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This presentation discusses the integration of Severe Acute Malnutrition (SAM) treatment into health systems, highlighting experiences and recommendations. It covers the context, background, strategic implications, practical implications, and next steps in integrating SAM treatment. The aim is to ensure that SAM treatment is available as part of regular health services, moving towards quality global coverage for children with SAM. Presented at the SAM International Conference in London, UK in October 2013.
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From Vertical to Horizontal: Experiences & Recommendations in Integrating SAM Treatment to Health Systems October 2013 SAM international Conference London, UK M Gallagher & A D Israel
Presentation Outline • Setting the context • Background • HSS & SAM treatment • Experiences – How does it look? • Strategic & practical implications • Conclusion
Setting the Context • Universal health coverage • Focus on design and implementation • Health systems strengthening (HSS) - -WHO 2007 • Integration – ‘institutionalization’ of SAM treatment
Background • Changing landscape of treatment of acute malnutrition with huge advances the last 25 years • Coverage still low at between 8-13% globally • Need to strengthen treatment of SAM as a disease – linkage Nutrition & Health • Learning from experiences of Global Health Initiatives (GHI) shift from disease specific to health systems strengthening
Shifting Dynamics of HSS Vertical Horizontal
Nigeria Partner support Government support
DR-Congo Partner support Government support
Where should we aim to go ? Partner support Government support
Strategic Implications • Bringing nutrition into health & working through the HSS building blocks to achieve sustainable availability & access to SAM treatment • Including SAM treatment as part of a minimum health package • Shift role of partners from ‘implementer’ to ‘facilitator’ • Simplifying CMAM protocols, implementation and follow-up • Transitioning from donor financing to MoH financing basic minimum health package of which SAM treatment is part of
Practical Implications General: • Identifying new ways of working from being model oriented to process oriented • Coordination of actors in working with one health system Design: • Comprehensive assessment of health system • Joint planning and implementation • Simplification of protocols and systems • Including strong component on community mobilization activities Implementation: • Working closely with authorities and communities to strengthen governance • Identifying financing gaps and mechanisms/timeframe • ‘Adaptive’ service delivery process • Human resources • Supply chain • Simplifying reporting and planning for integration of key indicators to the national information system
Next Steps • Health System Strengthening Task Force ToR being developed with support of WHO & UNICEF • ACF finalizing the Health Systems’ Strengthening Guidelines for 2014 • Health System Assessment tool being tested by UNICEF & partners • Experiences need to be further tested and documented in relation to quality of care and coverage
Conclusion There lies a significant opportunityahead with the increasing MoH leadership and commitment to SAM treatment, and with the evolving role of partners in support of it, to ensure that SAM treatment is available as part of regular health services, moving towards quality global coverage for children with SAM.
