session 2 country 2 kenya

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)

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Presenter name : Valerie WambaniTitle : Experience in scaling up IMAM inArid rural areas and urban settings

Background/country information

Total population: 39 M

Prevalence of SAM in U5s: 6%

Prevalence of MAM in U5s: 16%

Number U5’s affected by SAM: 112,847 (WFH < - 3z scores)

Other notable nutrition indicators : EBF 32%, anaemia in women55%, VAD children 76%

Population covered by IMAM: 250,000

Definition & degree of scale up: target 80% ASAL , 60% urban

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Food security situation

Food insecure population – Increase from 3.5 to 3.75 M (Long rainsassessment report July 2011)Pastoralists in emergency phase: 1.4 M

Scale upTimeframe 2007/2008:•Consensus on guidelines for Kenyan context, printing IMAM.

•National coordinating structure - Nutrition Technical Forum

•Monitoring tools

•Capacity building of health workers , On Job Training tool

Key terminology: Integrated Management of Acute Malnutrition(IMAM) , OJT, HiNi

Now part of the High impact Nutrition interventions (HiNi) beingpromoted

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Policy & Strategy EnvironmentSystems/structures to aid IMAM scale-up:Office of the President/ Prime Ministers officeKenya Food Security Steering Group, Crisis Response Centre,(multi-sectoral coordination)Nutrition Technical Forum (NTF), District Committees

Financing IMAM: Government, UNICEF, WFP, ImplementingPartners

Coordination: National level: Nutrition Interagency coordinatingcommittee reports to the Health Sector Steering Committee

Linkages with other programmes: MCH, IYCN, Disease control,WASH

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ResultsIndicators:•Recovery rates >75%

•Death rates <5 %

•Defaulter rates <15%

•Average length of stay is <60 days

•Programme coverage : Jan – Sept 2011: 54% MAM, 60% SAM ofthe expected caseloads

Other: integration of services – BSFP in 6 counties with GAM > 20% from August to December 2011

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Factors Contributing to Success

1.Commitment from district health management teams to leadthe process

2. Partner support for HR, M&E, On Job Training (OJT ), outreachsites

3.Strong coordination structure NTF with four working groups,

•Information WG

•Capacity development,

•Urban WG , ASAL WG

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Major Challenges & Obstacles

1. Inadequate capacity of health facilities to undertake full IMAMpackage- high staff turnover( OJT ongoing)

2. Integration within the health system is incomplete

3. Active case finding and poor referral system – lack of reliabletransport

•Pipeline breaks, storage, quality assurance ( aflatoxin in Unimix)– local production of RUTF- stability of product???

•Prolonged length of stay among pregnant women

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Key Learning Points

1. Leadership and oversight for IMAM implementation by theMinistries of Health (MOPHS, MOMS)- monthly meetings

2. Partnerships and coordination at all levels, supported by theHealth Sector strategy (SWAP)

3. community strategy implementation- use of CHWs for facilityimplementation of IMAM – screening & recording

•Nutrition sector response plan: strategy for scale up – focus onincreasing outreach sites to improve coverage & systemsstrengthening for sustainability

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Next Steps & Way Forward• Foster integration of health services- update on RUSF

• Scale up on-the-job training /mentoring for health workers

• Linkages with other sectors WASH/livelihoods/ food security

•Urban nutrition strategy being formulated

Obstacles: Government budget, Human resource gaps, Qualitycontrol of commodities , insecurity – Somalia borderinfrastructure development

National & international development: Home grown solutionspossibilities of local production of RUTF: strengthen communitysurveillance and defaulter tracing

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Acknowledgements ASANTE SANA

Government of Ethiopia, ENN teamMinistry of Public Health and Sanitation: Permanent Secretary,Director, Head, Dept of Family Health, Head, Division of Nutrition,Monitoring and Evaluation UnitUNICEF, Kenya ( Noreen/Dolores)Concern Worldwide, KenyaWorld Food Programme, KenyaWorld Health OrganisationACF, KenyaSave the Children UK, KenyaMerlin, and all NTF membersEmily Mates, Marie, JeremyDistinguished Audience at CMAM meetingHealth workers, caregivers and children in the programme

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Amaret Ekaliban, Lodwar District Hospital Stabilization Centre,Turkana County, 2011