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News CMAM Forum Update Community-based management of acute malnutrition 1 (CMAM) has been adopted by over 60 countries 2 (as of December 2011), to help combat acute malnutrition in children under five years and reduce childhood mortality. The expansion of the CMAM approach into a variety of contexts, and the escalating demand to consolidate and share CMAM data and experiences, has created the need for a clear, accessible mechanism to facilitate information sharing. Many governments and other stakeholders share similar challenges regarding the quality of CMAM implementation and scale-up of services but are not always successful in capitalising on lessons learned within and among countries or agencies, making it difficult to move forward to achieve greater impact in a coordinated and effective manner. There has been a ‘patchwork’ of initiatives relating to information-sharing on the management of acute malnutrition, with no overall ‘umbrella’ initiative to bring these groups together and facilitate progress in a coherent manner. In response to this need, a group of experts have collaborated in the creation of a CMAM Forum over the past year. The CMAM Forum aims to improve health outcomes of vulnerable populations through the provision of a robust information-sharing mechanism which expands the knowledge-base of management of acute malnutrition to help support implementation and monitoring of CMAM activities. CMAM Forum users are anticipated to be from a range of health and nutrition sectors with strong national representation. The Forum aims to be especially practical for those implementing programmes. The CMAM Forum development has a phased approach where in Phase One, the working modalities were explored and foundations built and during Phase Two, the CMAM Forum activities are being rolled out (pending funding). Phase One started in September 2011 with funding from UNICEF and Action Contre la Faim France (ACF-F). Two co-facilitators, seconded from ACF-F and Valid International, were appointed to lead the activities. A steering committee has been established with technical experts 3 to help guide activities. A website has been developed and just launched at www.cmamforum.org. In addition to general resources, the website includes sections on training, advocacy and research and monthly ‘Technical Briefs’ to summarise current topics pertinent to CMAM. Wherever possible, the Forum will create linkages and improve access to relevant initiatives and resources, rather than duplicate them. If you would like further information or to share any resources relevant to the management of acute malnutrition, please contact: cmamforum@gmail.com 1 Community-Based Management of Acute Malnutrition (CMAM) includes community outreach for community involvement and early detection and referral of cases of acute malnutrition, and follow up of problem cases in their homes, management of severe acute malnutrition (SAM) in outpatient care for children 6-59 months with SAM without medical complications, the management of SAM in inpatient care for children 6-59 months with SAM and medical complications and children under 6 months with acute malnutrition, and the management of moderate acute malnutrition (MAM) for children 6-59 months. CMAM is also known as Integrated Management of Acute Malnutrition (IMAM) or Community-based Therapeutic Care (CTC). 2 UNICEF Global SAM Treatment Update-2011, May 2012 Steering Committee members are from ACF-F, Concern Worldwide, Emergency Nutrition Network (ENN), Food and Agriculture Organisation (FAO), Food and Nutrition Technical Assistance II and III Projects (FANTA), IASC GNC, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), International Malnutrition Task Force (IMTF), Ministry of Health country representatives, Save the Children UK, UNICEF, United Nations Systems Standing Committee on Nutrition (UNSCN), Valid International, World Food Programme (WFP), World Health Organization (WHO). FANTA-2 reviews of national experiences of CMAM In 2010 and 2011, FANTA-2 conducted a series of reviews of community based management of acute malnutrition in Mauritania, Burkino Faso, Mali, Niger, Sudan and Ghana. The reviews involved document review and field trips. Areas of focus for Mauritania, Burkino Faso, Mali and Niger included CMAM integration into the health system and into other relevant health and nutrition initiatives, CMAM scale up plans and activities (national and sub-national), capacity development, and successes and lessons learned to inform strategy development and programming. In Sudan, community outreach experiences and strategy development for CMAM was the particular focus. In Ghana, on the request of the SAM Severe Acute Malnutrition Support Unit (SAM SU) of the Ghana Health Service (GHS), FANTA conducted a review of CMAM activities at district and learning site level including plans for scaling up. The objectives of the review were to assess the A standard for standards in humanitarian response Anew web portal has been launched recently to highlight key standards and guidance, and encourage those engaged in humanitarian response to incorporate them into their work. Humanitarian Accountability Partnership (HAP) International, People In Aid and the Sphere Project supported by the Active Learning Network for Accountability and Performance (ALNAP) have developed this initiative to bring greater coherence amongst standards and so increase the chance of them being put into practice. integration of CMAM services into the learning sites, assess learning sites’ performance, review recent plans and initiatives to scale up CMAM in Ghana, and provide recommendations for strengthening those plans. As well as individual reports for each review, a summary report of review findings in the four West African countries (Burkina Faso, Mali, Mauritania, and Niger) is available. The report discusses the key determinants for achieving maximum impact of CMAM integration, scale-up, and quality improvement. The determinants are grouped in five domains: the enabling environment for CMAM, competencies for CMAM, access to CMAM services, access to CMAM supplies, and quality of CMAM. Optimal practices, a summary of findings, constraints, and practical recommendations are provided for each key determinant. All reports are available to download at: http://www.fantaproject.org A workshop was held in May 2012 led by leaders of the Joint Standards Initiative (JSI) – HAP International, People in Aid and the Sphere Project. The JSI is working to create a coherent set of standards that can be used for small and large aid organizations involved in humanitarian response and development. The general consensus was that there is a need to consult field workers and local programme managers to determine the implementation of standards. For more information, visit: http://www.jointstandards.org/ What do you think of Field Exchange? The ENN is undertaking an evaluation of Field Exchange between June and August 2012 amongst those of you who receive it in print and access online copy. Through this evaluation, we wish to: • Gain an insight into your use of Field Exchange • Learn about your preference for print and online access to Field Exchange • Hear what you think about the ENNs role and activities We invite you all to complete the online questionnaire now available at: http://www.surveymonkey.com/s/fexevaluation. It should take about 20 minutes to complete and we would really appreciate that you take the time to complete it – the findings of this evaluation will be used to inform the development of Field Exchange. The questionnaire may also be downloaded from our website and submitted by email: thom@ennonline.net Some of you will be contacted by one of our researchers for more detailed feedback over the phone Thanks in advance for taking the time to talk to Illyahna, Bibi or Tara. If you have any trouble accessing the survey online and would like to feedback by phone, text us your name and number to: +44 7737 996822 or skype: thom.banks.enn 65
News Update on Minimum Reporting Package (MRP) trainings in London and Nairobi By Emily Mates, Nutrition Advisor, MRP, Save the Children UK The ‘Minimum Reporting Package’ (MRP) has been developed to support standardised data collection for emergency Supplementary Feeding Programmes (SFPs) (see Box 1). The need for this package was identified following analysis in 2005/6 (by the Emergency Nutrition Network (ENN) and Save the Children UK) of the efficacy and effectiveness of 82 emergency SFPs implemented between 2002 and 2005 . A key problem identified was that inadequate reporting standards were being followed, making it difficult to assess the efficacy of programmes without considerable re-analysis of data. An unexpected number of information gaps, inaccuracies and statistical errors were found, raising concerns over the quality of the interventions and implications, for the impact on beneficiaries, the accountability of agencies (to both donors and beneficiaries), and organisation’s capacity to learn from experience. The current phase of work (MRP rollout) is implemented by Save the Children UK and funded by ECHO to December 2012. London ToT Save the Children UK hosted a global training of trainers (ToT) in London in March 2012. Fourteen participants from eight international Box 1: What is the Minimum Reporting Package (MRP)? The MRP is a monitoring and reporting tool with harmonised reporting categories, definitions and indicators for 3 different (but often joined up) programmes to treat acute malnutrition: targeted Supplementary Feeding Programme (SFP), Outpatient Therapeutic Programmes (OTP), and Stabilisation Centre (SC). The MRP consists of three tools: user guidelines, software, and a software manual. The MRP presents harmonised reporting categories, definitions and indicators, conforming to the revised (2011) SPHERE standards for emergency SFPs across implementing agencies and countries . The tool intends to improve SFP programme management decisions, accountability and learning for moderate acute malnutrition (MAM) management as there is strong consensus for the urgent need for this learning across the international and governmental nutrition community. Box 2: Support services the MRP team* will provide for implementing agencies in 2012 • Regional ToT trainings for country level staff starting in May 2012 • Helpdesk for agencies for all questions around the MRP and use of the software • Development of distance learning tool (e-learning) to complement the MRP User guidelines, the MRP software manual and the MRP software • Translation of MRP tools into French *The SC-UK MRP team comprises of three technical experts led by Emily Mates. agencies were trained in the use of the MRP tools. Overall the MRP and accompanying software were positively received by agencies attending. Comments included: The MRP: “… is good and has great potential. I hope it is taken on by others (NGOs, the cluster) and can become a standard.” “… is off to a good start; (the software) is really user friendly in most aspects.” “… is an effective monitoring tool for higher level support.” The aspects of it mentioned as most useful were: • The MRP software is able to reduce time in preparing reports. • The user friendliness of the automatic calculation of performance indicators and graphs through the software. • The usefulness of the harmonised reporting categories and performance indicators being standardised across agencies. Agencies showed considerable interest in the MRP and its application at field level. All agencies present at the training announced plans to either use the MRP as their internal reporting system, or to ‘feed’ their internal data into the MRP centralised database, in order to contribute to the learning objective on MAM. MRP field use and complementarily with other systems The training initiated wider discussions on the MRP and its planned roll-out amongst agencies in 2012, with the opportunity for the MRP team to clarify issues raised by participants, for example on the MRP field use and complementarily with other systems. Whilst the focus is on emergency SFPs, indicators relevant to the collection of data from emergency therapeutic programmes that treat severe acute malnutrition (SAM) have recently been included. The development of an optional SAM module was driven by requests from NGOs who preferred to use one ‘package’ for reporting, where SFP was delivered as part of a ‘full’ CMAM programme that included both SAM and MAM treatment. Should national governments, UNICEF and other partners subsequently wish to use (or integrate) the MRP into national reporting systems, the software would need some alteration and/or further simplification in order to fulfil this need. Nairobi regional training Very positive feedback on the MRP and its software was received from participants of the regional MRP training that was held in Nairobi (8th -10th May, 2012). In attendance were 15 participants from seven agencies working in Somalia, South Sudan and Ethiopia. Training is planned for June/July 2012 in Niamey, Niger, as soon as the MRP tools have been translated into French. Additional considerations The MRP roll-out is expected to gather pace in 2012, following the regional trainings to be held in East and West Africa and additional support from the MRP team to implementing agencies (see Box 2). The MRP project can deliver standardised information within a short period of time, particularly for MAM programming, as long as critical stakeholders and enough implementing agencies support its application. Both the London and Nairobi trainings were well received by the implementing agencies in attendance, and were successful in training participants in the use of the MRP. The MRP includes a specific piece of software for analysis of data. This does not rule out the use of the reporting guidelines and/or the collection and analysis of data using other software systems that have been, or will be, developed for reporting and analysis of acute malnutrition programming data In the longer-term, the merging of MRP reporting categories within national reporting systems may prove useful. However, key to any successful merging is to ensure that systems already in place or those to be set-up have common reporting criteria and guidelines, to ensure that the data is comparable. 1 See report at http://www.ennonline.net/research/supplementary 2 There is also an optional severe acute malnutrition (SAM) module that may be useful for programme managers to use where SFP is delivered as part of a CMAM programme. 3 The MRP project will gather SFP data from partners, using the MRP software for analysis of SFP effectiveness and efficacy (learning objective of the MRP). 4 Agencies attending: ACF-Spain , ACF-USA Concern Worldwide, GOAL, Islamic Relief, World Vision, WFP and Save the Children UK 5 Agencies attending included ACF USA, Concern Worldwide, GOAL, IMC, Islamic Relief, Save the Children, WFP The European Commission’s Humanitarian Aid department funds relief operations for victims of natural disasters and conflicts outside the European Union. Aid is channelled impartially, straight to people in need, regardless of their race, ethnic group, religion, gender, age, nationality or political affiliation. This article has been produced with the financial assistance of the European Commission. The views expressed herein should not be taken, in any way, to reflect the official opinion of the European Commission. 66
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