Presenter: Dr. Sisay Sinamo (MD, MPH)Nutrition Advisor,

East Africa Regional Office

Outline 1. Purpose of the presentation 2. Rational for Integration 3. Status of CMAM integration in Africa 4. MoH Integration: A case of Ethiopia 5. Aims of IYCF into CMAM ToT and planning

workshop6. Integrating IYCF into CMAM ToT 7. Integrating IYCF into CMAM planning workshop8. Action plans 9. Roll-out and lesson

1) Purpose of the presentation

To share experiences in CMAM integration in MoH system and progress made to generate evidence on complementary models

2) Rational for Integration Effective model for the rehabilitation

malnourished children

Operational - variety of settings (stable and emergency)

More than 500,000 acutely malnourished children were rehabilitated

Trained over 10,000 community health workers and 2000 health workers

2) Rational for Integration CMAM integration

into MoH system: 2008

Evidence on the project model effectiveness

Demand for national level programming

MoH readiness and ownership to take the lead: guideline and tools

Complementary models: 2010

• CMAM provides timely and appropriate intervention to improve child survival

• Lack of linkage between the ‘rehabilitative approach’ and preventive approaches

• Partners collaboration to develop the tools and test model

3) Status of CMAM Integration Currently almost all countries has CMAM guideline

CMAM is considered as part of regular health service activity

NGOs are called when the case load is high; except

fragile state

MoH is responsible for logistics transport and training

NGOs minimal support to ensure the quality of the program

3) MoH Integration: A Case of Ethiopia Strong national level Emergency Nutrition Coordination

SAM Guideline approved in 2007

CMAM decentralization to the health post level in 2008 All food insecure districts has trained man power

Health workers are responsible for case management and reporting

Community volunteers conduct screening, referral and follow up

4) Complementary Models Two complementary models are under

operational research in Ethiopia:

IYCF support into CMAM

PD Hearth in the context of CMAM and ENA

4.1) IYCF support into CMAM OR It is joint 2 years OR project between WV, SC US,

ENN and Hawassa University

The OR project is operational in two WV Ethiopia ADPs (one intervention and one control)

The goal of the study is to test and document

models of IYCF-CMAM integration. How best to integrate activities that support,

promote and protect  IYCF into CMAM programs The efficacy of integrating IYCF support into

CMAM

4.1) IYCF support into CMAM OR Phase 1: 6 months

study design

stakeholder consultations;

ToT IYCF-CMAM integration

baseline IYCF assessments;

compilation and adaptation of IYCF-CMAM integration tools:

Phase 2: 12 months

Implementation

Training at district/site level

Testing of tools and job aids; wall chart, brief case and family folder

Data collection through cohort follow-up;

In-country mid-term review meeting

Phase 3: 6 months

Final IYCF assessment

data analysis and review,

In-country technical analysis and dissemination workshop,

Publication: research results and lessons learned

4.2) PD Hearth in Context of CMAM and ENA Is a joint 2 years OR project between WVE, WVK,

WITH and EHNRI

The overarching goal is to evaluate the effectiveness of:

Target Groups: children 6 – 24 months

the PD Hearth approach integrated into the context of the ENA & CMAM program on child growth and key child caring and feeding practices

Comparing with children in the ENA intervention and the CMAM program only.

4.2) PD Hearth in Context of CMAM and ENA Is a joint 2 years OR project between WVE, WVK,

WITH and EHNRI

The overarching goal is to evaluate the effectiveness of:

Target Groups: children 6 – 24 months

the PD Hearth approach integrated into the context of the ENA & CMAM program on child growth and key child caring and feeding practices

Comparing with children in the ENA intervention and the CMAM program only.

Improvement of child growth

Caregivers’ behavior change in ENA practices

4.2) PD Hearth in Context of CMAM and ENA

Pathway to the reduction of malnutrition

Counseling

Learning by doing

Caregivers’ behavior change in child feeding, caring and health seeking practices

Control

Intervention

4.2) PD Hearth in Context of CMAM and ENA

5) Lesson Increased national and regional partnership

opportunity and organizational visibility

WV and partners staff equipped in key CMAM competencies and quality of program improved over the past years

Provide opportunity to work with research institutes, universities in operational research

6) Way forward Provide ongoing technical support

CMAM projects & operational research projects

Document the lessons

Support the roll-out of project models and complementary models

Questions?