UNICEF Zimbabwe Situation Report #11 - 31 December 2016

Zimbabwe Humanitarian

Situation Report

UNICEF Results with Partners 2016

UNICEF Target

UNICEF Results

WATER, SANITATION & HYGIENE # of people provided with access to safe water (7.5-15L per person per day)

325,000 144,707

HEALTH # of children with diarrheal diseases have access to life-saving curative interventions, including oral rehydration therapy and zinc

50,000 86,556

NUTRITION # of children 6 to 59 months with SAM admitted to community-based treatment programmes

14,711 6,189

CHILD PROTECTION # of vulnerable children provided with child protection services

31,000 25,246

Funding requirement:

$21.8M

Funding Received:

$17M

Carry-forward:US$610,000 Funding

Gap: $4.2M

*Funds available includes funding received for the current appeal year as well as the carry-forward from the previous year.

SITUATION IN NUMBERS

Highlights

• The cumulative number of children aged 6-59 months who were treated for severe acute malnutrition (SAM) in the 20 priority districts with high global acute malnutrition (GAM) levels (5% and above) at the end of November 2016, was 6,189.

• During the period January 2016 to date, 2,310 typhoid cases have been reported in the country out of which 85 have been laboratory confirmed with 8 typhoid related deaths reported. A total of 10 cholera cases were reported during the same period, among them, 5 cases and 1 death were confirmed. UNICEF continues to support emergency preparedness and response interventions through supporting information, education, communication, disease surveillance, capacity development and prepositioning of emergency water sanitation and hygiene (WASH) and Health supplies in identified hot spots.

• As of 31 December 2016, UNICEF had received US $17.6 million against the 2016 HAC of US $21.8 million. With the available funding, UNICEF was able to scale-up its response to the El-Niño associated drought and respond to the multi-sectoral needs of vulnerable women and children with critical and life-saving, health and nutrition, WASH, education, HIV/AIDS and child protection services.

4.1 million

People facing food and nutrition insecurity from Jan-Mar 2017

(ZimVAC, July 2016)

6,189 Children aged 6-59 months with SAM from 20 drought affected districts who

were admitted and treated in the CMAM program between Jan-Nov 2016

(DHIS, December 2016)

2,310 Cumulative typhoid cases comprising

2,225 suspected, 85 laboratory confirmed and 8 reported deaths

(MOHCC, December 2016)

UNICEF Zimbabwe 2016 Humanitarian Requirements

US $21.8 million

Situation Report #11 – 31 December 2016

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UNICEF Zimbabwe Situation Report #11 - 31 December 2016

Situation Overview & Humanitarian Needs The El-Niño weather phenomenon’s impact on vulnerable women and children is increasing as we approach the peak of the hunger season (January-March 2017) with vulnerable women and children in districts with the highest food insecurity prevalence (over 70%), namely in Binga, Mudzi, Umguza and Buhera, being at a greater risk. Manicaland (761,084 people) and Masvingo (738,291 people) provinces are projected to have the highest number of people estimated to be food insecure during the peak period as shown in Figure 1 below.

Figure 1: Quarterly Provincial Food Insecurity Projections: ZimVAC: July, 2016 The period between November and December 2016 was characterised by an upsurge in diarrhoeal diseases (Typhoid and Cholera) in high risk areas namely Harare and Mwenezi. Harare continued to report typhoid cases every week and remained the epi-centre of the outbreak. Mwenezi Rural district reported a total of 7 cholera cases during the period between November and December which represented 70% of the cholera cases reported in 2016. In line with the seasonal forecast, most parts of the country witnessed an increase in precipitation during the month of December. This resulted in flash floods being reported in Hwange, Chiredzi and Mwenezi, creating a conducive environment for WASH related diseases such as cholera. Despite the improvement in rainfall, some major dams are yet to receive significant water inflows and the availability of water in major dams across the country remains critical. Save, Sanyati and Runde catchments remain the most affected with water levels below 50% (recorded on the 12th of December 2016).

Humanitarian leadership and coordination The Humanitarian Country Team (HCT), led by the Resident Coordinator, continues to provide overall leadership of the humanitarian response. UNICEF and the Government of Zimbabwe continued to provide coordination and leadership for the WASH, nutrition and education sectors and the child protection sub-sector. UNICEF led sectors supported the development of a national multi-hazard contingency plan during the period between November and December 2016; the plan focuses on 4 hazards, namely floods, drought, animal diseases, crop pests and epidemics, particularly diarrheal diseases that include cholera and typhoid. During the reporting period, the nutrition technical working group set up a sub-committee to spearhead planning for the SMART surveys which will be implemented in 23 districts (Beginning January 2017). Sub-national nutrition coordination is being led by the Food and Nutrition Security Committees (FNCS) at Provincial, District, Ward and Village levels. UNICEF is an active member of the Interagency Coordination Committee on Health (IACCH) chaired by the Ministry of Health and Child Care (MoHCC) with secretariat support from WHO. The IAACH led the National coordination of the response to diarrhoeal diseases. The WASH sub-national coordination structures in Masvingo Province (Provincial and District-Water and sanitation services committee (PWSSCs) and (DWSSCs) led the cholera response coordination efforts which led to a timely and effective cholera response in Mwenezi District.

Humanitarian Strategy UNICEF continues to work with the Government, UN Agencies and NGOs to provide access to critical and life-saving  Health and Nutrition, WASH, Education, Child Protection, Social Protection and HIV/AIDS services. As

UNICEF Zimbabwe Situation Report #11 - 31 December 2016 defined by the projects under the revised inter-agency humanitarian response plan and UNICEF’s response plan, UNICEF is implementing Emergency programmes in high-risk food and nutrition insecure districts. The response is being implemented in complementarity with ongoing development programmes in an effort to enhance sustainability and link humanitarian interventions with recovery and resilience building programmes. UNICEF is working with the Government and NGOs to implement the current drought response interventions in coordination with other UN Agencies. UNICEF and partners are supporting the Ministry of Health and Child Care to provide access to life-saving essential health, nutrition and WASH services through strengthening community-based management of acute malnutrition programmes and reaching children with critical water, sanitation and hygiene (WASH) services. UNICEF is supporting the Ministry of Public Service, Labour and Social welfare to strengthen child protection services to protect the most vulnerable children, particularly girls, from violence, abuse and exploitation. Children, adolescents and pregnant and lactating mothers on antiretroviral treatment (ART) are being supported through advocacy for an HIV sensitive supplementary feeding programme and are being supported for care and treatment. Communication for Development interventions are being mainstreamed in all sectors specifically focusing on  the  provision of technical assistance to Government and NGO Counterparts, formative research and the development of Information, Education and Communication (IEC) materials. The Ministry of Education is being supported to implement the emergency supplementary school feeding programme and the recovery oriented home grown school feeding programme through technical support for coordination and monitoring.  

Summary Analysis of Programme response

Nutrition UNICEF continued to support the implementation of the nutrition emergency response in 20 priority districts. The emergency response interventions include building the capacity of community health workers to conduct monthly active screening to identify children with moderate acute malnutrition (MAM) and Severe Acute Malnutrition (SAM) and refer them to health facilities for further management and treatment. Village health workers were also capacitated to provide community Infant Young Child Feeding (cIYCF) support for primary care givers of children under the age of two years. To date, 400 health workers in 20 districts were trained on the management and treatment protocols for severe acute malnutrition (SAM) based on global standards. A total of 38 of the health workers were trained in November in 2 districts (Gwanda and Mangwe). The training equipped the health workers with skills to scale up active screening and enhance the treatment of children with SAM during the peak hunger period. In addition, 2,000 community based workers were trained on active screening in the 20 targeted districts. A total of 48,043 children were screened for acute malnutrition nationally and a total of 21,019 children were screened in the 20 priority districts during the period October and November 2016 (DHIS 2). Table 1: Total number of children with SAM admitted in the CMAM program in the 20 high risk districts from January to November 2016

District

Infants less than 6 months Children 6-59 months

Admissions 0-5 months

Total HIV Tested 0-5 months

0-5 months

HIV+

Admissions 6-59 months

Total HIV tested 6-

59 months

6-59 months

HIV+

Gokwe North 40 39 1 702 598 29

Gweru 19 16 3 356 194 29

Umguza 3 1 0 131 83 20

Binga 21 17 0 403 286 10

Hwange 9 3 0 142 51 5

Makonde 17 8 0 309 96 9

Chegutu 9 4 1 367 206 46

Kariba 16 6 4 105 47 5

Mangwe 19 12 0 189 150 7

Matobo 6 2 1 110 58 14

Gwanda 15 8 0 190 107 27

Shamva 13 4 1 187 90 17

UNICEF Zimbabwe Situation Report #11 - 31 December 2016

Bindura 20 2 0 121 33 6

Mount Darwin 6 5 1 333 247 32

Guruve 2 2 2 186 120 24

Mwenezi 15 13 1 249 215 20

Chipinge 40 6 0 657 350 11

Chimanimani 11 9 1 182 130 14

Buhera 62 32 1 1,084 651 17

Nyanga 4 4 0 186 104 6

Total 347 193 17 6,189 3,816 348

(Source DHIS: 2)

During the period between January and November 2016, a total of 6,189 children aged 6 to 59 months were admitted into the community-based management of acute malnutrition (CMAM) program in the 20 priority districts. A total of 3,816 (67%) of these children were tested for HIV, and 348 (1%) of these children were found to be HIV positive. A total of 213,745 children aged 6-59 months (109,469 girls and 104,276 boys) received the first dose of vitamin A supplements during the period January-June 2016 across the 20 districts (DHIS 2). This represents 89% of the UNICEF’s targeted 240,051 children aged 6 to 59 months to receive vitamin A supplementation in the 20 districts in 2016. An additional 121,406 children in the 20 priority districts received the second dose of vitamin A supplementation (56,971 girls and 65,435 boys) during the period July-November 2016. Efforts are being made to improve the vitamin A supplementation coverage during the implementation of the emergency response in the 20 priority districts. To improve the coverage, village health workers will be trained to administer vitamin A supplements in the community. IMAM Outcome Data for the 20 districts with high GAM levels, January – November 2016 The average cure rate across the 20 priority districts was 59.4% in the Month of November, compared to 61% nationally. The cure rate for the programme is below the target of 75% based on the SPHERE standards. Training of health workers in the Integrated Management of Acute malnutrition (IMAM) as well as early identification of children with MAM and SAM in the targeted districts will assist in improving the cure rate for children treated for SAM. Chipinge, Nyanga, Mt Darwin, Gwanda and Binga districts achieved cure rates within the acceptable sphere standards (>=75%). The districts with cure rates below 50% were Kariba, Gokwe North, Guruve and Mangwe. Key interventions that are being implemented to improve programme performance in the four low performing districts include facility and community health workers training on IMAM and active screening. Due to the difficult terrain and lack of appropriate transport for movement of VHWs within the district, Kariba continues to underperform. The district’s cure rate improved from 13% in June to 25% in November. More community level volunteers will be trained in January to increase active screening and follow up of children with SAM. IMAM training for health workers in all the 20 priority districts will be scaled up in January 2017 in order to improve the performance of the programme. The defaulter rate for both national level and the 20 target districts was at 15.2% and 15.7%, just shy of the <15% target by the SPHERE standards. The death rate was 2.9% for the 20 districts and 3.2% nationally, both within the acceptable cut-off point of 5% as per SPHERE standards.

Water, Sanitation and Hygiene (WASH) To date, a total of 57 boreholes were repaired in 2 districts (39 in Mwenezi and 18 in Buhera district). A total of 57 Village Pump Mechanics (VPMs) were trained and 39 Water Point User Committees’ (WPUCs) were established in Mwenezi and Buhera Districts to enhance community based management of water points. A total of 20,154 people, including 11,265 children, were reached with safe water in Mwenezi District. The cumulative number of people reached with hygiene promotion interventions in Buhera in 2016 is 2,191 people, including 87 children.

Timire borehole -community members fetching water at the repaired borehole in

UNICEF Zimbabwe Situation Report #11 - 31 December 2016 To support the WFP supported Emergency School Feeding Programme in Mbire, Binga and Zvishavane, detailed technical assessments of WASH infrastructure in schools were conducted during the reporting period and the prioritization of schools in need of WASH services was concluded in the 3 target districts.

Education The Ministry of Primary and Secondary Education and other partners in the sector continued the implementation of the Emergency school feeding programme during the period November to the first week of December. Field monitoring reports reflected improvements regarding community engagement in the emergency school feeding programme. Communities’ enhanced their participation through the provision of labour for cooking, fetching firewood and water. This has been attributed to the mobilization conducted by the School Development Committees (SDCs). In an endeavour to complement community and Government efforts, UNICEF supported the Home grown school feeding programme by ensuring that the programme supported School Improvement Grants (SIG) which can be used to purchase products for the Home Grown Sustainable School Feeding Programme. Recipient schools were allowed to allocate up to 10% of the total grant received for the purchase of products. The verification process of the use of these funds will be conducted in January 2017.

Health Typhoid cases continued to be reported during the course of the year, with an increasing trend observed during the period between November and December. As of the 25th of December 2016 cumulative cases of typhoid were 2,225 suspected cases, 85 confirmed cases and 8 deaths (CFR 0.3%), with Harare being the epicentre of the outbreak. Suspected typhoid cases increased significantly during the 43rd week (ending 30 October) and the 51st week (ending 25 December) as shown in figure 3 below.

Figure 2: Typhoid Trends : Source: MoHCC weekly epidemic report

In response to the typhoid outbreak, UNICEF’s partner German Agro Action –Welthungerhilfe is implementing WASH interventions which include, hygiene promotion and the distribution of Non Food Items which include soap and water treatment tablets in Mbare, water quality monitoring and the rehabilitation of boreholes. A total of 7 cholera cases were reported during November and December 2016 in Mwenezi District. The Ministry of Health and Child Care with support from UNICEF, WHO, MSF-Belgium, Red Cross society and Christian Care managed to contain the outbreak in a timely manner with no deaths reported. UNICEF continues to monitor the health situation in emergency prone districts through established diseases surveillance mechanisms. The health sector prepositioned emergency health supplies in the National Pharmacy (NATPHARM) Masvingo provincial warehouse and is monitoring the stocks of essential drugs in diarrhoeal disease hot spots. Plans are underway to cascade diarrhoeal diseases and pneumonia case management trainings for 300 health workers in 10 selected high risk districts in January 2017.

HIV and AIDS Buhera district continues to record the highest number of ART clients Lost to Follow Up (LTFU). In order to assess and verify the LTFU reports, a joint field visit to Buhera was conducted by UNICEF and MoHCC. The joint field visit revealed that most of the cases were reported at the three hospitals in the district where clients are initiated on ART and referred back to the nearest health facilities for review and follow up. Follow Up discussions with the facility based health workers showed that the main reasons for LTFU include population movements from one district to the other or from one homogenous locality to another. In a bid to conduct a

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UNICEF Zimbabwe Situation Report #11 - 31 December 2016 detailed assessment of the Lost to Follow up Cases, financial and technical support was provided to the district to support data verification and follow up of the clients in the communities using Village Health Workers. Support is also being provided to MoHCC to strengthen HIV testing of children admitted into the CMAM programme, during the period January to November 2016 a total of 4,009 out of 6536 (61%) children aged 0-59 months admitted into the CMAM programme were tested for HIV.

Child Protection During the month of October, UNICEF and partners reached a total of 1,302 children across the country with critical child protection services, and of these, 439 children were from the 12 most drought affected districts. UNICEF continues to work on strengthening coordination of the emergency response, strengthening situation monitoring and sensitizing government actors responsible for disaster management and response as well as civil society organizations on the child protection risks that children are facing due to drought. In the month of October, UNICEF together with the department of child welfare in the Ministry of Public Service Labour and Social Welfare, completed a trend analysis of child protection cases reported during the period August to October 2016. The analysis indicates an increase in sexual violence including commercial sexual exploitation of children. Child neglect remains high, while there are more children without parental care and committing crime. The cases reported include physical abuse, emotional abuse, neglect, child prostitution, domestic violence, child labor and Unaccompanied and Separated Children (UASC). Cases of sexual abuse account for the highest number of reported cases in the month of October (27%) followed by child neglect cases (21%). Child neglect is a negative copying mechanism that caregivers are adopting to cope with the drought as most caregivers are leaving their children to find work in towns and foreign countries due to drought and other economic challenges. Most children are left on their own or with elderly caregivers who cannot provide protection and basic needs to these children. UNICEF is strengthening community based systems to prevent and respond to child protection risks as well as to provide critical child protection services especially to children that are affected by the drought. In December, a total of 13,881 labour constrained and food poor households (HH) in 9 districts comprising of 66,536 household members benefited from the Emergency Harmonised Social Cash Transfers (HSCT) programme funded by the Government of Germany benefiting vulnerable populations particularly children , the elderly and the chronically ill. A total of 45% of the beneficiaries were children, 20% were elderly aged (60 years and above) and a further 28% of the adults were either chronically ill or had a disability. In general, 76% of all the targeted households had children in them. Children and the elderly therefore constituted more than 65% of the beneficiaries, with a significant number of them further constrained by illness or disability. This presents a case of a high dependency ratio that makes social protection interventions integral particulalry in the face of a drought. The transfer was used to mitigate the effects of the drought through purchasing of food and supplementing inputs for the ongoing farming season. Further to the direct monetary support, the households were also supported with child protection services provided at pay points. The pay points provided a point of contact that allowed the families to be educated on available basic social services and how to access them.

Communication for Development (C4D) As part of preparedness mechanisms to mitigate an increase in diarrhoeal diseases, a cholera and typhoid public service announcement video was produced with UNICEF’s Goodwill Ambassador and prominent musician Oliver Mtukudzi in collaboration with the Ministry of Health. The video is being aired on national television. UNICEF also supported the Apostolic Women Empowerment Trust (AWET) to implement social mobilization activities for the prevention of diarrheal diseases in Mwenezi District. Messages on hygiene and key caring practices in complementary feeding and child care will be shared during the mass campaigns on active screening scheduled for January 2017 targeting mothers and primary care givers of children under the age of 2 years. The Knowledge Attitude and Practice (KAP) Survey conducted in conjunction with City of Harare was concluded and the final report was shared. The survey results showed that generally knowledge on typhoid was low despite the ongoing health education campaigns. Attitudes and practices related to the spread, prevention and control of typhoid were largely negative. The non-usage of soap during hand washing after using the toilet and before eating was prominent and the majority of participants were not treating their drinking water because they considered borehole water safe. UNICEF is working with partners to address the gaps identified by the survey and strengthen typhoid response interventions.

Supply and Logistics During the reporting period, UNICEF prepositioned adequate stocks of Ringer Lactate, ORS, Ciprofloxacin and other emergency related supplies in cholera prone areas as part of preparedness measures for an outbreak of diarrhoeal diseases. During the period January to November 2016, UNICEF procured a total of 33,279 cartons of RUTF against a target of 32,000 cartoons for distribution to all districts in the country. There were no supply gaps experienced in all the districts throughout the year. Procurement of the majority of borehole spares for

UNICEF Zimbabwe Situation Report #11 - 31 December 2016 Emergency borehole repair /rehabilitation programmes scheduled for 2017 was concluded and actual deliveries are expected in January.

Funding UNICEF received a total of US$ 17.6 million from a total requirement of US$ 21.8 million to meet the increased humanitarian needs of children in Zimbabwe to enable the organization to respond to the protracted drought with critical health, nutrition, HIV/ AIDS, WASH, education and child protection services. Interventions are focusing on supporting vulnerable and disadvantaged women and children to withstand, adapt to, and recover from emergencies. UNICEF is grateful to DFID, USAID (OFDA and Food for Peace), Global Affairs Canada, German Federal Office (AA Germany), GIZ and UK, Japan and German National Committees for UNICEF who have directly supported the ongoing response and donors that are contributing to regular development programmes that are contributing to resilience building.

UNICEF Zimbabwe Funding Requirements (as defined in Humanitarian Appeal 2016)

Appeal Sector Requirements Funds available* Funding gap

$ %

WASH** 6,700,000 6,041,434 658,566 10%

Education 3,388,000 88,388 3,299,612 97%

Health 2,390,200 0 2,390,200 100%

Nutrition 3,727,946 9,806,140 -6,078,194 -163%

Child Protection 880,000 806,063 73,937 8%

Social Protection 4,500,000 804,670 3,695,330 82%

HIV/AIDS 226,800 45,620 181,180 80%

Sector Coordination*** 17,804

Total 21,812,946 17,610,119 4,202,827 19% *Funds available includes funding received against current appeal and carry-forward ($613,361) from 2015. **A significant amount of the WASH funding was received during the last quarter of 2016. ***Sector coordination Funding Requirements have been dispersed within each sector.

Next SitRep: 28 February 2017 UNICEF Zimbabwe Humanitarian Action for Children Appeal: www.unicef.org/appeals/zimbabwe UNICEF Zimbabwe Facebook: https://www.facebook.com/www.harareunicef.co.zw/ UNICEF Zimbabwe Twitter: https://twitter.com/unicefzimbabwe

Who to contact

for further

information:

Dr.Mohamed Ayoya

Representative

Zimbabwe

Tel: +263 4 703941-2

Fax: +263 4 791163

Email: mayoya@unicef.org

Zimbabwe

Dr.Jane Muita

Deputy Representative

Zimbabwe

Tel: +263 4 703941-2

Fax: +263 4 791163

Email: jmuita@unicef.org

Victor Chinyama

Chief of Communication

Zimbabwe

Tel: +263 4 703941-2

Fax: +263 4 791163

Email: vchinyama@unicef.org

UNICEF Zimbabwe Situation Report #11 - 31 December 2016

SUMMARY OF PROGRAMME RESULTS *The health section did not receive emergency funding for the drought response however, the emergency activities were conducted as part of the routine emergency preparedness and response programmes supported through the development program. Supply of emergency drugs was part of the ZIPs/ZAPs program for the vital medicines distributed through NatPharm branches countrywide. **These activities have not been able to commence due to funding shortfalls. ***The variance from the targeted children is likely due to the fact that the nutrition humanitarian response treats children with moderate acute malnutrition with either RUSF or CSB+ which significantly reduces the number of children deteriorating to SAM or relapsing after treatment. ****Vitamin A supplementation is given in 2 doses, one between January and June and figures reported are for the second dose given between July and December 2016. *****The Education response has mainly been technical support for coordination, monitoring and response planning ******A significant amount of the WASH funding was received during the last quarter of 2016, this has attributed to a low coverage (Below 50%) however coverage will increase during the first quarter of 2017.

UNICEF Zimbabwe Results Table 2016

2016 Sector

Response

2016 UNICEF

Response

Target

Total

Results

Target Total

Results

WATER, SANITATION & HYGIENE******

# of people provided with access to safe water (7.5-15L

per person per day)* 853,000 205,108 325,000 144,707

# of people provided with critical WASH related

information to prevent child illness, especially diarrhoea 1,415,000 323,503 400,000 227,103

HEALTH

# of children with diarrheal diseases have access to life-

saving curative interventions, including oral rehydration

therapy and zinc*

50,000 86,556

# of children 6-59 months vaccinated for measles** 347,800 -

# of people reached with key health promotional

messages** 1,302,000 -

NUTRITION

# children 6 to 59 months with SAM admitted to

community-based treatment programmes*** 24,554 19,195 14,711 6,189

# of children aged 6 to 59 months receive vitamin A

supplementation**** 1,159,934 465,765 240,051 121,406

CHILD PROTECTION

# of vulnerable children provided with child protection

services 31,000 25,246

SOCIAL PROTECTION # of vulnerable families benefiting from social cash

transfers 73,000 13,881

EDUCATION

# of school-aged children, including adolescents with

access to quality education***** 150,000 -

HIV and AIDS # of children, adolescents and pregnant and lactating

mothers retained on HIV treatment** 13,200 -

% of children under 5 (of unknown or negative HIV

status) with SAM admitted in therapeutic feeding

programmes tested for HIV

70% 61%