Management of Acute Malnutrition but doing it differently Anne Philpott Nutrition Adviser Abigail Perry Humanitarian Adviser UK Department for International Development Introduction ID: 810230
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Slide1
Scaling up Community based Management of Acute Malnutrition; but doing it differently
Anne Philpott, Nutrition
Adviser
Abigail
Perry, Humanitarian
Adviser
UK
Department for International
Development
Slide2IntroductionCMAM has been a common element of our humanitarian programmes since the CTC model was first establishedIn recent years, DFID has been expanding nutrition investments:2011: Nutrition Position Paper published, outlining our goal to
reach 20 million pregnant women and children under five with nutrition relevant
services
by
2015
June
2013:
co-hosted
a global summit ‘Nutrition for Growth’ that galvanised additional £2.7 billion of financial commitments for nutrition
and published a compact
endorsed
by more than 100
stakeholders committed
to reduce
stunting.
DFID
committed to triple
its nutrition
funding by
2020
Increasingly providing longer-term funding for CMAM through national governments, including budget support and sector reform programmes
Today we will highlight some examples and our lessons from ‘doing CMAM differently’
Malawi
Ethiopia
India
Kenya
Slide3Malawi –Health Ministry and UNICEFDFID Malawi works with MoH to treat SAM – covering 85% of the health facilities. However a period of food insecurity meant that it was strengthened in 16 food insecure districts with DFID’s funding through UNICEF.Severe acute malnutrition
treatment in hospital with Nutrition
Rehabilitation
Centres
with therapeutic milk – and treatment at health facility, with therapeutic food – RUTF. Complemented with growth monitoring and promotion, Vitamin A supplementation, immunization, treatment of common childhood diseases for children under 5 years of old.RUTF local production with Valid International.
Slide4India –Health, Nutrition Depts and NGOsIndia has 40 % of global burden of SAM and no treatment in communityVery small scale provision under ‘emergency’ floods in BiharSince 2010 Govts
of
Odisha
, Madhya Pradesh with DFID, Valid and Right to Food NGOS are moving towards piloting CMAM –
Testing small scale women’s groups production
Comparing community with hospital treatmentState Agri companies piloting production in Madhya PradeshMinistry of Health issuing CMAM guidelines imminentlyMinistry of Women and Child Development in MP and Odisha testing community approaches to SAMPlans to develop a public sector product
Slide5Ethiopia – with Health Dept & UNICEFIn the new £36.3 million DFID funding programme support to make CMAM and integral part of Ethiopian National Nutrition Program. ensuring access to quality CMAM services and securing procurement of therapeutic food for CMAM through
multi-year and predictable funding for the program
.
CMAM
services will be expanded and integrated as routine service in every health post and at least one Stabilisation Centre (SC) per woreda (district)Aim is to integrate CMAM into the public health system of Ethiopia Regional Health Bureaus strengthened
to coordinate with NGOs
, forecast and manage supplies of therapeutic foods, and monitor performance.
Health Extension Workers’ supervisors will be trained to undertake accurate assessment of the overall
CMAM service quality using a score card system.
Government supply chain and logistics management will be strengthened and
CMAM supply chain management
will be progressively transitioned into the government’s Pharmaceutical Fund and Supplies Agency (PFSA) of the MOH. UNICEF has undertaken supply chain bottleneck analysis and RUTF leakage assessment
CMAM rollout in Ethiopia has enabled access to
trend data on admissions of severely malnourished children
to health facilities over the past few years – easy to see the progress or deterioration of a given nutrition situation.
Slide6Kenya ASALs – Emerging from humanitarian crisis£16.8 million between 2012 and 2015 to support scale up of HiNi* in arid
and semi-arid lands (
ASALs
)
through health system
Funding through NGOs to support service delivery and capacity strengtheningFunding through UNICEF to support system strengthening and county-level planning for nutritionFocus on flexibility in context of fluctuating GAM %:Supply chain management / forecastingHR surge capacityEarly warning / triggersKey challenges: gaps in broader health system, balancing focus on nutrition, underlying causes, availability of other donor
funding
*High impact Nutrition interventions
Slide7ConclusionDifferent contexts means there is currently no one-size-fits-all approach to funding CMAMKey to work within existing (or future) policies and systems to ensure CMAM can be sustained Critical period for lesson learning - for DFID and the broader nutrition community:
Implementing at scale
Building commitment and developing policy / practice
Positioning nutrition within health systems
Bridging development and humanitarian response through flexible approaches