Global experiences of CMAM scale-up A synthesis of lessons · Expert trainers (practically skilled...
Transcript of Global experiences of CMAM scale-up A synthesis of lessons · Expert trainers (practically skilled...
Federal DemocraticRepublic of EthiopiaMinistry of Health
EmergencyNutritionNetwork
CMAM/SUN Conference14th - 17th November 2011
Addis Ababa, EthiopiaScaling up Community Management of Acute
Malnutrition and Scaling up Nutrition (SUN)
Global experiences of CMAM scale-upA synthesis of lessons
Carmel Dolan, Jeremy Shoham & Andres Mejia Acosta (ENN)
Aim
Identify common enabling factorsand challenges
Contribute to genericguidance/lessons for scale up
Ways forward
Synthesis Report:
A work in progress…..
Informed by conference deliberations
Finalise and disseminate postconference
Some broad conclusions/lessons (1)
Getting CMAM onto the Agenda
Emergencies
Pilots
Determination of the scale of SAM
Agenda setting and keeping it there
Dialogue with experts and support from agencies
National champions for CMAM can come fromdifferent levels
Demand driven from districts seeing results
Technical groups/forums/exposure visits, learningsites
Inclusive process of developing guidelines
Some broad conclusions/lessons (2)Policies
Policy setting facilitated by group with buy in from nutritionpartners – advocating with one voice
Reflecting CMAM in health policy essential… but not sufficient
Planning
Scale up plans
Reliance on short term funding
Lack of good costing data
Some broad conclusions/lessons (5)Health system decentralisation andprogramme linkages
Balancing the degree of decentralisation (to achieve coverage)and capacity (to implement quality CMAM)
Integration within health/nutrition programmes-many entrypoints and
Between sectors
Inclusion of SFPs
Some broad conclusions/lessons (3)Developing Capacity-Health Structures& Communities
Additional human resources particularly at district and/or regionallevel.
Capacity development a challenge with short term funding
NGOs shift focus to capacity development -more reliable funding
Community component often not prioritised at beginning
OTP Dafur
Some broad conclusions/lessons (4)Developing Capacity (training)
Expert trainers (practically skilled on CMAM) conducting trainingwith follow-up mentoring has proved most effective
Train everyone (avoids turnover issues)
Training/mentoring for management of CMAM has provedparticularly important (planning, supply chain, monitoring andreporting, supervision) at district/regional level
Pre service training identified as a need everywhere but nothappening
Some broad conclusions/lessons (7)Speed and Modality
Balance speed for scale-up with programme quality
Balance geographical coverage with ‘true’ coverage
Phased approach, expanding based on demonstrated quality ofservice, and availability of resources has proved successful
Gradual building of coverage by adding measures to assess andact upon poor coverage
To much too soon can be triggered by short term funding anddetrimental to quality
Some broad conclusions/lessons (6)Supervision and MonitoringInsufficient supervision capacity & incomplete and late reporting
Joint supervision, third party monitoring
Simplification of monitoring formats
Potential to include some (not all) CMAM indicatorsin HMIS
Rapid SMS
Sphere indicators appear mostly reached in case studies
Coverage may need context specific timeframe
Coverage monitoring is essential
Some broad conclusions/lessons (7)
CMAM Financing
Majority of CMAM funding has come from emergency budgets
Short term funding reliance has limited scale-up.
Chronic emergency countries have managed to achieve scale-upwith short term funds
New opportunities from donors for longer term funding
Scaling Up Nutrition movement may offer main mechanism forintegrating CMAM into longer term arrangements
Some broad conclusions/lessons (7)CMAM Financing –key questions
Stop Start CMAM programming?
Global fund for CMAM?
How widespread new funding initiatives?
Can bilateral budgets support be used for CMAM?
Some broad conclusions/lessons (8)Supply – RUTF
Storage and constant supply issues
Pipeline breaks common
Registering RUTF as essential commodity
Forecasting problematic if based on estimates
Ways of improving reliability of pipeline
Some broad conclusions/lessons (9)Local Production of RUTF-what are the benefits?
Out of 9 case study countries, 5 are workingtowards local production
Reduced transit time, cost reductions (transport),support of local industry and farmers
Limited by number of factors, e.g. patent,ingredient costs, ingredient quality (peanuts),quality control requirements
Partnerships with producers, NGOs and farmers,working capital (investors), private sector
A Nutrition Governance Approach to CMAM
• Central Government Coordination• National development agendas• Strong executive leadership for coordination
• The effective decentralisation of CMAM• CMAM implementation at all government levels• Alternative decentralisation paths• The role of local elites
• The financing of CMAM• From emergency funding into long term funding• From donor dependency to government ownership
Central Government Coordination
• Embedding CMAM into National Development Agendas
• The Executive can play a critical role to generate greaterpolitical commitment around CMAM
• Strong executive leadership for coordination
• The Executive can play a significant role to improve thesustainability and quality of CMAM programming
The effective decentralisation of CMAM
• CMAM implementation at all government levels• Pre-existing decentralisation of governments contributed toeffective implementation
•Alternative decentralisation paths• Training, capacity development, and data sharing arealternative drivers to facilitate decentralisation
• The role of local elites• Increased local ownership can contribute to effective CMAMimplementation and scale up
The financing of CMAM
• Shifting from emergency funding into long term funding• Developing cost estimates to achieve long term CMAM goals• Promote greater political commitment through budgetsupport or nutrition sector earmarks
• From donor dependency to government ownership• In some cases, governments can reduce costs of RUTFthrough public-private partnerships, working with farmers,etc.• To improve the collection, reliability and transparency ofcosts and expected coverage data around CMAM
Acknowledgements
Tanya Khara, (ENN Consultant)Andres Mejia Acosta (IDS/ENN Consultant)Jeremy Shoham and Carmel Dolan (ENN)Emily Mates and Marie McGrath (ENN)Maria Isabel Berbegal (IDS)