Sylvester Kathumba, Nutritionist, Malawi Ministry of Health - PowerPoint Presentation

Slide1

Sylvester Kathumba, Nutritionist, Malawi Ministry of HealthKate Golden, Senior Nutrition Adviser, Concern, Dublin

CMAM Advisory Service in Malawi:

s

even years of scaling upSlide2

Background: CAS timeline & objectives

2006:

The

government of Malawi expressed its intention to scale up CMAM – for both SAM & lesser extent MAM

2006: CTC Advisory Services launched jointly by Concern & Malawi MoH; 5-year project (extended to 7) to:Standardize CMAM service delivery and toolsDevelop & roll out CMAM policy and guidelinesBuild capacity for CMAM service delivery at all levelsEstablish & manage a national CMAM reporting & monitoring systemAdvocate for strategic integration of CMAM into the health system

2013:

Concern’s

formal support to CAS

ended

in March

Final evaluation in July/August

Malawi

MoH

now taking over CAS functionsSlide3

Background: MalawiMalawi has:5 zones29 districts

618

health centresEstimated SAM case load at any time: 39, 062 (under-five prevalence of 1.5%, DHS 2010)Estimated GAM case load at any time: 104, 167

(under-five prevalence of 4.0%, DHS 2010)Slide4

Findings: coverage of facilities = 80%28,467 SAM children treated in 2012 and 36,122 MAM children81% of health facilities in 24 of total 29 districts now provide CMAM services

But

, no national survey of beneficiary coverage

conducted. Slide5

Findings: Cure rates above Sphere standardsSlide6

Conclusions: what has workedRapid scale up was facilitated by a fairly narrow CMAM focus CMAM guidelines finalised in 2007, recently reviewedCMAM

included in Essential Health Package

&

national policies Standard CMAM training package developed for in-service & (some) pre-service training A cadre of CMAM trainers at national level (30) & district (290) responsible for ongoing training

A costed CMAM Operational Plan helped coordinate actors 18 Learning Forums for real time exchanges & review of scale upEvolution of training curriculum to include practical aspects such as costing CMAM activities - most CMAM costs now included directly in District plans (minimal NGO funding direct to districts) Slide7

Conclusions: what could be improvedCAS largely achieved objectives, but not enough focus on service quality Inclusion of CMAM training in pre-service curriculum depends on wider, sometimes complex curriculum development processes

Support

strategy focused too much at national

level. District support was key, but not enough focus on zonal teams, who have become key players in the decentralisation process. Still need better monitoring of actual coverage of SAM cases (not just facilities) & strategies to identify & overcome access barriers as part of routine health service monitoring

A costed CMAM operational plan proved useful, but only developed in year 2; commitments & progress not well monitoredSlow integration of CMAM database into HMIS – complex processSlide8

Conclusions: future directionMoH will now take responsibility to:Regularly review the CMAM Operational Plan

Decentralise monitoring to the Zone and district level

Manage the CMAM database & integrate in HMIS

Ensure all core CMAM activities are included in District Implementation PlansMany of the CAS platforms & mechanisms can now be utilised for scaling up broader nutrition interventions beyond CMAMSlide9

Zikomo!“This project

was made possible by the generous support of the American people through the United States Agency for International Development (USAID)

&

Concern Worldwide. The contents are the responsibility of  Concern Worldwide and do not necessarily reflect the views of USAID or the United States Government and/or implementing partners.

Thank you to all the partners in Malawi that have made the CMAM Advisory Services & the scale up of CMAM in Malawi a success