session 6 pres 1 country 1 mozambique€¦ · 2.1% 1.8% 3.2% acute malnutrition rates (2008 mics)...
TRANSCRIPT
CMAM/SUN conference14th – 17th November 2011
Addis Ababa, EthiopiaScaling up Community Management of Acute
Malnutrition and Scaling up Nutrition (SUN)
MOZAMBIQUE
Edna Germack Possolo
Nutritionist and Head of Department of Nutrition/MoH
Background/country information
Total population: ~23 million
Prevalence of SAM in U5s: 1.3%
Prevalence of MAM in U5s: 2.9%
Chronic Food Insecurity: 35%
EBF: 37%; ACF: 37%
Gaza
Manica
Tete
NiassaCabo
Delgado
Nampula
Zambezia
Inhambane
Maputo
Maputo City
Sofala
1.3%
3.8%
2.6%
5.2%
3.5%
8.7%
5.1%
2.8%
2.1%
1.8%
3.2%
Acute malnutrition rates (2008 MICS)
PRN: Nutrition Rehabilitation Programme
UnderweightStuntingAcute Undernutrition
Story of CMAM Scale up
• 2002-2004: Standard inpatient treatment for SAM
• 2004: Outpatient treatment for SAM without complications for children with HIVintroduced in Maputo City
(2007) Began to expand to general health services and provinces
• 2005: Food Supplementation Programme to treat MAM introduced in emergencyaffected areas and expanded through country
• 2007-2010: Integration of the different components of treatment andrehabilitation linked as one unique programme:
Nutrition Rehabilitation Programme (PRN)
Extension of the target group
• August 2010-now:
• Approval of the new protocols
• Developed training materials
• Started training
• Implementation process
nutrition education
Nutrition Rehabilitation Programme (PRN)
Children 0-15 years
Policy & Strategy Environment
Relevant Policies / Strategies:
• National Nutrition Strategy
• Multisectoral Action Plan toReduce Chronic Undernutrition
• PRN is incorporated in HealthSector Plans and the IntegratedPlan to Achieve MDGs 4&5
IMCD Package(Health Center &Community)
HIV/AIDS & TB services
Medical Supply System
APEs curriculum(Community Health Workers)
National Health Weeks(MUAC assessment, 1x/year)
Social ProtectionProgrammes
(Nutrition Counselling)
Emergency preparedness andresponse plans
NutritionRehabilitation
Programme
Coordination and funding
Coordination:
• Swap group
• Nutrition Working Group (MoH & partners)– Aim: to improve nutrition programs by
strengthening the partnership withdonors and implementation partners
Financial Support:
• Government, UNICEF,WFP, USAID,Clinton Foundation
Strong focus placed on training of full PRN package
• Facility-based health workers
• CHWs
• Community leaders andtraditional healers
• Provincial-level health staff
Several programme monitoring tools developed:
• Individual- and programme-level monitoring forms
• Database to track admissions and outcomes
• Database to manage stocks of RUTF, CSB Plus and therapeuticmilks
Training and monitoring
Geographical coverage: out of approx. 1,280 health facilities:
• 191 provide inpatient treatment for SAM using newprotocols!
• 229 provide outpatient treatment using new protocols!
Performance:
• By mid 2011, 6,319 children <5 were admitted for in-patienttreatment for SAM, of which 11% (701) died
• In 2010, 31,503 children treated for MAM (using CSB orRUTF-based ration)
Facility based mortality of children under 5 due to SAM:
Year 2005 2006 2007 2008 2009 2010
Facility based deaths in children
under 5 due to SAM
15.2% N/A 11.5% 10.5% 11.8% 9.3%
Results
Successes
Success 1:
• Strong commitment by government and SWAP (at alllevels)
Success 2:
• Good integration in health programmes; increasinginterest and support from the communities
Success 3:
• Successful set-up of local production of RUTF,supported by Government and UNICEF (local RUTFnow procured from JAM by Clinton Foundation)
• Maintaining quality of training at all levels
• Recording and reporting
• Supply chain management
• Short funding cycles of donors (e.g. could affect support tolocal production of RUTF)
• Ensuring appropriate nutritioncounselling in all componentsof the programme
Challenges
• Essential to have all 4 components of the CMAM ‘model’ insame area
• Good partnership with donors, other sectors andimplementing partners is important
• Integration of PRN in key health programmes
• Establishing a link with social protection programmes
Key learning
• Finalise Volume Two of the Manual for the treatment of acutemalnutrition for adults (priority: pregnant & lactating women,HIV/AIDS, TB)
• Establish supportive supervision systems and ensure they areroutinely applied
• Prioritize community involvement and initiate in places whereit does not exist
• Introduce the new protocols inpre-service training of health andnutrition workers of all levels
• Advocate for Government policyto ensure ingredients for RUTFand other supplements comefrom local farmers/producers
Way forward
• Leonardo Chavane: National Directorate for Public Health
• Department of Nutrition
• Alison Tumilowicz, Melanie Remane, Dulce Nhassico, ArlindoMachava: FANTA-2/FGH360
• Tina Lloren, Vasconcelos Muatecalene, Isaltina Roque: Savethe Children
• Maaike Arts, Sónia Khan, Manuela Cau: UNICEF
• Nádia Osman, Gilberto Muai: WFP
• Other implementing partners
• Maria Pinto: USAID
• Kirsten Havemann: DANIDA
• Emily and Abi: ENN
Acknowledgements
Thank you