Food Security Unit –PLG Feb 2004

Presentation by : Dr Roohullah Shabon

Emergency Health & Nutrition Specialist

Save the Children,Emergency and Protection Unit,

Washington DC

SC Emergency Health & Nutrition Program in Ethiopia

Tens of thousands of people are estimated to have died from the food crisis in Ethiopia and over 13 million are still dependent on food aid for survival.

SC Emergency Health & Nutrition Program in Ethiopia

Save the Children-US Emergency Health and Nutrition Program (EHNP) aims at developing its activities in an integrated approach including health and nutrition. All program activities are undertaken with the goal of both immediate humanitarian relief and long term sustainable development.

Activities: Together with Government and other agencies.

Early Warnings System Collected, compile and analysis nutrition surveillance and

food security data. Revise and standardize early warning indicators and

parameters Conduct one-week rapid assessment of early warning

system.

Rapid Assessments Conducted 13 Rapid Assessments and participated in two

Consolidated Appeals. Development of “Rapid Health, Nutrition and Food

Security Assessment Tools” , Rapid Assessments guideline and train the staff.

Cont. Activities: Together with Government and other agencies.

Nutrition Surveys Development of nutrition survey guidelines, training

of the staff and technical and/or financial support provided to 17 Nutrition Surveys

Sub granting of Funds Funding has been provided to a total of 9

NGOs and 3 government agencies

Cont. Activities: Together with Government and other agencies.

Rapid Nutrition Response Programs At present running 6 TFCs, 1 NRU, 4 SFPs and 2 OTPs (Outpatient Therapeutic

Programme). A total of 4 CTC programs has been established by the EHNP in Arbegona, Aroresa, Bensa and Hulla woredas.

Admitted a total of 3,307 patients, of which 78.04% were cured. From March up to October 2003 , there were 725 severely malnourished

children in treatment. Handed over 5 TFCs; four to the government and two to local NGOs.

Health Unit and W/S UnitsThe Units will strengthen the EHNP Project Units’ health promotion efforts and build the local capacity of the regional/zonal MOH in terms of therapeutic/supplementary feeding management, health & nutritional surveillance, health and sanitation education and malaria control.

Therapeutic Feeding Centre

The objective of TFC is to reduce morbidity & mortality associated with severe malnutrition & restore health promptly in a population of affected areas.As soon as the numbers of severely malnourished cases are more than the capacity of the health facility, specific structure like Nutrition Rehabilitation Unit (NRU) is set up within the health facilities. When this is not possible as in emergency situations, TFC should be started.

The decision to open TFC is based on:

Result of Nut. Survey and Rapid Assessment. The prevalence of Severe Acute Malnutrition (SAM)

in a random survey among children under five years old is more than 3%.

The prevalence of Global Acute Malnutrition (GAM) is more than 10%.

Under-five mortality rate is more than 2/10000 per day.

The absolute number of severely malnourished is over 20 cases

Closure of TFC

Decrease in TFC admissions over 2 consecutive months, and average number of patients for the last two consecutive weeks (14 days) less than 20 inpatients in TFC

Under five mortality rate < 2/10000 per day

Prevalence of Severe Acute Malnutrition (SAM) < 3%

Prevalence of Global Acute Malnutrition (GAM) < 10 %

STAFFING PATTERN of TFC

Nutritionist Nutrition workers Health workers Logisticians Cooks, cleaners, guards Outreach workers Health educators/social workers

Community-based Therapeutic Care (CTC)

Start with supplementary feeding from Sudan, Ethiopia and Malawi, CTC is the best means to quickly respond to an emergency situation where there are high or increasing levels of severe malnutrition.

The CTC concept aim to integrate emergency nutrition with long-term programs by establishing structure that can be re-activated in future emergencies.

The main principles of CTC are

Coverage Access Timeliness Sectoral integration Capacity building

CTC has the following elements:

Therapeutic Feeding Centre (known as a Stabilisation Centre (SC) in our program):

The TFC will be only for severely malnourished children who are not well enough to be treated at the OTP site. They will be treated as inpatients until their condition is stable enough for them to be discharged home (normally 5-10 days). Some children will not respond to treatment at the TFC and will need to be referred to hospital.

Supplementary Feeding Programmed (SFP): This is made up of a two-weekly dry ration of Famix

or CSB, health education and very basic medical care in collaboration with existing health facilities

CTC has the following elements continue:

Outpatient Therapeutic Programme (OTP): There will be an OTP at every SFP distribution site. This is where the majority of severely malnourished children will be assessed and treated.

Outreach work. The community element of the CTC program must be strong in order to mobilize mothers/caretaker to bring their child to the SFP/OTP for screening.

Management Phases of CTC:

Stabilisation phase This is the initial phase of

treatment of severe malnutrition with complications as inpatient in stabilisation centre (previous TFC): life-threatening problems

are identified and treated specific deficiencies are

corrected metabolic abnormalities

are reversed feeding begins

Stabilisation phase

Target group: Children with

severe malnutrition with complications

Treatment According to WHO

protocols for the initial phase of the treatment of severe malnutrition with complications

Outpatient Therapeutic Programme (OTP)

2 groups of admissions: Direct OTP Indirect OTP

Direct to OTP People with severe

malnutrition with no complications

Admitted directly into OTP with no stabilisation phase

Indirect to OTP People who previously has

severe malnutrition with complications admitted into OTP after discharge from Stabilisation Centres

OTP treatment

RUTF (Ready Use Therapeutic Feeding) every week or two weeks

Systematic medication Direct OTP

Amoxicillin Vitamin A, Folic

Acid Mebendazole Anti-malarial Vaccination

Supplementary Feeding Programme (SFP)

Dry take home supplementary ration

Basic health care De-worming

Vit A

Measles

Consultation and appropriate referral if

necessary

Admission criteria same as WHO

Advantage of CTC

CTC programs bring treatment out of the center and to the peripheral areas. Thus greatly increasing coverage.

CTC programs are not meant to replace TFCs but to complement and integrate them into a larger, more accessible, and holistic program that allows better follow-up of patients.

Contin. Advantage of CTC

Integrates with food security programmes Shared trainings, workers Demonstration gardens Promotion of crops for local RUTF

Includes local production of RUTF where appropriate

Wide range of linkages to key social structures, key individuals

Mother to mother techniques for education and increasing participation

3. What is the difference of CTC & TFC

TFC 24 care centre based Food targeted to the child Use F100 and F75 Close/continuous follow-

up Quick weight gain More widely understood &

accepted High cost Cross infection Decrease household

economy-mothers away 20 days

Good for patients with complication dehydration and septicaemia.

What is the difference of CTC & TFC

CTC Stay in the household and

community based Empowering the family Mother to mother support

with PDI approach Use Ready to Use Therapeutic

Food (RUTF) Treating malnutrition where it

occurs More Coverage Community awareness and

participation lead to address food insecurity

Evolvement from emergency to development and vice versa

Study/Sphere:85% (75) Cure,4.1(10) Death,4,7(15) Default

Challenges to the CTC approaches :

Logistics-distance, weather, etc making outreach somewhat difficult

Lack of capacity and understanding in the government makes sustainability & exist strategy shaky

Resource intensive operation and need functional health centres system

CTC being new approach acceptability by partners is questioned