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specialists, CMAM programme managers, M&E
specialists, technical and financial partners, etc.
Given the importance of including the right
people in the assessment, a mapping of actors
prior to the assessment is advised (see below).
This will limit the risk of biased results.
Using results of the assessment, the feasibility
of addressing the identified gaps can be analysed
using the planning tool. This planning tool can be
used to facilitate comparison of the target result,
also present in the benchmarks matrix as the
benchmark or condition, with the existing situation,
or identified gap (See Figure 4 for an
example). Weaknesses, barriers to change and
opportunities are identified, interventions
proposed and budget and timelines defined. Once
this analysis is completed, proposed actions, timeline,
cost, etc. can be put together in a yearly or
multiyear action plan. Progress on implementation
of the action plan can then be monitored on a
regular basis.
Suggested process for use of the
framework
At this stage of development of the tool, four steps
are suggested. They are composed of:
Step 1: Pre-assessment
As indicated, the framework needs to fit context
specific needs. During the pre-assessment step, all
country specific details will be agreed. These
include: a) identification/ mapping of all relevant
stakeholders to be invited to support assessment
(government services, donors, CMAM partners,
etc.), b) agreement of the scope, time frame,
budget and dates of the assessment, c) identification
of IMSAM and health systems data sources
and documents, listing of identified gaps as well
as health system strengthening interventions, etc.
Step 2: Assessment using benchmark matrix
This step starts with a literature review of all relevant
documents. These can be HR policies, M&E
tools used, data collected from facilities, facility
registers, quality supervision reports, administrative
and budget documents, supply registration
lists, review of training curricula, client exit interviews
reports, etc. The benchmark matrix is then
filled out by different stakeholders or assessors.
It is important to note that this is a self-assessment
(important for stakeholders, especially
MoH, ownership) undertaken by a group of
experts. It is advised to organise group work in a
way that the assessors only assess the benchmarks,
or conditions, they are expert on. This also
helps keep duration of assessment to a minimum,
as different groups can work simultaneously.
After the group work, the different results will be
brought together and discussed as explained in
Step 3.
When available information is insufficient, key
informant interviews, e.g. health system users,
can be organised in order to complete the assessment.
In addition, site visits are highly
UNICEF/NYHQ2009-0204/Ysenburg, Somalia, 2009
A woman feeds a child a ready-to-use food
as part of a UNICEF-supported nutrition
programme in Jowhar Camp, Somalia
Figure 3: Example of visualisation tool with summary of results: IMSAM Human Resources – District level
assessment results
Results
Rating Level Adequacy
achieved
IMSAM Human Resources – District A
HR- mean* 1.4 46%
HR – mean
HR planning 1.2 40%
3.0
HR policy 3 100%
2.0
In-services
HR planning Performance management 2.3 76%
1.0
Training & education 1.3 43%
0.0
In-services 0.7 23%
Training &
education
Performance
management
*Average for all HR section results
HR policy
recommended as they allow direct observation
of most of the service delivery
components (e.g. facility registers, daily availability
of services, stock-out, reports….) and
therefore reduce the bias in the scoring.
Step 3: Analysis and validation
During the consensus building meeting, the
average rating for each condition is given,
visualised and results are reviewed. The
presentations and final assessment report
should include rating and summary of
comments, as rating alone cannot capture all
aspects of the conditions. For example, the
condition could be present but supported
100% by NGOs and therefore not sustainable.
Steps 1 to 3 are closely linked and implemented
during the same exercise, while Step 4
can be organised at a different moment after
analysis of assessment results.
Step 4: Development of multi-year and
yearly action plan
Starting from the identified gaps (conditions
that are not fulfilled, benchmarks not
reached), the stakeholders will analyse which
Legend
Rating Level Adequacy
achieved
Highly adequate 2.25 - 3 75 -100%
Adequate 1.50 – 2.24 50 – 74%
Present, but not adequate 0.75 – 1.49 25 – 49%
Not adequate at all 0 – 0.74 0 – 24%
gaps they want to address, how these gaps
will be addressed and within which time
frame using the planning tool (shared earlier
in Figure 4). This will be captured in the corresponding
action plan. From this exercise,
yearly and multi-year action plans can be
defined, including a corresponding monitoring
and evaluation approach.
Stakeholders can decide to repeat all steps
or parts on a yearly or multi-year basis as part
of monitoring, evaluation and planning of
national CMAM programmes.
Expected results
The process is expected to facilitate national
ownership, commitment and sustained
adequate investment in the management of
acute severe malnutrition and to provide a
standardised approach for identification of
bottlenecks in scaling up of IMSAM across
countries. Even, if the approach is meant to be
standardised, countries should adapt the
framework to their context.
This approach will allow for development
of yearly and multi-year costed actions plans
Figure 4: Example of Planning tool: HR function at community level
Level
HS function Target
Result
(benchmark)
Community HR Clear
written ToR
for CHW
Weakness
current
result
Oral ToR
Threat/
Barriers to
changing
result
Staff
turnover
Lack of
literate
staff
Opportunities
for change/
enabling
factors
National
guideline
exist
Objective
/expected
results
100% of
CHWs
have
signed a
JD
Proposed
intervention to
address change
- CHW supervisor
to write ToR
- DMO to
standardise ToR
according to
national
guideline
Impact on other
MNCH
programme &
HS Performance
- Standardisation
among CHWs
- Integration
with iCCM HR
performance
Feasibility Timeline/
implementation
speed
Human
Resources
needed
yes Year 1 - 90%
CHWs
position
staffed
Cost
Budget:
xx USD
TOR: Terms of reference CHW: Community Health Workers JD: Job description DMO: District Medical Officer iCCM: Intergrated Community Case Management
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