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Field Article
sion for relevant staff.
• Including reporting rates as one of the
performance evaluation indicators amongst
health workers.
• Discussion of reporting rates in the monthly
and quarterly review meetings held at
regional level, including analysis of reporting
submission to encourage the close
follow up for those facilities/woredas not
reporting.
• Continuous follow up and regular communications
with woredas an health facility
level experts, using all available
means (telephone, e-mail, fax
and other networks).
The benefits of the efforts towards
improving the reporting rate
(consistently above 80%), is that
there is now trend data which
shows the impressive expansion
and successful performance of the
TFP at primary health care level. 13
Additionally, widespread coverage
and accurate reporting of the TFP is
providing invaluable trend monitoring
data. In the absence of
routine nutrition information (see
below, challenges) reports of
increasing numbers of admissions
to the TFP have become crucial data
alerts for authorities to deteriorating
situations, as seen in the lowland
drought affected areas during 2011.
There remain on-going challenges
for the TFP reporting and
nutrition information systems.
Although the reporting rates have
remained consistently above 80%,
there is often a delay in timely
compilation and submission of
reports. The information often
comes late, reducing its efficacy for
‘early warning’ of deteriorating
situations. Also, the standardised
database for TFP monitoring is only
at regional level and has not yet
been implemented at woreda level.
With the expanding numbers of TFP
sites, there is increased importance
for this trend monitoring data to be
accurate and timely.
There are also opportunities for the reporting
systems. The HMIS has been revised and
now includes TFP data in a manner that enables
tracking performance standards against the
Sphere indicators. Moreover, HMIS reporting
from woreda to regional levels will soon change
from a quarterly to monthly basis. This will
create a solid opportunity to fully integrate
TFP/CMAM reporting into the national HMIS.
Linkages with other programmes
TFP/CMAM in Ethiopia has developed some
linkages with other nutrition programmes that
are implemented under the umbrella of the
NNP including:
Community Based Nutrition (CBN)
CBN is the preventative arm of the nutrition
service delivery outlined in the NNP. It aims to
use community capacity to assess and analyse
the nutrition situation of its own community
and take appropriate action. Monthly Growth
Monitoring and Promotion (GMP) sessions,
followed by community conversations and
counselling, are used as tools to elicit the triple-
Tibebu Lemma/for UNICEF Ethiopia. Copyright UNICEF Ethiopia
A cycle of assessment, analysis and action. The
programme has been gradually expanded,
training over 90,000 Community Health
Volunteers (CHVs). CBN has been scaled-up to
228 woredas in the four main regions of
Ethiopia (SNNP, Tigray, Amhara, Oromiya)
supported by development partners of the
FMoH. 14 In 2012, the CBN will be rolled-out to
an additional 115 woredas bringing the total
number of woredas to 343. UNICEF provides
technical assistance and support for government
implementation.
Seta Temesgen with her seven month old baby, Aynadis,
during weekly OTP (Geter Meda Health Post, Lasta
District, North Wollo Zone, Amhara Region)
OTP training is provided as part of CBN
training in the 343 CBN woredas where CBN is
implemented, creating an opportunity for both
programmes to benefit from this linkage. The
community conversations within the CBN are
proving useful in assessing and analysing why
a child is malnourished and what behavioural
changes could foster improved nutritional
status for the children in a family, using their
existing resources. Additionally, the presence of
TFP/CMAM in all CBN woredas provides good
opportunities for referrals and behavioural
change messaging for severely malnourished
children.
Enhanced Outreach Strategy (EOS)
The Enhanced Outreach Strategy/Targeted
Supplementary Food Programme (EOS/TSF)
was designed and initiated jointly by the FMoH,
the Disaster Risk Management Food Security
Sector (DRMFSS) (former Disaster Prevention
and Preparedness Agency), UNICEF and WFP,
to address some of the most critical child
survival and malnutrition problems in Ethiopia
and to provide a bridge to sustained nutrition
interventions through the HEP. The EOS was
launched in April 2004 with the aim of reducing
mortality and morbidity in 6.8 million children
under 5 years, as well as pregnant and lactating
mothers in 325 drought prone woredas across
Ethiopia. This was to be achieved through the
implementation of key child survival initiatives,
including Vitamin A Supplementation
(VAS), de-worming, measles vaccination and
screening for malnutrition and subsequent
treatment of malnutrition. A major success of
the EOS programme has been Vitamin A coverage
consistently recorded as over
80% since 2005.
The EOS has transitioned into
Child Health Days (CHD) in the
228 Woredas where the CBN
programme is currently being
implemented. To facilitate the transition
of more EOS woredas into
the CHDs, an operational plan for
transition has been prepared and is
under discussion between the
FMoH and key partners.
Using the opportunity presented
by the six-monthly VAS
campaigns, screening for acute
malnutrition using Mid-Upper
Arm Circum- ference (MUAC) in
drought- affected woredas is also
undertaken. Children and pregnant
and lactating women (PLW)
identified as moderately malnourished
receive 3-monthly supplementary
food rations through the
TSF, while those identified as
severely malnourished are referred
to the nearest health facility
providing TFP/CMAM services.
The number of woredas implementing
the TSF component of the
EOS has been reduced to 167
drought affected woredas in six
regions. This is largely due to the
lack of sufficient resources available
to procure and supply
supplementary rations. A concept
note has been developed by the
FMoH, DRMFSS, UNICEF and
WFP regarding the transition of
TSF into a programme for management
of MAM in the medium to long term.
RUTF in Ethiopia: supply, importation,
local production and distribution
mechanisms
The development and use of RUTF has been the
critical factor that helped to revolutionise the
management of SAM, through enabling outpatient
treatment for the vast majority of
malnourished children. From 2003 to 2005,
INGOs generally provided their own supplies
for the projects they implemented.
By 2005, the OTP was slowly being scaled
up. During the hunger gap in the same year,
UNICEF was required to air-lift approximately
400 metric tons of RUTF from their European
supplier. In addition to the extra costs associated
with air-freight, complicated and
time-consuming customs clearance processes
presented a challenge for the importation of
RUTF. UNICEF took on the role of central
15
See article regarding UNICEF global supply of RUTF including
Ethiopia in Field Exchange 42. Increasing access to
RUTF. Jan Komrska, UNICEF.p46-47.
18