Afghanistan
Nutrition Cluster Bulletin
Summary of annual Needs,
Targets and Achievements
(Jan-Dec 2015)
Estimated burden of 517,600 SAM and
570,000 MAM children (NNS 2013)
Assessments conducted
Jan to Dec 2015 Issue: 3
Nutrition Cluster Results highlights
 From January to December 2015, based on the received reports, 160,160 children (73,148 boys, 87,012
girls) have been admitted for treatment of both IPD SAM and OPD SAM, of which 32,174 (20%) children
were in the fourth quarter. During this
year, 22,271 were admitted in IDP SAM out
of which 3,584 were admitted in last quar-
ter of 2015. Similarly throughout the year a
total of 137,889 children were admitted in
OPD SAM programmes across the country
and out of these 28,590 were in last quarter
of 2015.
The total admitted children is 103% of the
IMAM program - U5 children admitted and trend by type of service: Jan to Dec 2015
HRP 2015 target of 155,279 children. The
overall reporting rate for 2015 is 70% for both
IPD SAM (58%) and OPD SAM (72%).
 From January to December 2015, based on the received reports, 144,252 (73,569 boys, 70,683 girls)
children were admitted in OPD MAM programmes of which 31,706 (20%) children were admitted in the
last quarter. This total children reached is 103% of the HRP 2015 target of 140, 309 children in the year.
The OPD MAM reporting rate is low at approximately 65%.
 Although there are differences in the performance indicators by programme, i.e IPD SAM , OPD SAM
and OPD MAM, the overall cure rate for children in the IMAM programmes was 93.4%, Death rate was
0.5 % and defaulter rate was 6.1%, all within the sphere standards.
 A total of 183,958 acutely malnourished pregnant and lactating women (PLW) have so far been reached
from January to December 2015 of which 36,668 (20%) PLW were reached during the reporting period.
It is import to note that this has already surpassed the annual target of 105, 342 PLW targeted.
 A total of 306,733 children have been reached with micronutrient supplementation from January to
December of which 70,558 were reached during the reporting period. The total reached is 52% of the
annual target for the cluster hence well behind target for the year mainly due to shortage of supplies as
well as under reporting.
 In 2015, a total of 995,288 mothers and caregivers have been reached with IYCF messages out of a
planned annual target of 624,554. The number reached has already surpassed the target for the year as
there is multiple reporting of beneficiaries if they receive the promotion messages more than once.
 From January to December 2015, 180 staff from 36 IPD SAM Units (TFUs) trained on management of
severe acute malnutrition, out of them 44 staff (18 female and 26 male) trained in the 4th quarter of
2015.
 Therapeutic Milk preparation kits, medicine and medical equipment, TFU files, and bedside chairs pro-
vided distributed to 36 IPD SAM in 13 high risk provinces.
 Between October to December 2015 ACF conducted one SQUEAC & SMART each in Ghazni and Lagh-
man respectively
 A total of 34 partners are providing nutrition services through 177 IPD SAM sites, 776 OPD SAM and 616
OPD MAM sites in all the country
Funding
reported
(Jan-Dec
2015)
For more information, please contact:
(1)Leo MATUNGA, Nutrition Cluster Coordinator, lmatunga@UNICEF.org, Tel: +93(0)798507615
(2) Alfred KANA, Information Management Officer, akana@UNICEF.org, Tel: +93(0)798507616
Website: afg.humanitarianresponse.info
 Page 2 Afghanistan Nutrition Cluster Bulletin

Nutrition Cluster Activities and Situation Overview

Key highlights for next
quarter (Jan– Mar) In 2015 the nutrition situation remained largely the same however the nutrition surveys (Laghman, Nuristan,
Kunar and Kandahar) revealed a worrisome situation as Severe Acute Malnutrition (SAM) in all these surveys
 Assessments (SMART, was above 2% and Global Acute Malnutrition (GAM) above the national average of 9.5% (NNS2013). In addition
in 2015 the needs of refugees from Pakistan who continued to pour in Khost and Paktika Provinces contributed
SQUEAC, SLEAC and RNA)
in increasing the nutrition caseloads that the nutrition cluster dealt with especially in Gulan camp and sur-
to be continued in the
rounding areas. On the other hand in late September the conflict in Kunduz led to displacements in Kunduz,
targeted provinces
Faryab, Badghis, Nangarhar even though they were not directly resulted in nutrition deterioration however it
affected normal nutrition service delivery as some nutrition centres have had to close for some time. In late
October a powerful earthquake struck Badakhshan province with a magnitude of 7.5 damaging almost 1100
homes and injuring almost 300 people. However the nutrition cluster partners had enough supplies to cater
the nutritional service needs in these areas. Sometimes the pipeline breaks for some of the food commodities
for the treatment of acutely malnourished pregnant and lactating women has impacted the programmes dur-
 Surveillance update ing the reporting period.
The following localized SMART nutrition surveys were
undertaken during the reporting period:

Laghman = GAM-10.1% SAM-2.3%

Implications: Even though there is a general improved
 Strengthen sub-national nutrition situation compared to NNS 2013, the rates
of malnutrition remain a concern and there is still
nutrition clusters.
need to provide life-saving needs especially to ad-
dress severe acute malnutrition as a SAM rate above
2% is deemed high.

The following Coverage assessments were undertak-

en during the reporting period:
 Contingency planning Overview of ACF project on assessments: provinces and partners
Ghazni, Coverage=32.3%
workshops. Implications: The localized coverage assessments indicate that there are some issues that needs to be ad-
dressed with regards to the coverage of nutrition services.

Also, Stunting remains high in all surveyed areas and generally consistent with NNS 2013 (ranging from 30% to
above 60 %. Kunar, Nangarhar Ghor and Nuristan being the most affected

 Advocacy strategy imple- The National Nutrition Surveillance System (NNSS) continued its implementation and 26 provinces are re-
porting from health facility sentinel sites, 13 provinces are reporting (356 sentinel sites of 99 HFs). NNSS has
mentation
been expanded to the third and last scale-up phase. In total, 175 facility-based sentinel sites and 933 communi-
ty-based sentinel sites have been selected.

Based on the information received from the cluster partners the cluster has $ 47,600,509/- (75%) of the total
revised target of $ 63,262, 622/-.

According to FTS the cluster is funded only (61.8%) $ 39,064,918/- vis-à-vis the HRP annual target. Therefore
this means that there are some delay in reporting by partners and donors into the FTS.

For more information, please contact:

(1)Leo MATUNGA, Nutrition Cluster Coordinator, lmatunga@UNICEF.org, Tel: +93(0)798507615
(2) Alfred KANA, Information Management Officer, akana@UNICEF.org, Tel: +93(0)798507616
Website: afg.humanitarianresponse.info
 Page 3 Afghanistan Nutrition Cluster Bulletin

Partnerships
Planning towards the Humanitarian Response Plan 2016 (HRP)
The cluster works to support the gov-

ernment of Afghanistan, ministry of

 Nutrition Cluster along with partners finalized the nutrition caseloads and target for the priority areas
Public Health’s Public Nutrition de- for the 2016 HRP and HNO

partment (PND) to respond to nutri-

 2016 will focus on Humanitarian Needs and acknowledging that other needs do occur. It focus on 17
tion crisis in the country.
priority provinces with SAM >3% according to NNS 2013. Additional 5 Provinces (Ghor, Takhar, Dai-
kundi, Bamyan, Jawzjan) with food insecurity as highlighted by SFSA and not included in first priority).
Acknowledgement is hereby given to

the following UN and NGOs for their

 Refugees populations especially in Paktika and Khost are also taken in account.
support to nutrition response:

AADA; ACBAR; ACF; ACTD; AHDS;  Flexibility to include disaster/conflict affected IDPs as well as accessible white areas.

AKHS; BARAN, BDN; BRAC; CAF; CARI-

 Caseload calculations taking into account localized survey results.
TAS Germany; CHA; Cordaid; CPHA;

CWS-P/A; DAC; Fews Net; GAIN;

 Approximately 1,576, 369 Children in need in the 22 priority provinces.
HADAAF; HHAAWC; HN-TPO; ICRC;

IMC; iMMAP; IRC; Islamic relief; Johan-

 Key targets includes: Screening= 1,300,000 ( 30% of U5): SAM= 97,036 (40% of burden), rehabilitation
niter; Medair; MI; Move; MRCA; of SAM sites= 37 IPD SAM, MAM-U5= 156,037 (40% of burden), AM-PLW=116,330 (100% of estimated
AM-PLW), IYCF=369,404 ( SAM+MAM+PLW), MNP=333,013, Nutrition Surveys=10 (RNA=5, coverage
MMRC-A, ORCD, OHPM, MSF; NEI; assessments=5), training on NiE, Cluster Coordination and on assessments.

NRC/protection cluster; Health Clus-

ter; PIN; PND/MoPH; PU-AMI; SAF;  Cluster funding requirement for 2016: USD $ 63, 246,962

Save The Children; SCA; SDO; SHDP;

 Afghanistan experiences high levels of chronic malnutrition (stunting) on top of the acute malnutri-
TIKA; WVI
tion. There is a need to advocate with donors for longer-term funds to sustainably and comprehen-
sively address the issue of malnutrition in the country. The Cluster is appealing to donors to move
UNICEF; WFP; WHO; FAO, UNOCHA from single-year funding modalities for nutrition activities to multi-year funding, in order to systemati-
cally address the dual burden of acute and chronic malnutrition in the country.
Main donors:

USAID OFDA/FFP, CHF, DFATD, JA-

PAN, KOREA , World Bank, European

Union and others.

For more information, please contact:

(1)Leo MATUNGA, Nutrition Cluster Coordinator, lmatunga@UNICEF.org, Tel: +93(0)798507615
(2) Alfred KANA, Information Management Officer, akana@UNICEF.org, Tel: +93(0)798507616
Website: afg.humanitarianresponse.info
 Page 4 Afghanistan Nutrition Cluster Bulletin

Story from UNICEF in Kabul

Constraints and Challenges
(treatment for severe acute
malnutrition at Indira Gandhi
Children’s Hospital in Kabul )
The Cluster experienced the following challenges during the reporting period:
By Sohaila Khaliqyar
 Timelines and completeness of reports by partners despite constant follow ups and reminders is a ma-
jor challenge

 Due to lack of partner capacity to conduct on time some of the assessments were delayed and the ones
which were conducted were in areas which comparatively accessible. However fragile security situation
limited the accessibility to most areas.

 Limited availability and lack of technical capacity at service delivery point in another challenge to pro-
gramming.

Two year old Samiullha sits in his mother’s  Poor community identification, referral and follow up of malnourished children.
arms and giggles shyly, hiding behind the
 Access to nutrition services though improving still remain a challenge as on average only about 40% of
scarf of his 24-year-old mother, Marzia. He
the health facilities are providing nutrition services.
is now on his way to good health but just a
month ago he was severely acutely mal-
 Deteriorating security situation in some areas become a key barrier for programme implementation,
nourished as a result of poor nutrition and
accessibility of programme to beneficiaries and vis-versa.
diarrhea. Samiullha lives with his mother,
his grandfather and uncle in Bala Hesar,  Due to the frail security situation in most parts of the country it is a big challenge for the program staff
Kabul .
to monitor all the activities at the field level
The family home does not have a kitchen,
safe water or a proper toilet. “My brother-
 Lack of funds to support IPD SAM units in provinces with prevalence of SAM between 2-4 %( according
in-law brings water in a barrel from a long to NNS 2013)
distance for drinking and other uses,” said
Marzia, “I cook in a corner of our corridor.”

Their dire living conditions are compound-

ed by their limited income. As a result,
Marzia has been unable to afford the varie-
ty of foods with the right micronutrients
Acronyms
that her son needs for his growth and de- AIMWG Assessment and Information Management Working TFU Therapeutic Feeding Unit
velopment. It also delayed Samiullha re- Group GAM Global Acute Malnutrition
ceiving early diagnosis and treatment. “He BPHS Basic Package for Health Services WHO World Health Organization
had diarrhea and was very sick,” said Mar- WG Working Group WFP World Food Programme
zia, “but due to lack of money I could not IMAM Integrated management of Acute Malnutrition FAO Food and Agriculture Organization
take him to the doctor. After almost one MN Micronutrient UNICEF United Nations Children’s Fund
month he was getting worse, so I borrowed NC Nutrition Cluster MoPH Ministry of Public Health
money and took him to the nearest health NCC Nutrition Cluster Coordinator OPD-MAM Out-Patient Department-Moderate Acute
centre and the doctors advised to visit IMO Information Management Officer Malnutrition

Indira Gandhi hospital”. PLW Pregnant and lactating women OPD-SAM Out-Patient Department-Severe Acute Malnu-
PND Public Nutrition Department trition
PNO Provincial Nutrition Officer IPD-SAM In-Patient Department-Severe Acute Malnutri-
CLA Cluster Lead Agency tion
SMART Standardized Monitoring and Assessments of Relief OCHA Office for Coordination of Humanitarian Affairs
and Transition MAM Moderate Acute Malnutrition
RNA Rapid Nutrition Assessment IYCF Infant and Young Child Feeding
NCA Nutrition Causal Analysis c-IYCF Community Infant and Young Child Feeding
SQUEAC Semi-Quantitative Evaluation of Access and Coverage IYCF-E Infant and Young Child Feeding in Emergencies
WASH Water , Sanitation and Hygiene NiE Nutrition In Emergencies
SAM Severe Acute Malnutrition CHF Common Humanitarian Fund
©UNICEF Afghanistan/2015/Sohaila Khaliqy SC Stabilization Centre
At Indira Gandhi Children’s Hospital in Kabul, Af-
ghanistan, Sami’s mother, Marzia, receives two
weeks’ supply of ready-to-use therapeutic food
For more cluster documents: http://www.humanitarianresponse.info/en/operations/afghanistan/nutrition

For more information, please contact:

(1)Leo MATUNGA, Nutrition Cluster Coordinator, lmatunga@UNICEF.org, Tel: +93(0)798507615
(2) Alfred KANA, Information Management Officer, akana@UNICEF.org, Tel: +93(0)798507616
Website: afg.humanitarianresponse.info