The Community Management of Acute Malnutrition (CMAM) is a methodology for treating acute malnutrition in young children using a case-finding and triage approach. Through the CMAM program, children who are severely malnourished are managed through the outpatient therapeutic care (OTP), while children with complication are treated through the in-patient program (Stabilization Centers-SC).
In Somalia, the CMAM program is being implemented across the entire country by the Ministry of Health and the implementing partners under the umbrella of the Nutrition Cluster; with technical and financial support from various international agencies included the UNICEF. This is especially important in a country such as Somalia that has one of the highest rates of wasting prevalence in the world with the prevalence of GAM being estimated as 14.3% and the SAM prevalence is estimated as 2.9%. It is currently estimated that 193,200 children in Somalia are acutely malnourished including 36,900 who are severely malnourished.
In order to continuously monitor the effectiveness of the CMAM programme, various indicators have been put in place which includes the cure rate, average length of stay, defaulter rates, death rates, program coverage e.t.c. However, program coverage is one of the most useful and reliable indicators for measuring the performance of CMAM programmes since it provides a reliable measure of impact by measuring the proportion of needs met by an intervention. The recent development of comprehensive and innovative coverage monitoring tools (including SQUEAC and SLEAC) by Valid International/FANTA-2 has provided the means by which to monitor programme coverage practically and easily.
A SQUEAC (semi-quantitative evaluation of access and coverage) assessment was conducted in Afmadow district, lower Juba region of Somalia from 9th – 26th December 2016. The assessment overall objective was to evaluate program performance and also identify the factors affecting the uptake of the OTP services in the district. The assessment was undertaken with the lead of WRRS, a local implementing agency in the district with active participation of Save the Children International, who also are implementing nutrition services across the district. Other agencies were actively involved in the process to include WASDA, IOM, ARC, and JRIA. With the use of the Bayesian technique, the assessment estimated a single coverage of 72.2% (66.0% - 77.7%).
The SQUEAC assessment through stage one and two was able to identify both positive and negative factors affecting program coverage. This was mainly obtained through analysis of qualitative and quantitative data from routine program data reports, interviews, discussions and small area surveys. The boosters mainly identified included; near distances to the to the OTP sites especially the settlements within the towns hence easier in accessibility. The program staffs attached to the facilities were competent enough and were active in community mobilization, active case finding, active defaulter tracing and follow-up. The community also reported to have good opinions and perceptions about the program thus it improved the community ownership aspect. There were good referral systems and linkages amongst the implementing partners and those without the CMAM program on referrals made during outreaches.
The recommendations formulated in summary points by the lower Juba sub-nutrition cluster include: 1) Have one chain of command in the ordering of RUTF, push and pull system directly from Mombasa hub as well as having close monitoring of the supplies,2)Advocacy for health and nutrition calendar days to create more awareness through education and sensitization on IMAM programming, 3) Strengthen the community structure in place and MOH by increasing the CHWS in number linked to villages, provide more IEC materials, increase the incentives and be consistent in wages /stipends, have provision of trainings for development and to ensure sustainability, 4) Ensure that the mobile clinics /outreaches that do not offer CMAM programs are well integrated to offer all services not directly but also with support from other implementing partners /stakeholders , 5) In addition to support groups have FTFSG to be able to educate them on nutrition programs and how they can assist their families and also interlink with the MTMSG to improve health seeking behaviors, 6)Advocacy of clear mapping of program activities to where people migrate to and have special cards for program beneficiaries that can be used to ensure swift transition and continuity,7)Advocacy for future programming to include other programs that can benefit the beneficiaries and improve on their household food security status and dietary diversity.