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AS Koroma/MOHS, Sierra Leone
Overview of production
in the RUTF factory in
Beira City
Information, education & communication
(IEC) materials on nutrition
in order to prevent diarrhoeal diseases that are strongly linked to
under-nutrition.
Social sector: Addressing the social-cultural issues at community
level that can have an impact on some of the underlying causes of
malnutrition e.g. early marriage and lack of exclusive breastfeeding.
Ways forward
The future for CMAM requires some key actions to move forward:
Advocacy to the government for higher allocation of government
funding through the annual budget allocated to the health sector,
in order to ensure the effectiveness and sustainability of CMAM.
Advocacy is needed also for the inclusion of CMAM training in the
undergraduate curriculum of universities.
In terms of planning and coordination, development of a mechanism
for coordination and communication between health and
other sectors, in order to strengthen programming that can prevent
undernutrition in a more ‘holistic’ manner than is currently being
achieved.
Community mobilisation is critical and requires:
• Boost community mobilisation practices by training the implementing
NGOs on methods of effective community mobilisation
and through the promotion of better IYCF linkages. In areas
where there are no NGOs, staff from health facilities in those
areas will conduct such mobilisation in their catchment communities.
• Identify additional strategies to mobilise the community
• Training and sensitisation of TBA’s on IYCF
• Involvement of community and traditional leaders in IYCF
In terms of support of the nutrition programme at district level, to
enhance nutrition surveillance and monitoring in particular, there
is an identified need to support transport (vehicles), communication
(information, education and communication (IEC) tools) and
information (documentation).
Lessons learned
Strengthening the capacity of health staff through regular monitoring
and supportive supervision is crucial to maintain quality
treatment and care of malnourished children.
Medical doctors need to be trained in CMAM for effective
management of complications in SAM in-patients. A medical
doctor needs to be attached to the nutrition programme in order to
conduct countrywide on-the–job training of staff at the CMAM
treatment site, especially in the stabilisation centres.
Supplies for the programme should be integrated into the existing
health system delivery channel of medical products, together
with training of health staff on stock management of supplies at the
initial stage of the programme for effective management of
commodities.
CMAM is a comprehensive programme and its components
must be accessible to communities. In particular, it is important to
ensure that every OTP site has an SFP component attached to it so
that there is an effective continuum of care for patients. There is
also a need to increase the number of stabilisation centres in the
districts.
Community mobilisation is critical for improving coverage and
access to services. A strategy must be in place to meet the community,
together with the establishment of the treatment service in the
community
For more information, contact: Aminata Shamit Koroma,
email: shamitamin@gmail.com, tel: +232 33705866
45
Maaike Arts, UNICEF, Mozambique
Field Article
Community management
of acute malnutrition in
Mozambique
By Edna Germack Possolo, Yara Lívia Novele Ngovene
and Maaike Arts
Edna Germack Possolo is Chief of the Nutrition
Department of the Ministry of Health, Republic of
Mozambique since 2009, where she has worked since
2007 as a public health nutritionist. Her responsibilities
include government policy and strategy development,
and coordination and management of public health
programmes within the MOH. She is also involved in curriculum development
and training of health workers, nutrition technicians,
undergraduate and postgraduate health professionals.
Yara Lívia Novele Ngovene is a Mozambican Nutritionist
who studied in Porto Alegre, Brazil. She has been working
in the Mozambican Ministry of Health since 2011
and is responsible for the management of the Nutrition
Department’s Nutrition Rehabilitation Programme.
Maaike Arts has a M.Sc in Nutrition from Wageningen
University and works with UNICEF. Since 2009 she has
been working as Nutrition Specialist with UNICEF
Mozambique, coordinating UNICEF’s support to the
country’s Nutrition Programme.
This document was drafted with support from FANTA-2/FHI360 (Alison
Tumilowicz, Melanie Remane, Dulce Nhassico, Arlindo Machava), Save
the Children (Tina Lloren, Vasconcelos Muatecalene, Isaltina Roque),
UNICEF (Sónia Khan, Manuela Cau) and WFP (Nádia Osman, Gilberto
Muai).
Acronyms:
ACS Agente Comunitário de Saúde (type of Community Health Worker)
APE Agente Polivalente Elementar (type of Community Health Worker)
CCR Consulta de Criança de Risco (‘at-risk child’ consultation)
CHAI Clinton Health Access Initiative
CHW Community Health Worker
CMAM Community Management of Acute Malnutrition
CSB Corn Soy Blend
FANTA Food and Nutrition Technical Assistance
JAM Joint Aid Management
MAM Moderate Acute Malnutrition
MoH Ministry of Health
MUAC Mid Upper Arm Circumference
PEPFAR President’s Emergency Plan for AIDS Relief
PRN Programa de Reabilitação Nutricional (Nutrition Rehabilitation Programme)
RUTF Ready-to-Use Therapeutic Food
SAM Severe Acute Malnutrition
SUN Scaling Up Nutrition
UNICEF United Nations Children’s Fund
USAID United States Agency for International Development
WFP World Food Programme
WHO World Health Organisation