of Tanandava Sud have received three transfers since January The remaining 2,561 households received their first transfer at the end of April. In February, UNICEF trained social workers of the national implementing agency, Development Intervention Fund, on the cash transfer process and related key messaging. Training is in progress to train Mother Leaders, a select group of beneficiary mothers who will support programme implementation. The programme s essential family practices coordinator/ C4D Specialist has been selected and the recruitment of specialized educators is in progress. The coordinator will oversee sensitisation training, monitoring of communication-effectiveness and use of the cash. Distribution of water vouchers for 3,500 (out of 10,000 total) families in affected districts through CERF and ECHO funds continues. This operation improves access to safe water for the targeted families with SAM children, pregnant women and families with mothers who recently gave birth. Communications for Development (C4D) The implementation of the emergency C4D strategy was launched in January 2017 in Androy and Anosy regions based on a rapid community needs assessment. UNICEF has supported the mobilisation of multiple communication channels and stakeholders to deliver lifesaving messages and facilitate community participation. UNICEF has supported the following capacity building activities: training of 151 mayors to use the Communication in Humanitarian Action Toolkit (CHAT), 12 radio station technicians on Aurelien, 21, a young peer educator who was trained to raise awareness of essential family practices in emergencies in Ambovombe district. UNICEF Madagascar/2017/Abela Ralaivita

6 key nutrition, WASH and health messages and 97 supervisors in supervision of youth peer educators. Through cascade trainings, an estimated 4,960 community actors have improved their interpersonal communication skills and knowledge of key nutrition, WASH and health messages. Monitoring of the different community mobilization activities is currently being undertaken by an independent institution, Human Network International, to assess the results/contribution of these interventions. Supply and Logistics For Nutrition: i) 40 hospital beds with mattresses have been dispatched to seven districts; ii) 338 cartons of 150 sachets of RUTF delivered to Amboasary district and, iii) 20 sets of two portable baby and child measuring boards delivered to the Ministry of Public Health regional offices in Androy. Funding UNICEF 2017 Requirements* Funds available for UNICEF** Funding gap Appeal Sector US$ % Nutrition 5,700,000 3,142,853 2,557,147 45% WASH 11,200,000 3,791,603 7,408,397 66% Health 5,500,000 2,503,459 2,996,541 54% Education 3,400, ,400, % Child Protection 2,100, ,446 1,861,554 89% Emergency Cash/Social Protection 3,000, ,731 2,285,269 76% Coordination- Cross sectoral 500,000 1,037, , % Total 31,400,000 11,428,238 19,971,762 64% *The Madagascar appeal is broader than the El Nino/drought emergency and funding requirements therefore include estimated funding requirements for the upcoming cyclone season expected to be further aggravated by La Nina. **Funds available includes funding received against current appeal as well as funds carried-forward from the previous year. Next SitRep: 30 June 2017 Internet: Facebook: Twitter: Who to contact for further information: Elke Wisch Representative UNICEF-Madagascar Tel: +261 (0) ewisch@unicef.org Jean Benoit Manhes Deputy Representative UNICEF-Madagascar Tel: +261 (0) jmanhes@unicef.org Matthew Conway Media Relations UNICEF-Madagascar Tel: +261 (0) mconway@unicef.org

7 Annex A SUMMARY OF 2017 PROGRAMME RESULTS Response Sector/Cluster Cluster 2017 Cluster Total Results UNICEF and IPs UNICEF 2017 UNICEF Total Results NUTRITION Number of children under 5 treated for SAM El Nino 35,000 6,201 35,000 6,201 Floods Number of caregivers of children in humanitarian situations 0-23 El Nino 65,000 4,877 65,000 4,877 months accessing IYCF counselling Floods 8, ,500 0 Number of children 6-59 months that receive deworming and El Nino 324,000 0* 324,000 0* Vitamin A supplementation* Floods 14, ,000 0 HEALTH Number of children under 5 with pneumonia treated with El Nino 66,000 10,908** antibiotics Floods 4,620 0 Number of children under 5 with diarrhoea treated with zinc and El Nino 63,000 5,505 ORS Floods 4,400 0 Number of basic emergency obstetric care facilities per 100,000 El Nino people 18 0** WATER, SANITATION & HYGIENE Number of people in humanitarian situations accessing water for El Nino drinking, cooking and personal hygiene 1,300, , , ,650 Number of internally displaced people and host community Floods members provided with safe water (7.5-15L per person per day) 270, ,000 0 Number of people in humanitarian situations supported to adopt Floods appropriate hygiene practices 270, ,000 0 CHILD PROTECTION Number of children in humanitarian situations accessing El Nino 172,000 0*** 5,600 0*** psychosocial support Floods 15, ,000 0 Number of children accessing child friendly spaces Floods 7, ,000 0 Number of children benefiting from family tracing & reunification Floods programmes 1, ,500 0 SOCIAL PROTECTION Number of vulnerable households receive cash transfers El Nino 15,000 3,227 Floods 5,000 0 EDUCATION Percentage of school-aged children who have dropped out of or who at risk of dropping out of school, including adolescents, completing catch-up classes in affected areas El Nino 50% 12%**** 50% 10%**** Number of children aged 5-18 in humanitarian situations access Floods 25,000***** 62,000 25,000***** 62,000 basic education (including through temporary structures) *Deworming and vitamin supplementation are part of Mother and Child Health Weeks that took place at the end of April. Results will be reported in next report. **10,908 cases of ARI (not specifically pneumonia were treated). For obstetric care facilities, there has been no funding; however, a grant was recently received that will allow us to progress on this indicator. Results will be reported as data becomes available. ***Interventions are currently ongoing, results will be reported in next sitrep. ****TBC, estimation is based on administrative data available for the academic years and , pending availability of administrative data for the academic year ). *****This target will be revised in the next HAC revision.