- Introduction
In March 2008, United Nations Children's Fund (UNICEF), the World Food Program (WFP), and the Academy for Educational Development's Food and Nutrition Technical Assistance (FANTA) Project, funded by the U.S. Agency for International Development (USAID), in collaboration with the Federal Ministry of Health (FMOH) and the South, North and West Darfur State Ministries of Health (SMOHs) conducted a joint review of the quality and effectiveness of selective feeding programs in South, North, and West Darfur States.
The review covered selective feeding programs and services for center-based and community-based management of acute malnutrition, including community outreach, inpatient care for stabilization of severe acute malnutrition (SAM) with complications, inpatient care for SAM until full recovery, outpatient care for SAM without complications, and blanket and targeted supplementary feeding programs (SFP).
The purpose of the review was to provide evidence-based recommendations to improve selective feeding programs in the short and medium term through both direct action (including training and technical support) and indirect action (including advocacy).
While some issues relating to general food distributions were considered, a full assessment into the impact of the general food distributions on the nutritional status of the population was beyond the scope of the review.
This joint report consolidates the analysis and recommendations of the interagency review of selective feeding programs in South, North and West Darfur States (Greater Darfur). This report, like the trip to Darfur, cannot hope to be exhaustive; rather it intends to highlight pertinent issues for selective feeding programming in Greater Darfur. The draft findings from the review were presented to the Nutrition Coordination Group in Khartoum and the report incorporates feedback from stakeholders.
1.1 OBJECTIVES
The overall objective of the review in Greater Darfur was to assess the quality, efficacy and effectiveness of selective feeding programs.
Expected outputs focused on specific recommendations to:
1. Strengthen coverage and community involvement
2. Promote good practice for improved quality performance of selective feeding programs
3. Improve appropriateness of selective feeding programs
4. Enhance sustainability of selective feeding programs
5. Strengthen capacities of FMOH/SMOH and implementing partners (IP) in Community-based management of acute malnutrition (CMAM)
1.2 METHODS
To meet these objectives, a 5-person interagency review team organized visits to Greater Darfur between March 12 and April 1, 2008. The review team observed a variety of programs for the management of acute malnutrition ranging from center-based to community-based approaches. Key elements for quality programming and effectiveness of selective feeding programs were identified within an analytical framework for CMAM integration, consisting of five domains, that was developed for previous country reviews and applied to Greater Darfur:
1. Enabling environment
2. Access to selective feeding services
3. Access to selective feeding supplies
4. Quality of selective feeding programs, and
5. Competencies for selective feeding
The review of selective feeding programs consisted of document reviews; field visits with direct observation of selective feeding services; semi-structured interviews (available upon request) with key informants at national, state, health facility and community levels; and discussions with health system staff, community health workers, community volunteers, beneficiaries and non-beneficiaries. The review team met with representatives of all relevant stakeholders, including the national and state governments, the UN, Ps, community leaders, community members, and selective feeding beneficiaries and non-beneficiaries. While sites were not randomly selected for visits, efforts were made to visit a wide variety of selective feeding sites to appreciate the diverse range of operational programs. The team often broke into two in order to increase the number of site visits. Some sites were selected based on service availability on the day of the visit by the review team, others on access and security.