Provision of integrated management and prevention of Acute Malnutrition to reduce morbidity and mortality in children less than five years as well as PLW in priority SAM management gap areas in Berbera, Zeila, Gabiley and Hargeisa - Somaliland. The national prevalence of Global Acute Malnutrition (GAM) has remained Serious (10-14%) over the past three seasons, the 2018 post Deyr season nutrition results indicate that the level of acute malnutrition is Critical (GAM 18%) in parts of Hawd and Guban livelihood zones due to food insecurity, high morbidity, low immunization and Vitamin-A supplementation, and poor care practices. 

ANPPCANSOM drought response plan will scale up treatment of severe acute malnutrition subsequently reaching an estimated 4,124 children affected by SAM living within Zeila (928 cases), , Berbera (1,135 cases), Gabiley (377 cases) and Hargeisa (1,684 cases). The accumulated figure reflect 90% of the total burden of the target districts based on 2019 nutrition cluster burden estimates as well as the projected figures for the first half of the year 2020. 

ANPPCANSOM will maintain treatment outcomes consistent with Sphere standards using the combined protocol for the management of acute malnutrition in close consultation and coordination with Somali Nutrition Cluster, Somaliland Nutrition Working Group and other nutrition partners including MOHD, UNICEF and WFP. ANPPCANSOM will build on and sustain the delivery of a holistic basic nutrition services package (BNSP) in priority to internally displaced people and their host communities and other socially marginalized groups in pastoral and hard to reach areas while ensuring the inclusion of treatment, promotion and prevention components in this project.

The project will provide facility-based and community based (BNSP) covering both curative and preventative interventions targeting children U5 years (boys and girls) and pregnant and lactating women. It will support the identification, referral and treatment of children suffering from severe acute malnutrition while SAM cases with medical complications will be referred to the nearest stabilization centers using standard referral forms. ANPPCANSOM will manage 22 fixed OTP sites and 2 stabilization centres (6 OTP fixed sites for Zeila district 9 fixed OTP sites and 1 SC for Berbera district, 6 fixed OTP sites for Hargeisa district 1 fixed OTP and 1 SC for Gabiley district). Efforts will be made to ensure integration of OTP and TSFP sites where possible.  In order to ensure the sustainability of nutrition interventions, local technical capacity will be strengthened by integrating SAM management into the Primary Health Care system through the functional MCH facilities. Additionally, the capacity of nutrition staff will be strengthened for effective service delivery at facility and community level. 

In addition, the project will support community mobilization and screening as well as micro-nutrient supplementation for PLW (multiple micro-nutrients and Iron folate) and Vitamin A supplementation for children between 6-59 months. It will also provide de-worming for children 12-59 months and pregnant women in the 2nd and 3rd trimester as well as counselling and promotion on infant and young child feeding compounded with health and hygiene promotion. Moreover, measles immunization will be provided to infants living within the catchment areas of the target health centers who are not immunized against measles. Systematic defaulter tracing for immunization services will also be conducted at community level. In order to strengthen the accountability with affected population, we will introduce mother-led MUAC approach to increase detection, identification and early referral of malnourished children. ANPPCANSOM will train mothers to use MUAC tapes to enable mothers screen, detect oedema and self-referral of their children to nutrition sites.