VZCZCXRO1014
RR RUEHROV
DE RUEHDS #2557/01 2271102
ZNR UUUUU ZZH
R 151102Z AUG 07
FM AMEMBASSY ADDIS ABABA
TO RUEHC/SECSTATE WASHDC 7456
INFO RUCNIAD/IGAD COLLECTIVE

UNCLAS SECTION 01 OF 05 ADDIS ABABA 002557 
 
SIPDIS 
 
SIPDIS 
 
DEPARTMENT FOR PRM/CMPT, PRM/AFR, AF/E 
GENEVA FOR RMA 
 
E.O. 12958: N/A 
TAGS: PREF EAID ET KE SU
SUBJECT: MONITORING AND EVALUATION OF INTERNATIONAL RESCUE COMMITTEE 
(IRC) REFUGEE ASSISTANCE PROJECT IN KAKUMA REFUGEE CAMP, KENYA 
(COOPERATIVE AGREEMENT NO. SPRMCO07CA032) 
 
¶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 
budget. 
 
¶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 
consideration.  END OF SUMMARY/ASSESSMENT. 
 
----------- 
SITE VISITS 
----------- 
 
¶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 
activities. 
 
¶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 
BPRM. 
 
--------------------------------------------- -- 
IRC'S MULTISECTORAL PROGRAM, ITS OBJECTIVES AND ACHIEVEMENTS 
--------------------------------------------- -- 
 
¶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 
services. 
 
- 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 
0.3/1000/month. 
 
- 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 
year. 
 
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 
percent. 
 
¶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 
15percent. 
 
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 
persons. 
 
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 
regulations. 
 
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 
camp. 
 
- 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 
disabilities. 
 
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. 
 
------------------------- 
CONCLUSION/RECOMMENDATION 
------------------------- 
 
 
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. 
 
YAMAMOTO