Cablegate: Monitoring and Evaluation of International Rescue Committee

DE RUEHDS #2557/01 2271102
R 151102Z AUG 07





E.O. 12958: N/A

1. SUMMARY AND OVERALL ASSESSMENT: Refugee Coordinator (refcoord)
Kent (Sam) Healy visited Kakuma refugee camp at Kakuma, Kenya,
several times the first 7 months of 2007. During these visits, time
was spent to monitor and evaluate the IRC program "Continuation of
an Integrated Health Care, and Adult and Special Needs Education
Program" funded by PRM under cooperative agreement number
SPRMCO07CA032. Refcoord has also met with GOE, UNHCR and other
implementers in Kakuma, as well as with IRC Kenya headquarters staff
in Nairobi to discuss their programming. The PRM cooperative
agreement contributes USD1,791,385 towards a total budget of
USD3,265,513 that covers IRC's operations in Kakuma.

2. Seven months into the cooperative agreement, IRC has made good
progress towards achieving its agreed to objectives. The three
satellite clinics have been operating 6 days a week, while Kakuma
hospital has operated 24 hours seven days a week. Despite constant
outbreaks of disease including measles, cholera and malaria, crude
mortality rate at the camp is .30/1000 per month, while under 5
mortality rate is .99/1000 per month. During the reporting period,
134 new latrines were constructed and 25 old latrines were
rehabilitated, while a ratio of 15 persons per latrine was
maintained. One hundred percent of children below five years of age
admitted at Supplementary Feeding Centers (SFC) and Therapeutic
Feeding Centers (TFC) received iron supplementation, while a vitamin
A supplementation campaign conducted in February 2007 reached over
95 percent of all children under five years of age. Finally, 246
disabled children were enrolled in mainstream schools, and 2,180
adult learners enrolled and were maintained in the Adult and Special
Needs Education program.

3. Some of the challenges brought up by IRC during the visits
include: high turnover of refugee incentive staff as large numbers
of the most skilled refugees repatriate to south Sudan; frequent
outbreaks of sickness and disease, particularly malaria, during this
grant period; aging structures built to last 5-10 years that have
now been in service for over 15 years; as well as a diminishing

4. IRC's management and administrative sections appear well run.
While small issues continue to emerge from time to time, especially
between IRC and UNHCR over scopes of activities and budgets, the
relationship between UNHCR and IRC appears much improved from the
previous grant cycle. Other NGOs operating at Kakuma confirm an
excellent level of coordination with IRC. Refcoord recommends that
IRC's follow-on proposal for its program in Kakuma receive positive


5. Refcoord traveled to Kakuma refugee camp (pop. 71,000+) in
northwestern Kenya three times in the initial seven months of the
project cycle. During the visits, refcoord conducted monitoring and
evaluation activities of IRC's Refugee Assistance Program for
Sudanese Refugees, meeting with IRC staff and visiting project

6. Indicators reported are based on the first quarterly report
covering the period January 1-March 31, 2007. The second quarterly
report was late and had yet to be submitted at the time of this M&E
report. During the reporting period, Kakuma's population was
reduced from 87,593 to 71,767, due to both the repatriation of south
Sudanese refugees, as well as a revalidation exercise that more
accurately counted the people in the camp. In addition, IRC
estimates it serves approximately 7,177 persons from the local
population. Thus, taken together, the IRC currently serves
approximately 78,944 people through its programs in Kakuma.

7. During the various visits, Refcoord met with IRC Field
Coordinator, Medical Coordinator, and other IRC field office and
camp staff; with UNHCR/Head of Sub-Office Mahmood Syed Hussain; with
refugee leaders and beneficiaries; and with other PRM NGO partners
working in Kakuma, to discuss IRC's performance in meeting
objectives outlined in its cooperative agreement with PRM. Refcoord
visited therapeutic and supplemental feeding programs, adult
education classes, the hospital and clinics, and sanitation project
sites. During one visit, Refcoord witnessed firsthand the
degradation of infrastructure due to age, when one of the Rubbhalls
that are used for hospital wards was severely damaged during a wind
storm. In Nairobi, Refcoord met with IRC country Director Kellie
Leeson, project coordinator Kelly Williams, as well as UNHCR Deputy
Representative Eddie Gedalof.

8. Based on discussions with a range of officials, both in Kakuma
and in Nairobi, it was clear that IRC closely coordinates the other
NGO partners in Kakuma and has an improving relationship with UNHCR.
Interlocutors we spoke with including UNHCR, the Kenyan Government,

ADDIS ABAB 00002557 002 OF 005

the Lutheran World Federation, FilmAid International, and the World
Food Program, were unanimous in their satisfaction with IRC's work.
Refugee leaders in Kakuma also spoke positively of IRC's efforts.

9. While at Kakuma, refcoord visited IRC's finance and
administration offices. IRC continues to follow good inventory and
administrative practices. All equipment and materials were clearly
marked for inventory purposes, and various financial and management
systems appeared to be in order. In discussions with staff, all had
signed and exhibited an understanding of the code of conduct, and
had undergone prevention of sexual exploitation and abuse (PSEA)
training as part of their orientation. In addition, many staff had
participated in one or more additional PSEA activities as part of
the separate PSEA project that IRC implements through a grant from

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10. Under the current cooperative agreement, IRC is continuing its
multi-sectoral programs to Sudanese refugees in Kakuma refugee camp.
The program provides services in areas of health, nutrition,
community-based rehabilitation, adult education, and support for
refugee populations with disabilities. Indicators reported below
are for January 1 to March 31, 2007 (the first quarter of the
12-month grant period):

11. OBJECTIVE A: To provide effective and efficient promotive,
preventive, curative, rehabilitative, and palliative health care

- Indicator 1: Quality of clinical care maintained to ensure
children under 5 years of age mortality rate maintained at less than
1.5/1000/month and Crude Mortality Rate (CMR) maintained at less
than 0.5/1000/month.

Performance - The under-five mortality rate during the reporting
period was 0.99/1000/month, while the crude mortality rate was

- Indicator 2: Increase vaccine coverage of fully immunized children
less than one year of age from 81percent to 90percent.

Performance - Vaccination coverage (full immunization) for children
less than one year was 86.1 percent.

- Indicator 3: 100percent of pregnant mothers attending first ANC
visit and 20percent of children under 5 years of age are provided
Insecticide Treated Nets (ITNs); home surveys to be conducted to
ensure increase from 78percent to 90percent of beneficiaries are
using ITNs properly on a nightly basis.

Performance - The ITN coverage for pregnant mothers was 85.3 percent
for the first quarter, and 66 percent of children under five years
of age were provided with ITNs. Two surveys on proper use of ITNs
are planned for June and December 2007.

- Indicator 4: Increase percentage of pregnant mothers delivering at
hospital from 38percent to more than 50percent with maternal
mortality ratio maintained at less than 200/100,000 live births per

Performance - 64 percent of deliveries during the first quarter were
conducted at the health facilities. The maternal mortality rate was
maintained at 152.2/100,000 live births per year.

- Indicator 5: PEP coverage among survivors of rape at 100percent.

Performance - PEP coverage among the rape survivors was 100

12. OBJECTIVE B: Adult and Special Needs Education - To build the
capacity of 2,250 disabled children and other vulnerable refugees
through adult and special needs education programs.

- Indicator 1: Enroll at least 250 disabled children in mainstream
schools, provide at least 70 of them with individual development
plans, and monitor attendance rates for all 250.

Performance - 246 disabled children were enrolled in mainstream
schools in the camp. A monthly average of
53 IEPs were developed and implemented during the reporting period.

- Indicator 2: 2,000 registered learners are enrolled in, and
attend, adult education programs, with 80percent receiving a pass
mark of at least 50percent in their examination.

ADDIS ABAB 00002557 003 OF 005

Performance - 2,180 adult learners enrolled and were maintained in
the Adult and Special Needs Education program. Examinations are
scheduled in May for beginners and intermediate levels, and August
for the advanced level of learners.

- Indicator 3: Train 30 teachers in special needs education.

Performance - A one-month training for the 30 regular teachers in
special needs education is planned for August 2007.

- Indicator 4: 365 beneficiaries will complete two months of
management training.

Performance - 36 health staff (refugees) completed a two-month
training of trainers (TOT) course, while 74 refugee and local
community leaders completed a four-day community self-management
skills training during the same period. Mid-level management
training is scheduled to begin in April; training of facilitators
(TOF) for TOT, is scheduled to begin in June.

- Indicator 5: 80 women enrolled in, and attend, management
training, with 80percent completing full course.

Performance - Two women-only classes with 80 participants started in
January and are ongoing.

12. OBJECTIVE C: Nutrition - To contribute to reduction of
malnutrition in camp.

- Indicator 1: Operate 2 Therapeutic Feeding Centers (TFCs) and 4
Supplementary Feeding Centers (SFCs) and provide adequate food
stocks for 100percent of caseload.

Performance - Two TFCs and four SFCs served the entire caseload
during the reporting period.

- Indicator 2: At least 50percent of the estimated malnourished
population (est. 1,817 from 2005 nutritional survey) attends SFC,
leading to decrease in GAM rate from 15.9percent to less than

Performance - A monthly average of 85.4 percent (1,551 of the 1,817)
of the estimated malnourished population attended the SFCs. GAM
rates will be provided following the annual nutrition survey to be
completed in September.

- Indicator 3: Conduct 3 mid-upper-arm circumference (MUAC)
screenings and 1 anthropometric nutritional survey for children
between six and 59 months of age.

Performance - One MUAC screening was conducted in February, reaching
6,756 refugee children within the camp and 1,274 in the local
Turkana community. Additional MUAC exercises are planned for June
and November 2007. The anthropometric survey has been planned for
September 2007.

- Indicator 4: Provide iron supplementation to 100percent of
children under the age of five years admitted at SFCs and TFCs.

Performance - every child under five years of age admitted at SFC
and TFCs received iron supplementation.

- Indicator 5: Provide vitamin A supplementation to 90percent of
children under the age of five years during 3 camp-wide campaigns.

Performance - A Vitamin A supplementation campaign was conducted in
February 2007, reaching 95.6 percent of children under five years of
age. It is unclear if follow-on campaigns are scheduled.

13. OBJECTIVE D: Sanitation - To ensure adequate latrine coverage,
promote proper hygiene practices, and implement vector control
strategies to ensure a healthy environment within the camp.

- Indicator 1: Camp latrine coverage from 1 latrine per every 20

Performance - The latrine-to-users ratio is estimated at 1:15.

- Indicator 2: Construct 500 family latrines in residential
community and rehabilitate 200 family latrines.

Performance - 134 new latrines were constructed and 25 old latrines
were rehabilitated during the first quarter.

- Indicator 3: Conduct daily inspections of food premises and
animal slaughter areas in conjunction with GOK Public Health
Department staff to ensure enforcement of public health

ADDIS ABAB 00002557 004 OF 005

Performance - A total of 345 butchery, hotel, tearoom, food store,
and grocery store inspections (an average of 4 per day) were carried
out in the first quarter.

- Indicator 4: Facilitate burial or disposal of 100percent of human
remains and animal carcasses within 24 hours notice by the
community, UNHCR, local authorities or the security agencies.

Performance -100 percent of human remains and animal carcasses were
buried or disposed of within 24 hours notice, including 82 human
bodies, 10 cat carcasses, and eight dog carcasses.

- Indicator 5: Conduct 1 residual spraying exercise in 100percent
of home to control mosquitoes within camp.

Performance - One indoor residual spraying exercise was conducted in
March 2007 to control mosquitoes. The spraying covered 22,134
houses (100 percent), 2,215 latrines, and all facilities at the camp
hospital, as well as all rooms in the staff quarters within the

- Indicator 6: Promote good hygiene practices through 1,600
house-to-house visits, 10 workshops, 12 camp-wide awareness
campaigns, and weekly child-to-child sessions at schools; monitored
by annual KAP survey of children in camp.

Performance - During the reporting period, 285 house-to-house visits
were made, six workshops were held (reaching 151 individuals), 39
bi-weekly child-to-child sessions were conducted in schools, and two
weekly sessions for non-school children were conducted. Though
currently behind schedule, IRC plans to increase the rate of
house-to-house visits and expects to meet the indicator by the end
of the project period.

14. OBJECTIVE E: Community-Based Rehabilitation - To enhance the
dignity of the disabled, provide therapeutic and psychological
services to physically disabled persons and reduce community stigma
towards the disabled.

- Indicator 1: Provide physiotherapy and ortho-surgical services to
90percent of identified eligible persons with disabilities (PWDs).

Performance -84 PWDs were identified and provided with appropriate
rehabilitation services.

- Indicator 2: Procure 10 tricycles and repair and maintain
100percent of tricycles used by PWDs in camp.

Performance - Procurement of new tricycles is planned for the second
quarter; IRC carried over eight tricycles purchased in the last
quarter of last year. In addition 24 tricycles were repaired.

- Indicator 3: Conduct 4 one-day community workshops for community
leaders on the rights of the disabled.

Performance - One community awareness workshop for identified
opinion/community leaders was conducted in March. It is unclear
when the other three workshops are scheduled.

- Indicator 4: Conduct 24 support group sessions for children with

Performance - Four children support group sessions were conducted
during the first quarter. Four sessions per month are planned for
February, April, June, August, October and December.

- Indicator 5: Teach orientation and mobility (O&M) and daily
living activities (ADL) to 10 visually impaired individuals for use
within camp and for transition to post-camp life.

Performance - In the first quarter, five visually-impaired persons
were taught O&M and ADL.

- Indicator 6: Create and disseminate STI and HIV/AIDS awareness
messages in Braille for 10 sight-impaired community members; create
and disseminate STI and HIV/AIDS awareness messages, transmitted
through sign language, for 20 hearing-impaired community members.

Performance - As yet, no awareness messages for either sight- or
hearing-impaired community members have been created or
disseminated. These activities are planned to commence during the
second quarter.


ADDIS ABAB 00002557 005 OF 005

15. IRC continues to provide quality services to the residents of
Kakuma during this time of transition. With the likely further
shrinking of the camp population as the Sudanese continue to
repatriate, IRC is already looking at further adjusting their
programming to meet this new reality. With its quality performance
during the first eight months of the current cooperative agreement
and the likelihood that it will met or exceed its agreed to
indicators, refcoord recommends that PRM give IRC's new proposal
positive consideration, in accordance with our priorities and within
our own budget constraints.


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