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Field Article
term sustainability. Malawi is a country
where health services are under-resourced
and dependent on external funding sources
for much of basic service provision.
However, it is hoped and anticipated that
external support for CMAM will be increasingly
phased out over the coming years, as
the MoH is more able to assume full management
and funding of CMAM activities.
V Wambani, Kenya, 2011
Specific challenges to the full integration
of CMAM at national level include:
• Sustained longer-term funding of CMAM
resources and supplies needs to be secured.
A total of US$45,697,975 is required for
2011-2015 that comprises US$2,625,000
for training, US$337,975 for community
mobilisation and US$42,735,000 for
supplies, equipment and service delivery.
• Continued technical support to the
CMAM scale-up in Malawi is necessary
to ensure high-quality, effective CMAM.
• There are human resource constraints, for
example, high turnover of staff within
health facilities, necessitating frequent retraining
and shortages of trained clinical
staff and other health workers. There are
difficulties in effective monitoring and
evaluation of CMAM activities, such as
late or incomplete reporting and poor
data quality from some facilities.
• There are difficulties sustaining community
outreach work, for example, some
volunteers are inactive because of lack of
incentive or expectation for financial
incentives and there is inadequate supervision
and documentation of outreach
activities.
Conclusions and way forward
In order to strengthen CMAM programmes
in terms of coverage, access and quality of
service, the Government of Malawi will
continue to advocate for CMAM, engage
partners, strengthen domestic resource allocation
through DIPs and budgets and
mobilise resources from non traditional
donors. It will continue to invest in strengthening
institutional and human capacity and
strengthen district and community systems
(Community Nutrition and HIV Workers).
Although CMAM in Malawi started in an
emergency context, the programme has
evolved and integrated into routine primary
health care services implemented by MoH
staff. The MOH in Malawi has a strong role
in providing CMAM services. The commitment
is evident from the great strides that
Malawi has taken to support the scale up
process. This has involved development of
CMAM and nutrition strategies, policies and
guidelines, financing CMAM, linking
CMAM to other child health activities and
interventions (notably HIV/AIDS) , delivering
on pre-service and in-service training,
and realising national production and
management of supplies of RUTF.
It is the view of the MoH in Malawi that
effective and efficient implementation of a
national CMAM programme will definitely
contribute to the reduction of child morbidity
and mortality and consequently improve
the wellbeing of Malawian society.
For more information, contact:
Mr Sylvester Kathumba, email:
kathumbasylvester@gmail.com,
sylvesterkathumba@yahoo.co.uk
Integrated management of
acute malnutrition in Kenya
including urban settings
By Valerie Sallie Wambani
Valerie Wambani is Programme Manager for Food Security and Emergency
Nutrition, Division of Nutrition, Ministry of Public Health and Sanitation. She is
responsible for coordination of the Kenya’s nutrition response activities, the
Nutrition Technical Forum, development and dissemination of guidelines, technical
support to district teams and resource mobilisation for implementation
response strategy.
The author would like to acknowledge the Permanent Secretary, Director and Head of the
Department of Ministry of Public Health and Sanitation, as well as the Department of Family
Health and Terry Wefwafwa (Head, Division of Nutrition). The author also acknowledges the work
and support of UNICEF Kenya, Concern Worldwide Kenya (special mention to Yacob Yishak and
Koki Kyalo), WFP Kenya, Nutrition Technical Forum members and Dolores Rio, UNICEF New York.
AMREF
ASAL
ASCU
AOP
CSB
GAIN
GAM
GIZ
ICC
IMAM
IP
African Medical and Research Foundation
Arid and Semi-Arid Lands
Agriculture Sector Coordinating Unit
Annual Operational Plan
Corn Soya Blend
Global Alliance for Improved Nutrition
Global acute malnutrition
German Society for International Cooperation
Inter-Agency Coordinating Committees
Integrated Management of Acute
Malnutrition
Implementing partners
Context
Kenya has a population of 38.7 million people,
of which 5,939,308 are children under five
(U5) years of age. The country is divided into
eight provinces: Coast, Eastern, Central,
North Eastern, Rift Valley, Nyanza, Western
and Nairobi. However, with the new dispensation,
these provinces are being phased out
to pave way for the 47 counties that will
feature more prominently after 2012 in terms
of governance. Agriculture, tourism and
manufacturing are the mainstay of the economy.
Two indicators of nutrition status of U5
children have worsened over the last two
decades (see Figure 1), with the Kenya
Demographic Health Survey (KDHS) 2008–09
reporting that 35% were stunted (2,096,575
children) and 6.7% were wasted (397,934) 1 .
However, the prevalence of underweight children
has reduced from 22% to 16.1% (956,228).
The prevalence of stunting was highest in
Mother and child in Turkana county
IP Implementing partners
KDHS Kenya Demographic Health Survey
MDG Millennium Development Goal
MAM Moderate acute malnutrition
MoH Ministry of Health
MoMS Ministry of Medical Services
MoPHS Ministry of Public Health and Sanitation
NTF Nutrition Technical Forum
NICC Nutrition Interagency Coordinating
Committee
PLW Pregnant and lactating women
RUTF Ready to Use Therapeutic Food
three provinces: Eastern, 41.9%, Coast, 39.0%,
and Rift Valley, 35.7%. Overall, the health
status of the population is poor, with an infant
mortality rate of 52 deaths per 1,000 live
births, an U5 mortality rate of 74 deaths per
1,000 live births, and a maternal mortality rate
of 441 deaths per 100,000 live births.
Kenya experienced a serious drought in
2011 affecting the northern parts of the country
and also had a mass influx of refugees
arriving from Somalia (July 2011). At this time
it was estimated that more than 1,500 refugees
were arriving each day, many of whom were
in very poor condition after travelling for
days and weeks to reach the camps. The
refugee camp of Dadaab, in particular, was
1
CBS, MOH, KEMRI, NCPD, ORC Macro, Cleverton, Maryland
USA, Centre for Disease control Nairobi, (2008/2009).
Kenya Demographic and Health Survey .pp 42-45
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