Acf 2012 Myanmar Nutrition (A1y) Evaluation 2012 Full Report

External Evaluation
Nutrition Programmes in the Maungdaw and Buthidaung

Townships, Northern Rakhine State, Myanmar
Funded by ECHO Juan Luis Domnguez-Gonzlez, May 2012
Photo ACF Myanmar
This report is commissioned by Action Against Hunger | ACF International. The comments contained herein
reflect the opinions of the Evaluator only.
External evaluation of Action contre la Faim
Nutrition projects in Maungdaw & Buttidaung, NRS, Myanmar
TABLE OF CONTENTS
1 EVALUATION SUMMARYp.5
2 CONTEXT ANALYSISp.7
2.1 Socio-political situation
2.2 A background to the emergency
2.3 Analysis of Malnutrition in NRS
2.4 Project background
3 CONSTRAINTSp.18
4 METHODOLOGY.p.18
5 FINDINGS..p.21
6 CROSS CUTTING PROCESSESp.34
7 CONCLUSIONSp.40
8 TOR CRITERIAp.44
9 RECOMMENDATIONS.p.49
10 ANNEXES
i. ToR ACF Nutrition Evaluation NRS Myanmar (final)
ii. Bibliography
iii. Project Logical Framework
iv. Best Practice
v. Itinerary Minutes
vi. Map of MGD, BTD & RTD townships
vii. Map of NRS - Buthidaung Township
viii. Northern Rakhine State Map
Evaluation report ACF Myanmar / Mar-Apr 2012 2/50

List of Acronyms
ACF Action contre la Faim

BTG Buttidaung
HOM Head of Mission
CCT Community Caretaker
CMAM Community-based Management of Acute Malnutrition
CP Care Practices
ECHO European Commission Humanitarian Office
GAM Global Acute Malnutrition
GOUM Government of the Union of Myanmar
GOW Gain of Weight
HD Health Department
HO Head Office
IEC Information, Education and Communication
INGO International Non-Governmental Organisation
KAP Knowledge, Attitudes, Practices
LOS Length of Stay
MAM Moderate Acute Malnutrition
MCH Maternal and Child Health
MGD Maungdaw
MNTN Myanmar Nutrition Technical Network
MSFH Mdecins sans Frontires - Holland
MOH Ministry of Health
MOU Memorandum of Understanding
MUAC Middle Upper Arm Circumference
PHC Primary Health Care
PM Programme Manager
RHC Rural Health Centre
RHSC Rural Health Sub-centre
SAM Severe Acute Malnutrition
SC-UK Save the Children-UK
SCCT Super Community Caretaker
TBA Traditional Birth Attendant
TL Team Leader
UN United Nations
UNDP United Nations Development Programme
UNICEF United Nations Childrens Fund
WFP World Food Programme
WHO World Health Organisation
W/H Weight per Height
W/A Weight per Age

FOREWORDS
This report would not have been possible without the support and encouragement of-
fered by ACF in Myanmar and in London. I would like to thank ACF teams both in Yangon, in
London, and in Maungdaw, Buttidaung and Sittway for all the help they have eagerly given
to me, and their efforts to make me feel almost at home. I have felt very much looked after
in every place I have been.
I would especially like to thank ACF national staff for their hard work, their enthusiasm,
their openness and their unflagging kindness and support. It happens not very often that a
completely alien person finds such warm and unfaltering hospitality when visiting remote
places where very committed people struggle to give the best of their skills to those in dire
need. It was worth the effort to visit and share with them a much-deserved break in their
daily tasks and some quiet talk.
Special thanks, too, to interpreter Rezaul Mustafa for his accuracy in translating, his inde-
fatigable devotion to his job, his hospitality in Buttidaung, and for the good moments I had
when travelling with him.

1 EVALUATION SUMMARY
CONTEXT ANALYSIS
SOCIOPOLITICAL SITUATION
Since taking up office, President Thein Sein has moved quickly to begin implementing his am-
bitious reform agenda. A series of important economic, political and human rights reforms were being
enacted. A release of political detainees was enforced, although some die-hards were still kept in
prison. The president reached out to government critics, including Aung San Suu Kyi and the ethnic
minorities.
In April 1st by-elections the National League for Democracy, won by a landslide in most
states, granting her and many of her party members a seat in the new parliament. Its leader Daw
Aung San Suu Kyi, the democracy advocate silenced for two decades by Myanmars generals with
house arrests and overturned elections, assumed a new role in her countrys political transition, ap-
parently winning a seat in Parliament to make the remarkable shift from dissident to lawmaker.
The president gives every indication of having the political will to put Myanmar on a new path.
Yet, success will be neither quick nor straightforward. Experience from elsewhere shows that the chal-
lenges of transforming a country emerging from decades of ethnic conflict and authoritarianism are
massive, and it is important that this be recognised in the Myanmar context.
A BACKGROUND TO THE EMERGENCY

The Muslim Rakhine reintegration conditions remain unsolved until today; the population is
still in a constant state of precariousness and vulnerability under the tight control of the army, the MI,
the border police and other groups. The level of economic development is very low, structural invest-
ments are insignificant and health services poor to non-existent.
Policies of exclusion and discrimination imposed on the Rohingyas by successive Burmese mili-
tary regimes have prevented them from developing socially and economically, and it seems that they
were deliberately designed to encourage departure to Bangladesh.
ANALYSIS OF MALNUTRITION IN NRS

According to ACFs tree problem and the majority of anthropometric nutrition surveys re-
viewed, which most stakeholders also seem to agree to, the main factors associated to children mal-
nutrition in NRS are:
a) High morbidity rates
b) Poor care, nutrition, and hygiene and child care practices
c) Cultural, traditional and religious behavioural patterns.
d) Lack of access to food at household level.
PROJECT BACKGROUND
i. ACF started a nutritional programme in the NRS in 2003 after a need assessment showed that the
level of malnutrition in the area justified a nutritional intervention, though it was present in the
Northern Rakhine State since 1993.
ii. The objective of the 2003 nutritional programme of ACF in the area was to provide nutrition assis-
tance to under-five years old children and women suffering from acute malnutrition.
iii. ACF nutrition programme in NRS has been carried out through the activities of two Stabilisations
Centres (SC) located in Maungdaw (MGD) and Buttidaung (BTD), where both children with severe
acute malnutrition (SAM) who also had medical complications, and all under-6 months old children
are being treated. There are six outpatient therapeutic Programme (OTP) centres where both SAM
children without medical complications and moderate acute malnourished (MAM) children are
treated.
iv. Next to each of the two SCs, there is a Mother Participation Centre (MPC) where SAM and MAM
children who show a static weight gain in both SCs and OTPs, are sent. The CP delivers psycho-
logical support to both mothers and babies.
v. Community Awareness is being conducted by community-chosen volunteers.

METHODOLOGY
According to DAC criteria, relevance, coherence, coverage, efficiency, effectiveness, accepta-
bility, access, equity, sustainability and accountability were assessed.
CONCLUSIONS
1. Extraordinary good and solid job: very effective work in the field and extremely committed staff.
Without any central or local institutional backstopping ACF was able to construct a full conceptual
and operational structure to treat malnutrition in NRS together with a comprehensive nutrition
information system.
2. ACF also developed a huge system of community-oriented activities, aiming at meeting the acute
needs perceived in care practices, health education, community awareness, mental health wellbe-
ing, etc.
3. Global and Moderate Acute Malnutrition rates overtime seem to resist all efforts made to appease
them, revealing a structural situation of undernourishment with an invariable size of vulnerable
children recurrently getting within and without acute malnutrition episodes.
4. It is debatable that a closer relationship with the MOH would have rendered better outcomes that
those obtained by ACF on its own.
5. The lack of adequate references from the clearly unsatisfactory and poorly developed MOH
healthcare network gave very little other choice to ACF than developing a network of its own to
tackle severe and moderate acute malnutrition.
6. The chronic malnutrition rates of women of childbearing age in the area, is not being addressed.
7. ACF still mistakes in its reports community-based with community-oriented, and that confusion
may hamper its strategies..
8. Gender seems to having not been a constant concern in ACF nutrition projects. Only recently clas-
sical rules of gender disaggregation were incorporated.
9. There seems to be a stable trend so far unexplored, of TFP and SFP admission rates much higher
for females than for males almost double on average starting midst 2010 up to-date.
10. Technical supervision and follow-up seems to have been insufficient.
RECOMMENDATIONS
I Need for resuming training.
II Translation of handbooks and manuals of use by every national team member, into Burmese
language.
III Need for a more attractive layout than present reporting: a more skilled design and more effec-
tive supervision of the language in use.
IV More individualized approach of the Care Practices Programme as far as reporting is concerned.
V Care Practices Programme needs to identify impact indicators to assess programme impact.
VI Need of analysing admission and discharge rates trends by treatment unit (OTP) in order to be
aware to fluctuations.
VII The appalling condition the MGD Township hospital is in, should raise a brow to the main health-
related INGOs working in the area.
VIII Global and Moderate Acute Malnutrition, together with chronic one, have become permanent
patterns of NRS population vulnerability.
IX Treating the project beneficiaries as what they truly are, vulnerable children and their mothers,
project reporting would gain in warmth and attachment.

2 CONTEXT ANALYSIS
2.1 SOCIOPOLITICAL SITUATION
The November 2010 elections in Myanmar were not free and fair and the country has not
escaped authoritarian rule. Predictably, in such a tightly controlled poll, the regimes own Un-
ion Solidarity and Development Party (USDP) won a landslide victory leaving the military elite
still in control. Together with the quarter of legislative seats reserved for soldiers, this means
there will be little political space for opposition members in parliament. The new government
that was formed also reflected the continued dominance of the old order with the president
and one of the two vice presidents drawn from its ranks and a number of cabinet ministers
recycled.
Nevertheless, it would be a mistake to conclude that nothing has changed. The top two
leaders of the former military regime stepped aside, and a new generation took over. A new
constitution came into force, which fundamentally reshaped the political landscape, albeit in
a way that ensured the continued influence of the military1.
Since taking up office, President Thein Sein has moved quickly to begin implementing his
ambitious reform agenda. A series of important economic, political and human rights reforms
were being enacted. A release of political detainees was enforced, although some die-hards
were still kept in prison. The president reached out to government critics, including Aung San
Suu Kyi and the ethnic minorities.
The opposition leader Aung San Suu Kyi, who said that the president was sincerely motivat-
ed, endorsed the dramatic changes led by President Thein Sein. Key political freedoms such
as the right to organize, assemble, speak out and run for political office are being exercised
in a way that was unthinkable even a year ago. The government has abandoned policies of
confrontation with the countrys ethnic minorities for a new peace initiative that has seen 11
cease-fire agreements signed with armed groups, leaving out only the resistant Kachin. The-
se deals are an encouraging first step in what needs to be a larger effort to rethink the way
the country sees itself after 60 years of civil war2.
The evidence suggests that domestic considerations are driving these reforms, but the new
government has also been much more engaged internationally. Myanmar is set to take over
the rotating chair of ASEAN in 2014.
The president gives every indication of having the political will to put Myanmar on a new
path. Yet, success will be neither quick nor straightforward. Experience from elsewhere
shows that the challenges of transforming a country emerging from decades of ethnic con-
flict and authoritarianism are massive, and it is important that this be recognised in the My-
anmar context. Powerful spoilers could complicate the process, and weak institutions and
lack of capacity could hold back progress. In order to build broad-based public support, the
government will need to deliver tangible improvements to ordinary peoples lives. Overcom-
ing deep-seated suspicions of government in ethnic minority areas will take time and great
effort and needs both a change in the abusive practices of the army and a new approach to
governing the periphery.
1
Myanmars Post-Election Landscape Asia Briefing N118. ICG. 7 Mar 2011
2
In Myanmar, Sanctions Have Had Their Day L Arbour, The International Herald Tribune. 5 Mar 2012

Beyond this, countries must be prepared for further positive developments, so should begin
crafting tangible and timely policy responses. At a time when the political deadlock in Myan-
mar is being overcome, states must be ready to make major changes to their own policies or
risk being overtaken by events3.
In April 1st by-elections the National League for Democracy, won by a landslide in most
states, granting her and many of her party members a seat in the new parliament. Its leader
Daw Aung San Suu Kyi, the democracy advocate silenced for two decades by Myanmars
generals with house arrests and overturned elections, assumed a new role in her countrys
political transition, apparently winning a seat in Parliament to make the remarkable shift
from dissident to lawmaker.
The main opposition party announced her victory on Sunday; if the result is confirmed, Ms.
Aung San Suu Kyi, a 1991 Nobel Peace laureate and the face of Myanmars democracy
movement, will hold a public office for the first time. But despite her global prominence, she
will be joining a Parliament that is still overwhelmingly controlled by the military-backed rul-
ing party.
With her entry into electoral politics, Aung San Suu Kyi, a symbol of moral fortitude in the
face of oppression, that role may change. Her party, which has been vague in its prescrip-
tions for the country, will be forced to take specific stands in the countrys two houses of
Parliament, where the debates have been increasingly lively in recent months.
Hundreds of foreign journalists and numerous teams of foreign monitors were allowed into
Myanmar to witness the voting, a contrast to previous years when a hermetic military gov-
ernment tried to keep out prying eyes4.
2.2 A BACKGROUND TO THE EMERGENCY5
Shortly after Burmas independence in 1948, a part of the Muslims carried out an armed re-
bellion demanding an independent Muslim state within the Union of Burma. Though the re-
bellion was quashed in 1954, Muslim militancy nevertheless entrenched the distrust of the
Burmese administration: Muslims were removed and barred from civil posts, restrictions on
movement were imposed, and property and land were confiscated. Even so, the Rohingyas
were close to having their ethnicity and autonomy recognised in the 1950s under the demo-
cratic government of U Nu, plans were thwarted by the military coup of General Ne Win in
1962.
Ne Wins Burma Socialist Peoples Party claimed that the Chinese and Indians with the
Muslims of Arakan grouped among them were illegal immigrants who had settled in Burma
during British rule. The central government took measures to drive them out, starting with
the denial of citizenship. The 1974 Emergency Immigration Act stripped the Rohingyas of
their nationality, rendering them foreigners in their own land. In 1977, the Burmese military
government launched an operation called Naga Min, or Dragon King, to register the citizens
and prosecute the illegal entrants. The nationwide campaign started in Rakhine State, and
3
Myanmar: Major Reform Underway ICG. 22 September 2011
4
The Myanmar elections T Fuller, The New York Times. 1 April 2012
5
So far, the best explanation of the intractable socio-political background situation in the NRS this consultant had access to,
belonged to an External evaluation of the project Promotion and Protection of Livelihoods of Marginalized Ethnic Groups in
Myanmar. Richard Ellert. November 2009. An abridged version of it was borrowed for this reports purpose (authors note)

the mass arrests and persecution, accompanied by violence triggered an exodus in 1978 of
approximately 200,000 Rohingyas into Bangladesh. Within 16 months of their arrival, most
were forced back after bilateral agreements were made between the GOUM6 and Bangla-
desh.
The State Law and Order Restoration Council (SLORC) significantly increased its military
presence in northern Rakhine State. Construction of military establishments and roads
sprawled throughout northern Rakhine and the border with Bangladesh. The build-up was
accompanied by compulsory labour, land and property confiscation, and forced relocation.
Mosques were destroyed, religious activities were banned, and Muslim leaders were har-
assed. The violence, impoverishment, and religious intolerance all conspired to drive out ap-
proximately 250,000 Rakhine Muslims into Bangladesh from mid-1991 to early 1992.
The Muslim Rakhine reintegration conditions remain unsolved until today; the population is
still in a constant state of precariousness and vulnerability under the tight control of the ar-
my, the MI, the border police and other groups. The level of economic development is very
low, structural investments are insignificant and health services poor to non-existent.
Policies of exclusion and discrimination imposed on the Rohingyas by successive Burmese

military regimes have prevented them from developing socially and economically, and it
seems that they were deliberately designed to encourage departure to Bangladesh. Among
those policies, the most repressive were: i) denial of citizenship; ii) restriction of freedom
and movement; iii) obstacle on family development; iv) the family list; v) land tenure and
land confiscation; vi) model villages; vii) forced labour or community work; viii) arbitrary ta-
xation; ix) control of economy through monopolies, and x) restrictions on hard wood.
2.3 ANALYSIS OF MALNUTRITION IN NRS7
According to ACFs tree problem and the majority of anthropometric nutrition surveys re-
viewed, which most stakeholders also seem to agree to, the main factors associated to chil-
dren malnutrition in NRS are:
e) High morbidity rates
f) Poor care, nutrition, and hygiene and child care practices
g) Cultural, traditional and religious behavioural patterns.
h) Lack of access to food at household level.
However, one of the latest anthropometric nutrition surveyors clearly expressed that the
fact that we didnt include complementary data and mainly the cross-sectional characteristic
prevents us from making any inference regarding the malnutrition causality8.
a) High morbidity rates
1. In the anthropometric nutritional survey in MGD and BTD townships done in January 20039,
previous to the first ACF nutrition projects onset, it was stated that 11.3% of all children
6
The Government of the Union of Myanmar
7
A not negligeable part of the evaluation inputs concerning secondary data is drawn from the findings obtained in the 1st
phase, which are contained in External evaluation ACF Nutrition Programme NRS Myanmar (V2). 05_07_2011 (authors
note)
8
Nutritional Anthropometric Surrey in children from 6 to 59 months, Maungdaw and Buttidaung townships, NRS, Union of
Myanmar. Bougma K, Preliminary report. February 2010

within 6 to 59 months old had regular diarrhoea with rates which were higher in the low
vulnerability areas (17.1%) than in the high vulnerability ones (7.0%). The population
stratification in vulnerability areas, together with the morbidity assessment was totally
abandoned in the following surveys. Therefore, as from 2006 causes of under-5 years old
mortality were surveyed instead of those of morbidity. Nevertheless, the under-5-year-old
mortality study was also abandoned in the 2009 and 2010 surveys.
2. Measles immunization coverage was regularly surveyed from 2003 onwards. However, in
that years survey mothers statements about the measles vaccination coverage of their
children werent accepted unless immunization cards could be shown as a proof10, and only
4.4% did (the explanation that Rural Health Sub-Centres midwives kept the majority of
childrens cards for fear of being lost or damaged was not corroborated with any objective
evidence). That rate went along the successive surveys as 9.9% 49.8% if taking in
mothers statements - (2006); 12.6% - 51.9% (2007); 7.8% - 60.35% (2008); while in the
two last surveys - 2009 and 2010 measles coverage rates were completely omitted from
the study, as was also omitted vitamin A coverage, which was included in 2006, 2007 and
2008 surveys. Measles became an issue again when ACF monthly reports started recording
increasingly alarming measles cases among children screened by ACF in midst 2011, which
led to a measles outbreak. A nationwide measles immunisation campaign is still ongoing.
3. Although the apparently poor and patchy condition of MOH healthcare network, as depicted
by most stakeholders, might lead to think that children morbidity is indeed high, the mor-
bidity rates of those children admitted in ACF nutritional centres may not be a valid sample
to infer morbidity patterns of the overall children population but only to make a fair as-
sumption, as the majority of children medically treated were also being admitted for malnu-
trition.
b) Poor care, nutrition, and hygiene and inadequate child care practices
The 2006 anthropometric nutrition survey targeted as most likely causes of malnutrition not
a lack of food, but poor care practices and to the low access to free health services11.
i. Low access to free health services

Care offered by the MOH facilities is not free of charge, but neither is that provided by
the traditional healers, and according to the 2007 nutritional survey a not negligible 30%
of women and children went to the nearest public PHC setting; the same rate as that of
those going to INGOs clinics and private PHC services together (30.5%), compared with
those seeing a traditional healer (5.7%), and almost double than those seeking assis-
tance with a CHW/TBA (18.3%)12.
Controversially, just one year earlier, the 2006 anthropometric nutrition survey, appar-
ently using different sampling methodology, found out that 42.5% of the households
consulted private health services and only 17.1% went to MOH facilities, the same rate
that those attending INGO clinics (16.7%).
9
Anthropometric nutritional survey in Maungdaw and Buttidaung townships, NRS. Schneider L. January 2003. Final report
10
It was decided not to consider the mothers statement as a proof of vaccination, since the knowledge about vaccination
was found to be extremely poor. The mothers in general did not know if the injection that the child had received was mea-
sles vaccination, a diphteria-tetanus-pertussis or an injection of antibiotics (Ibid. page 46)
11
Ibid. (page 34)
12
Anthropometric nutritional and retrospective mortality Survey. Maungdaw and Buttidaung townships, NRS. Biotteau M. Oc-
tober 2007. Final report

Access to health care can be taken as a legitimate proxy of the impact of provision of
systematic or specific treatment in the nutritional centres: in 2006 more that half (55%)
of those patients admitted to stabilisation centres or home treatment were sick besides
malnourished. Presence of disease was particularly common in children within the range
age of 6-59 months (66%) was reported in the 2007 evaluation13.
Therefore, it seems that reliable records witnessing actual access to health care services
are still far from both ACF current project registration and survey methodologies. More
data on the MOH facilities regarding care availability (minimum package of services14),
actual service costs (affordability) and proximity to the population (accessibility) need be
collected.
ii. Poor care practices
There seems to be a statistical association between mothers and childrens nutritional

status15. The study of the poor care and nutritional practices seems plagued with try-
and-error attempts, as the culturally very locked up NRS Muslim societies for rather
understandable reasons are extremely hard to unveil. The general demographic profile
of the women interviewed in successive surveys showed a clear majority of married
women with close pregnancy intervals and numerous children16 (6.9 children per house
on average according to 2006 anthropometric and nutrition survey), low family daily in-
come and insufficient food at the household. The common patterns leading to this situa-
tion are several:
- No family planning services with limited antenatal and postnatal consultations.

- Appropriate feeding practices not widespread: colostrum and exclusive breastfeeding
until 6 months of age is only given to half the babies; besides, no correct weaning
practices were observed, thus leading to inadequate feeding practices.
- Access to health care is extremely difficult, and the majority of mothers tend to go to
a traditional doctor or to the drug shop in case of sickness (as it has been shown
above, this statement is far from being conclusive).
- Although knowledge on hygiene is satisfactory, this seems not to be translated into
the household, as practices remain insufficient to prevent children from getting sick17.
- Conflicts are frequent in the family relationship; domestic violence is also frequent,
and coping mechanisms limited.
- Mother and child interactions are rare and difficult. Stimulation through play, talk or
songs is not part of the daily activities, and the youngest children tend to show a
slower psychomotor functioning18,19.
c) Cultural, traditional and religious behavioural patterns
Chronic energy deficiency is a long-term issue and the short-term treatment is not an ap-
propriate intervention to improve womens nutritional status. Nutritional interventions with
13
External evaluation of ACF Nutrition intervention (2003-2006) in Northern Rakhine State, Union of Myanmar Dr. Rossi L,
ACF Nutrition Consultant. April 2007 (page 24)
14
Drawn from Ivory Coast health facilities standard paquet minimum dactivits (PMA) (authors note)
15
While M. Biotteau didnt find any statistical difference between mothers nutritional status and those of their children in her
2007 survey (op.cit page 32), L Schneider (op.cit.) did find in 2003 that a malnourished mother had 2.28 times more risk
to have a malnourished child than a well-nourished mother (authors note)
16
7.5 children per household, according to UNHCR population survey 2005 (authors note)
17
ACF KAP survey Prevention centre Kyi Kan Pyn Village Tract. Peenaert P. June 2008
18
Ibid.
19
KAP Survey Prevention Centre Ay Tha Lyah ACF Myanmar. May 2011

simple ration distribution will not solve the problem: mothers severe and moderate com-
piled malnutrition in 2006 was 27.0%, similar to that of 2003 (26.6%)20. The range of
problems related to traditional, religious beliefs and habits, are multiple:
- Traditionally, men and children eat first and women eat when the others have fin-
ished.
- During pregnancy, women complain of nausea and vomiting in the first months and,
later, of the volume of foetus pressing the stomach. To avoid that, they prefer reduc-
ing the dietary intake.
- The marriages among Muslim population are at a very early age and the majority of
women get pregnant for the first time still very young, when body development is not
accomplished. Inevitably, the pregnancy stops any further body growth (the mean
height of the mothers sample was 150.1 cm).
- The last few months of the pregnancy and the first 40 days after childbirth, women
follow special purifying hypo-energetic diet based mainly on rice and fish, if the lat-
ter is available. During this period of energy shortage, the foetus and the milk pro-
duction draw out bodys reserves.
- The birth frequency is very high and womens bodies have little time to recover be-
tween two pregnancies. After each pregnancy women get thinner21.
- Beliefs concerning breastfeeding such as considering colostrum as unclean and moth-
ers do not respect the rule of exclusively breastfeeding infants until they reach 6
months old.
- Negative perception of children, considering them as a burden.
- Very low self-esteem as Muslim women are often despised by their husbands and the
educated members of the community because they consider them uneducated and
without any kind of refinement22.
There also seem to be traditional beliefs for not having enough milk:
- A drop of breast milk fell in the fire; therefore the mother will have a lower produc-
tion of milk.
- A man (not the husband) saw the breast of a woman during the first week after de-
livery.
- A child is healthy and is breastfeeding well, so it can create jealousy and a bad eye
will bewitch the mother.
- The mother was caught by the devil because she was outside when having her first
menstruation, because she went outside at twelve oclock, because she did not re-
spect the Muslim rules for women (taking care of her husband, covering her body,
staying in the house, etc.).
- The mother received a powerful injection from a doctor or nurse to help her recover
from the delivery (it seems that the powerful injections might well be oxytocin or er-
gometrine)23.
There also are some factors strongly related to the socio-political environment that impinge
on women and children wellbeing, such as:
- Domestic violence with repercussions on mothers and children.
20
According to a joint UNDP/UNICEF/SIDA 2009-2011 Poverty Dynamics Report, Rakhine is the region with the highest pov-
erty rates (43.5% average - 49.1% rural) in the country (page 28). A staggering 54.4% of rural under-5 years old is rec-
orded as moderately malnourished; the highest rate in the whole country (page 79), and 17% of rural under-5 years old is
recorded as severely malnourished (page 80). The countrys lowest immunisation rates are in Rakhine (67%). Antenatal
coverage reaches 55% (authors note)
21
Anthropometric nutrit January 2006. (op.cit. page 37)
22
ACF KAP survey June 2008 (op.cit.)
23
Ibid.

- High exposition of traumatic events such as torture and harassment.

- Cases of depression diagnosed amongst the woman surveyed and feeling of isola-
tion24.
- Women with ideas of suicide25.
As the ACF medical and nutritional coordinator very aptly put it in one of her many conver-
sations with this consultant, there is a double burden in women marginalisation within the
population of NRS: the Governments and that of their own cultural background (very tradi-
tional Muslim society).
d) Lack of food at household level
Main economic activities in Rakhine State (RS) are agriculture (rice paddy cultivation) and
fishing using limited technologies, suffering from a lack of appropriate inputs and poor ag-
ricultural/fishing support services. Only 30% of the total population has access to land. The
remaining 70% has to rely on the output of this limited number of farmers. The average
land size for farmers in the townships of NRS is 2.34 acres; this size of land cannot produce
enough rice, the staple food for the whole population. Food production and access to food
were negatively affected in 2007 and 2008 due to climate and market availability. Though
the situation slightly improved in 2009, households have not yet recovered from the shocks
of the past years and the perspectives for 2011 are uncertain, given the recently concluded
elections and the ensuing uncertainty of the humanitarian context. Global increase in fuel
prices generating inflation of all food items is highly affecting the purchasing capacity of
the poorest households. A high ratio of dependants that makes it difficult for heads of
households to feed their families. In addition, the floods that occurred in June 2010 in NRS
are likely to have an impact on the food security situation in 201126.
Food insecurity was cited by women interviewed as the main cause of malnutrition
(37.5%), although very little is known on the meaning of food insecurity for them. Lack of
[enough] food could be given as a definition. People interviewed closely associated malnu-
trition with disease. It can be shameful to talk about malnutrition in the family, so it is hard
to accept that one family member is malnourished27.
However, nothing of all above said can hide the hard fact that it might well be that, without
the unbearable restrictions and harassment inflicted upon NRS Muslim community by the
governmental policies, there would likely be almost no lack of access to food and most
probably not even severe acute malnutrition with the prevalence rates which are witnessed
today. NRS seems to be an area full of natural resources where rice and vegetables grow
plentiful, fish is abundant and trade opportunities with Bangladesh are many. However, the
extremely high reproductive rates per household 7.5 children on average (footnote16)
work against any programme aiming at granting households steady food security in NRS.
24
After their first menstruation, girls are not allowed to go out of their parents house, and when they are older, their hus-
bands house. They are hardly visited, and stay in the dark for the majority of the day (since houses in NRS do not have
windows), handling the household work and taking care of the children. The constraints they face have an impact on their
own health, mental and nutritional status, as well as on the way they are providing care to their children. The transmission
of information on care practices from a skilled or old woman to another in the same community is not easy with such physi-
cal constraints. ACF Nutrition Programme. KAP survey. Lefilleul A, Bataille A. June 2007
25
Integrated approach to malnutrition through nutrition, health and care practices Maungdaw, Buthidaung Townships. Rakhi-
ne State. ACF 2009-2010 (proposal, IR & FR)
26
Integrated approach to address malnutrition through nutrition, health and care practices. Maungdaw, Buttidaung Towns-
hips. Rakhine State. A1Z Proposal 20-01-2012. Draft 21-03-2012
27
KAP survey June 2007 (op. cit.)

2.4 PROJECT BACKGROUND
i. ACF started a nutritional programme in the NRS in 2003 after a needs assessment
showed that the level of malnutrition in the area justified a nutritional intervention,
though it was present in the Northern Rakhine State since 1993, implementing water and
sanitation programmes linked to health and hygiene activities. Food security surveillance
and family food programmes were also carried out in that same area since 2000.
ii. The objective of the 2003 nutritional programme of ACF in the area was to provide nutri-
tion assistance to under-five years old children and women suffering from acute malnu-
trition in NRS. Its goals were stated as (i) reducing the risk of mortality consequent to
acute malnutrition, (ii) detecting and treating severe and moderate cases according to
international protocols, and (iii) preventing future malnutrition. A specific Care Practices
(CP) component, together with a psychosocial scheme, aimed at complementing the
medico-nutritional approach for the severely malnourished children was added in early
2006. Later on a community awareness component was also included in 2008.
iii. ACF nutrition programme in NRS has been carried out through the activities of two Stabi-
lisations Centres (SC) located in Maungdaw (MGD) and Buttidaung (BTD), where both
children with severe acute malnutrition (SAM) who also had medical complications, and
all under-6 months old children are being treated. Every SC has a team formed by a
medical doctor (presently one for the two SCs), a head nurse, six nurses and twelve
therapeutic Feeding Programme agents (TFPAs). The stabilisation centres have 24-hour
nurse shifts. Whenever a childs condition worsens due to more serious medical compli-
cations, the SC physician refers him/her to the township hospital to be treated. ACF pays
for the whole treatment and full stay, but an ACF member (most commonly a TFPA) con-
tinues supplying therapeutic milks, as the hospital more often than not has none in
stock.
iv. In those cases where the limited provision of specialised care available at township hos-
pitals is not enough to manage the severe medical complications, the child can be re-
ferred to Sittways Regional Hospital, but as ACF is not being considered so far a medical
organisation, the child has first to be channelled through MSFH28 in Maungdaw.
v. There are six outpatient therapeutic Programme (OTP) centres, of which three are mo-
bile, thus covering ten villages - MGD and BTD township centres not included -, where
both SAM children without medical complications (therapeutic feeding programme), and
moderate acute malnourished (MAM) children (supplementary feeding programme) are
treated. RUTF29 for SAM children, and supplementary rations (WFP30 supplies oil while all
the remaining ingredients rice, beans, sugar, and a mix of several micronutrients - are
part of the ACF programme) for MAM children, are distributed on a weekly basis31. OTP
centres are staffed by a team leader, a nurse (delivering medical care) and six to eight
28
Mdecins sans Frontires-Holland (Artsen Zonder Grenzen), one of the very few INGOs allowed to work in NRS (authors
note)
29
Ready-to-Use Therapeutic Feeding products, mainly Plumpy-Nut for SAM and Plumpy-Doz for MAM (authors note)
30
World Food Programme
31
WFP transports the oil to its Maungdaw warehouse, so its very easy for ACF to fetch it to its own warehouse (not in the
past, when ACF took in charge transportation from Yangon). The reason for not accepting WFP full supplementary feeding
package lies in the very cumbersome WFP monthly reporting rules (ACF Medical Nutritional Coordinator).

rotating TFPAs. They systematically deliver health education, medical treatment of com-
mon ailments, Care Practices counselling, and the weekly supply of either RUTF or sup-
plementary feeding rations. A Home-Treatment component for the follow-up of children
with SAM without complications is part of the OTP care.
vi. A follow-up of 4 months after cured children are discharged, is established when they
receive family rations in order to prevent relapses and to monitor their evolution after
the treatment. This follow-up was withdrawn when ACF introduced the new discharging
criteria in February 2011. However, all infants (under-6 months old) as well as older
children on tuberculosis and/or HIV-AIDS treatment continued having a longer follow-up
treatment (6 months).
vii. Besides that, OTP teams to track defaulters and unknown children were carrying out
regular home visits. OTP teams also conduct active screening around the coverage area,
tracing down household-by-household possible malnourished children.
MAUNGDAW BUTHIDAUNG
SC1 Maungdaw Downtown SC2 Buthidaung Downtown
MPC1 Maungdaw Downtown MPC2 Buthidaung Downtown
OTP1 Maungdaw Downtown OTP3 Buthidaung Downtown
OTP2 Ngan Chaung (NC) OTP4 Inn Chaung (IC)

Kyein Chaung (KC) BTD North
OTP6 Zaw Ma Thet (ZMT) OTP5 Phone Nyo Lake (PNL)
Alel Than Kyaw (ALTK) BTD South Pha Yar Pyin Aung Pa (PAPP)
Mhin Lhut (MH)
Inn Din (ID)
Tha Wet Chaung (TWC)
Table 1: ACF project total care facilities (2012)
OTP Activity summary
a) At every OTP centre, a team member receives child and mother and checks out pos-
sible oedemas, skin folds, brittle hair, as well as henna marks and ankle bracelets if
he is already in the programme; then the child pass to the anthropometric measure-
ments MUAC, weight, height and the child is considered as SAM, MAM or healthy.
In the two first cases, both mother and child are led to a medical examination by a
nurse, who determines whether the child has any clinical ailments to be treated.
b) The child goes through the appetite test to ensure whether he/she can be cared as an
outpatient or needs inpatient care in SC. They then are taken to either health educa-
tion sessions together with other outpatient admissions, or Care Practices individual-
ized approach when a problem has been detected mother-child disaffection, other
psychosocial disorders From the latter may it may result in a referral to a higher
level of care: MPC.

c) Once both health education on nutritional topics, and special care to behaviour and/or
mental disorders have been completed, mother and child are registered, handed a
card, the child marked with henna or a bracelet, and then given either the RUTF or
supplementary food rations for one full week.
viii. ACF operational structure remains nowadays basically the same, but each SC has now 8
TFPAs instead, as increased demand met by OTP centres forced to transfer some SC
staff to them. From 2004 to 2009, OPT centres only looked after SAM children, but MAM
management (SFP) was also included after 2009.
ix. OTP centres have as of lately been overburdened with MAM children who were previous-
ly taken care of by Malteser - an INGO since recently, but it closed down its nutrition
centres a few weeks ago, although its TB-patient treatment continues.
x. Another wave of children with nutritional disorders came from MSFH, as it also trans-
ferred its malnutrition programme in exchange for being handed over ACF Reproductive
care component. Both transferrals were completed by May 2011.
xi. Next to each of the two SCs, there is a Mother Participation Centre (MPC) where SAM
and MAM children who show a static weight gain in both SCs and OTPs, are sent. Four
psychosocial workers, trained by ACF for that purpose and being part of the Care-
Practices Programme (CP), staff each MPC.
xii. The CP delivers psychological support to both mothers and babies. A social worker as-
sesses mothers with a malnourished child arriving in the SC, on their needs for psycho-
social support: focus-groups discussions, individual counselling, breastfeeding, health
education, sewing activities, toys for children, share-feeding activities, home visits for
babies showing special vulnerability, follow-up to hospital admissions, etc. An expat pae-
diatrician neurologist-psychiatrist runs the CP Programme.
xiii. Community Awareness was in the past being conducted by community-chosen volun-
teers Community Caretakers (CCT) - who carried out MUAC screening, health educa-
tion, and referral to OTPs (either to TFP or SFP) when they detected a malnourished
child. Two supervisors (team leaders) are in charge of supervising volunteer TCAs
(Community awareness technician). TCA teams from the OTPs visiting remote inaccessi-
ble villages do active screening accessible villages were screened by the CCTs who
didnt treat but referred to the OTP. Formerly there were around 1,200 CCTs to be su-
pervised by 11 TCAs (five in MGD and six in BTD). A new strategy starting in February
2011 reduced the number of CCTs to 320, keeping the same amount of ACF supervisors.
The large majority of these newly empowered community volunteers - named Super
Community Caretakers (SCCT) were already CCTs, and keep strong links with the pro-
ject, which regularly trains and updates them.
xiv. New ECHO 2012 to 2013 project proposal32, besides strengthening ongoing components,
introduces a Communitybased Management of Acute Malnutrition (CMAM)33 pilot pro-
ject in Buthidaung, integrated into MOH district healthcare structures. ACF assessment of
in-field requirements for this approach to be successful is still underway34.
32
Integrated approach to address malnut. A1Z Proposal 20-01-2012. Draft 21-03-2012 (op.cit.)
33
CMAM: a joint statement by WHO, WFP, UNICEF and the United Nations System Standing Committee on Nutrition in 2007
(authors note)
34
Integration of CommunityBased Management of Acute Malnutrition Washington DC, April 2830, 2008. Workshop Report

Access to MOH health services35
There is a Township hospital and a station hospital in each township. Besides, there are 21
Rural Health Centres staffed by a nurse and a Community Health Worker (CHW) - and 42
Rural Health Sub Centres staffed by a midwife and a CHW - in the whole NRS area
(Maungdaw, Buthidaung and Rathedaung). That corresponds to one rural health centre per
38,000 persons and one rural health sub-centre per 19,000 persons. In Maungdaw each
health centre has to cater to more than 52,000 persons while in Rathedaung each health
centre has to reach 21,000 persons. There are 344 pharmacies as a whole, so each pharma-
cy covers 2,300 persons on average.
There are 42 nurses in the overall area. This corresponds to one nurse for every 18,400 per-
sons. The national average is one nurse per 306 persons. In Maungdaw the coverage is par-
ticularly bad with only one nurse for every 58,500 persons. In terms of midwives, the cover-
age is slightly better with one midwife for every 5,500 persons in the whole NRS. The corre-
sponding figures for Maungdaw and Buttidaung are 7,200 and 4,400 persons respectively.
The national average is one midwife per 337 persons.
There are 1,484 Traditional Birth Attendants (TBA) in the area, one TBA for every 540 per-
sons. TBA coverage is more even between the different townships when compared to nurses
and midwives. There is one CHW for every 1,100 inhabitants. In Buttidaung the coverage is
highest with one CHW for every 700 persons; the corresponding coverage for Maungdaw is
about one CHW for every 1,500 persons. The MOH and UNICEF formerly trained the CHWs,
and both the health sub-centres and them are reporting to the TMO36. Their tasks are those
of monitoring the under-5 years old, support to immunisation campaigns, community educa-
tion, and nutritional screening (they perform MUAC assessment and deliver RUFT to SAM
without complications as from July 2010). Besides, there are 2 nutritional centres belonging
to the MOH in the RS capital Sittway, treating Buddhist malnourished children mostly.
UNICEF designed a surveillance system for Timely Warning on malnutrition37 starting June
2010 directly supporting MOH staff (mostly midwives) from 60 RHCs in appraising children
nutritional status with MUAC through a sentinel approach. First outcome disseminated did
not show significant changes38. Questioned about the ongoing activities of that surveillance,
UNICEF did not seem eager to talk about it, although informed that there had been a
presentation to all INGOs involved during the recently resumed MNTN39 first meeting (see
Itinerary Minutes 2).
However, some activities must still be going on between UNICEF and the MOH: in the APR
narrative Nut-Mya April 2011 FV it is explained that the MOH provided MISME (multi-
micronutrient powder) to the <5 years old children whose MUAC was <11.5 cm. Dosage was
1 sachet/day. They were working in BTD downtown areas. The distribution started last week
of April. Currently, the distribution is ongoing in Maung Nah VT only. It is reported that ACF
BNFs from this area have received this supplementation. Also reported, eeZee paste distribu-
35
Taken from a Village Tract survey of UNHCR conducted in 2006, quoted in Richard Ellerts 2009 FSL & WASH external eva-
luation (op.cit.)
36
Township Medical Officer, MOH representative at township level
37
Nutrition Surveillance for Timely Warning and Intervention System In Rathedaung, Buttidaung and Maungdaw Townships
Northern Part of Rakhine State. UNICEF May 2010
38
Nutrition Surveillance for Timely Warning and Intervention Three Townships in Northern Rakhine State. August 2010
39
Myanmar Nutrition Technical Network

tion by MOH in BTD took place, with a dosage of 2 sachets/day. Amount for 1 month at the
time (60 sachets) distributed to each SAM case identified (27 reported in March in BTD).
Eezee Paste was seen in MGD hospital but with a total of 17 children in charge. In March
UNICEF reported that quantities supplied to TMO were more than exceeding the needs (with
an expiring date end of August) (page 6).
3 CONSTRAINTS
The evaluation set up was split into two phases due to the delay exacted by the GOUM to is-
sue a compulsory Letter of Invitation any non-national needs to have it approved to grant
him/her access to areas under special governmental regulations, such as the NRS.
That is the reason why this consultant had to wait for almost a full year to gaining access to
an ACF field visit. Therefore, during the first phase of this evaluation, which took place from
May 14th through June 1st 2011, his stay was committed to project documentation review
covering ACF intervention from 2007 onwards, with a fleeting look at the previous 2003-
2006 period, which had already been evaluated in 200740.
Preparing a documentation selection for evaluation through scanning myriad papers a pro-
gramme can produce along nine implementation years takes time and effort, and it is not of-
ten easy for operational staff to find a niche among more demanding pending tasks for that
purpose. It should be neither an evaluators job, as he/she has not previous knowledge on
the relevance of the documentation generated by the programme.
However, as it happened then and has happened now, ACF-UK and ACF Myanmar were not
diligent enough in preparing a structured documentation portfolio ahead of this consultants
arrival, so he could start an orderly preparation of the assignment at an early stage. This,
which in the former visit was not an actual constraint as he had plenty of time to request
available documentation during his 2-week stay in Yangon, in the latter it meant a not-
negligible drawback, for a tight schedule loaded with ensuing field visits did not enable him
to dispose of that preparation work.
4 METHODOLOGY
4.1 TERMS OF REFERENCE41
To evaluate the programme design and results in an independent and structured manner, to
assess impact, appropriateness, efficiency, coverage, strategy, coherence, effectiveness and
sustainability.
To assess the programmes approach to transversal issues such as gender.
To provide recommendations that will improve the quality of the project and reinforce the im-
pact of future programming.
Identify strengths and weaknesses in the programme in order to inform the current pro-
gramme and ACFs overall learning.
40
External evaluation of ACF Nutrition intervention (2003-2006) in Northern Rakhine State, Union of Myanmar Dr. Rossi L,
ACF Nutrition Consultant. April 2007
41
See full TOR in annexes

To assess the achievement of objectives against indicators, in addition to overall impact

(positive and negative), relevance, coherence, coverage, efficiency, effectiveness, acceptabil-
ity, access, equity, sustainability (if appropriate) and results achieved (accountability) and
of the way these results have been achieved (lessons learned). The evaluation should con-
sider the design of the project in addition to its actual implementation.
The evaluation should contain conclusions and recommendations at both strategic and oper-
ational levels and outline a set of indicators that ACF could monitor to define when this exit
strategy could become an objective.
The evaluation is expected to provide one (1) key example of Best Practice from the project/
programme. This example should relate to the technical area of intervention, either in terms
of processes or systems, and should be potentially applicable to other contexts where ACFIN
operates. This example of Best Practice should be presented in the Executive Summary
and/or the Main Body of the report.
4.2 EVALUATION TECHNIQUES
a) Interviews: every interview was conducted following a tailored questionnaire, included in

annexes to this report.
b) Field notes: detailed itinerary and planning Trip Minutes, as well as people interviewed,
places visited, and persons contacted are to be found in Itinerary Minutes in annexes.
c) Project matrix: a table where evaluation criteria, as specified in the TOR, is contained and
given scores related to project implementation adherence to the criteria proposed.
d) Data collected from meetings and gatherings were reviewed and crosschecked.
e) Participatory observation: questions regarding from project acceptability by the target pop-
ulation to sources of drinking water and purification to sanitation, were discussed with the
technical teams at every project site, in order to increase the scope of the information ob-
tained.
f) Half-structured meetings: every meeting with staff and others followed a checklist, which is
also to be found in annexes.
g) Focus Group meetings: specifically address to men and womens groups of beneficiaries, in
order to check their knowledge on malnutrition, their acceptability in the components seek-
ing behavioural changes and how the beliefs were influenced by the information delivered
to them by the project.
4.3 SOURCES OF INFORMATION
This report is a compiled version of both the documentation review undertaken during May
2011 and documentation generated from then up to-date, and a field visit carried out along
March and April 2012. Those familiar with a previous paper presenting provisional impres-
sions after that documentation review will find some parts of this text already known, as
they are either a repetition or an update of previous statements regarding specific explana-
tions or findings.
Therefore, the aim of this integrated text is to give a comprehensive evaluation overview of
the successive project periods starting in 2003 up to-date, drawn form both project docu-

mentation and primary data through direct observation, semi-structured interviews, focus
group meetings, etc.
In this sense, TOR did not make explicit whether this evaluation is final or intermediate42,
and it had good reasons to not doing so, as this approach focuses on several interconnected
yearly projects being part of a more comprehensive programme, which involves other com-
ponents water and sanitation, food security and livelihood besides that of nutrition, the
latter the direct scope of this exercise. Consequently, this evaluation is more like a
pathologists wedged cut done to a long and very dynamic flow of events, as this consultant
sees it.
4.2.a Primary Data:

(see Itinerary Minutes in annexes)
Interviews with:
- Management team at ACF country head office in Yangon
- Central MOH Nutrition directory in Nay Pyi Taw
- International partner organizations working in NRS: MSFH, Malteser, UNICEF, and
WFP in Yangon
- MOH Northern Rakhine State Health Dept director and Nutrition head in Sittway
- MOH Maungdaw Township Medical Officer in Maungdaw
- International partner organizations in the field (Malteser, MSFH, UNHCR, and WFP) in
Maungdaw
Half-structured Meetings with:

- Expatriate ACF staff (Nutrition, Care Practices and FS&L PMs and Admin) in the field,
in Maungdaw
- Technical National staff (Nutrition and Care Practices) in the field, in Maungdaw
- SC staff in Maungdaw
- Operational teams in the field Maungdaw and Buttidaung
- SCCTs in Maungdaw and Buttidaung
Visits to:
- MOH Township hospital in Maungdaw
- SC in Maungdaw
- MPC1 and MPC2 in Maungdaw and Buttidaung
- OTP1, OTP2, OTP4, OTP5, and OTP6
- CP Prevention centres in Ay Tah Liya VT, Zular and Horitula hamlets
- MOH Station Hospital at Ale Than Kyaw, Maungdaw
- MOH RHSC at Phur Wut Chaung, Maungdaw
- MOH RHSC at Pha Yar Pyin Aung Pa, Buthidaung
Focus Group Meetings with:

- Prevention centres men and women gatherings in Maungdaw
- OTP waiting mothers gatherings in Maungdaw and Buttidaung
- OTP4 waiting mens gathering in Buttidaung
4.2.b Secondary data:
42
TOR ACF Nutrition Evaluation NRS Myanmar (final). pdf

Please find at the annexes to this report a detailed list of the documentation and bibliog-
raphy consulted.
5 FINDINGS
This report will give a passing review to previous projects based on available documentation
and information collected form key ACF members, both former and present ones, to focus
later on the ongoing 2011 to 2012 intervention up to-date, as the biggest share of primary
data obtained in the field belongs to the latter. Care has been taken, too, in analyzing the
2010-2011 project outcome, as both projects respond to almost identical proposals and as-
sumptions.
5.1 2003-2006 project development
Project overview:
1. As it was outlined in the first paragraph of the Project Background above, the first 3
years of implementation of the nutrition programme in NRS (2003-2006) were already
thoroughly assessed in April 2007 through an external evaluation43. It was, to this con-
sultants appreciation, a far-reaching exercise not excluding all possible programme vari-
ables and meticulously considering the outcomes from different angles.
2. The coverage of the programme in that periods last year (2006) was 53% and seemed
to be lower than expected, as the coverage in 2005 was 61%44. Later on, the report
stressed that in terms of clinical outcome, the quality of care [delivered] is high with
most part of performance indicators over the standard, and continued efficiency of the
programme increased in 2006 respect to 2005 as demonstrated by the improvement of
all indicators of performance in the last year. The better efficiency of the programme in
particular with the increasing of the curative rate, partially compensated the reduction of
coverage as demonstrated by the increasing of the met need indicator (resulting from
the combination of coverage and cured rates) passing from 36% in 2005 to 39% in
2006. SPHERE standards45 for SAM states that for an efficient nutrition programme the
rate of those cured must be above 70%.
3. In page 4 the report states that the impact of ACF nutritional centres is demonstrated by
the reduction of severe forms of malnutrition in the area and by the low mortality rate for
effect of the treatment of severe forms through the stabilisation centres activity and for
the presence of the supplementary feeding centres and OTP/HT components, that pre-
vented the onset of severe forms of malnutrition. Although the evaluation might take
praise for the former, it had no way to compare past children mortality rates. The report
concedes though, that because of lack of registration of under-5 mortality rates in the
years 2003, 2004 and 2005, it is difficult to demonstrate a causal relationship between
nutritional programme and mortality pattern (page 22).
43
External evaluation of ACF Nutr April 2007 (op.cit.)
44 a well developed OTP component and the community based approach should lead to a coverage higher than 70% (quoted
by the evaluation report from Community-based Therapeutic Care (CTC). A Field Manual. Valid International 2006, Oxford,
UK.)
45
The SPHERE Project handbook 2011 (page 169)

4. The report continued (page 21), the reduction of the prevalence of the severe forms of
malnutrition (3% in 2003 vs 1.4% in 2006) could be considered as a direct effect of the
presence of the programme in the area. Treatment of severe forms through the SC activi-
ty and the presence of SFC as well as the HV/OTP components contributed to prevent the
onset of severe forms of malnutrition. The project seemed to actually contain the onset
of severe acute malnutrition, not just up to 2006, but the trend continued through the
following years up till 2010 (the year when the last nutritional survey was carried out).
5. The report raises the alarm along several pages on the progressive deterioration of
women nutritional status could be considered a negative impact of the decision of not
admitting any more women in fertile age in the programme (page 4); the decision to
not admitting any more women in fertile age in the nutritional centres should be revised.
Exit indicators different from BMI cut-off points will [have] probably to be developed in
order to define appropriate discharge criteria for this age group (page 5); the increase
of the prevalence of severe forms of CED in pregnant women passing from 8.9% in 2000
to 12.7% in 2006, could be interpreted as the negative impact of the decision to not ad-
mitting MAM women in childbearing age in nutritional centres since 2005 (page 24);
The decision not to treat women malnutrition was an operational decision following the
observation of the low cure rate of this age group in 2005 (13%). If the evaluation of this
choice would have been performed in the light of the prevalence of women malnutrition
in the area, the decision is questionable (page 36). The author seemed to correctly in-
terpret the alarmingly rising malnutrition rates of childbearing-age women in the area,
and that a sizable share of that increase might be attributable to ACFs decision46.
Project overview:
1. From 2007 onwards the project design seemed to get along a well explored path and the
core component of the approach continued to rely on curative care of SAM children and
on food supplementation to MAM children in one or another of the nutritional centres re-
lated to the severity of the problem. The community-oriented components kept on grow-
ing with increased difficulties: the community-awareness programme, which started in
2008 had to redefine its outreach as the amount of trained community volunteers (CCTs)
linked to the project (1,200) were too many to be aptly supervised by just 11 ACF staff;
the care practice programme, run by a psychologist since the end of 2008, who also gave
support to women counselling activities suffered a setback by the end of 2009, and it re-
mained headless until January 2011 when a paediatric psychiatrist-neurologist took
over47.
2. In the 2008 to 2009 project proposal / intermediate report document, it was explained
ACF had to make admission/discharge protocol changes in order to increase the catch-
ment of vulnerable beneficiaries within the same coverage area. The following changes
were put in place in May 2007: admission criteria of pregnant and lactating women
changed from <22cm to <21cm MUAC; discharge of lactating women was done when the
46
From the anthropometric nutrition surveys reviewed by this consultant combined CEDII (moderate chronic malnutrition) and
CEDIII (severe chronic malnutrition) CEDI belongs to marginal chronic malnutrition and thus left out of the record - were
21.4% in November 2000; 26.1% in January 2003; 27.0% in January 2006; 28.8% in October 2007 the surveys conduct-
ed in 2008, 2009 and 2010 stop surveying that age-gender group (authors note)
47
Although supervised by a psychologist belonging to Sittway nutrition programme

child reached 4 months instead of 6 months (page 8) - in the 2007 evaluation report it
was extensively questioned the decision to withdraw support to women in fertile age /
pregnant and lactating women.
3. Very high rates of non-responders within the TFP admissions (21,4%, compared to
14.1% in Sittway), which really prevented rates of those cured to reach optimal levels
(2008 to 2009 project). Defaulter rates went down progressively, instead, showing good
programme acceptability. Surprisingly enough, in the 2009 to 2010 project proposal indi-
cators update tables showed the proportion of non-responders no longer, seemingly in
accordance with the adoption of SPHERE standards, and therefore the rates of those
cured increased around 15%48. Hence, non-responders rates, together with those of ad-
mission mistakes, hospital referrals, unknown and cheaters, were no longer considered in
the statistics leading to establish only the rates of those cured, dead or defaulters49.
4. Medical referrals were reduced from 5% of all admissions in 2008 to 1.4% in 2009 to
2010 project, although they rose again in 2010 to 2011 project (10%, with Buttidaung
standing for 73% of all medical transfers)50.
5. NCHS standards statistics seemed indeed to show a decrease in SAM rates overtime from
2003 to 2006 and then continued decreasing until 2010; however, WHO parameters also
showed a decrease in SAM during that same period 2003-2006, but failed to show the
same trend in the following years (see table below)51.
Acute malnutrition prevalence

Township Period NCHS reference WHO standards
SAM (95%CI) GAM (95% CI) SAM (95%CI) GAM (95% CI)
11-2000 2.0% 1.0 3.9 22.3% 18.6 26.6 2.7% 1.9 - 3.8 24.4% 18.6 - 31.2
01-2003 3.0% 0.9 3.9 16.4% 10.5 17.2 3.9% 2.8 - 5.4 18.5% 13.9 - 24.1
01-2006 1.4% 0.5 3.0 18.9% 15.5 22.9 1.9% 1.4 - 2.7 21.0% 15.9 - 27.2
Maungdaw &
Buttidaung 10-2007 1.8% 0.6 3.0 25.6% 19.7 31.5 4.6% 2.5 6.7 24.8% 19.2 30.5
11-2008 1.0% 0.0 - 1.5 20.7% 15.0 22.4 2.3% 1.3 - 3.4 20.1% 16.8 - 23.3
11-2009 1.0% 0.4 - 2.2 19.0% 14.0 - 21.6 2.6% 1.2 5.2 20.8% 16.7 25.6
12-2010 0.4% 0.1 - 1.7 19.9% 15.2 - 25.6 2.9% 1.5 5.5 19.7% 14.8. 25.8
Table 2: (the above table was drawn from the latest available anthropometric nutrition survey in 2010 52 after
compiling the disaggregate rates for every township)
48
Integrated approach to malnutrition through nutrition, health and care practices Maungdaw, Buthidaung Townships.
Rakhine State. ACF 2010-2011 proposal & IR (page 40)
49
Ibid. (pages 30 & 31): 8% of non-responders from May to October 2010 10% in October 2010
50
Ibid. (page 38)
51
Algorithms for converting estimates of child malnutrition based on the NCHS reference into estimates based on the WHO
Child Growth Standards Hong Yang and de Onis M. Department of Nutrition, World Health Organization, Geneva, Switzer-
land. BMC Pediatrics 2008, 8:19doi:10.1186/1471-2431-8-19
52
Anthropometric nutritional and retrospective mortality Survey. Maungdaw and Buthidaung townships, NRS. Bougma K?.
December 2010. Final report. Draft version (the report appears unsigned, and the name was taken from Microsoft WORD
document specifications)

6. The overall number of ACF screened children steadily increased from 2006 onwards53, but
the GAM prevalence remained the same.
5.3 2010 to 2011 project development
Project overview:
1. The 2010 to 2011 proposal seemed to boast from the beginning an integrated approach
of the different ACF programmes (Care Practices, Food Security and WASH54), the com-
prehensive understanding of the community becomes an asset for behavioural change55.
The EuropAid-funded food security, livelihood and WASH project was thus considered a
complementary effort to focus on malnutrition under a comprehensive holistic light56.
Even though by the beginning of 2011 the atmosphere at ACF head office in Yangon was
not very promising on that regard57, efforts have been made hence at both head office
and field level to strengthen those ties, with Maungdaw offices monthly meetings includ-
ing PMs from FSL / WASH and Nut. The new 2012 to 2016 FSL / WASH proposal being
presently under discussion gives nutrition a mainstream place in the project, likely result-
ing in a stronger shared geographic and operational approach58.
2. In activities related to the result (page 19): the treatment of severe acute malnutrition
has matured towards a Community-based Management of Acute Malnutrition (CMAM)
approach in 2006, in developing its Outpatient Therapeutic Programme (OTP) component
of treatment This might be a much wished-for development of transferring the man-
agement of MAM children to the community, but CMAM might not end up being the an-
swer to that wish.
3. 2007, 2008, 2009 and 2010 anthropometric nutrition and retrospective mortality surveys
were made using SMART methodology59. Under this approach the surveyor is requested
to randomly sample both households covered by ACF project and those not covered;
therefore, the outcome should be fairly valid to make assumptions about the malnutrition
status of the population in a determined area. This, cross-checked with the actual propor-
tion of households ACF project is covering, should give an estimate of ACF coverage, but
not on the actual impact.
4. Adoption of an alternative protocol60 was developed together with ACF headquarters nu-
trition advisor, with close follow-up of its effects on childrens medical and nutritional sta-
53
In 2007 the number of children treated in the Therapeutic Feeding Program doubled in comparison to the two previous
years, which can be explained a general deterioration in food security. In 2008, the Therapeutic Feeding Program faced an
unexpected sharp increase of admission numbers at the beginning of the lean season revealing an even more fragile situa-
tion than expected. In July 2008, the number of admissions was four times higher than July 2007 (Integrated approach to
malnutr ACF 2009-2010) (op.cit. page 13)
54
Water, Sanitation and Hygiene
55
Integrated approach to malnut ACF 2010-2011 (op.cit. page 2)
56
2.3.3.4 Integrated approach to prevent malnutrition food security, water/sanitation and hygiene promotion and care practi-
ces/mental health and in Maungdaw and Buthidaung Townships (Integrated approach to malnut ACF 2009-2010 (op.cit.
page 22)
57
See Itineray Minutes. Also confidential interviews not available for perusal (authors note)
58
Interview with FSL Nicolas Guillaud and WASH Morie Amodu. April 9th, 2012
59
Integrated approach to malnutrition through nutrition, health and care practices Maungdaw, Buthidaung Townships. Rakhi-
ne State. ACF 2008-2009 (proposal, IR & FR with comments). 27-04-2009 (page 3)
60
Evaluation of an alternative protocol for the treatment of severe acute malnutrition, implemented by ACF Myanmar from
July 2009 to January 2010 P James. LSHTM

tus (weekly data analysis and specific database)61. The idea was to switch beneficiaries
reaching the state of Moderate Acute Malnutrition (according to the WHO standards) to a
single Plumpy-Nut sachet per day instead of giving it according to their weight as rec-
ommended by the usual protocol. This enabled reducing the average weekly consump-
tion of Plumpy Nut per beneficiary from 23 sachets to 15 sachets62 and therefore being
in disposition to cope with the astringent import quotas approved by the GOUM.
5. In page 21, it says that the total cost of the entire treatment for each beneficiary is
79.53 Euro. It is understood that amount refers to the previous 2009-2010 interven-
tion63. The same amount was given by the CMN when asked by this consultant during the
recent field visit more than three years later, which bears for the accuracy of that fig-
ure64.
6. The total number of children referred to the hospitals in Maungdaw and Buttidaung dur-
ing this period was 263 children, which represents 5.8% of the total TFP admission. The
total mortality in the hospital was 47 children (17.9% of the total referral) (page 42).
7. The medical treatment costs for those patients referred to township hospitals continued
being a pending issue from the very beginning of the programme in 2003. The 2011-
2012 proposal still reads (page 23) In 2010 (May to Dec), an average of 8.9% of the
children treated in the TFP were transferred to the hospital. The daily referral-cost per
beneficiary remains difficult to evaluate as the time spent in the hospital as well as the
treatment received depends on the beneficiaries diseases. Furthermore the treatment
expenses are regularly increased without appropriate explanation from the hospital staff.
This issue is under discussion with the TMOs.
8. Admission protocols turned again to previous NHCS standards in February 2010: for un-
der-five children, W/H between 70% and <75%, and MUAC between 110mm and
<115mm would be registered as SAM. In February 2011, ACF modified again its protocols
for admission and discharge criteria in therapeutic feeding programmes, when the MOH
eventually accepted new admission criteria. The revised protocol raised admission criteria
for TFP from MUAC <110mm to <115mm. As a consequence, MUAC cut-off for SFP ad-
mission was thus increased to 115 mm, with discharge criteria of both TFP and SFP to
120mm65, in order to bring into line with W/H unified discharge criteria.
9. A total of 93,239 children were screened by ACF nutrition teams from May 2010 to April
2011, 11,507 through active screening (12.3%) and 81,732 through passive screening
(87.7%) in both townships66:
a. 4.6% SAM (1,640) and 25.3% MAM (9.098) out of 35,990 screened were admitted in
Maungdaw.
b. 3.1% SAM (1,764) and 16.3% MAM (9.337) out of 57,249 screened, were admitted in
Buttidaung.
61
Integrated approach to malnutrition through nutrition, health, care practices 2010-2011 (proposal, IR & FR) V1 18-7-2011
modified 25-07-2011 (page 10)
62
Ibid.
63
Integrated approach to malnut ACF proposal 2010-2011
64
Consulting Finacial Dept. the explanation was that so far it was a pending issue to be discussed and sorted out (authors
note)
65
Integrated approach to malnut (proposal, IR & FR) V1 18-7-2011 modified 25-07-2011 (page 14): MUAC cut-off of
115mm as the standard criteria for SAM admission.
66
Ibid. (page 74)

c. 3.7% of all screened children were admitted as SAM (3,404 children) and 19.8% ad-
mitted as MAM.
10. It also remained a pending issue the use of reliable impact indicators to assess communi-
ty-oriented activities (care practices, mental health, community awareness). Quality indi-
cators for activities aiming at behavioural changes within the communities are neverthe-
less the most difficult to obtain. The 2010 to 2011 proposal did not make any progress on
that67.
11. Active screening activities stopped in February 2010 to be resumed in September 2010.
They stopped again in February 2011 not to be recommenced up to-date (there is no
active screening in February due to no available staff and no real need/centre already
overloaded)68.
12. There is a reporting duality between performance indicators according to SPHERE stand-
ards (not including unknown, admission mistakes, and non-responders in the nutritional
statistics) and those the project is accounting for. Its not clear that ACF reporting rates
of cured and defaulters reflect the reality (see APR Jan11, page 13: unknown cases that
may have been defaulters in reality).
13. Community involvement seems to resist ACFs efforts to tug them into actively participat-
ing in fighting malnutrition. Out of a minimum of 15% children admitted to the nutrition
centres and referred by the community, as state ACF indicators, only 4.2% actually were
so69.
Project overview:
1. There seems to be a rather stable trend beginning by midst 2010 in TFP new admission
registrations70, where the rate of admitted females is much higher that of males on a
regular basis - 65.2% against 34.8% in 2010 -, and that trend seems to be also the norm
along 2011 (64.5% and 36.5% respectively) and early 2012. Additionally, the rate of fe-
males discharged as cured also doubles that of males, as it does the rates of defaulters
and non-responders. Unpredictably enough, the rate of deaths among males is more
than 50% higher than that of females (60.9% and 39.1% respectively) in 2011, while
72.3% female deaths against 28.7% for males in 2009 and 61.5% female deaths against
38.5% for males were recorded in 2010.
2. Furthermore, compiled statistics for SFP indicators disaggregated by sex, which started
being registered only in 2011 (ACF SFP - Gender repartition 2010 -2011 FV), also seem
to reflect that same trend: 61.8% female and 38.2% male admission rates. The defaulter
and non-responder rates follow that same pattern but the death rate seems alike for both
females and males.
67
Integrated approach to address malnut. A1Z Proposal 20-01-2012. Draft 21-03-2012 (op.cit. pages 17 & 27)
68
ACF APR February 2011 (page 12)
69
Integrated approach to malnut 2010-2011 (proposal, IR & FR) V1 18-7-2011 modified 25-07-2011 (op.cit. page 74)
70
ACF TFP - Gender Repartition bnf. 2009-2011 FV

3. The Care Practices Programme took-off an impressive flight of its own. What in May 2011
seemed to be one added-up component to the main body of the Nutrition programme
has developed into a dynamic well thought-over community approach with a sound con-
ceptual framework. It has transferred strength to restore community-based coping
mechanisms, through prevention centres and community-members gatherings.
4. Active-screening activities were stopped altogether since Nov10, because of tasks of

training new SCCTs, shortage of HRs, and no need perceived (APR April 2011 page 11).
Although they were resumed for a very short period, March 2011 was the very last month
when active screening was conducted in BTG in MGD it was February 2011. No active-
screening actions were implemented throughout the period leading to April 10th, 2012,
date of this evaluations end of field visit.
5. The question raised by this consultant on whether active-screening actions were trans-
ferred to SCCTs, was answered in the intermediate report 14 December 2011, which
reads: Active screening in the Community: the total number of children identified and
referred by SCCTs was 3,712. Out of them 1,212 (32.7%) were SAM, while 400 (10.7%)
were MAM and the rest (2,100 children (56.6%) were not in the admission criteria. It was
observed that the number of rejections were becoming less and less each month, alt-
hough it was still slightly high. This is an indication that SCCTs' skills on taking MUAC and
oedema are improving71.
6. A total of 44,223 children were screened by ACF nutrition teams from May 2011 to No-
vember 2012 through passive screening in both townships72; of those 14,056 (31.8%)
were admitted: 7.5% SAM (3,318) and 24.3% MAM (10,738). Besides, 9.3% of all
screened were referred by SCCTs73. However, just two pages above in that same report,
when pointing out SFP impact indicator, it states 12,509 (62.3% of the overall target)
MAM children admitted in SFP.
7. Some confusion appears in different ACF documents regarding SPHERE standards for im-
pact indicators: in the 2010 to 2011 project final report two different cut-off standards for
those discharged are shown74 depending on whether TFP discharge rates - cured 70% /
defaulters <15% / deaths <5% / Gain of Weight (GOW) 5gr/Kg/day / Length of Stay
(LOS) <45d - or SFP discharge rates - cured 65% / defaulters <15% / deaths <5% /
GOW 2.5gr/Kg/day / LOS <100d.
However, in the 2011 to 2012 project intermediate report only six months later, the rates
for both TFP and SFP are the same (cured 75% / defaulters <15% / deaths <3%), ex-
ception made of those belonging to GOW and LOS the same as above for TFP and al-
so the same for SFP GOW but <68d instead of <100d for LOS75. SPHERE standards be-
longing to 2011 give overall discharge rates for therapeutic care of: Cured >75%, defaul-
ters <15%, and deaths <10%76.
71
Integrated approach to malnutrition through nutrition, health, care practices 2011-2012 Intermediate report. 14 December
2011 (page 28)
72
73
Integrated approach to malnut Intermediate report. 14 December 2011 (op.cit. page 23)
74
75
Integrated approach to malnut Intermediate report. 14 December 2011 (op.cit. pages 11 & 20)
76
The_Sphere_Project_Handbook_2011.pdf (page 169)

8. According to ACF Myanmar Administration Manager report, ACF-referred patients overall

expenditure on hospital stays throughout 2011 amounted to 9,258.45 , transportation
costs for other patients referred through MSF and others not included. This amount
cross-checked with the total amount of hospital referrals for 201177, which was of 270
although this figure does not match with that registered in APRs belonging from January
through December 2011 -, gives an average expenditure on hospitalization costs per pa-
tient of 34.3 , which is slightly lower than the gross figure offered by MSFH for its aver-
aged incurred costs per patient on hospitalization stays (50-100 US$) (see Itinerary
minutes 2).
9. The overall amount of hospital referrals from May through November 2011 half project
duration - was 176, of which 12 died (7%), as stated in 2011 to 2012 projects interme-
diate report78.
10. There seems to be some confusion about terminology in the documentation produced ei-
ther directly by ACF or on behalf of it, particularly so with regards to the terms caretak-
er and caregiver. The explanation given to this consultant that part of the confusion
arose from the flawed translation of the English concept into French does not stand for
scrutiny. Furthermore, the much-abused word beneficiaries as both ACF teams and
texts consulted liberally use whenever they are talking about children, seemed to over-
step ACFs need of accuracy.
This consultant considers out of the scope of this evaluation the Reproductive Health pro-
gramme, even though follow-up was included in APRs until its complete transferral to MSFH.
The approach to the project thus taken by herewith below belongs to the latest ECHO-
funded 2011 to 2012 project still in progress, which is where direct physical observation by
the author took place. It does not presume, though, that during implementation of past pro-
jects a few or many of the activities explained underneath were developed in a different
way.
It may be fitting to place here a blueprint of the project goals, as these have not sensibly
varied along 2010, 2011 and half-2012:
77
As recorded in APR_A1X-A1Y-Nut-CP Mya-Jan-Dec-2011
78

4,050 severely malnourished children under five are admit-

To detect, treat and prevent severe and moderate acute ted to TFP
SPECIFIC OBJECTIVE:
malnutrition in the target population 14,700 moderately malnourished children under five are
admitted to SFP
RESULTS ACTIVITIES INDICATORS
1. Running of Stabilization entres (SC), Mother Participation Centres
(MPC) 4,050 beneficiaries with severe acute malnutrition are ad-
2. and Outpatient Treatment Programme (OTP) with distribution points mitted in the TFP following the NCHS standards
1. Treatment of severe acute 3. OTP follow up with home visits for absent cases and specific needs The TFP statistics meet following criteria
malnutrition is accessible and 4. Breastfeeding support is provided to the caretakers in the nutrition - Cured 70% / Defaulter <15% / Mortality <5%
adequate for xxxxxxx benefi- centres - Gain of weight 5g/kg/day / length of stay <45 days
ciaries 5. Follow-up of 3 months for discharged cured TFP beneficiaries 50% caretakers identified for breastfeeding counselling re-
6. Provision of referral for treatment of serious diseases ceive it
7. Activities aimed at promoting the bonding and the caretaker-child re-
lationship are provided to the caretakers
8. Running of 7 SFP distribution points 14,700 beneficiaries with MAM are admitted in the SFP fol-
2. Treatment of moderate acute 9. Passive screening in SFP centres and 2 screening centres in NRS lowing the NCHS standards
10. Provision of referral for treatment of serious diseases The SFP statistics meet following criteria
malnutrition is accessible and
11. Provision of activities to promote nutrition health, hygiene and positi- - Cured 65% / Defaulter <15% / Mortality <5%
adequate for xxxxxxxx bene- ve care practices - Gain of weight 2.5g/kg/day / length of stay <100 days
ficiaries 60% caretakers increase their knowledge in hygiene, health
and care practices
12. Provision of activities to promote nutrition/ health/ hygiene/ positive
care practices in nutrition centres
13. Training of the key leaders in the communities on malnutrition,
3. Prevention and detection of treatment centres and referrals
malnutrition is effective in the 15 % of the children admitted to the nutrition centres are
14. Provision of passive screening for malnourished cases in nutrition
referred by the community
nutrition centres and with the centres
2 nutrition surveys are conducted and shared with the part-
participation of the communi- 15. Training of the INGOs and governmental health personnel on the
ners
malnutrition and the detection of the malnutrition
ties 16. Psychosocial support is provided to the identified caretakers in the
framework of the nutrition centres.
17. Conducting anthropometric nutrition survey at annual basis
Table 3: (taken from Integrated approach to malnutrition through nutrition, health, care practices 2010-2011 (proposal, IR & FR) V1 18-7-2011 modified 25-07-2011 (page 10)

Result 1. Treatment of severe acute malnutrition is accessible and

adequate for xxxxxxx beneficiaries
1. Running of Stabilization entres (SC), Mother Participation Centres (MPC) and Out-
patient Treatment Programme (OTP) with distribution points
The main project answer to the severe acute malnutrition relies on the Thera-
peutic Feeding Program (TFP), built on Stabilization Centres, OTP centres, also
involving Mother Participation Centres and closely linking them to the two former
ones.
Adoption of an alternate treatment protocol by which RUTF administration was

reduced in accordance with an ACF-design new protocol (see above), meant a
slackening in the requirements of importing RUTF, thus favouring an improved
availability.
Medical teams task division, complementation of competences and skills, sound

technical upgrading, and an outstanding motivation and hard working commit-
ment are the patterns of ACF TFP network.
However, some practice shortcomings in medical nursing care at OTP centres

level might be explained by high turnover of nursing staff, the new ones in need
of closer follow-up of skills and proper updating of capacities.
The decision to assemble TFP and SFP activities within one same centre OTP
optimized human resource efficiency and enabled teams to convey a more com-
prehensive response to malnutrition.
An effort was made to reduce rates of admission mistakes, unknown and cheat-
ing cases, through the use of both hennas indelible marking and ankle bracelets
to children admitted in the programme.
2. OTP follow-up with home visits for absent cases and specific needs
Recurrent increase of staff workload, an aftermath of the boosted acceptability of

ACF programme by the population, hampered OTP team members availability for
developing adequate follow-up to special cases, home visits and active-
screening, the former two particularly so, which resulted in a total arrest of ac-
tive-screening and a substantial decline in home visits.
Special follow-up for infants below 6 months or less than 3 kg weight. These
children attend a weekly distribution during 6 months after discharge. Mothers
receive a supplementary ration to increase energy intake at home and support
production of breast milk
3. Breastfeeding support is provided to the caretakers in the nutrition centres
Allocation of Care Practices approach into every OTP gave team members
(TFPAs) a better scope in identifying collateral causes of malnutrition, thus being
Evaluation report ACF Myanmar / Mar-Apr 2012

30/50
able to either address or appropriately refer them to MPCs. However, weakness-

es in the management of those cases revealed need for a strengthened training
update. Several OTP members expressed need for a closer CP support to their
actions, besides, and asked about the possibility of a psychosocial worker inte-
grated in every team.
Pre and post test revealed that 100% of the mothers who had gone through
counselling sessions found theses had a positive impact on their knowledge and
practice as they either decided to restart breastfeeding or prolonging it79.
4. Follow-up of 3 months for discharged cured TFP beneficiaries
In spite of available staff constraints for extended actions, this activity could be
maintained by means of reducing the number of follow-up months allocated to
children discharged though reinforcing follow-up protocols for special children.
5. Provision of referral for treatment of serious diseases
There seems to be a basic weakness in ACF registration quality of cases referred

either to medical INGOs mainly Malteser for TB-suspected cases and MSFH for
other general disorders and to MGD and BTG MOH hospital facilities, as no
gender is considered both in referral cases and in those discharged and dead
within hospital premises.
That same weakness applies to recording hospitalization costs, and whether or

not these reflect actual treatment rendered.
6. Activities aimed at promoting the bonding and the caretaker-child relationship are
provided to the caretakers
Psychosocial approach of mother-child incapacity to build on natural bondage

was based on infant massaging, as to increase mother-child wellbeing. It also
gives mothers the possibility to "speak" a natural language to their children (skin-
to-skin language). Focus group discussions to increase/refresh their knowledge
on how to cope with the family needs in terms of care practices (children, their
husbands and themselves). Toy making with simple materials to create means to
"speak" child language, and to enter in the child's interest as a way to enable
mothers starting again to enter in a dialogue with their children80.
Care Practices Programme activities are reported to reach all targets, and there is
no reason whatsoever to doubt it, but lack of proper recording CP impact as
translated into indicators seems to be also clear.
Result 2. Treatment of moderate acute malnutrition is accessible and

adequate for xxxxxxxx beneficiaries
7. Running of 7 SFP distribution points
79
Integrated approach to malnut 2010-2011 (proposal, IR & FR) V1 18-7-2011 modified 25-07-2011 (op.cit. page
48)
80

31/50
As mentioned above, SFP activities are strongly linked to TFP by means of inte-
grating both programmes into the same structures: OTP centres. Even though
from February 2011 and the sharp increase in admissions in both OTP and SFP
made it impossible to run activities following this schedule. Both SFP and OTP
beneficiaries were welcomed during the same day was stated in June 2011 final
report81, this consultant found nowhere the confusion caused by overwork the
mentioned document reported. OTP centres organizational set up was clearly
understood and perceived by the OTP teams, and they had different days allo-
cated to TFP cases and SFP ones.
8. Passive screening in SFP centres and 2 screening centres in NRS
All passive screening is presently done in OTP centres.
9. Provision of referral for treatment of serious diseases
Due referral to both an upper technical level of either nutritional or systemic

treatment SCs or to a more specific approach of dysfunctional behaviour
MPCs was dealt with celerity and efficiency. Appropriate means of transport,
both by road (stand-by ACF car) and by river (stand-by ACF boat), ensured fast
and reliable transferral of mother and child and thus, lives were put at minimum
endangered exposure.
There were rather a few questions raised by the nurses at MGD OTP centres
about the increased flow of MAM children carrying associated disorders who
could not be treated using 1st line antibiotic treatment but had to be referred to
an MSFH clinic instead, which in some cases was far away. ACF only allows com-
plete medical treatment to MAM children in BTG, for lack or complementary
INGO services.
Result 3. Prevention and detection of malnutrition is effective in the

nutrition centres and with the participation of the communi-
ties
10. Provision of activities to promote nutrition health, hygiene and positive care practi-
ces in nutrition centres
As direct physical observation confirmed, there is a clear-cut organizational struc-

ture at every OTP centre in which nutrition health education and care practices
are systematically approached and addressed. Each one takes place in a separate
setting, at different stages of the screening and identification process, and both
are carried out with strict adherence to protocols. Care practices responsible, to-
gether with medical (nursing) input and in accordance with the team leader opin-
ion, decides which course to take with every case under observation, and wheth-
er further referral to MPC is convenient
11. Training of the key leaders in the communities on malnutrition, treatment centres
and referrals
81
Integrated approach to malnut 2010-2011 (proposal, IR & FR) V1 18-7-2011 modified 25-07-2011 (op.cit. page
62)

32/50
3 SCCT training workshops were conducted covering the topics planned in the
proposal. Then refresher training was also conducted to ensure that the SCCTs
remember all the main messages of each topic. Additional refresher training on
MUAC measurements and oedema checking was conducted. Home-visit protocol
training, basic report writing and lessons on how to organise and manage meet-
ings will also be provided.
Active screening in the Community: as foreseen active-screening activities were

transferred from OTP teams to community-based SCCTs, although nowhere in
the documents reviewed this new strategic choice is shown. In spite of what the
text states, the number of rejections remained more or less the same as in pre-
vious projects (56.6%)82.
Market awareness actions were undertaken so as to avoid supplementary food

rations being sold in the market. Key messages on malnutrition treatment and
the importance of ensuring that mothers do not sell rations intended to treat
their children were disseminated. Spot checks were also carried out to see if
therapeutic products were on sale.
Thorough psychosocial training of trainers was organized for 49 ACF members

facilitated by the University of Psychology of Yangon and Yinthway Foundation.
The aim of this training was to improve the capacity of the staff to facilitate train-
ings and follow-up meetings and to ensure that the staffs understand and are
equipped to deliver trainings to community volunteers, community leaders and
Traditional Birth Attendants (TBAs). Training will be cascaded down to reach
community members.
A group of community leaders started a group where they summon interested

parents to teach them what they have learned in the training. This initiative is
being supported by ACF and taken as an example for other communities to learn
from and replicate83.
12. Provision of passive screening for malnourished cases in nutrition centres
According to this consultants direct observation, all screening done in OTP cen-
tres is passive.
13. Training of the INGOs and governmental health personnel on the malnutrition and
the detection of the malnutrition
MSFH staff was trained on anthropometric measurements, in accordance with a

well-developed training programme to partnering INGOS starting from previous
projects. However, planning for the training of MoH Buthidaung Reproductive
health centre staff is in the process84 did not take place and it seems very un-
likely that it will at this stage of project finalization (April 30th, 2012), and prepa-
ration for the new proposal MOH/ACF joint approach to CMAM is still in the ap-
praisal phase.
82
Integrated approach to malnutrition through nutrition, health, care practices 2011-2012 Intermediate report. 14
December 2011 (page 28)
83
Ibid (page 30)
84
Ibid (page 30)

33/50
14. Psychosocial support is provided to the identified caretakers in the framework of

the nutrition centres
A sizable amount (80-90%) of mothers were found to have emotional impair-

ment when their children were admitted in the programme. This was linked to
different reasons: on average above 38% of the beneficiaries in the SC or MPC
had lost a child due to medical issues, and/or malnutrition in the past. Many
mothers also had problems related to either economical stress/joblessness in the
family or caused by worries about the children left alone at home, or related to
being abandoned by the father without any support given to the family85.
Direct observation of the development of Care Practice Programme has led to the
perception that it has turned into a real breakthrough. The strengthening of
community involvement in the management of their psychosocial impairments
appears to have led to an enhanced community cohesiveness and the restoration
of hidden and nearly forgotten coping mechanisms, which may be the embryo of
a future involvement and participation of community-based moderate acute mal-
nutrition management.
It is likely that this consultant not being a nutritionist by professional background

may find SQUEAC surveys, as that conducted by December 2011, inferior in in-
formation gathering than the yearly anthropometric surveys carried out up till
now by ACF. He feels far more comfortable by the latters flexibility and adapta-
bility than by the former, clearly more technically driven.
6 CROSS-CUTTING PROCESSES
Planning
Planning was based on already well-tested developments, which ensured a

smooth progress from one yearly project to the next. However, it also could
have been the seed for a slow path to innovation and renovated approach. The
upcoming 2012 to 2013 ECHO-funded project may bring about new challenges
to ACF as the beginning of plans for an exit strategy may be in the offing.
Management
This consultant had very little chance to throw a glance at previous manage-
ment issues, as his first visit to the project (May 2011) witnessed a very re-
cently arrived new head of mission and no previous documentation was availa-
ble to point out previous strengths and weaknesses. That may explain his neg-
ative perception on how previous management styles could not build links with
the MOH and therefore be so backward in terms of project sustainability and
handing-over strategies86. However, just one year later it seems obvious to him
that a new management style has taken place, both in terms of building links
85
Ibid (page 31)
86
External evaluation ACF Nutrition Programme NRS Myanmar (V2). Dominguez JL. 05_07_2011 (pages 23 to 25)

34/50
with the MOH and the support given to field operational teams, and that may
pave the way for a better understanding of the new political changes together
with an MOH opening up.
Monitoring & Supervision
The SQUEAC survey already mentioned emphasized the need for closer moni-
toring and supervision in the field. The management in the field, who clearly
understood that without strengthened supervision, intervention quality could
be hampered, also shared this need. However, there was complete agreement
in that, without slackening time-consuming activities such as monthly APRs,
monthly travels to the capital for permit renewal, the sheer dimension of the
operational staff would make extremely hard to ensure projects proper moni-
toring.
Chances are that the current governmental softening of tight regulations to in-
ternational cooperation might be near. ACF HQs have also eased the reporting
burden by allowing APRs to be presented every second month instead.
Notwithstanding the very visible efforts made by the technical coordination in

place as far as supervisory visits into the field are concerned, a pervasive feel-
ing of loose technical monitoring and supervision could not be avoided by the
author: documentation reviewed revealed sparse technical backstopping to the
operational teams in the field, together with a weak feedback to field reporting.
Systematic nutritional technical advisory feedback from HQs seemed also be
wanting, besides occasional field visits by HQs nutritional advisers.
Insufficient analysis of statistics incurred by the project, which indicate trends

that might and should influence technical planning and management was ob-
served, and a seeming inactivity to long-time pending issues often became vis-
ible lack of due analysis of average costs incurred by hospital referrals; cost
estimates of SAM treatments overtime; lack of reaction to the huge and con-
stant disparity between female and male admission and death rates, among a
few rather casual ones In APR narrative Nut Myanmar May 2011 PC pro-
gramme reporting showed mistakes no one detected and/or corrected, which
suggested no one was reading those reports. There is a full long paragraph re-
peated in the text (page 30). In APR narrative Nut Myanmar August 2011,
defaulter rates in MGD increased above SPHERE standards since June, with
26.7% in August 2011. As a likely explanation, Ramadan was to account for
but this is too high a rate when compared to previous two years during Ram-
adan (26.7% in 2011; 17.3 % in 2010; and 4.6% in 2009) (page 9). Again,
this worrying record provoked no reaction from the technical coordination.
Exit Strategies
An exit strategy exercise was scheduled for August 2011 to discuss on how to
prepare communities to self-sufficiency in terms of food security87. No infor-
mation was forwarded to this consultant about the outcome of that exercise.
87
Conversation with ACF MNC

35/50
However, strategies tending to both engage the MOH into ACF intervention
policies, and to community capacity-building to strengthen coping mechanisms
to address moderate acute and chronic malnutrition seem to be in progress.
This, considering the context difficulties faced by the population in terms of as-
sociating initiatives, etc. The 2010-2011 proposal reads the current pro-
gramme is not sustainable due to its high demand in terms of manpower and
budget to meet the needs of the beneficiaries. However, in 2010, ACF will con-
tinue to seek different channels to increase local and national health systems,
as well as communities participation in treatment and prevention of malnutri-
tion88.
There are some hints that it may be high time to start preparing an exit sce-
nario:
1. In ACFs 2011-2013 country strategy89 there is indication that ACF is starting

to envision a pullout policy: though the context is far from allowing the ini-
tiation of a partnership approach, options to increase linkages with the MOH
and other structures (MRCS, Metta foundation) should be regularly fol-
lowed (page 11).
2. The very recent changes in governmental policies and openness towards

the international community may influence the way national authorities per-
ceive humanitarian and development aid delivered by INGOs.
3. The new attitude towards ACF shown by national MOH authorities both at
central level and peripheral one.
4. The decentralization policies already enacted which will likely give more au-
tonomy and decision-making capacity to State and District MOH officers.
5. The new influx of international donors which may result in easing limitations
for getting funding to support fresh initiatives in delivering humanitarian
and development aid.
6. The likely constraints experienced by one of ACFs main donor of the nutri-
tion programme, ECHO, regarding available funds in the near future 2013
to 2015.
For this scenario to be in place, three main requirements must be also in place:
a) A strengthening of MOH structures in terms of health care availability (infra-

structure, technical skills, health facility equipment, etc.), accessibility (pro-
activeness by MOH staff towards the NRS populations, reciprocate trust
built-in), and affordability (increased international funding of health ser-
vices so far paid for: reproductive health, maternal & child care, acute and
chronic malnutrition).
b) Actions tending to restore community coping-capacity to enable the trans-
ferral of knowledge for the management of MAM by the communities, as a
way to start building sustainability to the project90.
88
Integrated approach to malnut ACF 2010-2011 (op.cit.)
89
Country strategy 2011-2013 Myanmar v1 (2) ACF, 1 September 2010
90
Maria Biotteau, October 2007; Brigitte Tonon, November 2008; Karim Bouma, December 2009 & December 2010

36/50
c) Slackening of restrictive governmental policies enforced upon the NRS

population91.
There may be the most difficult of ACF endeavours to put in place the 2012 to
2013 CMAM pilot project jointly implemented by MOH and ACF in Buttidaung.
It will likely suck effort, funding and enthusiasm, as the operational working
cultures are overwhelmingly different. Nevertheless, no matter how many ob-
stacles appear in the way and the realization by ACF that this first step is going
to be intricate, and that it will surely take longer than one full year to accom-
plish, it seems clearly a must to ensure future sustainability.
ACF may be in the right path towards strengthening community coping capaci-
ty by means of Care Practices programme achievements, which will expectedly
develop further to ensure progressive assumption of responsibilities by the
communities.
It seems still too early to assume that restricting governmental policies towards
NRS have some odds to be released. Several key informants approached
showed a pessimist view about the degree of importance given by the new
government to NRS issue, and that this importance might be paramount to any
assumption of further changes improving the population livelihood.
The moment seems not being ripe for straightforward suggestions on impact
indicators to follow up that difficult exercise. ACF will be confronted with re-
questing from MOH health network the same protocols to abide by and per-
formance indicators it has been applying so far, by fear of engaging itself into
an unequal two-tiers care system, ACFs and that of MOH.
Gender
To obtain a gender balanced approach in any health intervention is not an easy

job. Any bias towards female beneficiaries may be duly interpreted as casually
skewed, and there is a widespread tendency to assume that by targeting wom-
ens needs (reproductive health, maternal & child care, mother with malnour-
ished children) gender is looked into, while reality is somehow different.
Somewhere along the latest 2010 to 2011 project final report92, it reads as one
of the justification of gender considerations in the programme: the direct bene-
ficiaries are children under 5 years old and their caregivers which are most of
the time their mothers. The care practices / mental health component works
closely with mothers and ACF, with the presence of the Care Practices expatri-
ate contributes to their protection and provides them information concerning
support available. During the individual follow up in the SCs, cases of violence,
neglect and abuse in the domestic environment are often addressed. This al-
lows a safe space for women to express their feelings, fears and feel listened
and valued, enhancing their level of self-esteem and reducing the feeling of
helplessness, common among women exposed to domestic violence.
91
As one of the surveyors very ably put it: Although humanitarian actors have made considerable efforts, side ef-
fects of these actions are evident such as destructuration of coping mechanisms, which has led to limited sustaina-
ble impact. The main lessons learnt from humanitarian action reveal the priority to extend and improve the inte-
grated community approach to have a larger impact on the community and to improve sustainability of the activi-
ties. Anthropometric nutrit 2008 (op.cit. page 46)
92
Integrated approach to malnut 2010-2011 (proposal, IR & FR) V1 18-7-2011 modified 25-07-2011 (op.cit.)

37/50
The obvious understanding from this paragraph seems to infer that, because of
the project addressing malnutrition and therefore involving mothers behaviour
and practices, traditions and custom it stuck to a gender approach. It is like as-
suming that because a specific project deals with reproductive health has gen-
der tacitly incorporated. Conversely, that any intervention aiming at decreasing
bladder cancer high rates in men suffering from repeated bilharzias, would im-
ply a skewed gender preoccupation.
Nevertheless, ACF actually did design the project successive phases with gender
in mind, as the development of Care Practice/Mental Health Programme specifi-
cally targeted women/mothers with behavioural and practices disorders tightly
linked to gender.
On the other hand, until recently early 2009 - TFP admission and discharge
rates were not disaggregated by gender, and only in 2011 SFP admission and
discharge rates started being also disaggregated in 2010 records SFP only
register overall disaggregated admissions, not discharges. Neither screening nor
hospital referrals nor death exits, were split by gender.
TFP admission rates in 2010 and 2011 showed a stable trend by which the pro-
portion of female admissions and, consequently, that of cured, defaulters and
non-responders - almost doubled that of males. That same trend was found in
SFP admission rates for 2011. No analysis on that trend was yet made that this
consultant is aware of.
The overwhelming majority of ACFs national staff in the field is male excep-
tion made of nurses. Does it mean that gender issues do not concern ACF? Not
the least. A more obvious explanation lies in the fact that for Muslim societies,
women are not meant to work outdoors, and illiteracy and low educational
background contrives against them.
ACF can do much more than it is doing concerning gender issues that, to the
author, their lack is more caused by not enough diligence than by disregard.
Advocacy
It seems to be one of ACFs pending issues. The restricted socio-political situa-

tion in the near past was not all conducive to speak out. Even a very much
outspoken agency like MSFH had to refrain from openly questioning govern-
mental health policies.
However, it would be a mistake not reviewing increased room for advocacy as

expectedly allowed by the recent GOUM openness, and if ACF manages to be-
come a trusted interlocutor before the MOH, and it seems to have many
chances to reach that level, the ground for advocacy might be impressive.
International humanitarian principles and standards
Humanitarian imperative comes first (principle 1)

38/50
This consultant has obtained no further information on ACF response to Nargis

cyclone in May 2008 beyond an IASC generic document93.
Response to the Giri cyclone in December 2010-January 2011 was swift and
straightforward, and ACF played a fundamental role in ensuring food rations to
those affected: The distribution of supplementary blended food rations by ACF
has covered 1,838 households in Myebon. The second phase of distribution will
cover 3,500 under-two children and is expected to start during the third week
of December94
Build on local capacity (principle 6)
Only since very recently building on local capacity may have a chance to devel-
op, through a vigorous and impressive community linkage strengthening and
reinforcing coping capacities by adequate community training and propitiating
ground for interaction and discussion, conducted by a Care Practices Pro-
gramme with admirable initiative.
Similar initiatives may be in progress carried out by ACF partnering projects

Food Security and Livelihood, and WASH.
Involve programme beneficiaries in the management of relief aid

(principle 7)
A lack of social tissue and low educational level notwithstanding, national staff
arising from those same communities has influence project goals and strate-
gies through direct participation in the shared management of malnutrition.
A more advanced beneficiary participation may have taken place in ACF Food
Security & Livelihood & WASH projects, which fall out of this evaluation.
Reduce future vulnerability (principle 8)
Refer to the above principle 7
Accountability towards both the beneficiaries and the donors

(principle 9)
An issue difficult to answer. On one side, the donor seems to complain about
the lack of accountable information received in the past. On the other, the
agency seems to be convinced that all possible available information has been
handed. From what it looks like a by-product of past times, this consultant tru-
ly believes that both donor and agency are reaching more optimal shared
ground for accountability.
A different question comes from whether ACF has shown a certain degree of
accountability to beneficiaries: a better interaction with what may be consid-
ered one of the projects indirect beneficiary, the MOH, the answer may be
positive. ACF has shown along the last year a penchant for sharing with the
93
Myanmar, Cyclone Nargis : One Year On May 1st, 2009
94
OCHA Emergency Situation Report Cyclone GIRI 20_12_2010

39/50
MOH its results and achievements. Conversely, in what regards to direct bene-
ficiaries, this consultant thinks the moment is still not ripe for initiating that
process, which takes more than simple willingness, but demands capacities to
build up a degree of interaction very unlikely to be available so far.
7 CONCLUSIONS
1. Extraordinary good and solid job: very effective work in the field and extremely
committed staff. Terrific organization of different operational layers and very effi-
cient nutrition outposts. Very good logistic know-how.
2. Without any central or local institutional backstopping ACF was able to construct a
full conceptual and operational structure to treat malnutrition in NRS together
with a comprehensive nutrition information system -, which only from February
2009 to November 201195,96 screened 247,621 children and treated 26,738 (10.8%)
with severe acute malnutrition with an average rate of those cured of 86%, and
86,241 (34.8%) with moderate acute malnutrition. The proportion of those treated
amounted to 5.9% of the overall under-5 year old population in Maungdaw and in
Buttidaung in 2011.
3. When taking 247,621 children as the amount of those screened over the last three
years (February 2009 through November 2011), and a proxy estimate of NRS over-
all population of around 700,000 people, from which around 15% are children un-
der five years old that is, 105,000 per year it results in an amount of 82,540
children screened per year, i.e. a 79% coverage of the overall population of under
five years old, which looks as an impressive project performance altogether.
4. Moreover, when assessing children found to be severely acute malnourished and

admitted per year 8,912 it results in a rate of 8.5% out of the overall children
under-five population (105,000), therefore much higher than the SAM rates report-
ed in the latest UNICEF 2011 MICS for the whole Rakhine Division97 (WHO stand-
ards (W/H) = 2.8%; NCHS standards (W/H) = 1.8%). It also reflects the fact that
those children are not totally representative, as they belong to a population of chil-
dren not feeling well. The same applies to MAM rates: ACF MAM admissions after
screening are 34.8% of the estimate overall population (WHO standards (W/H) =
10.8%; NCHS standards (W/H) = 10.3%).
5. ACF also developed a huge system of community-oriented activities, aiming at

meeting the acute needs perceived in care practices, health education, community
awareness, mental health wellbeing, etc. The number of mothers supported with
these activities is impressive, as it is the nutritional awareness-raising to communi-
ty members. It is all the more regrettable that ACF would not contrive to design
workable impact indicators to show the degree of achievement reached by those
activities obviously, outcome indicators were in place.
6. Even though ACF showed an understanding that children immunisation and micro-
nutrient intake were fundamental issues in the fight against malnutrition at very
95
APR_A1X-A1Y-Nut-CP Mya-Jan-Dec-2011. Document in Excel
96
Integrated approach to address malnut. A1Z Proposal 20-01-2012. Draft 21-03-2012
97
Myanmar Multiply Indicator Cluster Survey 2009-2010. UNICEF / MOH. October 2011

40/50
early stages of its intervention, not enough seems to have been done to strengthen
those topics within its approach. No statistics are shown on the immunisation sta-
tus of severe and moderate acute malnourished children admitted anthropomet-
ric nutrition surveys included measles immunisation status from 2003 to 2008, be-
ing totally omitted in 2009 and 2010 surveys as are not micronutrient coverage
(vitamin A, iron, iodized salt, etc.), even though ACF enclosed micronutrients in its
supplementary feeding programme ration mix.
7. Global and Moderate Acute Malnutrition rates overtime seem to resist all efforts
made to appease them, which speaks again about a structural situation of under-
nourishment with an invariable size of vulnerable children recurrently getting within
and without acute malnutrition episodes.
8. Moderate acute and chronic malnutrition in NRS also seem to have settled down as
a structural permanent blueprint of the harsh living conditions endured by the Roh-
ingya population. ACF has done a great job in containing severe acute malnutrition
even reducing it provided one relies on NCHS references and strengthening
MAM detection and proper treatment. The former, by using the only approach mak-
ing any sense: that of a rigorous, perfectly designed, epidemiologically sound clini-
cal engagement with the appropriate skills and resources. The latter, by developing
community-oriented tools to address the cultural, behavioural, and educational
background in which those populations live.
9. The effort made by ACF in its fight against malnutrition in NRS seems to be beyond
question, and the achievements reached so far are utterly praiseworthy. No one
can fairly guess what would have happened leaving the Rohingya population to
fend for themselves when faced with a situation like the one ACF found in 2003 be-
fore starting the programme98 there were no available children mortality statistics
at that time but for sure a reasonable assumption can be made that ACF actions
have at least kept that mortality at bay.
10. It is debatable that a closer relationship with the MOH would have rendered better
outcomes that those obtained by ACF on its own. The seemingly premeditate poli-
cies enacted by the GOUM to isolate and stifle populations considered as alien to
the countrys identity, did not allow for a fruitful collaboration with local authorities
who seemed to perceive INGOs as working against the countrys high interest. It
has taken combined efforts and appropriate and timely political changes to see the
light through the tunnel. In that sense, ACF proposal for a joint pilot programme
using Community-based Management of Acute Malnutrition approach in Buttidaung
looks as a fair initiative for partnering with the MOH, so as to prepare the begin-
ning of an exit strategy in the longer term.
11. Despite what this consultant believed before about what he considered excessive
medicalisation of ACF nutrition programme99, the lack of adequate references from
the clearly unsatisfactory and poorly developed MOH healthcare network gave very
little other choice to ACF than developing a network of its own to tackle severe and
moderate acute malnutrition. And this system seems to be clearly operational and
effective.
98
Anthropometric nutrit January 2003 (op.cit.)
99
External evaluation ACF Nutrition Programme NRS Myanmar (V2). 05-07-2011 (page 25)

41/50
12. Monthly overviews outlining a trend whenever there was either a monthly increase
or decrease in the number of children admitted or screened, while in the previous
or following ones that trend was reversed, seem to be of very little value, if any,
regarding rapidly changing malnutrition admission rates. This consultant believes
than malnutrition admission appraisals shorter than every two or three months
bear very little significance.
13. A recurrent issue raised several times, both by the previous external evaluation and
this author alike, is the chronic malnutrition rates of women of childbearing age in
the area, and that a sizable share of it might be attributable to ACFs 2006 decision
to withdraw that age and gender group from its scope. ACF kept on leaving out
malnourished women from its successive projects. This author expressly enquired
other INGOs in the area, namely Malteser and MSFH, about the problem and the
answer was negative: they did not take care of either under- or malnourished
women in childbearing age. Then, who focuses on them? Is this apparent negli-
gence perhaps provoked by the assumption that women deliberately keep them-
selves undernourished so babies they deliver have, as a result, a lower weight at
birth, and thus their risk at labour diminish?
14. The shift from NCHS standards to WHO parameters in February 2009 increased
dramatically the severe acute malnutrition admission rates, in clear detriment to
moderate acute malnutrition, whom ACF project withdrew from its intervention
during three months (February, March and April 2009). ACF resumed its SFP activi-
ties in May 2009 but it took a time to draw MAM children to visit OTP centres
again.
15. It comes to anybodys mind that if ACF turned out being pretty sure that no malnu-
trition cases went undetected and thus there was no need for active-screening ac-
tivities, programme coverage and therefore the SQUEAC survey wouldnt have
been needed.
16. ACF still mistakes in its reports community-based with community-oriented, and
that confusion may hamper its strategies. ACF nutrition programme does not seem
to have reached by far the level of a community-based policy, merely struggling
to keep up with a community-oriented approach still wanting to be fully devel-
oped. The opposite can be said about the Care Practices/Mental health programme,
which is well deep into enhancing community-based coping capacities and
strengthening behavioural change.
17. Nutrition project impact is accurately reflected in ACF statistics monthly compila-
tion, excluding actual coverage. Exceptions are the community awareness and Care
Practices components, which so far have not found appropriate indicators to reveal
their impact.
18. It remains hard to understand the lack of proper answer to questions about SAM
and MAM unitary costs, and hospital referrals averaged cost. But it also bears re-
sponsibility on the donor who, besides complaining that successive project budget
was getting far too expensive, did nothing to request a better financial reporting
regarding those issues.
19. There might be a fundamental flaw in how nutrition indicators were taken. Until
2009, the rates of those cured were made out from the proportion of children

42/50
cured related to overall discharged (here including defaulters, non-responders and

those having left for unknown causes), following SPHERE standards for the pro-
grammes curative rates. However, from 2009 onwards the rates of those non-
responders and those who left for unknown causes disappeared from reports sta-
tistics. If all these children are taken into account, then the cured rates might be
lower though still above SPHEREs minimum standards but, at least, there would be
a more accurate parameter to assess actual programme impact, even though the
met need indicator might be less reassuring. In the project ending May 2011 it
seems that for calculation of cured rates the non-responders were included.
20. Gender seems to having not been a constant concern in ACF nutrition projects. On-
ly recently classical rules of gender disaggregation were incorporated. The fact that
the very rigid and closed traditional Muslim communities where ACF worked, placed
women in a clearly disadvantaged situation, which a humanitarian intervention had
very little chances to address, may explain in part the intrinsic weakness of ACF
approach. However, a better project data analysis and research might have given
the edge to react in a more comprehensive way.
21. There seems to be a stable trend so far unexplored, of TFP admission rates much
higher for females than for males almost double on average starting midst
2010 up to-date. Correspondingly, rates of those cured, non-responders and de-
faulters are also much higher for females than for males. However, when looking at
death rates, both 2009 and 2010 show that same trend of many more female
deaths than those of boys, while in 2011 the rates are the opposite, more males
than females died in TFP centres.
22. Compiled statistics for SFP indicators disaggregated by sex started only in 2011,
but they also seem to reflect that same trend: 61.8% female rate admission and
38.2% male one. The defaulter and non-responder rates follow that same pattern
but the death rate seems alike for both females and males.
23. Gender-disaggregation did not include hospital referrals and deaths, so an estimate
on whether there also were statistical differences in the seriousness of disorders
experienced either by females or males when arriving in ACF therapeutic facilities.
24. Technical supervision and follow-up seems to have been insufficient, whether be-
cause of task overload or staff limitation. Donor concerns on research not being
part of an emergency response are unfounded. Research; be it anthropomorphic
surveys or else, is required to ensure that needs targeting is adequate. But it also
requires appropriate monitoring of results, which seems not having been in place.
25. Although there may no doubt be good reasons to keep on this kind or terminology
beneficiaries, caretakers, caregivers, etc. it appears to sound pretty cold and
detached to an external observer because beneficiaries are, above all, very sick
children and their caretakers or caregivers your choice - are, in their majority,
very afflicted mothers, some of them sick as well. Besides, it creates abundant con-
fusion in texts, which depicts a blotched supervisory care on the terminology used.
Furthermore, the wording seems to transmit a sort of uneasiness, as if what really
mattered were to reach the targets, which basically are numbers and rates, thus
leading to sentences like this one: with MGD surpassing BTD in BNF load
(APR February 2011 page 3).

43/50
8 TOR CRITERIA
This consultant has followed instructions issued by the TOR where possible. It has
to be outlined that DAC criteria exposed in those TOR looked a bit contradictory, as
there appeared to be two different approaches to it: one related to point 3.3
Scope of the evaluation (page 6) and the other one linked to criteria topics ex-
panded questions (pages 6 & 7). In the latter topics such as Strategy and Gen-
der were included while Effectiveness and Sustainability were not. Conversely,
rather a few of topic lists items were not reflected in specific questions under top-
ics outlined.
After discussion ACF decided that topics first mentioned in page 6 relevance,
coherence, coverage, efficiency, effectiveness, acceptability, access,
equity, sustainability and accountability - should be the requirements to be
followed. Strategy and Gender, as topics outlined in the expanded list below
should be optional instead.
Whereas no questions were detailed to many of the items considered in the former
list, comments below only respond to the latter.
Impact
1. Positive impact on the beneficiaries: the project has positively influenced the target
population in an overwhelmingly way. That influence seems to having been so
dramatic that ACF remains as the main reference point for mothers and children,
these suffering from what the former may believe is malnutrition, even though it
may turn out not being so. The degree of trust and hope ACF has aroused in the
most impoverished households is demonstrably very high.
2. Benefit to the most vulnerable groups: overall, ACF has reached the most vulnera-
ble groups, children dying from malnutrition and mothers unable to help them.
However, ACF had to withdraw from providing help to chronic malnourished women
of childbearing age, and it was neither in the capacity to tackle chronic malnutri-
tion.
3. Community perception: a praiseworthy effort has been made towards community

behavioural change, improved knowledge on malnutrition and causes leading to it,
as well as weaving ties among households with the aim at strengthening their cop-
ing capacity.
4. Short-term results achieved: the intervention has turned into a chronic emergency
situation whose profound causes are rooted in structural socio-political challenges.
Short-term results have been totally achieved, though.
Appropriateness
5. Were the actions undertaken appropriate in the context of the needs of the target
populations and the context of the situation?: needs were thoroughly assessed and
the vulnerable populations were adequately targeted. The situational socio-political
context allowed for very few options to meet those needs, and ACF most likely

44/50
chose the most cost-effective one in terms of life preserved and vulnerability ad-
dressed.
6. Was the assistance appropriate in relation to the customs and practices of the tar-
get populations?: it was clear from the first assessments that one of the main
causes for the vulnerability of the population and the high malnutrition rates was
the misguided community and household behaviour and conflicting traditions to-
wards women and children alike. The intervention aimed at creating better condi-
tions for those practices to be understood and reviewed and, if need be, altered.
7. What was the level of beneficiary participation in project design and implementa-
tion?: although the extremely low educational level of the families where malnour-
ished children were targeted, did not allow for involving them into project dynam-
ics, ACF did indirectly so by enabling national staff belonging to those same popula-
tions have a say and participate in project design.
8. How effective and appropriate were these processes in ensuring relevant and time-
ly project delivery in support of the most needy and vulnerable?: as whole, succes-
sive yearly ACF projects steered their course adapting extremely well at a rapidly
changing environment. The yearly anthropometric surveys became the main tools
for new approaches and better targeting vulnerability.
9. Was the assistance provided in a timely manner?: ACF quickly learnt how to change
its operational resources to the ever-changing challenges and responded adequate-
ly and in time to the needs, as well as to react to humanitarian requirements.
Efficiency
10. Were resources used efficiently?: the feeling is that resources were used judicious-
ly, but some reporting shortcomings tarnished that feeling: lack of assessment of
unitary cost per SAM, MAM, and hospital referrals.
11. Management performance: there very few if any records on management before
2011. Into-the-field technical staff high turnover did not allow, either, for due in-
formation. However, good and consistent management was evident along last year.
12. Cost-effectiveness: there is a chronic weakness in both donors and INGOs alike to
default on specific financial indicators to enable cost-effectiveness assessment: lack
of requirements of cost per unit achieved, be it malnourished children cured, ma-
ternal & child care discharge cost, hospital length of stay particularly so when
there are enough accounting tools at hand to extract it. That would allow evalua-
tors to compare between different interventions aimed at similar goals. All attempts
made by this consultant to obtain samples of unit costs from ACF partner organiza-
tions in the field, namely Malteser and MSFH, failed most likely due to that unwrit-
ten rule of avoiding transparency beyond a threshold.
13. Quality of technical support: it seemed to be imbalanced: ACF HQs did not seem
too diligent in backstopping technical needs into the field, besides intermittent field
visits, although that appeared to change last year.
14. Project follow-up: insufficient monitoring and supervision at either HQs, head office
or in the field. Poor feedback and lack of data analysis and research.

45/50
Coverage
15. Were the worst affected groups covered within the limitations of the resources
available?: the answer must be yes, but it does not avoid questioning about vulner-
able groups such as women of childbearing age not having had their needs met.
16. Was the geographical coverage of the ACF programme appropriate?: there must be
always a trade-off between needs and resources. In an area of the extension of
NRS, ACF has covered overtime four districts Maungdaw, Buttidaung, Rathedaung
and Sittway at different stages of project implementation. An impressive out-
come.
17. What efforts were made that particular populations, vulnerable groups and areas
were not overlooked?: ACF has regularly conducted anthropometric and KAP sur-
veys along the duration of consecutive yearly projects, as to appraise the increased
need and changing environments. This has resulted in a finely tuned ability to re-
spond.
18. Were beneficiaries correctly and fairly identified and targeted?: Yes, although some
shortcomings were detected (see above point 11).
Strategy
19. Was the assistance provided in a way that took account of the longer-term con-
text?: No, but neither the socio-political situation nor the blocked collaboration with
the MOH, nor the extremely damaged communitys coping capacities allowed for a
longer-term planning.
Coherence
20. What steps were taken by ACF to ensure that its responses were co-ordinated with
other agencies?: the degree of interaction between ACF and other partner organi-
zations especially so with those working in the same area - was very strong.
Permanent communication avoided overlapping and leaving - to an extent, as
women of childbearing age seemed to be left out - vulnerable groups without cov-
erage. ACF became the only INGO tacking malnutrition in NRS as other agencies
transferred their programmes to her.
21. Integrated approach for major impact: ACF involved different complementing ap-
proaches from the very beginning of its nutrition intervention some of them were
already in place - and, although operational integration took many coordinated ef-
forts without visible results in the past, it seems that the degree of integration
reach by the present management is praiseworthy.
22. Policies related to resources: the feeling is that ACF made an optimal use of the re-
sources allocated, although outcome recording would not allow for more detailed
financial analysis.
Gender

46/50
23. Was gender considered in ACFs assessment of the situation?: yes, definitely, alt-
hough it took a while to enact this approach, based mainly on the Care Practices
component.
24. And in the implementation of the programme?: yes, again. The gender approach
imbedded into the Care Practices programme was clearly from the very beginning,
but took a remarkable bust during last year. The weak side of it was that monitor-
ing and supervision only recently started being aware of the need for incorporating
gender in the statistics.
25. Did the programme include special components for women and if so, were these
systematically monitored?: components for women were there, well designed and
implemented, but monitoring lacked sufficient diligence in incorporating those into
statistics, exception made of the Care Practices Programme.
Score: 1 low; 5 high

CRITERIA 1 2 3 4 5 RATIONALE
Relevance Relevance and appropriateness are almost synonyms see below.
Interaction between ACF, partner organizations and other stakeholders was
very strong and the way in which they complemented each other was out-
Coherence standing; a less than successful interaction was achieved with MOH authori-
ties at every responsibility level, more likely due to MOH policies in NRS
than to ACF shortcomings.
There seems to be different values to assess the degree of coverage at-
tained. Coverage according to the SQUEAC survey reflects quite different
levels than the estimate proposed by this consultant in CONCLUSIONS. The
Coverage coverage expressed here relies on the latter and not the former, although
groups such as women of childbearing age had not had had their needs
met, although under-five children coverage was very high.
ACF remains as the main reference point for mothers with sick and mal-
nourished children and has efficiently reached the most vulnerable groups.
Impact The impact achieved has been considerable in terms of proportion of chil-
dren.
Needs were duly assessed and the vulnerable populations were adequately
targeted, especially there where malnutrition clusters were identified, thus
Appropriateness creating better conditions for feeding practices and improving customary di-
ets with a balanced nutrient intake.
Resources were used judiciously although some shortcomings (weak moni-
toring and supervision tools, insufficient records analysis, lack of adequate
Efficiency follow-up of activities) hindered achievements on specific activities: home
visits, active screening, market awareness
Expensive project requiring a great deal of logistics and manpower, which
makes for expensive achievements. On the other hand, no cost-
effectiveness analysis was available, as ACF did not develop on SAM & MAM
Effectiveness unit-costs, and other partner NGO involved in malnutrition namely MSFH
and Malteser were less than enthusiastic about sharing their unit costs
and project expenditure with this consultant.
Political situation blocked MOH collaboration and community-coping capaci-
ties did not allow for a longer-term approach. However, previous ACF coun-
Strategy try management seemed little conducive to explore alternative ways to in-
teract with MOH; something which other partner NGOs working in the same
environment managed to do.
Project acceptability by the vulnerable population was extremely high: ACF
Acceptability as the point of reference for the most vulnerable population to turn to
whenever children became sick.
Access to PHC services was greatly improved thanks to a fruitful collabora-
Access tion with MSFH and Malteser, which together established the very pattern
for a comprehensive care services offer.

47/50
Equity was achieved through ACF presence in both urban and rural areas.
Geographic coverage, though hampered by the very difficult accessibility in
physical terms, was considered very even, in spite of a unavoidable concen-
Equity tration of more complex care at the township capitals, but care was taken
to reach the majority of vulnerable population, even from townships like
Rattidaung, where ACF services were not existent.
It took a while to start implementing this approach and it seems now in the
Gender process of being consolidated, although questions are arising on the analy-
sis of admissions disparities between male and female children.
So far no sustainability has been worked out, mostly due to very detri-
mental environmental conditions, but ACF needs to strive gaining local self-
Sustainability reliance through measures aimed at strengthening community coping-
capacity and MOH care services accessibility, availability and affordability,
together with improved quality of care.
Table 4: DAC criteria matrix requested by the TOR

48/50
9 RECOMMENDATIONS
I There is always a need for an orderly and structured project documentation collection
prior to setting an evaluation in motion. It will increase cost-effectiveness by saving
time and money to the agency and an extra effort to the consultant.
II In the context of a changing environment where quality standards are being either re-
placed or updated, and when new phenomenal approaches are expected pilot project
jointly with MOH, community development - the need for updating and consolidating
gains already obtained by resuming training, looks unavoidable. Reinforced upgraded
training to ACF technical staff and community-based volunteers network seems to be a
must.
III It also seems imperative translation of handbooks and manuals of use by every national
team member, into Burmese language. High turnover of nursing staff all Burmese
and not enough knowledge of English by TFP agents, diminish an easy transferral of
skills and knowledge. ACF should take more profit of an excellent translator in the field.
IV There seems to be a need for promoting project achievements in a more attractive lay-
out that present reporting, especially so when freshly established ties with Nutrition
Dept in Nay Pyi Taw, Health Dept director in Sittway and TMOs demand a more skilled
design and more effective supervision of the language in use, as its quality is some-
times very low (copy & paste). Reporting does not seem to be one of ACFs strongest
assets.
V The impressive Care Practices Programmes growth and development requires a more
individualized approach as far as reporting is concerned. Because of the very detailed
and descriptive reporting needs the programme demands, very different to those re-
quired by the more clinical nutrition programme, incorporating CP programme out-
comes to the main body of Nutrition reporting contributes to discourage the readers in-
terest and limits its effect.
VI Care Practices Programme needs to identify impact indicators to assess programme im-
pact; for instance, changes incurred in first six-month full breastfeeding after attending
CP sensitizing activities, as duly registered at SCs and MPCs; average nutritional status
of children older than 5 years within the household of women assisted in the pro-
gramme, etc.
VII It might be a helpful choice that of analysing admission and discharge rates trends by
treatment unit (OTP) in order to be aware to fluctuations in reception of children pre-
sumably malnourished at different seasons along the year.
VIII The reporting duality between performance indicators according to SPHERE standards
(not including unknown, admission mistakes, and non-responders in the nutritional sta-
tistics) while the project is accounting for those, should be eliminated: ACF should re-
port the cured, defaulters and death rates taking into account those numbers so far not
accounted for (see APR Jan11, page 13: unknown cases that may have been default-
ers in reality).

IX In meetings with Maungdaw OTP teams, the need for use of 1st line antibiotics to treat
ailments in SFP children was raised, as the amount of MAM children with disorders re-
quiring the use of antibiotics increased after Malteser nutrition component closed down.
Conversely, Buttidaung OTP SFPs are authorised to use antibiotics the reason being
that they havent got MSF and Malteser clinics at hand. An effort should be made to
clarify and thoroughly explain to the teams (TL included!) ACF malnutrition manage-
ment protocols, and why the differences in approach between MGD and BTG.
X The appalling condition the MGD Township hospital is in, should raise a brow to the
main health-related INGOs working in the area. This consultant could not have access
to the hospital medical statistics but, as the TMO put it when asked about the surgery
room infection rates, his answer was: obviously very high; there is no way to isolate
the room. The squalor and deterioration of wards and equipment was evident for any-
one to watch. Main INGOs ACF included should focus at one time on hospital reha-
bilitation and equipment renovations, as many of their children, women and men re-
ferred suffer the brunt of it (in the specific case of ACF referred children with a mortali-
ty rate of between 8% to 15%!).
XI Global and Moderate Acute Malnutrition, together with chronic one, have become per-
manent patterns of NRS population vulnerability. Envisaging the transferral of treat-
ment of severe acute malnutrition to a rehabilitated MOH care network, the strengthen-
ing of communities coping capacities to manage moderate acute malnutrition, and the
development of community tools to rein in food insecurity and thus chronic malnutri-
tion, besides helping them to dispose of safe water and sanitation, seem to be the an-
swer to a foreseeable scenario.
XII Treating the project beneficiaries as what they truly are, vulnerable children and their
mothers, project reporting would gain in warmth and attachment, and thus would avoid
a terminology, which seems more apt to a chain factory than to a humanitarian inter-
vention.
XIII There must be less cumbersome ways to facilitate intermediate and final project reports
than the one currently in use. Even though considering the format imposed by ECHO is
far from being user friendly at all, although it must be said that the latest reporting
format received contributes to make explanations better summarized, the reader in
this case the author gets very often lost on which parts of the text belong to the in-
termediate report and which parts to the final one. It becomes very hard to keep fo-
cused on a text with those myriads of subchapters (4.3.2.2.3.A2 Final Report)100 to
complete an awesome 106-page document. Reducing the length of detailed explana-
tions and concentrating on a summarized description of achievements might be one;
giving different font styles and/or colours to those parts belonging to the intermediate
report and those to the final ones might be another but, in any case, reducing the sys-
temic repetition of same paragraphs once again along the text would no doubt help.
Girona, Spain, May 17th, 2012
100
Integrated approach to malnutrition through nutrition, health, care practices 2010-2011 (proposal, IR & FR) V1 18-7-
2011 modified 25-07-2011 (page 72)

Myanmar A1X Evaluation (Stage 2) Terms of Reference
TERMS OF REFERENCE
For the External Evaluation of ACFs
External evaluation of Action Contre la Faim

Nutrition Programme In the
Maungdaw and Buthidaung Townships
Northern Rakhine State
Programme Funded by
ECHO
ECHO/-XA/BUD/2010/01014
ECHO/-XA/BUD/2011/91017
September 2011
Page 1 of 10
1. CONTRACTUAL DETAILS OF THE EVALUATION
In order to have access to field project sites, the evaluator must receive a Letter of Invitation from
the Government of Myanmar. Although the application was made, the process may be lengthy and
with no indication on when the visa will be granted.
The evaluator was not granted a visa allowing a visit to programme sites before the project came to
an end (April 2011).
In consultation with ECHO Office in Yangon, ACF Paris headquarters and the evaluator, it was agreed
that the external evaluation of the project would be done in two distinct phases.
The first phase took place in May-June 2011 and consisted in a desk review organized from Yangon.
A preliminary report was prepared and shared with the final reporting of the ECHO/-
XA/BUD/2010/01014 project.
The second phase will be organized at a later stage (once a visa is granted) in 2011 or latest Q1 2012
and will complement the evaluation with a visit to field project sites, where the project was
continued under a new ECHO contract ECHO/-XA/BUD/2011/91017.
The present Terms of Reference are prepared for Phase II.
1.1. Key Evaluation Dates
Date: 17th March 2012

End Date: 29th April 2012
Submission of Draft Report 17th April 2012
Submission of Final Report 29th April 2012
1.2. Language of the Evaluation
Language Requirements for the Evaluation: English

Language of the Report: English
1.3. Work plan & Timetable
Activities Working Days

Travel to Myanmar 2
Meeting with ACF Head of Mission & Nutrition Coordinator 2
Travel to NRS 1
Meeting and interviews with ACF project managers and staff 3
Meeting and interviews with local stakeholders (INGO and MoH) 2
Field sites visit in Maungdaw and Buthidaung (SC, MPC, OTP) 7
Interviews targeting both beneficiaries and non-beneficiaries of the programme 2
Travel back to YGN 2
Draft final report 7
Debrief meeting with ACF Coordination team 1
Debrief meeting with ECHO Representative 1
Final report 5
Travel back 1
Page 2 of 10
Debriefing at HQ 1
Total 36
2. DETAILS OF THE PROGRAMME
Name of the Programme: ACF Nutrition Programme in the Maungdaw and Buthidaung
Townships
Location North Rakhine State, Myamnar
Starting Date: 01/05/2010
End Date: 30/04/2011
2.1. Map of Programme Area
Page 3 of 10
Maungdaw North
1 OTP-SFP 2 sites
Buthidaung North
1 OTP-SFP
Buthidaung Downtown
1 SC
1 MPC
1 OTP-SFP
Buthidaung South
1 OTP-SFP 2 sites
Maungdaw Downtown
1 SC
1 MPC
1 OTP-SFP
2.2. Programme Overview
Proposal to be provided to the Evaluator
2.3. General Objective
The risk of mortality due to acute malnutrition is reduced in Maungdaw and Buthidaung in the
Northern Rakhine State, Union of Myanmar.
2.4. Specific Objectives/Results
To detect, treat and prevent severe and moderate acute malnutrition in the target population.
Result 1: Treatment of severe acute malnutrition is accessible and adequate for 4,050 beneficiaries
in Maungdaw and Buthidaung Townships
Result 2: Treatment of moderate acute malnutrition is accessible and adequate for 14,700
beneficiaries in Maungdaw and Buthidaung Townships
Result 3: Prevention and detection of malnutrition is effective in the nutrition centres and with the
participation of the communities.
Result 4 : Surveillance of the malnutrition
Page 4 of 10
2.5. Programme Activities
Activities link with result 1: Treating severe acute malnutrition in the TFP
A1. Running of 3 Stabilization Centres (SC), 2 Mother Participation Centres (MPC) and 12
Out-patient Treatment Program (OTP) with 12 distribution points
A2. OTP follow up with home visit for absent cases and specific needs
A3. Breastfeeding support is provided to the identified caretakers in the framework of the
nutrition centres.
A4. Follow up of 4 months for discharged cured TFP beneficiaries
A5. Provision of referral for treatment of serious diseases
A6. Activities aimed at promoting the bonding and the caretaker-child relationship are
provided to the caretakers.
Activities link with result 2: Treating moderate acute malnutrition in the SFP
A7. Running of 12 SFP distribution points

A8. Passive screening in SFC centres and 2 screening centres in NRS
A9. Provision of referral for treatment of serious diseases
A10. Provision of activities to promote nutrition health, hygiene and positive care practices
Activities link with result 3: Prevention and detection of malnutrition
A11. Provision of activities to promote nutrition/ health/ hygiene/ positive care practices in
nutrition centres
A12. Training of the key leaders in the communities on malnutrition, treatment centres and
referrals
A13. Provision of passive screening for malnourished cases in nutrition centres
A14. Training of the INGOs and governmental health personnel on the malnutrition and the
detection of the malnutrition
A15 Psychosocial support is provided to the identified caretakers in the framework of the
nutrition centres.
Activities link with result 4: Surveillance of the malnutrition
A16. Conducting anthropometric nutrition survey at annual basis in each Townships.
3. AIM OF THE EVALUATION
3.1. Target User(s) of the Evaluation
ACF ELA Unit (ACF-UK)

Implementing HQ Nutrition Technical Advisor, Care Practices Technical Advisor,
Responsables des Programmes
Field Level Nutrition and Health Coordinator, Head of Mission
Other ECHO
3.2 General Objectives of the Evaluation
Page 5 of 10
To evaluate the programme design and results in an independent and structured manner, to
assess impact, appropriateness, efficiency, coverage, strategy, coherence, effectiveness and
sustainability.
To assess the programmes approach to transversal issues such as gender.
To provide recommendations that will improve the quality of the project and reinforce the
impact of future programming.
Identify strengths and weaknesses in the programme in order to inform the current
programme and ACFs overall learning.
3.3. Scope of the Evaluation
The purpose of this independent, structured evaluation is to assess the appropriateness, relevance
and impact of ACF nutritional intervention in NRS.
During the Phase I of the evaluation, the evaluator did not have access to the field or the direct
beneficiaries. It was therefore understood that the evaluation of the project on the DAC criteria
could not be completed in Phase I.
However, the output of the Phase I, through the methodology proposed in section 3.6, allowed the
production of a preliminary report that included:
- A contribution to the causal analysis of malnutrition in NRS;
- Analysis of the successive phases of programming since ACF started Nutrition activities in
NRS, looking at context and protocol changes;
- Assessed the contribution of those successive projects to ACF overall and specific objective in
NRS in reducing mortality caused by malnutrition;
- Structured the Phase II of the evaluation, in consultation with HoM, CMN and HQ, around
key assumptions and questions taken from the below;
- Explored perspectives for an exit strategy.
Building on the findings of Phase I, the second Phase of the evaluation will assess the achievement of
objectives against indicators, in addition to overall impact (positive and negative), relevance,
coherence, coverage, efficiency, effectiveness, acceptability, access, equity, sustainability (if
appropriate) and results achieved (accountability) and of the way these results have been achieved
(lessons learned). The evaluation should consider the design of the project in addition to its actual
implementation.
The evaluation should contain conclusions and recommendations at both strategic and operational
levels and outline a set of indicators that ACF could monitor to define when this exit strategy could
become an objective
Impact
The impact assessment will be closely linked to the indicators detailed in the Logical Framework
Analysis (see attached annex), but may include some additional indicators if necessary.
Appropriateness
Were the actions undertaken appropriate in the context of the needs of the target populations
and the context of the situation?
Page 6 of 10
Was the assistance appropriate in relation to the customs and practices of the target
populations?
What was the level of beneficiary participation in project design and implementation?
How effective and appropriate were these processes in ensuring relevant and timely project
delivery in support of the most needy and vulnerable?
Was the assistance provided in a timely manner?
Efficiency
Were resources used efficiently?
Coverage
Were the worst affected groups covered within the limitations of the resources available?
Was the geographical coverage of the ACF programme appropriate?
What efforts were made that particular populations, vulnerable groups and areas were not
overlooked?
Were beneficiaries correctly and fairly identified and targeted?
Strategy
Was the assistance provided in a way that took account of the longer-term context?
Coherence
What steps were taken by ACF to ensure that its responses were co-ordinated with other
agencies?
Gender
Was gender considered in ACFs assessment of the situation, and in the implementation of the
programme? Did the programme include special components for women and if so, were these
systematically monitored?
3.3. Evaluation Criteria
ACF-IN subscribes to the Development Assistance Committee (DAC) criteria for evaluation: Impact,
Sustainability, Coherence, Coverage, Relevance / Appropriateness, Effectiveness and Efficiency. ACF-
IN also promotes systematic analysis of the monitoring system and cross cutting issues (gender,
HIV/AIDS etc). All external evaluations are expected to use DAC criteria in data analysis and
reporting. In particular, the evaluation must complete the following table and include it as part of
the final report
The evaluator will be expected to use the following table to rank the performance of the overall
intervention using the DAC criteria. The table should be included either in the Executive Summary
and/or the Main Body of the report.
Criteria Rating Rationale

(1 low, 5 high)
1 2 3 4 5
Impact
Sustainability
Coherence
Coverage
Page 7 of 10
Relevance/Appropriateness
Effectiveness
Efficiency
3.4. Best Practices
The evaluation is expected to provide one (1) key example of Best Practice from the
project/programme. This example should relate to the technical area of intervention, either in terms
of processes or systems, and should be potentially applicable to other contexts where ACFIN
operates. This example of Best Practice should be presented in the Executive Summary and/or the
Main Body of the report.
3.5. Evaluation Outputs
The result of this evaluation should be presented in a written report and through several oral
presentations:
One on the mission (to Head of Mission and relevant technical staff)
One at HQ Pool level.
3.6. Methodology
3.6.1. Outline of Methodology for this Dual Evaluation
Methodology Phase I Desk review in Yangon

Study of documents related to the project
Meeting with donor (ECHO) for a briefing
Interviews with Head of Mission, Nutrition Coordinator and Project Managers
Semi-structured interviews with ACF staff
Meetings with Yangon based partners and stakeholders
Methodology Phase II Visit to project field sites

Discussions with beneficiaries, authorities, stakeholders and partners involved in the
implementation of the programme.
Visits to targeted communities and project sites
Any other evaluation activity deemed necessary by the evaluator during the fieldwork.
PRA (Participatory Rural Appraisal) Interviews targeting both beneficiary and non-beneficiaries
of the programme.
Meeting with donor (ECHO) for a briefing/debriefing
Semi-structured interviews with ACF staff
3.6.2. Briefing
Prior to the evaluation taking place, the evaluator is expected to attend a telephone briefing with
ACF HQ in Paris, and at field level with the Head of Mission and/or the relevant technical focal point.
Briefings by telephone must be agreed in advance.
3.6.3. Field activities (Phase II)
Consultants are expected to collect an appropriate range of data. This includes (but not limited to):
Page 8 of 10
Direct information: Interviews with beneficiaries - Visit to project sites and to the facilities
provided to the beneficiaries
Indirect information: Interviews with local representatives; interviews with project staff
expatriate and national staff); meeting with local authorities, groups of beneficiaries,
humanitarian agencies, donor representatives and other stakeholders. For indirect data
collection, standard and participatory evaluation methods are expected to be used (HH
interviews and FGDs with beneficiaries, non-beneficiaries, key informants health workers,
teachers and leaders)
Secondary information analysis: including analysis of project monitoring data or of any other
relevant statistical data.
3.6.4. Report
The report shall follow the following format.
Cover Page
Table of Contents
Executive Summary: must be a standalone summary, describing the programme, main
findings of the evaluation, and conclusions and recommendations. This will be no more than
2 pages in length.
Main Body: The main body of the report shall elaborate the points listed in the Executive
Summary. It will include references to the methodology used for the evaluation and the
context of the action. In particular, for each key conclusion there should be a corresponding
recommendation. Recommendations should be as realistic, operational and pragmatic as
possible; that is, they should take careful account of the circumstances currently prevailing
in the context of the action, and of the resources available to implement it both locally and
in the Commission. Annexes: Listed and correctly numbered. Format for the main body of
the report is:
o Background Information
o Methodology
o Findings & Discussions
o Conclusions Recommendations
o Annexes
The report should be submitted in the language specified in the ToR. The report should not be longer
than 30 pages including annexes. The draft report should be submitted no later than 10 calendar
days after departure from the field. The final report will be submitted no later than the end date of
the consultancy contract. Annexes to the report will be accepted in the working language of the
country and programme subject to the evaluation.
3.6.5. Debriefing & Learning Workshop
The evaluator should facilitate a learning workshop:

To present the draft report and the findings of the evaluation to the Mission and other
stakeholders.
To gather feedback on the findings and build consensus on recommendations.
To develop action-oriented workshop statements on lessons learned and proposed
improvements for the future.
3.6.6. Debriefing with ACF HQ
Page 9 of 10
The evaluator should provide a debriefing with the relevant ACF HQ on her/his draft report, and on
the main findings, conclusions and recommendations of the evaluation. Relevant comments should
be incorporated in the final report.
4. RIGHTS
The ownership of the draft and final documentation belong to the agency and the funding donor
exclusively. The document, or publication related to it, will not be shared with anybody except ACF
before the delivery by ACF of the final document to the donor.
ACF is to be the main addressee of the evaluation and its results might impact on both operational
and technical strategies. This being said, ACF is likely to share the results of the evaluation with the
following groups:
Donor(s)
Governmental partners
Various co-ordination bodies
Intellectual Property Rights

All documentation related to the Assignment (whether or not in the course of your duties) shall
remain the sole and exclusive property of the Charity
Page 10 of 10
ANNEX 2
Bibliography
_______________________________________________
ECHO papers on Myanmar:
- Strategic assessment and evaluation of assistance to NRS EC. December 2006
- EuropAid A3A integrated joint assessment 2009
- Establishment of a medium term strategy for Northern Rakhine State in Myanmar. Final
report. Van de Velde P TRANSTEC (ECHO-funded). May 6th, 2010
ACF project proposals, intermediate and final reports:
- Integrated approach to malnutrition through nutrition, health and care practices Maungdaw,
Buthidaung Townships. Rakhine State. ACF 2008-2009 (proposal, IR, FR with comments).
27-04-2009
- Integrated approach to malnutrition through nutrition, health and care practices Maungdaw,
Buthidaung Townships. Rakhine State. ACF 2009-2010 (proposal, IR & FR)
- Integrated approach to address malnutrition through nutrition, health and care practices.
Maungdaw, Buthidaung Townships. Rakhine State. ACF. January 2011
- Integrated approach to malnutrition through nutrition, health, care practices 2010-2011

(proposal, IR & FR) V1 18-7-2011 modified 25-07-2011
- Integrated approach to malnutrition through nutrition, health, care practices 2010-2011

Intermediate report. 14 December 2011
- Integrated approach to address malnutrition through nutrition, health and care practices.
Maungdaw, Buthidaung Townships. Rakhine State. A1Z Proposal 20-01-2012. Draft 21-03-
2012
ACF Activity Progress Reports from 2007, 2008, 2009, 2010, 2011 and 2012 (up to
February)
ACF anthropometric surveys:
- Anthropometric nutritional survey in Maungdaw and Buthidaung townships, NRS . Schneider

L. January 2003. Final report
- Anthropometric nutritional and retrospective mortality Survey. Maungdaw and Buthidaung

townships, NRS. Pantchova D. January 2006. Final report

townships, NRS. Biotteau M. October 2007. Final report

townships, NRS. Tonon B. November 2008. Final report
- Anthropometric nutritional and retrospective mortality Survey. Sittwe Township, Rakhine

State. Biotteau M. January 2008. Final report
townships, NRS. Bougma K. December 2009. Preliminary report. Version 2
- Anthropometric nutritional and retrospective mortality Surrey. Maungdaw and Buthidaung

townships, NRS. (Bougma K?). December 2010. Final report. Draft version
- Semi-Quantitative Evaluation of Access & Coverage (SQUEAC) Nov-Dec 2011
ACF KAP surveys:
- ACF Nutrition Programme. KAP survey. Lefilleul A, Bataille A. June 2007
- ACF KAP survey Prevention centre Kyi Kan Pyn Village Tract. Peenaert P. June 2008
- Baseline KAP Survey. Prevention Centre Ay Tha Lyah ACF Myanmar. May 2011
- Water, Sanitation and Hygiene Dept. (WASH). KAP Survey. Maunhdaw & Buthidaung
Townships, NRS. ACF Myanmar. Jacquart C. May-September 2008
ACF protocols and Guidelines:
- Non-Responder to the Treatment. Mother Participation Centre (MPC) Methodology.

Capitalization document. March 2009 Updated July 2009
- Therapeutic Feeding Program Protocols. Summary. Myanmar. February 2010 Updated

February 2011
- SFP Nutrition Protocol in NRS NCHS Reference. Integration with TFP. February 2011
External evaluations:
- External evaluation of ACF Nutrition intervention (2003-2006) in Northern Rakhine State,

Union of Myanmar Dr. Rossi L, ACF Nutrition Consultant. April 2007
- Promotion and Protection of Livelihoods of Marginalized Ethnic Groups in Myanmar. May

2006-October 2009 Ellert R. November 2009
ACF-related papers:
- Mental Health Study Report, Mauhngdaw, NRS A Bataille (Care Practices Program Manager)
December 2007
- Consequences of the implementation of WHO growth standards in ACF nutrition

programmes. Ghesquier S. & Israel AD. August 2009
- Inputs in Nutrition to NRS with UNICEF Assistance NUT NRS comments Clemence and
Jorunn 2010
- ECHO visit NRS 2010-Report
- Evaluation of an alternative protocol for the treatment of severe acute malnutrition,

implemented by ACF Myanmar from July 2009 to January 2010 P James. LSHTM
- Country strategy 2011-2013 Myanmar v1 (2) ACF, 1 September 2010

- ACF Evaluation Policy & Guidelines 2011
- Guidelines for the Integrated Management of Severe Acute Malnutrition in- and outpatient
treatment Nutrition and Health Department. ACF International. 2011-2012
- Myanmar visit report Senior Nutrition Advisor. AD Israel. February 2012
- Addressing undernutrition in Myanmar. A joint initiative by ACF, Save the Children and World
Food Programme. February 2012
UN papers:
- Nutrition Survey in WFP Project areas in Magway, Lashio, Kokang and Wa . WFP Myanmar.
April-June 2005
- Algorithms for converting estimates of child malnutrition based on the NCHS reference into
estimates based on the WHO Child Growth Standards Hong Yang and de Onis M. Dept of
Nutrition, WHO, Geneva, Switzerland. BMC Pediatrics 2008, 8:19 doi:10.1186/1471-2431-8-19
- Integration of CommunityBased Management of Acute Malnutrition (CMAM) Washington

DC, April 2830, 2008. Workshop Report
- Comprehensive Food and Vulnerability Assessment in NRS: Maungdaw, Buthidaung and

Rathedaung townships. WFP Myanmar. June 2008
- Myanmar, Cyclone Nargis : One Year On May 1st, 2009
- UN Joint Humanitarian Initiative 2010 (March 2010)
- Nutrition Surveillance for Timely Warning and Intervention System In Rathedaung,

Buthidaung and Maungdaw Townships. Northern Part of Rakhine State. MOH / UNICEF. 10
May 2010
- Nutrition Surveillance in NRS. First Analysis August 2010
- Household Survey Northern Rakhine State. UNHCR. November 2010
- OCHA Emergency Situation Report Cyclone GIRI 20_12_2010
- Integrated Household Living Conditions. Survey in Myanmar (2009-2010) Poverty Dynamics

report. UNICEF / UNDP / SIDA: June 2011
- Myanmar Multiply Indicator Cluster Survey 2009-2010. UNICEF / MOH. October 2011
Press articles:
- The Myanmar Elections. ICG. Asia Briefing N105. 27 May 2010
- Elections in Burma (Myanmar) won't be fair, but they will be significant J Della-Giacoma.
The Christian Science Monitor. 15 July 2010
- Myanmars Post-Election Landscape. ICG. Asia Briefing N118. 7 March 2011
- Myanmar's Budding Political Spring M Abramowitz, T Pickering. The National Interest. 26

October 2011
- Myanmar: Major Reform Underway. ICG. Asia Briefing n 127. 22 September 2011
- Myanmar: a new peace initiative. ICG. Asia Report N214. 30 November 2011
- In Myanmar, Sanctions Have Had Their Day L Arbour, The International Herald Tribune, 5
March 2012
- The Myanmar elections T Fuller, The New York Times. 1 April 2012
- Aung San Suu Kyi hails 'new era' for Burma after landslide victory Esmer Golluoglu (a
pseudonym for a journalist working in Rangoon) The Guardian, 2 April 2012
- DEVEX newsreel. J Lei Ravelo, 2 April 2012
- Reform in Myanmar: One Year Asia Briefing N136. 11 April 2012

ANNEX 3 PROJECT LOGICAL FRAMEWORK
To detect, treat and prevent severe and moderate acute 4,050 severely malnourished children under five are admit-
malnutrition in the target population ted to TFP
SPECIFIC OBJECTIVE: 14,700 moderately malnourished children under five are
admitted to SFP
RESULTS ACTIVITIES INDICATORS
1. Running of Stabilization entres (SC), Mother Participation Centres
(MPC) and Outpatient Treatment Programme (OTP) with distribution 4,050 beneficiaries with severe acute malnutrition are ad-
points mitted in the TFP following the NCHS standards
1. Treatment of severe acute 2. OTP follow-up with home visits for absent cases and specific needs The TFP statistics meet following criteria
malnutrition is accessible and 3. Breastfeeding support is provided to the caretakers in the nutrition - Cured 70% / Defaulter <15% / Mortality <5%
adequate for xxxxxxx benefi- centres - Gain of weight 5g/kg/day / length of stay <45 days
ciaries 4. Follow-up of 3 months for discharged cured TFP beneficiaries 50% caretakers identified for breastfeeding counselling re-
5. Provision of referral for treatment of serious diseases ceive it
6. Activities aimed at promoting the bonding and the caretaker-child re-
lationship are provided to the caretakers
2. Treatment of moderate acute 14,700 beneficiaries with MAM are admitted in the SFP fol-
7. Running of 7 SFP distribution points lowing the NCHS standards
malnutrition is accessible and
8. Passive screening in SFP centres and 2 screening centres in NRS The SFP statistics meet following criteria
adequate for xxxxxxxx bene- 9. Provision of referral for treatment of serious diseases - Cured 65% / Defaulter <15% / Mortality <5%
ficiaries - Gain of weight 2.5g/kg/day / length of stay <100 days
10. Provision of activities to promote nutrition health, hygiene and positi-
ve care practices in nutrition centres
11. Training of the key leaders in the communities on malnutrition,
3. Prevention and detection of treatment centres and referrals
60% caretakers increase their knowledge in hygiene, health
malnutrition is effective in the and care practices
12. Provision of passive screening for malnourished cases in nutrition
15 % of the children admitted to the nutrition centres are
nutrition centres and with the centres
referred by the community
participation of the communi- 13. Training of the INGOs and governmental health personnel on the
2 nutrition surveys are conducted and shared with the part-
malnutrition and the detection of the malnutrition
ties 14. Psychosocial support is provided to the identified caretakers in the
ners
framework of the nutrition centres.
ANNEX 4 BEST PRACTICE
Title Team building training and shared team member

(max 30 words) accountability
Innovative Features and Key Development of team culture and complementarity:

Characteristics - Even though different levels of competence and
(what makes the selected practice different) knowledge gather together into a team, be it
doctors, nurses, team leaders, TFP agents, helpers
teams seem to respond to a shared ambition and
their members try to complement each other in the
tasks to be implemented.
- Regular task rotation by every OTP centre team
member, which ensures optimal competence sharing
and skill understanding, and where both unexpected
staff leave and staff time-offs are either
conveniently replaced or promptly substituted.
- Regular post rotation by team members being
shifted from SCs to OTP centres and the other way
round; in this manner, TFP agents end up being
proficiently trained on tasks development in different
layers of programme implementation.
Practical/Specific Promoting team shared values by reducing the layers
Recommendations for Roll Out (how of different responsibility and accountability: ACF
can the selected practice be replicated more nutritional teams to be formed by people having the
widely) same training / same specialisation and assuming the
same responsibility as part of a team. Team members
are thus trained to be able to respond to every need
at every step along the ladder.
ANNEX 5 ITINERARY MINUTES
Itinerary/Planning Trip Minutes
People interviewed/Places visited/persons contacted:
18/03/2012.-
- 1930: departure from Barcelona with stopover in Singapore.
19/03/2012.-
- 1600: arrival in Yangon, Myanmar. Picked up by ACF driver and taken to ACFs main
office. Welcomed by ACF HOM Alexandre LeCuziat. Short briefing on practi-
cal issues: allowance money, security cash, hotel location, etc. Taken to Guest
Care Hotel.
20/03/2012.-
- 0815: picked up by ACF car. Short meeting with ACF CMN Jogie Abucejo Agbo-
gan.
- 1400: meeting with HOM Alex LeCuziat.
Topics:
o things have much improved since last years visit: in August 2011 the MoU was
eventually signed and regular talks between MOH and ACF started at central
(Nay Pyi Taw) and State (Sittwe) level, and joint pilot project was proposed and
accepted by MOH authorities, so ACF could start preparing an exit strategy;
o because of an initiated decentralization process, state and division authorities
have more say on local policies, although it has to be reflected on district col-
laboration, namely Maungdaw, as ACF interaction with Buthidaung TMO was al-
ready smooth;
o no more anthropometric surveys were conducted, but a SQUEAC survey done
by the end of last year helped a lot on assessing weaknesses in data collection
at field level, among detecting flaws in coverage; its expected that data regis-
tration has visibly improved now;
o MOH supervision and control on INGOs was much strengthened, with meeting
held with them to information sharing on programmes and activities;
o the main INGO working in NRS besides ACF, Malteser, saw funding from EC
withdrawn and its health component cancelled;
o governmental changes have also meant a boost to civil society;
o some tips on Nay Pyi Taw authorities and discussion on how to proceed tomor-
row;
- 1500: meeting with Jogie.
Topics:
o developments in ACF relationship with the MOH are already in progress: NPT
asked ACF to get involved in a measles campaign along UNICEF mostly lo-
gistic support and community awareness: ongoing till end of March;
o there was a joint MOH-INGO meeting in NPT February 23rd;
o restrictions on importing Plumpy-Nut or EeZee paste (Indian) seem to be loos-
ening;
o WFP/ACF collaboration was boosted in 2011;
1
o there is a shared action SC-WFP-ACF (draft);
o village database of no. of malnourished children;
o she reckons the technical support given by HQs to her and to the project has
increased;
o it was found that statistics were manipulated at ACF BTD;
At 1600 Jogie had to go and the talk was postponed. To be continued
21/03/2012.-
- 0615: departure by road to Nay Pyi Taw. Arrival 1215.
- 1400: meeting with MOH Nutrition Dept Deputy Director Dr. May Khin Than
(0943032162; maykt2011@gmail.com) and Assistant Deputy Director Dr. Htin
Lin (Alex introduced me to her and Dr Htin came in later). See discussion in
Questionnaires.
- 1500: spent the evening at the hotel.
22/03/2012.-
- 0745: departure by road back to Yangon. Arrival 1315.
- 1430: phoned ECHO office. The responsible wont be in place until March 28th. Mal-
teser hasnt made an appointment and nothing else has been done with WFP
and others. I put a bit of pressure on Jogie as very little time if any is left on
my way back to Yangon.
Deskwork.
23/03/2012.-
- 0900: meeting with WFP Programme officer Kai Roehm (95949317407:
Kai.Roehm@wfp.org) and assistant Khin Khin Wint Aung (95949335304;
KhinKhinWint.Aung@wfp.org).
Topics.-
o collaboration between WFP and ACH has been strengthened as of lately, alt-
hough theyve been active in MGD since 2009: in Feb-Mar12 they carried out a
blanket feeding campaign in MGD and in BTD; they drew up a joint concept
note for shared strengthened cooperation in 2012;
o changes in the MOH have much facilitated things; MOH even requested them
aid for the Chin State; WFP has worked in facilitating permits for ACF;
o WFP aims at providing prevention by means of those blanket feeding actions
in NRS;
o in Bangla Desh (Coxs Bazaar) nutrition conditions are worse as only refugees in
camps receive food rations on a regular basis, while an estimate 200,000 illegal
refugees are in nearly desperate situation;
o they conduct nutritional assessments through its partners; the latest assess-
ment carried out by them dates back to 2005;
o the underlying causes of malnutrition in NRS and why its so hard to build com-
munity-based handling of MAM as is the norm in many other countries has a lot
to do with dynamics within communities, which are beyond INGOs analysis;
o WFP has started a strong educational component to allow the NRS population
access to higher education, and it seems to be working!;
2
- 1400: meeting with MSFH Medical Coordinator Dr. Maria S. Guevara (9595107869;
Myanmar-medco@oca.msf.org).
Topics.-
o even though theyve handed over nutritional activities to ACF in MGD and BTD,
they still care on average 20/30 patients per month within their PHC facilities in
Sittwe as there is no ACF centre there;
o patient referral to hospitals is still problematic, and they have found out that the
average patient hospital stay costs them between 50 and 100 USD;
o restrictions for MSF staff to visit hospitalized patients have been the same as
those enforced to ACF: even in Yangon MSF has no access to hospital records,
discussing with doctors, etc., although they also expect changes on that side,
based on a need for standardization of HIV/AIDS handling at hospital level;
o however, malnutrition has always been a thorny issue in Myanmar;
o it isnt that there has been an agreement with ACF on taking in malnutrition in
childbearing age women, but that as part of their PHC support women arriving
are treated for all kind of ailments, the same way that for immunization actions
to pregnant women, they report to the RHSC midwife, who has scheduled visits
to MSF centres for immunisation activities;
o MSF has changed its strategy regarding malaria handling: instead of continuing
a vertical programme they shifted to an integrated one as part of a full care
package;
o records on referrals are to be found in the field: MGD and BTD MSF offices;
1510: continuation talk with Jogie.

o assessment on joint pilot project MOH/ACF is still pending: one of the reasons
for her to flight to Sittwe on Monday was to start this assessment with BTD
TMO, but he resigned and there is a temporarily appointed TMO who doesnt
show the least inclination to take any action;
o she found out when contacting RHSCs that what mothers interviewed in those
successive anthropometric surveys said about immunisation cards being kept
by the midwives at HSCs wasnt like that: they did keep immunisations adminis-
tered in a record book they showed whenever an immunisation campaign was
about to start to be supplied with vaccines;
26/03/2012.-
- 0845: meeting with Malteser PHC Coordinator MGD NRS Carine Weiss
(carine.weiss@malteser-international.org). Shes in the country since June
2011. Malteser is working in NRS since 2004.
Topics:
o Malteser decided to close down the nutrition programme on Jan12: MCC (ma-
ternal and child centres); they had a strong community-based approach on nu-
trition completed with basic child education;
o they opened up 32 MCCs which were run by a community-based MCC commit-
tee; each MCC was operated by 2 volunteers chosen by the community, togeth-
er with 2 kindergarten teachers trained by Malteser;
o they only assessed and treated MAM; any SAM case was referred to ACF; food
rations were provided by Malteser no coordination with WFP;
o they also worked on rehabilitating and equipping MOH infrastructures (delivery
units, incinerators, water supply;
3
o they built consistent links with MOH regarding their MCH care programme; they
took care of pregnant women and paid for care delivered at RHSCs (rural health
sub-centres); besides, the built a network of TBAs who would perform ANC to
women, and also a sort of supervisory body with the TMO: monthly meetings at
TMO with midwives responsible of RHSCs, which Malteser attends;
o theyve experienced the same uneasiness as ACF concerning hospital-referred
cases: MOH would charge them far higher than actual costs; its considered a
programme weakness;
o the greatest challenge was the communities very low educational level that
hindered them from understanding most basic concepts, let alone the pro-
gramme details;
o there seems to be a strong cultural barrier playing an important role in the
communities deprived condition;
o Malteser had access to statistics based on the RHSCs they worked with: there
are available MOH statistics, though very unreliable;
o they havent got accumulated average costs of MAM cases treatment expenses,
or averaged costs of hospital referral treatment;
o they consider income-generating activities as very pertinent;
o she promised to send a copy of previous nutrition project reporting (????);
- 1250: picked up from the hotel to get a 1430 flight to Sittway. Arrival 1545. Taken
to State DHO to check-in. Meeting afterwards with State Health Director Dr.
Than Tun Aung, MPH (954321202 /9 595408973; aungthan-
tundr@gmail.com). An affable man whos been in this posting for the last 3
months and who, apparently only, doesnt seem very much knowledgeable on
the ACF projects in the past, although he appears to bear a very positive atti-
tude toward INGOs in general and to ACF in particular he spoke on Malteser
with a lot of insight so he knows pretty more than he looks like. It also at-
tended the meeting a lady from the nutrition dept. At the end, he requested to
appoint another meeting the day of my way back to discuss, with the nutrition
head, about the findings obtained and new opportunities to collaborate.
Topics:
o he reckons there has been a very good cooperation between MOH and ACF
since the beginning it rather sounds like a wishful thinking;
o ACF should work hand-in-hand with the MOH; he proclaims that when mid-
wives at the RHSCs diagnose a case of malnutrition, they immediately refer it to
the closest ACF centre;
o asked why ACF still finds so many troubles in its daily relationship with MGD
TMO, he says that ACF works in a very different way as Malteser does: the lat-
ter has rehabilitated, has built infrastructures, has equipped and has accompa-
nied health facilities, while ACF has only worked with its own centres, but not
with the MOHs;
o among ACF shortcomings form its work in NRS, there is a very limited geo-
graphic expansion just 2 townships when needs are many more; they
would be happy for ACF to expand to other townships, and maybe it would be
easier to loosen a bit the tight travelling regulations imposed onto ACF expatri-
ate staff;
o MOH has got many needs ACF hasnt addressed: equipping RHSCs with weigh-
ing scales (both adult and Salter), supplies to the village food bank
4
Spent the overnight at a Sittway hotel.
27/03/2012.-
- 0600: (0615 as the liaison officer got up late) taken to the pier to board a speedboat
that would take us to Buthidaung in 3 hours. The driver was late, too, and
departure was at 0655. Shortly after, the 75HP outboard engine got in trouble
and the speed was reduced to a dribble. It took 8 hours to get to BTG (arrival
1450)!! Had lunch at ACF guesthouse and immediately after firstly passing by
a MPC where Barbara explained the dynamics of her work drove to MGD.
Welcoming gathering with all the staff present at that moment very tasty wa-
termelon!
- 1600: meeting with ACF expatriate staff: FS&L PM Kelvin Richmond Nyanfor (KR),
CP PM Barbara Julia Bobba (BB), head of base regional log Muhammad
Azhar Khan (AK), Reg admon Aurore Dupin (AD), BTG Nut Mgr Louise
Logre (LL), and MGD Nut Mgr Stphanie Blanc (SB) (see questionnaire).
Topics:
o asked whether they were handed the document from the previous 1st phase vis-
it they all answered that they had received it and some even read it;
o (1) its a good thing that weve started collaborating with the MOH now, as con-
tacts were difficult in the past (LL); the approach at that time wasnt probably
the best, but at that time it was difficult to do otherwise; at least, with the de-
velopment of malnutrition handling at community level an exit strategy is be-
ginning to be formulated (SB);
o (2) nobody knows what would have happened if ACF werent here; maybe it
has just been containment, nobody knows (BB & SB); the major problem seems
to be the impressive chronic malnutrition: stunting is pervasive; the impact of
chronic malnutrition on acute malnutrition must have been breathtaking (SB);
ACF has a life-saving mandate, which is not a good way to treat malnutrition
with a long-term impact, but it has a logic according to the ACF mandate (LL);
even if ACF has recognized the problem with stunting they havent turned a
black eye to it, but with the input on SF&L, WASH ACF has taken perhaps not a
direct way to address the chronic malnutrition but still there it is (KR); and be-
sides, there has been not enough funding to tackle all the problems encoun-
tered (AD); many women come because their child is sick, and they end up
thinking ACF is a food distribution organisation (LL); communities havent got
the perception that their children are being given medical treatment for the
malnutrition (AK);
o (3) if we look at the needs, ACF action has been very limited (SB); ACF hasnt
got enough margin to work in other areas (AD); According to the objectives
there is enough budget (LL); the context has impaired sounder strategies (KR);
impact is something reach by just one agency: it needs other agencies also do-
ing their work (FAO, WFP), UNICEF (AK);
o (4) yes, they know they can tell their opinion (BB); opinions from the beneficiar-
ies have been taken into due account whenever a needs assessment is con-
ducted: ACF large teams of local staff have a lot of room to replicate what
communities share with them and they participate with that mindset in discus-
sions (KR); in Nut programme it doesnt really happen;
o (5) they all agree that the training ACF has given to the local staff has been of a
very high quality: very good training; every local ACF member get a yearly per-
formance evaluation (SB);
5
o (6) it is a very big programme and the lack of supervision is in good part due to
international staff shortage, and thats affected programme quality (LL, SB); ex-
pat staff spend very limited time in the field (they are forced to get to Yangon
every month to renew permits, they spend a lot of time doing deskwork and
thats also accountable for this lack of supervision, which they consider abso-
lutely fundamental as it strengthens team bonding (SB); it also builds self-
confident in the teams, and to allow teams to build that confidence needs to be
restored (KR); they all agree they get good supervision from Yangon, both from
Jogie and from Alex;
o (7) reporting has been a nightmare until very recently, as Veronique (ACF Paris
) agreed on a two-month reporting for the Nut programme, and somehow re-
porting length has been also reduced to some extent; they are working on
how to make reporting easier and more substantial for decision-making: they all
have agreed in making a APR review to get some conclusions (SB);
o (8) concerning they new proposal, they all sent their comments and suggestions
and feedback is expected; field reporting very seldom receives feedback from
Yangon, and only once in a very long while from Paris (SB);
o (15) opinions from the field are not enough taken into account; they lack infor-
mation from Yangon on the financial constraints the programme is suffering, so
they can better take decisions (SB) BB doesnt agree;
Stay at the UNCHR guesthouse in a large compound located in the Maungdaw

outskirts.
28/03/2012.-
-0815: working time with Jogie to re-schedule the agenda and to discuss about some
technical issues, like the overwhelming girls new admission rates compared to
those of boys in the TFPs.
MAUNGDAW BUTHIDAUNG
SC1 Maungdaw Downtown SC2 Buthidaung Downtown
MPC1 Maungdaw Downtown MPC2 Buthidaung Downtown
OTP1 Maungdaw Downtown OTP3 Buthidaung Downtown
OTP2 Ngan Chaung (NC) OTP4 Inn Chaung (IC)

Kyein Chaung (KC) BTD North
OTP6 Zaw Ma Thet (ZMT), OTP5 Phone Nyo Lake (PNL),
Alel Than Kyaw (ALTK), BTD South Pha Yar Pyin Aung Pa (PAPP)
Mhin Lhut (MH),
Inn Din (ID)
Tha Wet Chaung (TWC)
- 0945: visit to ACF SC: very warm welcome. The building was rented in 2008, next to
an old one since February now occupied by CARE, as they needed a bigger
space to accommodate the rising demand. ACF rehabilitated the structure and
supplied it with water from a well with hand pump, and sans filter.
Each SC has a staff formed by 1 MD (he shares his time 3 days in MGD and 2
days in BTG), 1 TL, 8 Nut TFP agents who rotate to be at least 2 permanently
in the SC facility, 2 CP psychosocial workers. They have a 30-patient capacity
and now they have 14 in-patients, 8 with medical complications, 4 under 6
6
months old included. MPC patients with their mothers spend the night there as
they have a permanent shift.
The MD can discuss referred cases with hospital MDs but he cannot see the
admitted childrens medical records. Admission protocols are widely disseminat-
ed in every centre, and they are poster-like plastered and hung in the walls, but
even with this, staff has had troubles in adapting to rapidly changing admission
criteria.
- 1100: departure to visit a community prevention group gathering in Ay Tah Liya VT

Horitula hamlet, originally it was an activity scheduled by CP Francesca and
Barbara, but they accepted me in and even gave me room for a women focus
group discussion (see topics asked in the questionnaire).
Topics:
o (1) is a disease which can be caught from water, lack of hygiene, disease, inad-
equate food, diarrhoea, lack of good breastfeeding habits, lack of variety of
food;
o (2) first they try to improve appropriate childcare; if this is not enough they
take him/her to ACF never to the RHSC, as it costs money and the care is not
good -; if ACF tells them that is a disease they cant treat, then they go to a pri-
vate doctor;
o (3) all of them have delivered their last baby assisted by the TBA, who doesnt
charge them at all (dubious!);
o (4) they all know and they have discussed it with their husbands and all agree
as they see that they cant feed so many mouths; before it was different as they
lacked knowledge, and didnt know how to take care, and there husbands didnt
like it either;
o (5) no; during the raining season they suffer food scarcity;
o (6) definitely yes: lack of enough food makes breastfeeding more difficult as
mothers produce less milk;
- 1430: taken to the TMO Dr Kyaw Maung Maung office for presentation. I had
planned to spend some time alone with him but he didnt give me a chance. I
asked his permission to approach the RHSCs during my field visit and he
agreed. He also agreed in visiting the township hospital and he himself led us
to a touring visit: the hospital is in appalling condition; the surgical room hasnt
got the minimum sterilized environment; the wards are filthy and patients seem
to accept the widespread squalor. He suggested having a meeting outdoors
along these coming days, which we gratefully accepted.
29/03/2012.-
- 0700: departure by car to Ale Than Kyaw (OTP-6) together with Resoul Mustafa,
translator, and U than Shwe, Deputy Nut MGD. Arrival 0805. Welcome by TFP
team leader Khin Maung Win. The centre started being operational in May
2011. A TL, 1 nurse, 1 hygienist (helper), and 7 TFP agents form the team.
They treat both severe and moderate malnutrition in an outpatient mobile (one
day per centre) facility. They cover around 6 VTs with an approximately total of
5,000 households (around 40,000 people).
They screening 150-200 children daily; of those 30%-40% admitted of those
around 10 with SAM. The nurse give medical assessment to every admitted
child, and together with the TL, decide whether he/she can be kept as outpa-
7
tient of needs an inpatient facility, in which case they try to convince the moth-
er to have him/her referred to MGD. The team has a stand-by car for every re-
ferral and for carrying the team to the next OTP location.
They take in every child along the following steps: child inspection about oe-
demas, skin folds, check-up of henna marking, bracelets; anthropometric
measurements (weight, height); appetite test; medical consultation (she gets a
monthly drug re-stocking); focus group counselling; delivery of a weekly
amount either PN or premixed SFRs. SAM treatment will go on for 10 wks max-
imum; MAM treatment will be delivered for a 14 wks maximum; the average
treatment length is around 7-8 wks. They havent got a CP section so far, and
they meet with SCCTs once every 3 months.
While sitting and watching the screening process, we manage to have a meet-
ing with women in the waiting room.
Topics:
o they come here because children are very sick;
o (1) children have malnutrition because of bad hygiene, diarrhoea, belly swollen,
fever some other think there is no explanation: it simply is like this;
o (7) most of them have gone to the MOH health centre for immunisation, and
the majority are happy with the attention they received; cost is reasonable
(500-700-1,000 Kat related to the type of problem);
o (8) all know what birth spacing is they learned it at MSF care centre - and
they practice it as to avoid being pregnant earlier than every 3-4 years hus-
bands wouldnt accept not being pregnant during, say, 10 years;
o (9) the majority of households agree that during 3 months per year they expe-
rience food shortages (during rainy season);
o (10) milk is provided by Allah, so food scarcity doesnt affect its production by
the mother; maybe shortage of food make it less abundant but Allah compen-
sates;
- 1015: departure from OTP-6 and stop at Ale Than Kyaw in-patient health centre.
We ask permission to the nurse for having a talk with her, after giving her as-
surances that weve got permission from TMO. Nurse Daw Khin May Chit.
Shes been here for the last 2 years. The centre is more than 30 years old, but
looks clean and in good condition. The team is former by 1 MD absent for the
measles immunisation campaign; 2 Ns; 5 midwives who are autonomous -
dont depend on the centre but report directly to the TMO and who assist de-
liveries in the communities (in case there is any complication they refer the
woman to the centre); and 2 ANs (helpers).
The centre covers the population inhabitant of 6 VTs, 6,248 households and
52,716 people. All together, they give care to around 500 patients per year
(less than two patients per working day), and they assist around 3-4 deliveries
per month. The doctor keeps a medical record for every patient, which is the
same than that of the nurse. For the EPI, its midwives who come to the centre
to pick up vaccines and give the shots: they keep a register handed over to the
TMO.
- 1050: departure to Onn Taw village tract, to meet 3 SCCTs, who started working
with ACF in 2012 (as MSF-H handed over its nutrition programme to ACF).
8
Hosted at the house of a former ACF member who left to work for Malteser and
very likely will go back to ACF.
Topics:
o they received one-day training in a workshop after they were chosen by the
community: the reason why they think they were chosen is because they are
reliable and showed interest in helping people around; the community supports
them but without any material support;
o they are monthly visited by the technician on community awareness, and every
three months they will have a new one-day workshop;
o their task is gathering the population to discuss about malnutrition and other
health issues, and inquire about cases of malnutrition; they dont do active
screening but the visit households whenever the are told someone is very sick;
o they measure the MUAC and take records in paper sheets provided by ACF;
o they clearly express their need for more training;
o when confronter with the fact that half the number of children they refer are re-
jected because lack of compliance with malnutrition criteria they accept it as
one of their weaknesses that can be overcome with more training: they confess
its not easy for them to accurately measure the MUAC; besides, they dont be-
lieve they refer more under pressure from families;
o in the time for questions, they request that OTPs should reject children arriving
who are not opportunely referred by SCCTs: I explain to them that no NGO
could do that, as their goal is to save lives, but as their skills improve, the trust
of the community on them will also increase;
- 1145: after a coffee break, we leave. Arrival Maungdaw at 1250.
Deskwork.
30/03/2012.-
- 0910: visit to OTP-1 MGD, at walking distance. 1 TL, 1 N, 6 TFP agents and 1 helper
conform the team, mostly old ACF members. TL and 7 TFP agents were else-
where attending a workshop. The OTP has been operational for 7 years.
They believe they have got enough equipment to perform their tasks, with the
exception of under 6 months old management: they would need a better-
adapted scale. They collect water from a hand pump well and filter it. 2 la-
trines.
Theyve been furbished with updated protocols, although they still keep the old
ones. Register books are weekly sent to main office.
The nurse declares a permanent good drug supply; the main ailments she as-
sists are LRTI, scabies, diarrhoea, and measles.
One of the TFP agents raises the issue of discharged mothers being handed a
jelly can. He thinks it would be better to give them a supplementary rice ration.
- 1500: arrival at Ay Tah Liya VT, Zular hamlet, to attend a mens prevention group
gathering, led by ACF TCA. Around 25 men are gathered (see questionnaire).
Topics:
o (1) disease caused, or if you have many children, or if you spend less time in
feeding them; or after stopping breastfeeding, or when a new pregnancy, if you
dont get enough food or you give it not in time; or when youve got no chance
to feed with colostrum;
9
o (5) they always go to MSF clinic whenever their wives get pregnant, but all of
them deliver at home helped by a TBA; she doesnt charge them but they nor-
mally hand a gift;
o (6) they all know;
o (7) during rainy season and flooding, as many among them cannot go out to
work;
o (8) yes, very much;
o (9) because the midwife comes regularly to give the shots;
o (11) its forbidden by their religion that women go out on their own, but they
would accept whenever their wives ask their permission;
o (13) they ask too much money and they discriminate against them;
- 1415: meeting with technical local staff (see questionnaire)
Topics:
o (1) at the beginning we didnt know the impact of malnutrition; were happy to
work this way; we should collaborate with MOH; integration with MOH could be
better for the project; MOH has got very few services for the prevention so it
doesnt involve communities; it would be better to start working with the MOH;
its rather difficult: just to organize a training course takes too long; its doubtful
how much MOH staff would get involved; if we start working with them ACF
should need more staff; it has to be considered that households here havent
got enough income to pay for the health care , so more opportunities to work
should be needed;
o (2) the preventive side should be increased; it would be sustainable provided
we could reduce all causes of malnutrition; both the curative and preventive
sides are important alike; there is a third option; actively work at household
level; treatment is more important than prevention;
o (4) the majority are married and also have children, but only a few take birth
spacing measures; other issues should be considered: accessibility, affordabil-
ity;
o (5) very much; they have actively participated in the new proposals design;
o (6) they all think there is not enough staff to do all the scheduled activities;
o (7) they dont seem to be very happy with the quality of the training; MD didnt
receive any training on malnutrition; TFP agents are not happy that only team
leaders receive regular training, although thats changing;
o (8) motivation, communication, independence, direct assistance to people in
need, no discrimination, neutrality, transparency; on the side of weaknesses:
logistic constraints; NRS context; frequent budget shortages; lack of recom-
mendation letters (only service certificates); too much Nut staff: they dont get
easy promotion, contrary to what happens in FSL, WASH; to few opportunities
for training and management positions;
01/04/2012.-
- 1900: picked up to encounter TMO and have dinner with, together with MGD PM
Stephanie Blanc and Deputy Admon Aung Myo Naing, who made the ar-
rangements for the appointment but, eventually, the guy didnt show up.
02/04/2012.-
- 0905: road trip to (OPT-2) centre in Ngan Chaung. Arrival 1020: meeting with the
TFP team: 1 TL (Maung Htay Win), 2 Ns, 8 TFP agents, and 2 helpers. The
team has increased with the closure of Malteser nutrition programme. They
10
have 2 OTPs in charge (Ngan Chaung and Kyein Chaung). They assist around
100 children (TFP) on Mondays and 300 children (SFP) on Tuesdays. The centre
was opened in 2004 and at that time it was only TFP. From 2009 onwards it
combined TFP and SFP.
Topics:
o asked about whether theyve got enough equipment nurses said that they
would like to have a sort of exploration table, as they are forced now to explore
the child sitting in her mothers lap or in a small chair, Which is a sensible re-
quest;
o they havent got troubles on admission protocols changes;
o they continue doing active screening in the community some TFPAs devote a
2nd day to do it -, but only 10% of HVs because of lack of staff;
o the most frequent disease treated at the centre are LRTI, otitis, high fever, diar-
rhoea, skin diseases and malaria during the rainy season;
o theyve found many MAM children who are sick, but as treating them with AB is
restricted on ground that they should seek MSFN help its clinic is very far
away (3-hour walk) they would like to also treat them;
o theyve found that bracelets are re-usable, so very difficult to prevent cheating;
o they would like the nurse to participate in health education sessions explaining
to the mother how to properly use drugs;
o why they should not take RUTF when doing HVs?
- 1130: meeting with 5 SCCTs at a nearby house.
Topics:
o theyve been working as community for 3 years, first as CCT and now as SCCT;
o they were chosen to promote health;
o they all complain of insufficient training: difficulties for adopting the new proto-
cols for measurement;
o they hold monthly meetings within the community, and weekly active search
household by household; they dont expect compensation from the community;
o they still lack trust in their way to measure and take the weight;
o quested on the reason why so many of their referrals are rejected, the answer
is that they need more training; they dont feel any pressure from families to re-
fer the child;
o some SCCT women find difficult to fill in the reporting forms they cannot read
- so they ask their sons or daughters for help;
o they show an interest in WASH activities;
- 1200: focus group meeting with waiting mothers (see questionnaire).
Topics:
o (2) their children get thinner when the have malnutrition;
o (1) when the cut down breastfeeding, or when they add extra milk, or not
enough breastfeeding, or when they get pregnant still breastfeeding a baby, or
because of a gastric disease;
o (3) yes, pregnant women should eat more;
o they never go to a RHSC, so they dont get antenatal care; when they have to
deliver they do it at home with a TBA, whom they have to pay 500 Kyat if the
newborn is a girl and 1,000 kyat if its a boy;
o when the campaign pass by their homes; they have an immunisation card;
11
- 1230: trip back. Arrival 1330. On our way we passed by RHSC Phur Wut Chaung
VT, which was closed.
03/04/2012.-
- 0900: meeting with Malteser PC Mark Brownbridge, MC Dr. Than Than Myint
and TB mgr Dr. Win Bo. Apparently there was a misunderstanding as they
thought the appointment was for 1000 but, anyway, they took me in (see ques-
tionnaire).
Topics:
o (1) they are working on a TB programme, MCH within a PHC approach until
very recently a nutrition programme -, and WASH;
o (2) the reason behind the closing down of the nutrition programme was a
shortage of funding;
o (3) they had a community-based approach by which Malteser staff worked in
the community together with the kindergarten teachers; they decided to trans-
fer all MAM children to ACF; they continue working on MCH so they train auxilia-
ry midwives and TBAs to take care of pregnancies at MOH health facilities; and
they pay the MOH for every delivery assisted 5,000 Kyat; they had no access to
MOH records;
o (5) malnutrition is strongly linked to food security, so ACF should mix up those
two approaches;
o (6) even at community level there has been a reasonable involvement, but its
doubtful whether that will give and sustainability at community level
o (8) MSFH is the leading organization on health & nutrition, but coordination
doesnt seem to work unless very specific issues more than one INGO is inter-
ested about;
o (9) Malteser has very positive feelings about ACF the PM was part of ACF in
the past and theyre doing a very professional work; they have a very strong
team;
- 1010: meeting with MSFH PC Pawan Donaldson - shes been here for 1 year -,
Malaria Field Mgr Anayet Ullah, and Med Prog Mgr Tay Za Kyi Mangar.
Again a misunderstanding, as they were asked to make an appointment with
someone from nutrition, while I was looking into broader issues. Eventually, the
PC, although clearly remarking that she hadnt allocated time for me, accept-
ed to meet me (see questionnaire).
Topics:
o (1) besides running vertical programmes malaria, HIV/AIDS, TB - they have
PHC clinics where pregnant women are admitted and taken care of: they treat
those arriving malnourished;
o (2) they are not targeting under nutrition in childbearing age women;
o (3) good relationship and good access to health facilities, although they have no
access to medical records;
o (6) according to their record, malnutrition is increasing;
o (8) there no way to ensure sustainability in this environment;
12
Just before leaving, the Med. Prog. Mgr. complained of how women referred by
ACF arrived in their clinics without the slightest knowledge on how properly
breastfeed, how to cook, etc.
- 1410: meeting with UNHCR head officer Dr Eng Dinesh Shrestha (+95.98610123;
sheresthd@unhcr.org). Hes been in this position for 2 years now (see ques-
tionnaire).
Topics:
o (1) he believes NRS is going lower into the Govt priorities; there are two clearly
defined communities with apparently opposed interests and needs; the social
development is very low for both communities and the border with Bangla Desh
is part of the problem: BD is not helping NRS;
o (4) the constraints faced by INGOs here is the staffs high turnover; they should
stay at least for 2 years;
o (5) the MOH shows an appalling lack of pro-activity towards the INGOs;
o (6) the nutritional situation is very shaky: very complex to foresee any clear im-
provement on malnutrition and, actually, on anything at all but, if something
can work, it will surely be community-based;
- 1500: meeting WFP head of sub-office Hongyi Xie (honggyi.xie@wfp.org) and Sr

Nut Prog Assistant Shair Ahmed (shair.ahmed@wfp.org).
Topics:
o theyve been working in NRS from 1994;
o in 2008 they took over from Malteser an entire VT: Tha Man Ther, next to Ye
Nauk Nga Ther, where theyve been doing blanket feeding1 up till now; ACF
withdrew from that place when they realized that because of being too far
away, they would be able to cover that population according to their policies;
o UNICEF also started a programme with the MOH by training CHWs and supply-
ing RHSC midwives with RUTF, until October 2011, when they closed down;
o NRS is one of the very few places where WFP is implementing a programme,
and theyd rather withdraw provided someone else stepped in;
o WFP has received a lot of funding and they would like INGOs to built partner-
ship with them;
o NRS hasnt reached a stage so far allowing us to think of sustainability: there
was a previous experience by AMI in BTG when they started a joint programme
with the MOH, in which they would pay contributions to the best performing
midwives, and they replied that either they paid everyone or no one at all, and
the project was closed down;
- 1800: debriefing with ACF expatriate and local staff
Topics raised:
committed staff;
2. Active screening: SCCTs? ACF? Impact on coverage records;
1
Blanket feeding is a way to fight malnutrition by supplying every child in a population, well- and malnourished alike,
a regular food ration, especially so during the lean session
13
3. Criteria Admission changes: need for extra update strengthening on staff - es-
pecially community-based SCCTs. To avoid confusion, outdated manuals should
be withdrawn from OTPs;
4. Explore the possibility of setting discharge criteria higher than MUAC 120mm
maybe 122mm, to minimize relapses and re-admissions;
5. SPHERE discharging criteria: when non-responders, referrals, admission mis-
takes, unknown, etc. are taken into account, the rates of those cured go down:
so performance indicators based on SPHERE dont completely reflect the reality;
6. Need to review the APR findings on a regular basis: female admission rates,
female death rates, non-responders;
7. Handing over more tasks to national staff: data collection and compilation, ex-
panded supervision tasks so the management team can devote more time on
research, survey preparation, data analysis and feedback;
8. CP reporting: need for independent reporting. Long-term perspective;
9. Surveys: anthropometric, KAP and SQUEAC: field has to streamline the parame-
ters for research: same parameters agreed for every survey, plus adding those
of specific current concern (measles immunisation, infant immunisation, and
postnatal and infant vit. A administration rates, etc.);
10. Chronic malnutrition amongst childbearing age women and children. Whats the
matter? MSF doesnt seem to cover them; neither does ACF or Malteser;
11. Long-term Exit Strategy: explore the likelihood of involving the TMO MGD into
CMAM project pilot;
04/04/2012.-
- 0730: departure from MGD. Arrival 0815 to BTG. Went to ACF office and from there
to the river pier. Departure by speedboat at 0910. Arrival 0935 in (OTP-4) Inn
Chaung VT, Twa Gyi hamlet. Meeting with the team, formed by 1 TL, 1 N, 7
TFPAs, and 1 H. The centre was opened in July 2009 and they cover around 95
hamlets.
Topics:
o they usually see around 150 TFP children the first day and, together with the 4
remaining days, they total 575 children, both SAM and MAM; of those, around
25-30 are referred by the SCCTs;
o they havent got any problem adapting to the new protocols (they can show the
latest one) although some have troubles reading in English;
o they know of SCCTs operational in their area, although they very seldom visit
the OTP;
o they think theyve been well trained, but they would need a refreshment course
on nutrition;
o the nurse wouldnt mind an examination table, although shes doing fine now:
she usually sees LRTI, skin infections, diarrhoea, scabies, fever;
o the village has a well with a hand pump dug by ACF; they have a filter plus they
add Waterguard;
o they would like having a generator for the rainy season too dark;
o if they had motorbikes, they could many more HVs: out of 34 HHs needed they
only went to 15, and they are doing now much lees or no active screening for
lack of staff:
o questioned about the much better records they show their answer is that
theyre not cheating, but that the majority of the staff comes from this area
theyre working in, so they know everyone around and they track down default-
ers much better; besides, the area is very small compared with OTPs in MGD;
14
o they would like ACF had a staff immunisation (hep A, B, dysentery) policy, as
that of MSFH;
- 1030: meeting with group of mothers in the waiting room (see questionnaire).
Topics:
o (2) when they have cough, diarrhoea, thinness;
o (7) they are quite happy with ACF, even when theyre rejected: its their first
choice when a baby gets sick; they never go to the RHSC; theyd rather to
MSFH clinic (less than one-hour walk);
o (8) they all know it and they think it would be very helpful, but RHSC midwives
(they pass from time to time by the village and sensitize about birth spacing,
but they ask money for it; husband also agree;
o (9) they experience food shortage during the rainy season;
o (10) they all agree that how much food the mother eats affects breast milk pro-
duction;
o (11) they all say children are correctly immunized but they always forget the
cards;
o (12) many amongst them;
o they havent got a right idea of who SCCTs are (UNHCR?);
- 1100: meeting with group of men (see questionnaire).
Topics:
o many men are coming with the child to the OTP because the path is dangerous
for some women;
o (2) they dont know what malnutrition is but when a child is sick and after tak-
ing him to the doctor he doesnt get better, they take him to ACF centre;
o (6) some say its a good idea while some others say that the Quran is against it;
o (7) they have food shortage every years, but especially this one is worse;
o (8) some agree but others say that milks is Allahs gift and so mothers are not
affected by the food they eat;
- 1135: meeting with SCCTs.
Topics:
o they are working as CCTs since 2009, and now they are SCCTs;
o theyve had 8 training sessions; they think theyve got fair enough;
o they hold community meeting once or twice per month, while they also do
screening; they dont need to do active home screening: they know everyone
and therefore they can tell whether a child has a problem;
o they consider very important to hold SCCT ACF identity cards;
We wait until 1215 as the team has prepared food. I insist in eating together
with them, but theyre still working, so we leave at 1255 arriving in BTG at
1300.
- 1405: departure from BTG. Arrival 1440 in (OTP5) Pha Yar Pyin Aung Pa VT.
Meeting the team formed by 1 TL, 1 N, 7 TFPAs 2 are away doing HVs. They
cover around 50 hamlets. We stop by the RHSC, which remains closed despite
its opening hours clearly exhibited in a cardboard at the gate.
15
Topics:
o they see 150 children daily on average, half of them SAM;
o some of the SCCTs come to the centre regularly;
o they have no troubles in understanding protocols: TL explains to them parts of
text they dont understand;
o just 25% of HVs planned achieved because of shortage of staff;
o they consider theyve got enough equipment to carry out their tasks;
o among the most frequent ailments LRTI, skin infections, scabies, fire burns;
o they bring fresh water from BTG in jelly cans, as there is no hand pump in the
village freatic layer of undrinkable quality and they use filters and Wa-
terguard;
o they only have one protocol booklet, which causes sometimes difficulties;
o asked about the high performance rates they explain that its because they do
many HVs (??) so they can follow up defaulters; the team member majority are
from this area, so they can track down defaulters;
o they are concerned about children above 5 yeas old who come to the centre
with a W/H slightly above cut-off figures, but who look emaciated;
05/04/2012.-
- 0645: picked up from ACF guesthouse and taken to the jetty to board express-boat
to Sittway. Departure 0745. Arrival 1310: Picked up by ACF logistics/driver.
Taken to Shwe Thakin hotel.
- 1450: accompanied by ACF deputy admin Zin Mar Aung to the Sate Health office to
meet Director Dr. Than Tun Aung. He asked us to postpone the meeting for
one hour, as he had to meet State Governor to organize Water Festival celebra-
tions. He kept his word and by 1600 we met, accompanied by Nutrition head Dr
Mya Mya Than. He wanted to know about my visit and impressions, so I did
most of the talking.
Topics:
o I explained to him the very good job ACF is doing in NRS and how they fight
very hard to contain malnutrition in those areas where the lack of opportunities
condemn households to a situation of food deprivation;
o I informed him on the contact with MGD TMO and his apparently goodwill, as
he guided us through the hospital and authorised me to visit MOH RHSCs; I de-
scribed the appalling condition the township main hospital is in, and how the
MOH could build strategic partnerships with INGOs so they could contribute to
the hospital rehabilitation;
o I told him that both MOH and ACF could benefit from a deeper collaboration be-
tween them, as ACF has become the only agency working on malnutrition in
NRS bar WFP; CMAM pilot project could be a good occasion to build that col-
laboration, but much more could be done in terms of training, registration, and
access to MOH statistics;
o I informed him that the majority of women I had meetings with, considered
birth spacing as an excellent choice, but that access to contraceptives was ob-
structed by the high prices midwives asked women to pay, so maybe a pilot
project offering free access to contraceptives could help;
06/04/2012.-
16
- 1320: late departure from Sittway. Late arrival (1520) in Yangon. Picked up (1540)
by ACF car and taken to ECHO office. Arrival 1610. Meeting ECHO representa-
tive Christophe Reltien, already met during last years visit.
Topics:
o I explained how reluctant was I to have the paper with my preliminary impres-
sions disseminated, as documentation review was far too weak a tool to reach
any valid conclusion;
o I also informed him that what I saw and experienced about ACF project was of
a high quality and the implementation was professionally very scrupulous; ACF
being now the only INGO taking care of malnutrition in NRS, ECHO should re-
assess its previous ideas of withdrawing support to ACF nutrition project;
o he observed that it was clear that funding constraint had to be enforced, but
ECHO and EuropAid would be evaluating their priorities in both humanitarian
and development fields for 2013;
o I told him of Sittways new Health Dept. directors pro-activeness, and even
MGD TMO led us to a hospital visit: I stressed the appalling conditions the hos-
pital was in and asked whether a joint action from all ECHO-funded INGOs in
NRS could start rehabilitating some hospital wards (maternal & child) and the
surgery room, and he answered that was something to be considered;
o he agreed that even with the new Govt openness, NRS was very low in the po-
litical agenda;
- 1650: going to Guest Care Hotel.
09/04/2012.-
- 0900: debriefing with HOM.
Topics raised:
committed staff. Terrific organization of different nutrition outposts and very
good logistic know-how;
13. Promote the project achievements to the Nutrition Dept in Nay Pyi Taw, to the
Health Dept director in Sittway and, perhaps, to TMOs: need for a skilled de-
signer (reporting not one of ACFs strongest assets). Language quality very low
(copy & paste);
14. Chronic malnutrition amongst childbearing age women and children. Whats the
matter? MSF doesnt seem to cover them; neither does ACF or Malteser;
15. Supervision and analysis / research: handing over more tasks to national staff:
data compilation and analysis, expanded national supervision tasks (more train-
ing) so the management team can devote more time on systemic supervision,
research, survey preparation, data analysis and feedback;
16. CP Programme reporting: need for independent reporting. Long-term perspec-
tive;
17. Monthly APRs: very limited, if any, feedback (neither from Paris nor from Yan-
gon) and lack of discussion on changes in trends found. Need to review the
APR findings on a regular basis: female admission rates, female death rates,
non-responders;
18. Criteria Admission changes: need for extra update strengthening on staff;
19. Surveys: anthropometric, KAP and SQUEAC: field has to streamline the parame-
ters for research: same parameters agreed for every survey, plus adding those
17
of specific current concern (measles immunisation, infant immunisation, and
postnatal and infant vit. A administration rates, etc.);
20. Long-term Exit Strategy: explore the likelihood of involving the TMO MGD into
CMAM project pilot;
- 1100: debriefing with FSL and WASH coordinators Nicolas Guillaud

(fsco@mm.missions-acf.org), and Morie A. Amadu (washco@mm.missions-
acf.org).
Topics:
o WASH: theyre striving for full geographic and operational integration;
o FSL: any new activity WASH and FSL is coordinated with Nut;
o Chronic malnutrition: areas where Nut centres display their work must be based
on vulnerability criteria: theyre using proxy indicators for diet quality;
o they both agree that integration has much improved through shared technical
meetings in the field;
o new WASH/FSL project to start July12 place mainstreaming WASH/FSL/Nut
shared activities;
o CP is now a small component in FSL, but it will also be mainstream;
o Monitoring teams in the filed commonly working together;
- 1500: meeting with UNICEF officers Nutrition Dr. Kyaw Win Sein
(kwsein@unicef.org) and Child survival Dr. Siddhartha Nirupam
(snirupam@unicef.org); MNTN coordinator UNICEF-contracted Dr. Aye Thwin
(aye.thwin@gmail.com) showed up for a few minutes later. UNICEF seems to
have been caught with a foot astride after the latest events. They are still talk-
ing about good and bad partners, and whether INGOs should get closer to the
Govt side. When I asked about that surveillance system they put in NRS and
whether they had closed down it, they reacted very strongly, claiming about
bad communication lines, and so on, as the project or whatever they prefer to
name it continues in good health apparently they presented latest results in
the last MNTN meeting (check with Jogie).
10/04/2012.-
- 0950: departure from Yangon to Bangkok. Arrival 1145. Interail to Bangkok central
station. Taxi to ECHO office. 1430: meeting with ECHO Regional Health (Nutri-
tion) advisor Dr. Marie T. Benner (marie.bener@echofield.eu). It was an open
discussion / sort of briefing-debriefing chat on the appraisal of my recent field
visit and topics already discussed in our previous meeting nearly a year ago.
Topics:
o accent on community-driven approach to tackle MAM: need for strengthening
local coping capacities;
o worried about sustainability: no way out so far: question mark on whether
CMAM will be the answer to involve MOH;
o insisting in keeping TFP under medical approach while handing over SFP to
long-term funding structures;
o extremely high out-of-control birth rates should be tackled;
o EC/UN/Govt. joint approach to 3 MDGs in Rakhine State will pave the way for
funding long-term initiatives;
18
- 1830: departure to Barcelona via Singapore. Arrival (0855) on 11/04/2012. End of
field visit.
19
ANNEX 6 Map of MGD, BTD & RTD Townships
Myanmar Information Management Unit
Buthidaung Township
Rakhine State
9215'E 9220'E 9225'E 9230'E 9235'E 9240'E 9245'E 9250'E
India
Sagaing
2120'N
2120'N
Bangladesh
Kyee Hnoke
Auk Bo Ka
Lay(198128)
Thee(198129)
(Ba Da Kar)
Chin
(Ba Da Kar)
Paletwa
Pan Zi(198125)
(Ba Da Kar)
Kyaung Zar
Hpyu(198126)
(Ba Da Kar)
Nga/Myin Baw Kha
Mway(198131)
Paletwa Mandalay
(Ba Da Kar)
Nga/Myin Baw
Ku Lar(198130)
(Ba Da Kar)
Sin Shey
Myo(198132)
(Ba Da Kar)
2115'N
2115'N
Ba Da
Kar(198124)
(Ba Da Kar)
Rakhine Magway
Bay of Bengal
Pu Zun
Chaung(198134)
(Kyaung Taung)
Kyaw U(198137)
Bago
Thea Ni (Kyaung Taung)
Chaung(198136)
(Kyaung Taung) Ah Yaing Kwet
Chay(198263)
(Laung Yon)
Sar Kaing(198135)
(Kyaung Taung)
Tin Ah Wa Pyin(198251)
Kyaung
Taung(198133) May(198139) (Kha Maung Chaung)
(Kyaung Taung) (Tin May)
Kyauk Twe
Chaung(198138) Laung Chaung(198249)
(Kyaung Taung) (Kha Maung Chaung)
2110'N
2110'N
Pe Tha Du
(West)(198152)
(Kyun Pauk)
Oe Hpyu (Thet
Kyway Chaung + Myo)(198145)
Ah Din Gyi(198253)
Rakhine(198149) (Goke Pi)
(Kha Maung
(Kyun Pauk) Chaung)
Kyway Chaung Nan Tha Yway(198247)
Ku Lar(198148) Oh Byu(198142) Pe Tha (Kha Maung Chaung)
(Kyun Pauk) (Goke Pi) Htu(198143) Chaung
Kyauk (Goke Pi) Chay(198202)
Kyway Chaung Kha (Ta Ya Gu) Than Pu
See(198147) Yar(198200)
Mway(198151)
(Kyun Pauk) (Ta Ya Gu)
(Kyun Pauk) Yoe Ni Zay(198255)
Kyway Chaung Kha (Kha Maung Chaung)
Pan Kone
Mway (Lower)(198153) Ma(198203)
Kyun Pauk Ku Sa Hone Kha
(Kyun Pauk) (Ta Ya Gu)
Lar(198146) Mway(198144)
(Kyun Pauk) (Goke Pi)
Maung Hnit
Pe Lun Kha
Ma(198262)
Mway(198150) Sa Hone(198141) Pauk Kyat (Kha Maung Chaung)
(Kyun Pauk) (Goke Pi) Wa(198209)
(Ta Ya Gu) Sit Pauk
Chaung(198261)
(Kha Maung Chaung) Chaung Pauk(198245)
(Kha Maung Chaung)
Hmaing Sa
Ri(198198)
(Ta Ya Gu) Chaung Pauk Let Pan
Ba Ho Pyin Ywar Nar(198252) Kaing(198244)
Goke Thit(198199) Sin Ma U (Kha Maung Chaung) (Kha Maung Chaung)
Pi(198140) (Ta Ya Gu) Kaing(198205)
(Goke Pi) (Ta Ya Gu)
Ba Ho Pyin Ywar Sin Hpyu

Haung(198201) Taung(198246)
(Ta Ya Gu) Ta Ra (Kha Maung Chaung)
Gu(198197)
Pauk (Ta Ya Gu)
Kyat(198204) Don Kya(198256)
(Ta Ya Gu) Doe (Kha Maung
Seik Ta Tan(198206) Chaung) Ah Yaing Kwet
Ra(198211) Gyi(198248)
215'N
215'N
(Ta Ya Gu)
(Ta Ya Gu) (Kha Maung Chaung)
Pan Be Chaung
Ku Lar(198155)
(Myauk Ye (a) Thea Din (Bei
Pan Be Chaung) Nga Thaing Dut)(198254)
Pan Chaung(198210) (Kha Maung Chaung)
Be Chaung Rakhine(198154) (Ta Ya Gu) Thin Baw
(Myauk Ye (a) Pan Be Chaung) Hmauk(198260) Ku Lar
(Kha Maung Chaung) Chaung(198259)
(Kha Maung Chaung)
Baw Di Kaing(198250)
(Kha Maung Chaung)
Pi Ywet
Rakhine(198207) Nga Tin Tein(198265)
(Ta Ya Gu) Let Pan(198257) (Aw Ra Ma (a) Yee
Yin Ma Kyaung (Kha Maung Chaung Pyin Hla)
Taung Gyi Maung Hnit Taung(198194) Chaung)
Zee Hton Yin(198157)
Rakhine(198156) Ma(198193) (Yin Ma Kyaung Taung)
(Zee Hton) (Nga Yant Chaung)
(Zee Hton)
Yae Let Pan
Chan(198208) Hpyar(198258)
(Ta Ya Gu) (Kha Maung Chaung)
Yin Ma Zee Ah Nauk Pyin(198195)

Hton(198158) (Yin Ma Kyaung Taung)
(Zee Hton) Kyein Chaung(198196) Pein Hne Chaung(198266)
(Yin Ma Kyaung Taung) (Aw Ra Ma (a) Yee
Thar Si Chaung Pyin Hla)
Myo(198159)
(Zee Hton)
Nga Yant Nat Seik(198275)
Chaung(198188) (Aw Ra Ma (a) Yee
(Nga Yant Chaung) In Chaung(198212) Chaung Pyin Hla)
(Ta Ya Gu)
Pauk Taw Pyin(198192) Chaung Ma Yae(198270)
(Nga Yant Chaung) Yin Ma Zay(198191) (Aw Ra Ma (a) Yee
Pyin Chaung Pyin Hla)
(Nga Yant
Buthidaung
Khaung(198162) Chaung) Yin Ma(198190)
(Ba Da Nar) (Nga Yant
Chaung) Aw Ra Ma(198264)
210'N
210'N
Kyee Hnoke (Aw Ra Ma (a) Yee
Thee(198189) Chaung Pyin Hla)
(Nga Yant Chaung)
Zay Teit Kone
Ywar Thar Kaung(198184) Taung(198215)
Yar(198163) (Inn Chaung) (Thin Ga Net)
Ba Da (Ba Da Nar)
Ba Da Nar Ywar Khu Thin Ga Myauk
Nar(198160)
Thit(198186) Taung(198216) Net(198213) Chaung(198243)
(Ba Da Nar) Yin Tu Chaung Nge(198267)
(Inn Chaung) (Thin Ga Net) (Thin Ga Net) (Oke Taung)
Baung(198161) (Aw Ra Ma (a) Yee
(Ba Da Nar) Inn Chaung Daing Chaung Pyin Hla)
Net(198183) Ba Da Nar Ku Inn Chaung Done Paing(198214) Min Kaing(198268)
(Inn Chaung) Lar(198185) Zay(198187) (Thin Ga Net) (Aw Ra Ma (a) Yee
(Inn Chaung) (Inn Chaung) Chaung Pyin Hla)
Laung Chaung Ku Mi Khar Li(198180)
Daing Net(198164) (Mee Chaung Khaung Swea) Mee Chaung
Laung Chaung Mee Chaung Khaung Zay(198217) Htu Myaung Lay(198269)
(Laung Chaung) Oke Taung Aung Kywe
Ku Lar(198166) Swea(198179) (Mee Chaung Zay) Kaing(198278) (Aw Ra Ma (a) Yee
(Laung Chaung) (Mee Chaung Khaung Swea) (Rakhine)(198242) Chaung Pyin Hla)
Pyain (Aye Yar Cha)
(Oke Taung)
Chaung(198167) Maung Hla Ma Myit Nar(198227) Bo Gyi Chaung(198218)
Tha Lu Pyar(198271)
(Laung Chaung) (a) Lin Bar (Dar Paing Sa Yar) (Mee Chaung Zay) (Aw Ra Ma (a) Yee
Si Li(198181) Hpaw
Tay Ahr Li(198221) Li Pi(198277) Chaung Pyin Hla)
(Mee Chaung
Khaung Swea) Zar Ti (Mee Chaung Zay) (Aye Yar Cha)
Pyin(198226) Mar Zi(198220)
Kone Tan Ywar (Dar Paing Sa Yar)
(Mee Chaung Maung
Thit(198182) Kan Paing Taung Chay(198273)
Zay) Chaung(198280)
(Mee Chaung Khaung Swea) Chaung(198237) (Aw Ra Ma (a) Yee
Khaik Mu Ra(198219) (San Hnyin Wai) (Aye Yar Cha) Chaung Pyin Hla)
(Mee Chaung Zay) Chan
Sin Swei Gaung Ni(198225) Thar(198284)
Nga Kyi Tauk (Dar Paing Ywar Thit(198222) Khar Lar U(198272)
Ya(198165) (Aye Yar Cha)
Daing Nat(198177) Sa Yar) (Mee Chaung Zay) (Aw Ra Ma (a) Yee
(Laung Chaung) Nga Kyi Tauk Nga Kyin
Chaung Pyin Hla)
Ku Lar(198176) (Nga Kyin Tauk) Tauk(198173) Aye Yar
Taung Chaung
(Nga Kyin Tauk) (Nga Kyin Tauk) Dar Paing Sa Yar(198223) Pyin Shey Cha(198276)
(Dar Paing Sa Yar) (Aye Yar Cha) Gyi(198274)
(Rakhine)(198235) (Aw Ra Ma (a)
Saint Aung(198224)
Kyauktaw
(Kyauk Taung (a) Yee Chaung
(Dar Paing Sa Yar) Pyin Shey) Ma Yee
Aw Lan Pyin Ku Aw Lan Kha Mway Pyin Hla)
Hpaung Taw Mee(198283)
Lar(198178) Pyin(198174) Chaung(198239) Dar Sauk
Pyin(198232) (Aye Yar Cha)
(Nga Kyin Tauk) (Nga Kyin Tauk) Chin Tha (San Hnyin Wai) Paing(198282)
Myaung(198171) (Chin Tha Mar)
Mar(198231) (Aye Yar Cha)
(Tat Min Maung Gyi Htaunt(198228) Ah Htet Kywe
(Chin Tha Mar) Tha Ra
Chaung) Tha Yae Kone (Maung Gyi Kaing(198279)
Tan(198175) Htaunt) (Aye Yar Cha) Zaing(198281)
Tat Min Maung Nu(198233) (Aye Yar Cha)
Chaung(198168) (Nga Kyin Tauk) Pale
(Chin Tha Mar)
2055'N
2055'N
(Tat Min Chaung) Taung(198234)
(Chin Tha Mar)
San Hnyin Myo Ma

Hpa Lan(198170) Sin Oe Pyin (Ywar Pyin Shey Ku Wai(198236)
Taung Paing(198172) Chaung(198359)
Gyi)(198229) Ku Toet Lar(198238) (San Hnyin Wai)
(Tat Min (Tat Min Chaung) (Pyin Chaung)
(Maung Gyi Htaunt) Seik(198301) (San Hnyin Wai)
Chaung)
Hpyar Mauk(198169) (Nan Yar Kone) San Hnyin Wai
(Tat Min Chaung) (Rakhine)(198241)
Sin Oe Pyin (San Hnyin Wai) Pyin
(Middle)(198230)
Chaung(198358)
(Maung Gyi Htaunt)
Taung (Pale (Pyin Chaung)
Yae Bu(198286)
Taung)(198299) (Ka Nyin
(Nan Yar Kone) Tha Yet Kin Ma Let Pan
Pale Taung(198297) Chaung) Chaung(198360)
Nu(198291)
(Kun Taing (a) (Pyin Chaung)
(Tha Yet Kin Ma Nu)
Zee Pin Taung)
Ywar Ma Si Pin Thar
Rakhine(198304) Yar(198240)
Let Wea Det(198316) (Ywar Ma) Gone (San Hnyin Wai) Ta Man
(Let Wea Det Pu Nar(198305) Nan Yar Kone(198296) Thar(198287)
Zun Chaung) Done Chaung(198310) (Ywar Ma) (Kun Taing (a) (Ka Nyin Chaung)
(Let Wea Det Pyin Shey) Zee Pin Taung)
Let Wea Det(198308)
(Let Wea Det
Pyin Shey) Htin Shar Pyin(198309) Ah Nauk(198295)
(Let Wea Det Pyin Shey) Than (Kun Taing (a)
Chay(198300) Zee Pin Taung)
Buthidaung (Nan Yar Kone)

Zay Di Taung(198326)
(Ka Kyet Bet Kan Pyin)
Kun Taing Ywar Gyi(198293)
(Kun Taing (a)
Zee Pin Taung)
Kyauk Pyin
Chaung(198288)
(Ka Nyin Chaung)
Myaung
Nar(198321) Ah Shey(198294)
Myauk(198322) (Ba Gone Nar) (Kun Taing (a)
(Ba Gone Nar) Zee Pin Taung)
Oe Thei(198327)
(Ka Kyet Bet Taung (Ywet Nyo
Kan Pyin) Kan Gyi
Taung)(198346)
Kyauk Hla Pyin(198311) Pyin(198328)
(Ywet Nyo Taung)
(Let Wea Det (Ka Kyet Bet Kan Pyin)
Pyin Shey)
Ah Twin Hnget
Ah Lel(198320) Thay(198349)
2050'N
2050'N
(Ba Gone Nar) (Ah Twin Hnget Thay)
Hnget Thay(198352)
(Ah Twin Tha Yet Pyin
Hnget Thay) (Rakhine)(198363)
(Tha Yet Pyin)
Maungdaw Kan Gyi

Pyin(198323) U Hla
(Ba Gone Nar) Hpay(198343)
Taung(198319) (U Hla Hpay)
(Ba Gone Nar)
Thein Taung(198353)
(Ah Twin Hnget Thay) Htan Shauk
Pyin Khan(198350)
Shey(198340)
Let Pan Pyar Pin Yin(198351) (Ah Twin Hnget Thay)
Kaing(198338) (Kin Chaung) (Ah Twin Hnget Thay) Pyar (Yi)
(Kin Chaung) Yae(198366)
(Lay Myo)
Chaung Hpon Nyo
Tha Peik Taung Pauk(198367) Leik(198370)
Ahr Kar Pyan Ka (Rakhine)(198377) (Lay Myo) (Hpon Nyo Leik)
Mway(198339) (Tha Peik Taung) Zaw Baw(198374)
(Kin Chaung) (Wa Ya Kyun) San Goe
Tha Bauk
Chaung(198337)
(Kin Chaung)
Kin
Chaung(198336)
(Kin Chaung) Taung Chay(198378)
(Tha Peik Taung)
Wa Ra
Kyun(198373)
(Wa Ya Kyun)
Taung(198408)
(San Goe Taung)
Ponnagyun
Daing Net Na Nwin
Taw Kan(198385) Ku(198405)
Pyin(198384) (Sein Hnyin Yet Chaung(198386)
(Sein Hnyin Pyar) (Sein Hnyin Pyar) (Kyauk Yant)
Pyar)
Sin Thay
Pyin(198412)
Kyauk Yant U Yin (San Goe Taung)
(Rakhine)(198404) Thar(198410)
Pyin Shey Ah Shey (Kyauk Yant) (San Goe Taung)
Maungdaw
Tin Set(198387) Say Oe
(Ku Lar)(198383) (Sein Hnyin Kya(198401)
(Sein Hnyin Pyar) Pyar) (Say Oe Kya) Sa Par
Htar(198415)
Sein Hnyin Pyar (Sa Par Htar)
Zay(198381)
Shat Shar
(Sein Hnyin Pyar) Khaung
Taung(198409)
Pyin Shey(198382) Taik(198411)
2045'N
2045'N
(San Goe Taung)

(Sein Hnyin Pyar) Gu Dar (San Goe Taung)
Pyin(198390)
(Gu Dar Pyin)
Zay Di Taung
(Rakhine)(198424)
(Wet Ma Kya (a)
Zay Di Taung)
Hpoe Khaung Chaung(198393) Zay Di Taung

(Hpoe Khaung Chaung (Ku Lar)(198425)
(a) Kan Pyin) (Wet Ma Kya (a)
Zay Di Taung)
Hpa Yon Chaung

(Daing Nat)(198436)
(Hpa Yon Chaung)
Thay Kan
(Rakhine)(198433)
(Kyauk Hpyu Thar
Thay Kan) Wet Ma Kya(198430)
(Thay Kan Gwa Son)
Gwa
Son (Rakhine)(198428)
(Thay Kan Gwa Son)
Pyaing Gaung Gyi(198429)

Taung(198439) Hpa Yon Chaung (Thay Kan
(Hpa Yon Chaung) (Ku Lar)(198438) Gwa Son)
(Hpa Yon Chaung)
Kywe Cho Maw(198444)

(Ah Htet Kywe
Cho Maw)
Thaing Ta
Poke(198421)
(Thaing Ta Poke)
Rathedaung
2040'N
2040'N
Bay of Bengal Pyaing

Taung(198449)
(Pyaing Taung) Doe Wai(198454)
(Kywe Yine Khat)
Kilometers
0 3.5 7 14
9215'E 9220'E 9225'E 9230'E 9235'E 9240'E 9245'E 9250'E
Map ID: MIMU227v01

Village Elevation (Meter) Projection/Datum: Geographic/WGS84
Town 0 - 100 Myanmar Information Management Unit (MIMU) is an Inter-Agency Standing Creation Date: 5 Aug 2009. Designed for A1
State/Division Boundary 101 - 200 Committee (IASC) common resource providing information management services,
Village Nmae including GIS mapping and analysis, to the humanitarian and development actors
Twnship Boundary 201 - 300 both inside and outside of Myanmar. Data Sources: Boundaries-WFP(2008) modified
War Yar Lit (196214)
Village PCode
Road 301 - 400 (Bu May)
by MIMU (2009); Placed names-Ministry of Home
Village Tract Name
info.mimu@undp.org
River 401 - 750 Affairs (GAD) Translated by MIMU
Disclaimer: The names shown and the boundaries used on this map do not imply official endorsement or acceptance by the United Nations.
Myanmar Information Management Unit
Northern Rakhine State

Rakhine State
925E 9210E 9215E 9220E 9225E 9230E 9235E 9240E 9245E 9250E 9255E 930E 935E
India
Myo(197794)
(Tat Chaung)
Tat
Chaung(197792) Sagaing
2125N
2125N
Baw Tu (Tat Chaung)
Lar(197791)
(In Tu Lar)
Bangladesh
Bangladesh
In Tu
Hpar Zay
Lar(197790) Dar(197793)
(In Tu Lar) (Tat Chaung)
Chin
San Su Ri(197799)
Gu Mi Yar(197797) (Kar Lar
Naw Yar(197798) Day Hpet)
(Kar Lar
(Kar Lar
Day Hpet)
Day Hpet) Aung Tha
Pyay(197800)
(Kar Lar Day Hpet)
Kar Lar Day

Hpet(197795)
(Kar Lar Day Hpet)
2120N
2120N
Kyaung Toe(197811)
(Bauk Shu Hpweit)
Mandalay
Aung Zan(197809)
(Bauk Shu Ah Nauk Tan Kyee Hnoke
Chaung(197796) Auk Bo Ka
Hpweit) Lay(198128) Thee(198129)
(Kar Lar Day Hpet) Myo (Ye Aung (Ba Da Kar)
Chaung)(197804) (Ba Da Kar)
Mar Zay(197803) (Ye Aung San Ya Bway)
Shee Dar(197810)
(Bauk Shu
Hpweit)
(Ye Aung San
Ya Bway) Ye Aung San
Ya Bway(197801) Kyaung Na Hpay
Paletwa
(Ye Aung San Ya Bway) (Myo)(197808)
Sin Thay Ah Shey Kha Maung (Kyaung Na Hpay)
Pyin(197813) Seik(197817) Pan Zi(198125)
Hlaing (Hlaing Thi) (Kha Maung Seik) (Ba Da Kar)
Thi(197812) Taing Ye Bauk Kyar(197821) Kyaung Na Hpay
(Hlaing Thi) Bin Gar(197822) (Kha Maung (East)(197805) Kyaung Zar
(Kha Maung Seik) Seik) Gaw Yin(197806) (Kyaung Na Hpay) Hpyu(198126)
Baw Taw Lar(197816) (Kyaung (Ba Da Kar)
Tone (Hlaing Thi) Na Hpay)
Chaung(197814) Ah Shey Htan Chaung Thit Tone Nar Nga/Myin Baw Nga/Myin Baw Kha Rakhine Magway
Paletwa
(Hlaing Thi) Ah Nauk Ka Maung (Htan Kar Li)(197807) Lay Myo(197826)
Taung Seik(197820) Ku Lar(198130) Mway(198131)
(Kyaung Na Hpay) (Thit Tone Nar Gwa Son) (Ba Da Kar)
Pyo(197815) (Kha Maung Seik) (Ba Da Kar)
(Hlaing Thi) Ah San Kyaw(197818)
(Kha Maung Seik) Nan Yar Kaing(197828)
(Nan Yar Sin Shey
Bay of Bengal
2115N
2115N
Nga Yant Kaing) Myo(198132)
Chaung(197823) Ba Da (Ba Da Kar)
(Nga Yant Chaung) Let Yar Chaung(197827)
Ukhia (Thit Tone Nar Gwa Son)
Kar(198124)
(Ba Da Kar)
Hmaing Sa Ri(197824)
(Nga Yant Chaung) Thit Tone Nar
Gwa Son(197825) Ta Man Thar
(Thit Tone Nar Gwa Son) Ah Nauk Rakhine(197835)
Ta Man Thar
(Ku Lar)(197829) (Ta Man Thar)
(Ta Man Thar)
Ta Man Thar Ta Man Thar Ah Shey
(Myo)(197830) (Ku Lar)(197831)
Ta Man Thar
(Ta Man Thar) (Ta Man Thar)
Zay Nar(197834)
(Ta Man Thar) Ta Man Thar Bo
Hpaung Seik(197833) Hmu Gyi(197837) Pu Zun
(Ta Man Thar) Ta Man Thar Thea (Ta Man Thar)
Kone Tan(197838) Chaung(198134)
Bago
Taungpyoletwea Ta Man Thar
Taung(197836)
(Ta Man Thar)
(Ta Man Thar) Ta Man Thar (Bo Hmu Gyi
Thet)(197832)
(Ta Man Thar)
That
(Thet
Nyar)
Kaing
Kaing
Nyar(197839)
Laung Boke(197840)
(Kyaung Taung)
Thea Ni Kyaw U(198137)

(Kyaung Taung)
(Thet Kaing Chaung(198136)
(Kyaung Taung) Ah Yaing Kwet
Yae Nauk Ngar Thar Nyar) Laung Boke(197854)
Chay(198263)
(Daing Nat)(197842) (Pa Da Kar Day
Sar Kaing(198135) (Laung Yon)
(Yae Nauk Ngar Thar) War Nar Li)
Yae Nauk (Kyaung Taung) Tin
Ngar Thar(197841) Kyaung Ah Wa Pyin(198251)
Taung(198133) May(198139)
(Yae Nauk Ngar Thar) (Tin May) (Kha Maung Chaung)
Pa Da (Kyaung Taung)
Mee Kyauk Twe
Done Ku Lar(197859) Kar Ywar Thit(197858)
Taik(198089) Zaw Za Dein(197851) Chaung(198138) Laung Chaung(198249)
(Pa Da Kar Ywar Thit) (Pa Da Kar Ywar Thit)
(Mee Taik ) Pa Da Kar (Pa (Kyaung Taung) (Kha Maung Chaung)
2110N
2110N
Min Gyi (Tu Lar Da Kar Day War Nar Li) Pe Tha Du
Kun Thee Tu Li)(197847) San Kar Pin Yin Than Hpa Yar(197856) Taung(197850)
Pin(198094) (Myo)(197846) (Pa Da Kar Day (Pa Da Kar Day (West)(198152)
(Min Gyi (Tu (Kyun Pauk)
(Kun Thee Pin ) (San Kar Pin Yin) War Nar Li) War Nar Li) Tat Chaung(197853)
Lar Tu Li)) Oe Hpyu (Thet
(Pa Da Kar Day
Kyway Chaung + Myo)(198145)
La Baw Wa(197855) War Nar Li)
(Pa Da Kar Day Rakhine(198149) (Goke Pi)
Min Gyi (Ku Lar)(197848) San Kar Pin Nan Tha Yway(198247)
Let Hpweit War Nar Li) Wet Kyein(197860) (Kyun Pauk) Kyway Chaung
(Min Gyi (Tu Lar Tu Li)) Yin(197845) Pe Tha (Kha Maung
Kya(198095) (Wet Kyein) Ku Lar(198148) Oh Byu(198142) Chaung
(San Kar Pin Yin) Htu(198143) Chaung)
(Kun Thee Pin ) Myo Mi (Kyun Pauk) Kyauk (Goke Pi) Chay(198202) Than Pu Ah Din
(Goke Pi)
Chaung(197844) Wet Kyein Kyway Chaung Kha See(198147) (Ta Ya Gu) Yar(198200) Gyi(198253)
(Myo Mi Chaung) (Myo)(197861) Mway(198151) (Kyun Pauk) (Ta Ya Gu) (Kha Maung Chaung)
(Kyun Pauk) Pan Kone
(Wet Kyein) Kyun Pauk Ku Yoe Ni Zay(198255)
Kyet Kyein(197863) Sa Hone Kha Ma(198203)
Thea Chaung (Done Paik (Aung Seik Lar(198146) Mway(198144) (Ta Ya Gu) (Kha Maung Chaung)
Hpar Ri(198099) Kyway Chaung Kha (Kyun Pauk)
Pyin)) (Goke Pi)
(Thea Chaung ) Mway (Lower)(198153) Maung Hnit
(Kyun Pauk) Pauk Kyat Ma(198262)
Sa Hone(198141)
Myaw Pe Lun Kha (Goke Pi) Wa(198209) (Kha Maung Chaung)
Sit Pauk
Mu Hti(198100) Chaung(197843) Ree Dar(197864) Mway(198150) (Ta Ya Gu)
Zaing Thar Khar (Thea Chaung ) Chaung(198261)
(Myaw Chaung) (Done Paik (Aung (Kyun Pauk) Chaung Pauk(198245)
Li(198102) Hmaing Sa (Kha Maung Chaung)
Thea Chaung Maw Seik Pyin)) (Kha Maung Chaung)
(Thea Chaung ) Bo Bar(197865) Ri(198198)
La Bi(198098) (Done Paik (Aung Let Pan
Done Paik(197862) Ba Ho Pyin Ywar (Ta Ya Gu)
(Thea Chaung ) Kyun Pauk Pyu Seik Pyin)) Goke Kaing(198244)
(Done Paik (Aung Thit(198199)
Su(198116) Kyein Chaung(197857) Pi(198140) Sin Ma U Kaing(198205) (Kha Maung Chaung)
Seik Pyin)) (Ta Ya Gu)
(Kyun Pauk Pyu Su ) (Kyein Chaung) (Goke Pi) (Ta Ya Gu)
Leik Ya Zone Leik Ya (Middle)(198106) Ba Ho Pyin Ywar Chaung Pauk Sin Hpyu
Karr Yar(198105) (Leik Haung(198201) Ta Ra Nar(198252) Taung(198246)
(Leik Ya ) Ya ) Baw Tar Li(198117) (Ta Ya Gu) (Kha Maung Chaung) (Kha Maung Chaung)
(Kyun Pauk Pyu Su ) Gu(198197)
Laung Done Zay Pauk Kyat(198204) (Ta Ya Gu)
Kyauk Chaung Ywar Zee Pin Chaung Ah Yaing Kwet
(South)(198111) Di Pyin(197868) Kyun Gaung(197870) (Ta Ya Gu) Gyi(198248)
Thit(198120) Doe
215N
215N
(Zee Pin Chaung ) (Laung Don) (Laung Don) Pan Be Chaung Seik Ta Tan(198206) (Kha Maung Chaung)
(Kyauk Chaung )
Myar Ku Lar(198155) Ra(198211) (Ta Ya Gu) Don
Thaung Khu Lar(198112) Myo Zin(197871) (Myauk Ye (a) (Ta Ya Gu) Kya(198256) Thea Din (Bei
Ah Lel(198121) Sin Thay Nga Thaing
(Zee Pin Chaung ) Thit(197892) (Laung Don) Gyit Dut)(198254)
(Kyauk Chaung ) Pyin(197873) Pan Be Chaung) Pan Be Chaung Chaung(198210) (Kha Maung Chaung)
(Myo Thit) Rakhine(198154) (Kha Maung Chaung)
Doe Chaung(197872) (Laung Don) (Ta Ya Gu)
Thin Baw Hmauk(198260)
Tan(197882) (Laung Don) (Myauk Ye (a) Pan Be Chaung) Ku Lar Chaung(198259)
(Kha Maung Chaung)
(Doe Tan) (Kha Maung Chaung)
Ah Htet Pyu
Ma(197885) Sa Bai
Lin Bar Gone Yae Myet(197867) Baw Di Kaing(198250)
(Ah Htet Pyu Ma) Kone(197866)
Nar(197883) (Sa Bai Kone) (Kha Maung Chaung)
Koe (Sa Bai Kone) Hpan Pi Ywet
Taung Yin(197886) (Doe Tan) Rakhine(198207) Nga Tin Tein(198265)
Auk Pyue Ma Taung(197887) (Ah Htet Thein Taung(197884) Pyaung Pyit(197876) Myaung(197877) Let Pan(198257)
(Ta Ya Gu) (Aw Ra Ma (a) Yee
(Rakhine)(197889) (Ah Htet Pyu Ma) Pyu Ma) (Ngar (Ngar Sar Kyu) Maung Hnit (Kha Maung
(Doe Kyet Yoe Pyin Zee Hton Chaung Pyin Hla)
(Pyu Ma Ka Nyin Tan) Kat Pa Kaung(197890) Sar Kyu) Ma(198193) Chaung)
Pyu Ma Ka Nyin Tan) (South)(197881) Kywe Ta Rakhine(198156)
(Kat Pa Kaung) (Zee Hton) (Nga Yant Chaung) Yae
Tan(197888) (Kyet Yoe Pyin) Ma(197880) Let Pan
(Pyu Ma Ka Nyin Tan) Ngar Sar (Kyet Yoe Pyin) Yin Ma Kyaung Chan(198208) Hpyar(198258)
Leik Aing(197875) Lu Ban Taung Gyi
Tha Dut
Kyu(197874) Taung(198194) (Ta Ya Gu) (Kha Maung Chaung)
Nga Khu Pyin(197879)
Taung(197891)
(Ngar Sar Kyu) (Ngar Sar Kyu) Yin Ma Zee Yin(198157) (Yin Ma Kyaung Taung)
Ya(197894) (Kyet Yoe Pyin)
(Kat Pa Kaung) Hton(198158) (Zee Hton)
(Nga Khu Ya) Ah Nauk Pyin(198195) Pein Hne Chaung(198266)
(Zee Hton)
Yae Myet Kyet Yoe Pyin(197878) Thar Si (Yin Ma Kyaung Taung) (Aw Ra Ma (a) Yee
Nyar Khu Ya (Ku
Lar)(197895) Taung(197893) (Kyet Yoe Pyin) Myo(198159) Kyein Chaung(198196) Chaung Pyin Hla)
Nga Yant
(Nga Khu Ya) U Shey (Yae Myet Taung) (Zee Hton)
Chaung(198188) (Yin Ma Kyaung Taung) Nat Seik(198275)
Kya(197901) Ngan Chaung(197909) In Chaung(198212)
(Nga Yant Chaung) (Aw Ra Ma (a) Yee
(U Shey Kya) Gone Nar(197910) (Ngan Chaung) (Ta Ya Gu) Chaung Pyin Hla)
Chaung Ma Yae(198270)
(Ngan Chaung) Pauk Taw (Aw Ra Ma (a) Yee
Pyin
Pwint Hpyu Hpar Wat Chaung (Yuar Haung)(197914) Yin Ma Zay(198191) Pyin(198192) Chaung Pyin Hla)
Khaung(198162)
Chaung(197902) (Hpar Wut Chaung (Ywar (Nga Yant Chaung) (Nga Yant Chaung) Aw Ra Ma(198264)
(Ba Da Nar)
(Pwint Hpyu Chaung) Thit)) Hpar Wut Chaung (Ywar Thit)(197913) Yin Ma(198190) (Aw Ra Ma (a) Yee
210N
210N
Myaw (Hpar Wut Chaung (Ywar Kyee Hnoke Thee(198189) (Nga Yant
Chan Pa Yin Taung(197904) Taung(197911) Chaung Pyin Hla)
Thit)) (Nga Yant Chaung) Chaung)
Pyin(197896) (Pwint Hpyu Chaung) (Myaw Taung) Thea Chaung(197916) Kone
(Chan Pyin) Zin Paing Nyar(197903) Yae Khat Chaung Gwa Son(197906) (Hpar Wut Ba Da Ywar Thar Ba Da Nar Ywar Taung(198215) Khu Taung(198216) Myauk
(Pwint Hpyu
Kyar Gaung
(Yae Khat Chaung Gwa Chaung (Ywar Thit)) Nar(198160) Yar(198163) Thit(198186)
(Thin Ga Net) (Thin Ga Chaung(198243) Tu Chaung Nge(198267)
Sa Bai Pin
Yin(197897)
Chaung) Taung(197905)
Son) Gwa Son(197907) (Ba Da Nar) (Ba Da Nar) (Inn Chaung) Net) (Oke Taung) (Aw Ra Ma (a) Yee
(Yae Khat Chaung Min Kaing(198268)
(Chan Pyin) (Kyar Gaung Taung) Ba Da Nar Thin Ga Done Paing(198214) Chaung Pyin Hla)
Gwa Son) Yin Baung(198161) Ku Lar(198185) Inn Chaung (Aw Ra Ma (a) Yee
Tha Inn Chaung Daing Net(198213) (Thin Ga Net)
(Ba Da Nar) (Inn Chaung) Zay(198187) Chaung Pyin Hla)
Lu Chaung(197912) Laung Chaung Net(198183) (Thin GaChaung)
Net)
Dar Gyi Daing Net(198164) Laung Chaung (Inn Htu Myaung Lay(198269)
Yae Twin (Myaw Taung) (Inn Chaung) Oke Taung Aung Kywe
Kyun(197898) Zar(197908) Maung Hnit Ma (Laung Chaung) Ku Lar(198166) Ku Mi Khar Hpaw Tay Ahr (Aw Ra Ma (a) Yee
Mee Chaung Zay(198217) Li(198221) (Rakhine)(198242) Kaing(198278)
(Yae Twin Kyun) (Dar Gyi Zar) (Gyi)(197923) (Laung Chaung) Li(198180) Chaung Pyin Hla)
(Mee Chaung Zay) (Mee Chaung Zay) (Oke Taung) (Aye Yar Cha)
(Maung Hna Ma) Pyain Chaung(198167)
(Laung Chaung) (Mee Chaung Khaung Swea) Myit Nar(198227)
Ywet Nyoe Bo Gyi Chaung(198218)
Taung(197899) Kyauk Chaung(197926) (Dar Paing Sa Yar) Li Pi(198277) Tha Lu Pyar(198271)
Baw Htee(197932) (Mee Chaung Zay) (Aye Yar Cha)
(Ywet Nyoe Taung) (Maung Hna Ma) (Aw Ra Ma (a) Yee
(Thu U Kan Paing Taung Chay(198273) Chaung Pyin Hla)
Kone Tan Ywar Maung Chaung(198280)
Ywet Hnyo Taung Dar Gyi Lar) Kan Pyin(197931) Maung Hla Ma Zar Ti Pyin(198226) Chaung(198237) (Aw Ra Ma (a) Yee
Thit(198182) (Aye Yar Cha)
Kyauktaw
(Ku Lar)(197900) Zar(197921) (Thu May Ze Tu (a) Lin Bar (Dar Paing (San Hnyin Wai) Chaung Pyin Hla)
Lar(197925) Sin Swei (Mee Chaung Khaung Swea)
(Ywet Nyoe Taung) (Tha Yet Oke) U Lar) Kyauk Pyin Si Li(198181) Sa Yar) Mar Zi(198220) Chan Khar Lar U(198272)
Thu U (Maung Hna Ma) Seik(197927) Ya(198165) Nga Kyin Tauk(198173) (Mee Chaung (Mee Chaung Zay) Thar(198284) Taung Chaung (Aw Ra Ma (a) Yee
Nga Toe(197918) Tha Yet Lar(197930) (Laung Chaung) Aye Yar
(Nga Kyin Khaung Swea) Gyi(198274) Chaung Pyin Hla)
(Tha Yet Oke) Oke(197917) (Thu U Lar)
(Kyauk Pyin Seik) Ywar Thit(198222) Cha(198276) (Aye Yar Cha)
(Tha Yet Oke) Nga Kyi Tauk Tauk) Gaung Ni(198225) (Aw Ra Ma (a)
Saint Aung(198224) (Dar Paing Sa Yar) (Mee Chaung Zay) (Aye Yar Cha) Ma Yee
Set Khwar Set Khwar Ku Lar(198176) Nga Kyi Tauk Mee(198283) Yee Chaung
Ah Bu Gyar(197920) Pi Yae(197919) (Dar Paing Sa Yar) Pyin Shey Kha Mway
(East)(197928) (West)(197929) (Nga Kyin Tauk) Daing Nat(198177) (Aye Yar Cha) Pyin Hla)
(Tha Yet Oke) (Tha Yet Oke) Hpaung (Rakhine)(198235) Chaung(198239)
(Kyauk Pyin Seik) (Kyauk Pyin Seik) Myaung(198171) (Nga Kyin Tauk) Tha Chin Tha
Taw Pyin(198232) Mar(198231) (Kyauk Taung (a) (San Hnyin Wai)
Min Ga Lar Ahr (Tat Min Aw Lan Pyin Yae Kone Tan(198175) (Chin Tha Mar) Pyin Shey)
Kyee Kan Pyin Chaung) Ku Lar(198178) (Nga Kyin Tauk) (Chin Tha Mar) Ah Htet Kywe Dar Sauk
Sheik Kyar(197922)
(West)(197944) (Nga Kyin Tauk) Tat Pale Taung(198234) Maung Kaing(198279) Paing(198282)
(Tha Yet Oke) Tha Ra
2055N
2055N
(Kyee Kan Pyin) (Chin Tha Nu(198233) (Aye Yar Cha) (Aye Yar Cha)
Min Chaung(198168) Maung Gyi Mar) Zaing(198281)
Htaunt(198228) (Chin Tha Mar)
(Tat Min Chaung) San Hnyin (Aye Yar Cha) Myo Ma
Hpa Lan(198170) (Maung Gyi Htaunt) Sin Oe Pyin (Ywar Pyin Shey Ku
Taung Paing(198172) Wai(198236) Chaung(198359)
Min Ga Lar Gyi(197961) Kyee Kan Pyin (Tat Min Gyi)(198229) Lar(198238)
(Tat Min Chaung) (San Hnyin Wai) (Pyin Chaung)
(Min Ga Lar Gyi (South)(197945) Chaung) (Maung Gyi Htaunt) (San Hnyin Wai)
Kyauk Hlay Thar Zay (Kyee Kan Pyin) Sin Oe
(Pyin Hpyu)) Ku Toet Seik(198301) Pyin
Kar(197950) Kone(197957) Hpyar Mauk(198169) Pyin (Middle)(198230) San Hnyin Wai
Kyee Kan Pyin (Nan Yar Kone) Chaung(198358)
(Kyauk Hlay Kar) (Zin Paing Nyar) (Tat Min Chaung) (Maung Gyi Htaunt) (Rakhine)(198241) Yae Bu(198286)
(Middle)(197943) Let Pan (Pyin Chaung)
Haw Ri Tu Pale Taung(198297) Tha Yet Kin Ma (San Hnyin Wai) (Ka Nyin
Zin Paing (Kyee Kan Pyin) Nu(198291) Chaung) Chaung(198360)
Lar(197958) Nyar(197955)
Taung (Pale (Kun Taing (a) (Tha Yet Kin Ma Nu) (Pyin Chaung)
(Zin Paing Nyar) (Zin Paing Nyar) Ywar Ma Zee Pin Taung) Si Pin Thar
La Baw Taung)(198299)
Rakhine(198304) (Nan Yar Kone) Yar(198240)
Zar(197967) Nwar Yon
Doe Tan(197956) Done Chaung(198310) (Ywar Ma) Nan Yar Kone(198296) (San Hnyin Wai)
(La Baw Zar) Ah Kyaw(197968) Taung(197964)
(Zin Paing Nyar) (Let Wea Det Pyin (Kun Taing (a) Zee Pin Ta Man
(La Baw Zar) (Nwar Yon Taung) Let Wea Det(198316) Gone
Shey) Taung) Thar(198287)
(Let Wea Det Pu Nar(198305)
Har Bi (West)(197975)
(Bat Kar Gone
Nar) Khway
Bet Kar Gone
Nar(197973)
(Bat Kar Gone Nar)
Zun Chaung)
(Let Wea
Htin
Det
Shar
Pyin(198309)
Pyin
(Ywar Ma)
Shey)
Buthidaung Than
(Ka Nyin Chaung)
Lar Bin Gar(197974) Let Wea Chay(198300) Kyauk Pyin

(Bat Kar Gone Nar) Det(198308) Zay (Nan Yar Kone) Chaung(198288)
Kan Paing Nar(197937) (Let Wea Det Pyin Shey) Di Taung(198326) Kun Taing Ywar Gyi(198293) (Ka Nyin Chaung)
Pan Htein(197942) Haw Ri Tu Lar(197981)
(Shwe Zar Kat Pa (Shwe Zar Kat Pa Kaung) (Ka Kyet Bet Kan Pyin) (Kun Taing (a) Zee Pin Taung) Ah Shey(198294)
(Aye Tar Li Yar) Myauk(198322)
Kaung) Auk (Let Thar)(197982) Myaung Nar(198321) Kan Gyi (Kun Taing (a)
Zin Tu Lar(197979) (Ba Gone Nar)
Kyauktaw
(Aye Tar Sar Kon Boke(197983) (Ba Gone Nar) Pyin(198328) Zee Pin Taung)
(Aye
Kan Beit(197935) Shwe Zar Li Yar) (Aye Tar Li Yar) (Ka Kyet Bet Kan Pyin)
Tar Li Yar)
(Shwe Zar Kat Pa Kaung) (West)(197940) Zu La(197980) Kyauk Hla Pyin(198311) Oe Thei(198327) Taung
(Shwe Zar Kat Pa Kaung) Zay Di Pyin(197938) (Aye Tar Ywar Haung(197990) (Let Wea Det Pyin Shey) (Ywet Nyo Taung)(198346)
(Ka Kyet Bet
(Shwe Zar Kat Li Yar) (Myo Thu (Ywet Nyo Taung)
Gone Nar(197941) Ah Lel(198320) Kan Pyin)
2050N
2050N
Pa Kaung) Gyi)
(Shwe Zar Kat (Ba Gone Nar) Hnget Thay(198352) Ah Twin Hnget
Pa Kaung)
Aung Ba La(197939)
Kan (Ah Twin Thay(198349) Tha Yet Pyin
(Shwe Zar Kat
Kya (South)(197989) Hnget Thay) (Ah Twin Hnget Thay) (Rakhine)(198363)
(Myo Thu Gyi) (Tha Yet Pyin)
Pa Kaung)
Kan Gyi
Maungdaw Pyin(198323)
(Ba Gone Nar) Taung(198319)
(Ba Gone Nar)
U Hla
Hpay(198343)
(U Hla Hpay)
Thein Taung(198353)
(Ah Twin Hnget Thay)
Let Pan Htan Shauk Khan(198350)
Ba Gone Pyar Pin Yin(198351)
Kaing(198338) (Ah Twin Hnget Thay)
Nar(197998) (Ah Twin Hnget Thay)
(Kin Chaung) Pyar (Yi)
(Ba Gone Nar) Yae(198366) Hpon Nyo
Pyin
Pan Taw Pyin Ywar Shey(198340) Ahr Kar Pyan Ka (Lay Myo) Leik(198370)
(Kin Chaung) Mway(198339) (Hpon Nyo Leik)
Thit(197994) San Goe
(Kin Chaung) Zaw Baw(198374) Wa Ra Chaung Taung(198408)
(Pan Taw Pyin) Kin
Hpway Na Ru Tha Bauk Chaung(198336) Tha Peik Taung (Wa Ya Kyun) Kyun(198373) Pauk(198367) (San Goe Taung)
Ah Shey(197995) Yar(198000) Lar(197999) Chaung(198337) (Lay Myo)
(Kin Chaung) (Rakhine)(198377) (Wa Ya Kyun)
(Pan Taw Pyin) (Ba Gone Nar) (Ba Gone Nar) (Kin Chaung) (Tha Peik Taung) Na Nwin
Daing Net Taung Chay(198378)
Yae Hpu Pa Din(198003) Pyin(198384) Ku(198405)
Nu Nar Sar Ri(198010) (Du) Chee Yar Tan (Tha Peik Taung) (Kyauk Yant)
Pyin(198004) (Pa Din) (Sein Hnyin Pyar) Yet Sin Thay
((Du) Chee Yar Tan) (East)(198008) Pyin(198412)
(Pa Din) Taw Kan(198385) Chaung(198386) U Yin
((Du) Chee Yar Tan) (San Goe Taung)
(Sein Hnyin (Sein Hnyin Pyar) Thar(198410)
Pyin Shey Ah Shey Tin Set(198387) Pyar) Say Oe
(Ku Lar)(198383) (San Goe Taung)
(Sein Hnyin Kya(198401) Sa Par
(Pa) Nyaung Pin (Sein Hnyin Pyar) Pyar) (Say Oe Kya) Kyauk
(Du) Chee Yar Htar(198415)
Gyi(198020)
Tan (West)(198011) Ywar Thit Kay(198014) Yant (Rakhine)(198404) (Sa Par Htar)
((Pa) Nyaung Pin Gyi) Pyin Shey(198382) Khaung
(Ywar Thit Kay (Gaw Du (Kyauk Yant)
Zaw Ma Tet(198045) ((Du) Chee Yar Tan) Sein Hnyin Pyar
Dakhinpara (Sein Hnyin Taik(198411)
2045N
2045N
Thar Ra)) Zay(198381) Shat Shar
(Zaw Ma Tet) Pyar) (San Goe Taung)
Tha Ray Kon Gaw Du Thar Ra (Sein Hnyin Pyar) Taung(198409) Zay Di Taung
Baung(198016) (East)(198017) (San Goe Taung)
Din Gar(198046) (Rakhine)(198424)
(Ywar Thit Kay (Ywar Thit Kay
(Zaw Ma Tet) Gu Dar (Wet Ma Kya (a)
(Gaw Du Thar Ra)) (Gaw Du Thar Ra))
Pyin(198390) Zay Di Taung)
Hpoe Khaung Chaung(198393)
Tha Yae Kone Tan (Gu Dar Pyin) Zay Di Taung Lun Taung(197668)
(Hpoe Khaung Chaung (Sin Khone
(West)(198055) (Ku Lar)(198425) Yae Gaung
(a) Kan Pyin) Taing) Sin
Saw Gi Nar (Sin (Tha Yae Kone Tan) (Wet Ma Kya (a) Chaung(197678)
Na Mar)(198047) Zay Di Taung) Khone Taing Zay(197667) (Yae Gaung Chaung)
Gyin Hpa Yon Chaung Nga Yant
(Zaw Ma Tet) (Sin Khone Taing)
Chaung(198054) (Daing Nat)(198436) Chaung(197680)
Thay Kan
(Tha Yae Kone Tan) (Hpa Yon Chaung) Sin Khone Taing Sin Khone Taing (Yae Gaung Chaung)
Ka Nyin (Rakhine)(198433) Aung Taing Taung
(Ku Lar)(197666) (Rakhine)(197665)
Tan(198050) (Kyauk Hpyu Thar Pyo(197682)
(Sin Khone Taing) (Sin Khone Taing)
(Ka Nyin Tan) Thay Kan) (Yae Gaung Chaung)
Aung Taing (Laung Kha Yu
Wet Ma Kya(198430) Chaung(197679)
Kan Paing Gyi Gwa Son Chaung)(197681)
Saung Paing Nyar(198042) (Thay Kan Gwa Son) (Yae Gaung Chaung)
(Lower)(198034) (Rakhine)(198428) (Yae Gaung Chaung)
(Ah Lel Than Kyaw) (Chein Khar Pyaing Gaung Gyi(198429) (Thay Kan Gwa Son)
Li) Chein Khar Taung(198439) Hpa Yon Chaung (Thay Kan Oe Hpauk
Li(198041) (Hpa Yon Chaung) (Ku Lar)(198438) Gwa Son)
Maw Tu Lar(198032) Ywar Thit(197671) Oke Hpo (Oe
(Chein Khar Li) (Hpa Yon Chaung)
(Ah Lel Than Kyaw) (Oke Hpo (Oe Hpauk)) Hpauk)(197669)
Kywe Cho Maw(198444) (Oke Hpo (Oe Hpauk)) Pe Tha
Zay Kone Kan Paing Gyi (Ah Htet Kywe Kan Sit(197670) Du(197683)
Tan(198033) (Upper)(198031)
(Ah Lel Than Kyaw) (Ah Lel Than Kyaw)
Kon Tan (U Daung U Daung (Kone

Tan)(198023)
Cho Maw) (Oke Hpo
(Oe Hpauk))
Ohn Thaing
Chaung(197672) Ta Poke(198421)
(Ohn Chaung) (Thaing Ta Poke) Baw Di Kaing(197686)
Ahr Kar Yet Khone Taing(197673)

(Pe Tha Du)
(Pe Tha
Du)
Mrauk-U
Ah Nauk)(198024) Nay Pu Khan(197687) Let Wea Yae Chan Chaung
(U Daung) (U Daung) Taung(197674) (Yet Khone Taing) (Pe Kha Mway(197704)
Det(197689)
2040N
2040N
Zon Mar(198026) (Yet Khone Taing) Done(197688) (Yae Soe Chaung)
(U Daung) Hpar Ti (a) Zee Khaung(197675) Tha Du) (Pe Tha(Pe Du)Tha Du)
(Zee Khaung) Taung Yae Zar
Ko Ri(198025) Gaw Yar Chaung(197676) Yae Soe
Tha Pyay Khar Li(198058) Te Su(197705)
(U Daung) (Zee Khaung) (Yae Soe Chaung) Chaung(197702)
Taw(198062) Kyaung (Gaw Yar Khar Li)
Nga San Baw (Moke Soe Chaung) (Ywar Haung)(197690) (Yae Soe Chaung)
(Tha Pyay Taw) Taung(198059)
(Gaw Yar Khar Li) (Nga San Baw)
Pyaing Kin Pun
Kone Ah Myet Chaung(197703)
Taung(198449) Tan(197695) Taung(197691)
Doe Wai(198454) (Yae Soe Chaung)
(Pyaing Taung) (Pyein Taw) (Nga San Baw)
(Kywe Yine Khat) Aung Zay
Myin Hlut Ya(197693) Ma Nyin
(West)(198065) Kyauk Yan Thar
Hpway (Pyein Taw) Taung(197694)
(Myin Hlut) Maung Hpyu (Da Pyu Zay(197706)
Yar(198071) (Pyein Taw) Chaung)(197707) (Kyauk Yan Thar Zay)
Hpet Pyein
(Myin Hlut) Myin Hlut Myin Hlut (East)(198067) (Kyauk Yan Thar Zay)
(Middle)(198066) (Myin Hlut) Leik(197581) Taw(197692)
(Myin Hlut) (Hpet Leik) (Pyein Taw) Nyaung Pin
Myin Hlut Ywar Hla(197698)
Thit(198069) Tha Pyay Hman Ni Yae Myet (Ywar Yae Poke(197708)
(Yae Myet)
Kan Nar Ywar (Myin Hlut) Tar Zaw(197578) Taw(197582) Pyin(197584) Thit)(197696) (Kyauk Yan Kyauk Laing Gwin Gyi
Haung(198072) (Thein Taung) (Hpet Leik) (Kyein Tan) (Yae Myet) Thar Zay) Tan(197709) Kha Mway(197712)
(Myin Hlut) Shee (Kyauk Tan)
Dar(198070) Thin Ga Kyein Tan(197583) (Kyauk Tan)
Kyauk Pan (Kyein Tan) Sauk Khat Ywar Haung
(Myin Hlut) Net(197577) Pyin Yae Myet (Ywar Myaw Chaung Kha
Du(198075) (Tha Mee Hla)(197699)
(Thein Taung) Thein Taung(197576) Wan(197588) Haung)(197697) Mway(197711)
(Kyauk Pan Du) (Tha Mee Hla)
(Thein (Pyin Shey) Kan (Yae Myet) (Kyauk Tan)
Taung) Doe Wai Pyin(197587) Aung Myay
Kyauk
Chut Chaung(197585) (Pyin Shey) Kone(197700) Kyauk Tan Ywar Nwar Hla
Yan(197579)
Pyin(197590) (Kyein Tan)
(Thein Taung) Pyin Shey (Sa Hpo (Tha Mee Hla) Sauk Khat Ywar Thit(197710) Kyaw(197713)
(Chut Pyin) Kyun)(197586) Thit(197701) (Kyauk Tan) (Nwar Hla Kyaw)
Chin (Pyaing (Tha Mee Hla)
2035N
2035N
Taung)(197591) (Pyin Shey)
(Chut Pyin) Maw Htee Swea Ywar Htee Swea Ywar Laing Gwin Chay
Thet(197592) Thit(197716) Haung(197715) Aung Thar Kha Mway(197714)
(Chut Pyin) Htet(197580)
(Thein Taung) Zay Di (Htee Swea) (Htee Swea) Zay(197717) (Nwar Hla Kyaw)
Pyin(197589) (Htee Swea) La Mont
(Zay Di Pyin) Taing(197719)
Auk Nan (La Mont Taing)
Yar(197603)
(Auk Nan Yar) Thaung Da
Rar(197718)
Than Du(197600) Nwar Tin
Kyaung (Thaung Da Rar) Koke(197720)
(Pauk Pin Yin
Pauk
(Pauk Pin Yin(197599)
Taw)) Taung(197604) (La Mont Taing)
Pyaing Taung(197594) (Pauk Pin Yin (Pauk (Kyaung Taung)
(Ah Htet Be Lar Mi(197601) Taw)) Ywar Thit Sa Par
Nan Yar) (Pauk Pin Yin Ah Du(197602) Kay(197724) Htar(197721)
Thin Baw Kha Maung
(Pauk Pin Yin Gwa (Kha Naung Gyi) (Sa Par Htar)
Kwe(198078) (Pauk Taw)) Tone(197605)
(Pauk Taw)) Son(197606)
(Thin Baw Kwe) Ah Htet Nan (Gwa Son) (Kyaung Taung)
Yar(197593) Sin Oe(197595)
(Ah Htet Nan Yar) (Ah Htet Kan Pyin(197722)
Lay Gwa Son (Ywar Bar Ta
Ponnagyun
(Sa Par Htar)
Nan Yar) Kyun
Ka Nyin Thit)(197730) Lay(197743)
Paw(197608) Se Kan Ywar
Navy Seik(197596) Chaung(197607) (Lay Gwa Son) (Bar Ta Lay)
(Kyun Paw) Thit(197726)
(Ah Htet Nan Yar) (Ka Nyin Chaung) (Kha Naung Gyi) Lay Gwa Son (Ywar
Inn Din Nyaung Pin Hla(197598) Bat Kar(197728) Haung)(197729)
Kha Naung Se Kan Ywar
(East)(198081) Pan Kaing(197610) (Ah Htet Nan Yar) (Nga Tauk
Gyi(197723) Haung(197733) (Lay Gwa Son)
(Inn Din) (Pan Hpaw Pyin) Mi Nyo Htaunt(197611) Tu Gyi)
Pan Hpaw (Mi Nyo Htaunt) (Kha Naung Gyi) (Nga Tauk Tu Chay) Tha Yet Chaung
Inn Din (West)(198082) Pyin(197609) Kha Mway(197744)
(Inn Din) (Pan Hpaw Pyin) Nga Tauk Tu (Bar Ta Lay)
Mi Nyo Htaunt Pyar Pin Kan Pyin(197725)
2030N
2030N
Chay(197731)
Kyone Pyin(197615) Thar Si(197613) Ywar Thit(197612) Yin(197622) (Kha Naung Gyi) (Nga Tauk Tu Chay) Tun Ya Wai Ywar Kyein
(Thit Ka Toe) Thit Ka (Mi Nyo Htaunt) (Mi Nyo Htaunt) (Pyar Pin Yin) Pyar Thit(197746) Thar(197747)
Taung Hla Maw(197732)
Toe(197614) Chaung (Middle)(197740) (Tun Ya Wai) (Kyein Thar)
(Nga Tauk Tu Chay)
(Thit Ka Toe) (Pyar Chaung Gyi) Kar May
Bay of Bengal
Tun Ya
Pyar Chaung
Tha Win Chaung(198085) Kan Yan Aung
Wai(197745) (Rakhine)(197748)
Pyin(197616) Gyi(197739)
(Tha Win
Chaung) (Thit Ka Toe)
Baw Di Kone(197631) Mi Chaung Yae
(Kyauk Sar Taing) Thauk(197630)
Pyin(197617)
(Yan Aung Pyin) Rathedaung (Pyar Chaung Gyi)
Ah Wa
(Tun Ya Wai) (Kyein Thar)
Kar May (Kha
Mway)(197749)
(Kyein Thar)
(Kyauk Sar Taing) Pyin Kaung Ywar Dar(197742)
Kyauk Sar Pyin Kaung Ywar
Lone Tin(197618) Thit(197737) Haung(197741) (Pyar Chaung Gyi) Soe
Taing(197629) Kon Tan Zay(197632) (Yan Aung Pyin) (Pauk Taw)(Pyar Chaung Gyi)
(Kyauk Sar May(197750)
(Kyauk Sar Taing) (Soe May)
Taing) Khway Tauk Chaung
Ywar Thit (a) Hnin Aung Zay Pauk Taw Gyi(197752)
Pauk Taw Chay(197734)
Kon Ya(197738) (Lay Kan (Pauk
Si Kone(197624) (Pauk Wet Noke
(Pauk Taw)
Tan (Rakhine)(197619) Naw (Nyaung Pin Hla) Ah Lel Chaung(197626) Taw) Pauk Taw Chay Taw Gyi)) Thee(197751)
(Kon Tan) Wai(197621) (Nat Chaung) Ywar Thit(197735) (Soe May)
Nat
(Kon Tan) Chaung(197625) (Pauk Taw)
Myin Lay Kan(197753)
Hpu(197627) (Nat Chaung) (Lay Kan (Pauk Taw Gyi))
(Myin Hpu) Myin Hpu Ywar Kaung Ri Chaung Kyauk Ah Htet Na Gar
Koe Tan Kauk Thit(197628) Ywar Haung(197636) Son(197736) Say Oe Mauk(197757)
Ywar Ma(197652) (Myin Hpu) (Kaung Ri Chaung) (Pauk Taw) Min Kya(197754)(Na Gar Mauk) Auk Na Gar
(Koe Tan Kauk) Aung Kan(197760) (Say Oe Kya) Ah Lel Na Gar
Koe Tan Kyun Chaung(197637) Ku Taung(197761) Mauk(197755)
Mauk(197756)
Seik(197633) (Kaung Ri Chaung) Ku Taung Ywar (Min Kan) (NaMauk)
Gar Mauk)
Koe Tan Kauk Kauk(197649) (Aung Seik)
(Ku Taung) (Na Gar
Chay(197762)
(Rakhine)(197654) (Koe Tan Kauk)
(Ku Taung)
(Koe Tan Kauk) Kaung Ri Chaung Thet(197634) Tin
(Aung Seik)
2025N
2025N
Ywar Thit(197635) Nay Pu Paung Koke(197758)

Chein Khar Li
(Ku Lar)(197651) (Aung Seik) Khan(197641) Zar(197639) (Tin Koke)
Bar Sar
(Koe Tan Kauk) Ra(197653) (Paung Zar) (Paung Zar)
Than Ah Nauk Laung
Chein Khar Li (Koe Tan Kauk) Kyet Yoe Kone
Chaung(197638) Pyin(197763) Zin(197759)
(Rakhine)(197650) Tan(197640)
(Than Chaung) (Ah Nauk Pyin) (Tin Koke)
(Koe Tan Kauk) (Paung Zar) Taung Thar
Shwe Laung Tin(197765) Yar(197764)
Tha Yet Tha Yet Chaung(197642) (Shwe Laung Tin (Ah Nauk Pyin)
Pyin(197643) (Tha Yet Chaung) (Paik Seik))
(Tha Yet Chaung) Thar Zay
Myin Gan Htaunt(197770)
Chaung(197766) (Thar Zay Htaunt)
Myin Gan Chaung (Myin Gan Chaung)
Done Laung Kone Tan(197767)
(Myin Gan Chaung) Seik Gyi Nar(197768) Chay Yar
Paik(197655) Chaung(197644)
(Myin Gan Chaung) Taw(197771)
(Done Paik) (Laung Chaung) Kan (Thar Zay Htaunt)
Pyin(197777)
Ka Paing Aung Ma(197645) (Kan Pyin)
(Laung Chaung) U Gar(197769)
Chaung(197646)
(U Gar)
(Laung Chaung) Pyin Chaung Ku
Yae Lar(197647)
Hpyu Kan(197648) (Ka Paing) Hpyu
(Ka Paing) Kat Chaung(197772)
Yae Paik
Chaung(197778) (Hpyu Chaung)
Son(197774)
(Kat Chaung)
(Yae Paik Son) Daing Kyat(197773)
Kyet Yoe (Hpyu Chaung)
Thar Si(197659)
(Aung Ba La)
Aung Ba
La(197656)
(Aung Ba La) Nyaung Pin Gyi
Seik(197775)
(Kyet Yoe Seik)
Hpa Yar Hla(197776)
Ponnagyun
2020N
2020N
(Ku Lar)(197780) (Kyet Yoe Seik)

Sin Paik(197657) Ku Lar (Nyaung Pin Gyi) Auk Zee
(Aung Ba La) Nyaung Pin
Chaung(197660) Leik Taunt Teit Lel(197784) Kaing(197789)
(Ku Lar Chaung) Nyaung Pin Gyi Su(197785) (Nyaung Pin Lel) (Zee Kaing)
(Rakhine)(197779) (Nyaung Pin Lel)
Tan Aye(197658) (Nyaung Pin Gyi)
(Aung Ba La) Ah Lel Zee
Kyun
Pan Zin Gyi(197783) Kaing(197788) Let Pan Pin
Yin(197787)
Maw(197781) (Let Pan Pin Yin)
Ah Ngu Maw (Kone (Kyun Gyi) (Let Pan Pin Yin)
(Nyaung Pin Gyi)
Tan)(197661)
(Ah Ngu Maw Kone Tan) Sar Pyin Sar Pyin
Ma Gyi Chay(197782) Gyi(197786)
Chaung(197664) (Sar Pyin Chay) (Sar Pyin Gyi)
(Ah Ngu Maw)
Pauktaw
Ah Ngu Maw
(Rakhine)(197662)
(Ah Ngu Maw)
Ah Ngu Maw (Ku
Lar)(197663)
(Ah Ngu Maw)
Kilometers Sittwe
0 5 10 20
2015N
2015N
925E 9210E 9215E 9220E 9225E 9230E 9235E 9240E 9245E 9250E 9255E 930E 935E
Village Elevation (Meter) Map ID: MIMU297v01

Myanmar Information Management Unit (MIMU) is an Inter-Agency Standing
!
( Town 0 - 100 Committee (IASC) common resource providing information management services, Projection/Datum: Geographic/WGS84
International Line 101 - 200 including GIS mapping and analysis, to the humanitarian and development actors
State/Division Boundary 201 - 300 both inside and outside of Myanmar.
Creation Date: 16 October 2009. A-1
Village Nmae
Township Boundary 301 - 400 War Yar Lit (196214) Data Sources: Settlement - UNICEF
(Bu May) Village PCode
Road 401 - 750 Village Tract Name
info.mimu@undp.org Boundaries - WFP(2008) modified by MIMU (2009);
River
Placed names-Ministry of Home Affairs (GAD) Translated by MIMU
Disclaimer: The names shown and the boundaries used on this map do not imply official endorsement or acceptance by the United Nations.

Acf 2012 Myanmar Nutrition (A1y) Evaluation 2012 Full Report

Hochgeladen von

Dokumentinformationen

Originaltitel

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

Acf 2012 Myanmar Nutrition (A1y) Evaluation 2012 Full Report

Hochgeladen von

Copyright:

Verfügbare Formate

External Evaluation

Nutrition Programmes in the Maungdaw and Buthidaung

Funded by ECHO Juan Luis Domnguez-Gonzlez, May 2012

Photo ACF Myanmar

6 CROSS CUTTING PROCESSESp.34

Evaluation report ACF Myanmar / Mar-Apr 2012 2/50

ACF Action contre la Faim

Evaluation report ACF Myanmar / Mar-Apr 2012 3/50

Evaluation report ACF Myanmar / Mar-Apr 2012 4/50

A BACKGROUND TO THE EMERGENCY

ANALYSIS OF MALNUTRITION IN NRS

Evaluation report ACF Myanmar / Mar-Apr 2012 5/50

Evaluation report ACF Myanmar / Mar-Apr 2012 6/50

2.1 SOCIOPOLITICAL SITUATION

Evaluation report ACF Myanmar / Mar-Apr 2012 7/50

2.2 A BACKGROUND TO THE EMERGENCY5

Evaluation report ACF Myanmar / Mar-Apr 2012 8/50

Policies of exclusion and discrimination imposed on the Rohingyas by successive Burmese

2.3 ANALYSIS OF MALNUTRITION IN NRS7

a) High morbidity rates

Evaluation report ACF Myanmar / Mar-Apr 2012 9/50

i. Low access to free health services

Evaluation report ACF Myanmar / Mar-Apr 2012 10/50

ii. Poor care practices

There seems to be a statistical association between mothers and childrens nutritional

- No family planning services with limited antenatal and postnatal consultations.

c) Cultural, traditional and religious behavioural patterns

Evaluation report ACF Myanmar / Mar-Apr 2012 11/50

Evaluation report ACF Myanmar / Mar-Apr 2012 12/50

- High exposition of traumatic events such as torture and harassment.

d) Lack of food at household level

Evaluation report ACF Myanmar / Mar-Apr 2012 13/50

2.4 PROJECT BACKGROUND

Evaluation report ACF Myanmar / Mar-Apr 2012 14/50

MPC1 Maungdaw Downtown MPC2 Buthidaung Downtown

OTP1 Maungdaw Downtown OTP3 Buthidaung Downtown

OTP2 Ngan Chaung (NC) OTP4 Inn Chaung (IC)

OTP Activity summary

Evaluation report ACF Myanmar / Mar-Apr 2012 15/50

Evaluation report ACF Myanmar / Mar-Apr 2012 16/50

Access to MOH health services35

Evaluation report ACF Myanmar / Mar-Apr 2012 17/50

4.1 TERMS OF REFERENCE41

Evaluation report ACF Myanmar / Mar-Apr 2012 18/50

To assess the achievement of objectives against indicators, in addition to overall impact

4.2 EVALUATION TECHNIQUES

a) Interviews: every interview was conducted following a tailored questionnaire, included in

4.3 SOURCES OF INFORMATION

Evaluation report ACF Myanmar / Mar-Apr 2012 19/50

4.2.a Primary Data:

Half-structured Meetings with:

Focus Group Meetings with:

4.2.b Secondary data:

Evaluation report ACF Myanmar / Mar-Apr 2012 20/50

5.1 2003-2006 project development

Evaluation report ACF Myanmar / Mar-Apr 2012 21/50

5.2 2007-2010 project development

Evaluation report ACF Myanmar / Mar-Apr 2012 22/50

Acute malnutrition prevalence

Evaluation report ACF Myanmar / Mar-Apr 2012 23/50

5.3 2010 to 2011 project development

Evaluation report ACF Myanmar / Mar-Apr 2012 24/50

Evaluation report ACF Myanmar / Mar-Apr 2012 25/50