Integrated Management of Acute Malnutrition

1. Integrated Management of Acute Malnutrition Session 7: Forecasting, procurement, and storage of supplies

2. Session 7: Training Objective Enable health workers to forecast supplies for management of SAM and understand the procurement process.

3. Session 7: Learning objectives By the end of the session, participants should be able to • Forecast supplies for the management of SAM • Understand the procurement process • Understand the importance of proper storage of supplies

4. Session 7: Content • Overview • Estimating the number of SAM cases • Forecasting • Procurement and distribution • Storage

5. Overview

6. Overview • Any programme cannot function well without regular supplies. • Delays in procurement and breaks in supply damage the programme by discouraging both community members and health service providers. • Over-supply is also a problem – most therapeutic supplies have expiry date of 2 years from date of production. • At start of a programme, it is difficult to accurately estimate supply requirements. Problems in under/over supply may occur. • When programme is well established, and client flow more stabilized, under/over supply should be minimized.

7. Recap: supplies required • Therapeutic commodities, including F100, F75 , ReSoMal and RUTF • Equipment to prepare and give therapeutic milks and supplementary food, including measuring jugs, water boiling/treatment and storage equipment and cups • Routine drugs, e.g. antibiotics, vitamin A supplements, deworming tablets • Anthropometric equipment, including MUAC tapes, weighing scales, and height/length boards • Job aids and counselling materials • Monitoring, reporting and supervision tools, including registers, ITC cards, referral forms, and reporting sheets

8. Estimating the number of SAM cases

9. Estimating number of SAM cases • In order to forecast supplies, we need to estimate the number of SAM cases. • We can estimate the number of cases using: • Survey data: generally used for forecasting at the national level • Previous caseload from monitoring reports: generally used for forecasting at the health facility level

10. Estimating the number cases using survey data • We need to know the • Population of children aged <5 years • Estimated prevalence of SAM • Estimated incidence, which is the number of new cases occurring every year (incidence is approx 2 times prevalence) • Estimated coverage of services (ideally not below 70%) • Estimate percentage that will be treated through OTC and ITC (approximately 80% will be treated through OTC and 20% through ITC if cases are detected early) • If local data on the prevalence of nutrition are not available, use data from national surveys such as the DHS.

11. E X A M P L E

12. Estimating # cases using previous caseload • E.g. a health facility sees approx 10 patients per month which equals 120 patients per year • Caution! • We don’t have accurate data on caseload at the start of the programme • Previous caseload may not be accurate if coverage goes  up or 

13. Exercise 1 !

14. Exercise 1 • Estimate the number of SAM cases that will be treated as inpatients and outpatients in the following population • Total population = 40,000 • Children under five = 20% • Prevalence SAM = 1% • Incidence is twice the prevalence • Expected coverage is 70% • 80% of cases will not have complications

15. Forecasting

16. Forecasting • Because of the short shelf-life of supplies, they need to be ordered in small quantities on a regular basis • Supply requirements can be estimated using • Excel-based forecasting tools (available from UNICEF) • Manually • It is helpful to know the average quantities of therapeutic supplies and drugs needed to treat a child with SAM in Zanzibar. Until this data becomes available, use the amounts given in the next slide to estimate requirements

18. Packaging of supplies *MSD/CMS may have different packaging

19. Exercise 2 !

20. Procurement and distribution

21. Procurement and distribution • All of nutrition supplies (F75, F100, RUTF, ReSoMal) should be registered and included in the Essential Drug List (EDL) to ensure access and availability at all levels.

22. CMSD Procurement Department Procurement by donors until institutionalized into government system Zonal Material Manager Reports and orders DMO office (store or pharmacy) Supplies Health facility Referral hospital

23. Storage

24. Storage • Proper handling of supplies is important as damage leads to waste. • All products at all levels must be stored according to the specific storage requirements to ensure they can be used safely and effectively to treat acute malnutrition. Avoid storage in direct heat. • ‘FIFO’ (First in First out) should be applied to avoid products expiring • Caution! Most products have a two-year expiry date from the date of production

25. Summary • Timely procurement of supplies is essential to ensure that services for treating SAM function smoothly. • Allow at least four months lead time for UNICEF to procure from overseas • Maintain buffer stock of 3 months in country at all times • Tools are available to help estimate supply requirements