Standard Operating Procedures for Activation of
Description: Standard Operating Procedures for Activation of Select Simplified Approaches. Orientation on SOP, Sept 5, 2022 Simplified approaches refer to modifications simplifications to existing national and global protocols for the treatment of
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slide1. Standard Operating Procedures for Activation of Select Simplified Approaches. Orientation on SOP, Sept 5, 2022<br>
slide2. Simplified approaches refer to modifications/ simplifications to existing national and global protocols for the treatment of child wasting. These modifications are designed to improve effectiveness, quality, coverage and reduce the cost of caring for children with uncomplicated wasting.
The Simplified Approaches can be used to maintain service availability and continuity in exceptional circumstances until standard programming is established or resumes.
This Somalia SOP is adapted from the USING SIMPLIFIED APPROACHES IN EXCEPTIONAL CIRCUMSTANCE Guidelines Published by UNICEF Nutrition in collaboration with the global Simplified Approaches Working Group. What the simplified approaches?<br>
slide3. Family MUAC: Engaging family members to screen and refer their children
CHW-led treatment of wasting: Management of wasting by Community Health Workers (CHWs)
Reduced Frequency of Follow-up Visits
MUAC and oedema only: Admission, treatment, discharge based on Mid-upper arm circumference (MUAC) and/or oedema
Expanded admissions criteria: Systematic expansions of MUAC to include more children (e.g., 120mm or 125mm)
Use of a single treatment product: Use of ready-to-use food (RUF) for the treatment of all wasted children in need of treatment
Optimized Dosage: Treatment dosage of RUTF product modified over course of recovery What the simplified approaches?<br>
slide4. Recurrent drought= high prevalence of acute malnutrition with exacerbating factors.
Existing IMAM services affected by pipeline breaks
Continuum of care not reached due to low coverage and pipeline breaks
Limited resources and capacities.
Mitigation measures
MoH, NC, UN, partners developed a strategy including the Simplified Approaches Why simplified approaches in Somalia?<br>
slide5. Tool to guide activation, rollout and implementation of appropriate simplified approaches.
Current timeframe for implementation = Aug 2022 to June 2023.
Can be extended in consultation with the CLA, WFP, MoH and partners.
Partners that procure their own supplies should utilize the SOP too. SOP strategy<br>
slide6. Overall objective:
To improve the quality and coverage of the management of uncomplicated acute malnutrition among children 6-59 months in critical contexts.
Specific objectives:
To increase the coverage of acute malnutrition treatment services among children 6-59 months in locations with GAM rates ≥ 15% in the presence of aggravating factors with neither OTP nor TSFP services.
To provide a sustainable continuum of care for the treatment of acute malnutrition in locations with a GAM rate of ≥ 15% in the presence of aggravating factors where MAM and/or SAM treatment services are interrupted due to supply, financial or human resources limitations. SOP strategy<br>
slide7. Expanded admission criteria of uncomplicated acute malnutrition among children 6-59 months and treatment using a single product:
Where the is OTP and not TSFP:
Increasing MUAC and weight for height z score cut-offs for admission and treatment in OTP to <125mm and <-1.5 Z score
For SAM cases, dosage based on weight as per the national IMAM protocols
MAM children given 1sachet of RUTF per day irrespective of weight
Where there is TSFP and not OTP
Admission criteria based on bilateral pitting oedema(+, ++), MUAC <125 mm and <-2 weight for height z score) in children 6-59 months
Treat all cases detected based in above criteria in TSFP
SAM children receive 2 sachets of RUSF irrespective of weight per day and MAM cases receive one sachet per day.
Visit frequencies are weekly for SAM cases and fortnightly for MAM cases Proposed Simplified Approaches in the Context of Somalia<br>
slide8. Family MUAC: Already being promoted and done by some MoH, UN agencies and partners.
Community Health Worker (CHW) led treatment of uncomplicated wasting. Currently implemented by some partners but not streamlined
Reduced frequency of follow-ups. Other proposed simplified Approaches<br>
slide9. Activation of the simplified approaches.
Exceptional circumstances
Pipeline breaks for more than 2 months
Lack of either SAM or MAM treatment services.
Hard-to-reach and inaccessible locations
Hard-to-reach and inaccessible locations
Locations with a GAM rate of ≥ 15% with aggravating factors. Decision pathway<br>
slide10. Decision pathway: Activation scenarios and adoptable simplified approaches.. Pipeline break of nutrition supplies* for the treatment of MAM** OR SAM for more than 2 months. or absence of either OTP or TSFP services.
AND District with a GAM rate of ≥ 10% with aggravating factors. Expanded Admission Criteria
Use of a Single Product in OTP or TSFP
Family MUAC Scenario 2
Hard-to-reach and inaccessible locations
AND: Lack of either SAM or MAM treatment services.
AND: Locations with a GAM rate of ≥ 15% with aggravating factors. Expanded Admission Criteria and Use of a Single Product for treatment
Reduced frequency of follow-up treatment:
Family MUAC
OR
CHW-led treatment of wasting (integrated into iCCM) Deactivation for scenario 1
pipeline breaks are resolved (supply assured for > 3 months.
Establishment of either OTP or TSFP sites in locations where expanded criteria were triggered as a result of an absence of either.
GAM rates have reduced to <10% without aggravating factors Deactivation for scenario 2
Area has become accessible.
OTP and or TSFP established and operational for at least 3 months
GAM reduced to 10-14% without aggravating factors
GAM rates have reduced <10% with aggravating factors<br>
slide11. Activation process Initial trigger: changes in the humanitarian context (increased malnutrition, aggravating factors, poor coverage.
Creation of a task force (NCC, MoH, UNICEF, and WFP, other)<br>
slide12. Target Beneficiaries: children 6-59 months in special contexts with uncomplicated acute malnutrition
Areas of implementation: locations with exceptional circumstances as defined in the decision pathway.
Partner selection: Several factors including capacity, access, geographical coverage, Local Vs International, staffing capacity, functionality of OTPs etc.
-Will depend on due diligence of the NCC desk<br>
slide13. Factors to consider during caseload calculation:
UNICEF’s RUTF pipeline capacity to support the expected caseload.
WFP’s RUSF pipeline capacity to support the expected caseloads.
The overall nutritional situation and needs
Expected duration of implementation of the simplifications (weeks or months).<br>
slide14. Roles and responsibilities of stakeholders NCC desk
Overall coordination
Regularly map areas that meet the exceptional circumstances scenarios
Orientation of implementing partners
Overall monitoring of the nutrition situation
Regular updates of partners on
Dissemination of the lessons learned
Programme, GAM rate, and geographical coverage data UN (UNICEF/WFP)
Supplies procurement and prepositioning of RUTF/RUSF
Logistical support to partners
Technical backstopping
Knowledge management and documentation of lessons learned
Date on the response matrix<br>
slide15. Roles and responsibilities of stakeholders MoH
Orientation of frontline workers on the SOP
Implementation
Monitoring and reporting
Sharing lessons learned and feedback on the Overall monitoring Implementing partners
Support the NCC Desk in the mapping of areas that meet the exceptional circumstances scenarios.
Orientation of frontline workers
Implementation of the
Monitoring and reporting
Sharing lessons learned and feedback
Key Operational instructions and recommended actions<br>
slide16. Use existing OTP/TSFO tools
NC to have a system to track locations implementing the approaches
ONA template to capture MAM cases
Data disaggregation by SAM and MAM
All children to receive treatment cards
Program performance will be based on standard indicators in the national guidelines Monitoring and reporting<br>
slide17. Any changes to be done in consultation and coordination with the CLA, WFO, Government, partners
Other aspects of care to follow the national IMA guidelines.
Living document
All partners to adhere to SOP even when using their own supplies
Duration of implementation: temporary/3months/dependent on context evolution Key points<br>
slide18. Thank you<br>
slide2. Simplified approaches refer to modifications/ simplifications to existing national and global protocols for the treatment of child wasting. These modifications are designed to improve effectiveness, quality, coverage and reduce the cost of caring for children with uncomplicated wasting.
The Simplified Approaches can be used to maintain service availability and continuity in exceptional circumstances until standard programming is established or resumes.
This Somalia SOP is adapted from the USING SIMPLIFIED APPROACHES IN EXCEPTIONAL CIRCUMSTANCE Guidelines Published by UNICEF Nutrition in collaboration with the global Simplified Approaches Working Group. What the simplified approaches?<br>
slide3. Family MUAC: Engaging family members to screen and refer their children
CHW-led treatment of wasting: Management of wasting by Community Health Workers (CHWs)
Reduced Frequency of Follow-up Visits
MUAC and oedema only: Admission, treatment, discharge based on Mid-upper arm circumference (MUAC) and/or oedema
Expanded admissions criteria: Systematic expansions of MUAC to include more children (e.g., 120mm or 125mm)
Use of a single treatment product: Use of ready-to-use food (RUF) for the treatment of all wasted children in need of treatment
Optimized Dosage: Treatment dosage of RUTF product modified over course of recovery What the simplified approaches?<br>
slide4. Recurrent drought= high prevalence of acute malnutrition with exacerbating factors.
Existing IMAM services affected by pipeline breaks
Continuum of care not reached due to low coverage and pipeline breaks
Limited resources and capacities.
Mitigation measures
MoH, NC, UN, partners developed a strategy including the Simplified Approaches Why simplified approaches in Somalia?<br>
slide5. Tool to guide activation, rollout and implementation of appropriate simplified approaches.
Current timeframe for implementation = Aug 2022 to June 2023.
Can be extended in consultation with the CLA, WFP, MoH and partners.
Partners that procure their own supplies should utilize the SOP too. SOP strategy<br>
slide6. Overall objective:
To improve the quality and coverage of the management of uncomplicated acute malnutrition among children 6-59 months in critical contexts.
Specific objectives:
To increase the coverage of acute malnutrition treatment services among children 6-59 months in locations with GAM rates ≥ 15% in the presence of aggravating factors with neither OTP nor TSFP services.
To provide a sustainable continuum of care for the treatment of acute malnutrition in locations with a GAM rate of ≥ 15% in the presence of aggravating factors where MAM and/or SAM treatment services are interrupted due to supply, financial or human resources limitations. SOP strategy<br>
slide7. Expanded admission criteria of uncomplicated acute malnutrition among children 6-59 months and treatment using a single product:
Where the is OTP and not TSFP:
Increasing MUAC and weight for height z score cut-offs for admission and treatment in OTP to <125mm and <-1.5 Z score
For SAM cases, dosage based on weight as per the national IMAM protocols
MAM children given 1sachet of RUTF per day irrespective of weight
Where there is TSFP and not OTP
Admission criteria based on bilateral pitting oedema(+, ++), MUAC <125 mm and <-2 weight for height z score) in children 6-59 months
Treat all cases detected based in above criteria in TSFP
SAM children receive 2 sachets of RUSF irrespective of weight per day and MAM cases receive one sachet per day.
Visit frequencies are weekly for SAM cases and fortnightly for MAM cases Proposed Simplified Approaches in the Context of Somalia<br>
slide8. Family MUAC: Already being promoted and done by some MoH, UN agencies and partners.
Community Health Worker (CHW) led treatment of uncomplicated wasting. Currently implemented by some partners but not streamlined
Reduced frequency of follow-ups. Other proposed simplified Approaches<br>
slide9. Activation of the simplified approaches.
Exceptional circumstances
Pipeline breaks for more than 2 months
Lack of either SAM or MAM treatment services.
Hard-to-reach and inaccessible locations
Hard-to-reach and inaccessible locations
Locations with a GAM rate of ≥ 15% with aggravating factors. Decision pathway<br>
slide10. Decision pathway: Activation scenarios and adoptable simplified approaches.. Pipeline break of nutrition supplies* for the treatment of MAM** OR SAM for more than 2 months. or absence of either OTP or TSFP services.
AND District with a GAM rate of ≥ 10% with aggravating factors. Expanded Admission Criteria
Use of a Single Product in OTP or TSFP
Family MUAC Scenario 2
Hard-to-reach and inaccessible locations
AND: Lack of either SAM or MAM treatment services.
AND: Locations with a GAM rate of ≥ 15% with aggravating factors. Expanded Admission Criteria and Use of a Single Product for treatment
Reduced frequency of follow-up treatment:
Family MUAC
OR
CHW-led treatment of wasting (integrated into iCCM) Deactivation for scenario 1
pipeline breaks are resolved (supply assured for > 3 months.
Establishment of either OTP or TSFP sites in locations where expanded criteria were triggered as a result of an absence of either.
GAM rates have reduced to <10% without aggravating factors Deactivation for scenario 2
Area has become accessible.
OTP and or TSFP established and operational for at least 3 months
GAM reduced to 10-14% without aggravating factors
GAM rates have reduced <10% with aggravating factors<br>
slide11. Activation process Initial trigger: changes in the humanitarian context (increased malnutrition, aggravating factors, poor coverage.
Creation of a task force (NCC, MoH, UNICEF, and WFP, other)<br>
slide12. Target Beneficiaries: children 6-59 months in special contexts with uncomplicated acute malnutrition
Areas of implementation: locations with exceptional circumstances as defined in the decision pathway.
Partner selection: Several factors including capacity, access, geographical coverage, Local Vs International, staffing capacity, functionality of OTPs etc.
-Will depend on due diligence of the NCC desk<br>
slide13. Factors to consider during caseload calculation:
UNICEF’s RUTF pipeline capacity to support the expected caseload.
WFP’s RUSF pipeline capacity to support the expected caseloads.
The overall nutritional situation and needs
Expected duration of implementation of the simplifications (weeks or months).<br>
slide14. Roles and responsibilities of stakeholders NCC desk
Overall coordination
Regularly map areas that meet the exceptional circumstances scenarios
Orientation of implementing partners
Overall monitoring of the nutrition situation
Regular updates of partners on
Dissemination of the lessons learned
Programme, GAM rate, and geographical coverage data UN (UNICEF/WFP)
Supplies procurement and prepositioning of RUTF/RUSF
Logistical support to partners
Technical backstopping
Knowledge management and documentation of lessons learned
Date on the response matrix<br>
slide15. Roles and responsibilities of stakeholders MoH
Orientation of frontline workers on the SOP
Implementation
Monitoring and reporting
Sharing lessons learned and feedback on the Overall monitoring Implementing partners
Support the NCC Desk in the mapping of areas that meet the exceptional circumstances scenarios.
Orientation of frontline workers
Implementation of the
Monitoring and reporting
Sharing lessons learned and feedback
Key Operational instructions and recommended actions<br>
slide16. Use existing OTP/TSFO tools
NC to have a system to track locations implementing the approaches
ONA template to capture MAM cases
Data disaggregation by SAM and MAM
All children to receive treatment cards
Program performance will be based on standard indicators in the national guidelines Monitoring and reporting<br>
slide17. Any changes to be done in consultation and coordination with the CLA, WFO, Government, partners
Other aspects of care to follow the national IMA guidelines.
Living document
All partners to adhere to SOP even when using their own supplies
Duration of implementation: temporary/3months/dependent on context evolution Key points<br>
slide18. Thank you<br>