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Yacob Yishak and Regine Kopplow

Yacob Yishak and Regine Kopplow. Contributing to Resilience A Model for Nutrition Surge Capacity. Trends in Global Acute Malnutrition. 2010 and 2011 nutrition surveys were conducted between April and June. Data from these surveys was used to construct maps. Four Factors.

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Yacob Yishak and Regine Kopplow

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  1. Yacob Yishak and Regine Kopplow Contributing to Resilience A Model for Nutrition Surge Capacity

  2. Trends in Global Acute Malnutrition 2010 and 2011 nutrition surveys were conducted between April and June. Data from these surveys was used to construct maps

  3. Four Factors Create resilience over the long term Good coordination Strengthen government capacity (e.g. Health System Strengthening) Early scaling up of food, nutrition and livelihood interventions (including water)

  4. Creating Resilience • Community involvement and dialogue • Switching to drought resistant livestock • Promoting diversified livelihoods • Rangeland management • Conflict mitigation • Increasing water availability • Early, gradually intensifying emergency interventions in health and nutrition, water, and food security

  5. Nutrition Surge Capacity Strengthen the capacity of government health systems to effectively manage increased caseloads of severe acute malnutrition without undermining on going systems strengthening efforts. The objective is not to reduce malnutrition!

  6. Surge capacity model components 1. Risk analysis 2. Threshold setting 3. Monitoring against thresholds/ triggering surge support 4. Provision of surge support Health system (strengthening where needed) 5. Scaling down of surge support

  7. Health system strengthening Caseload Health System Capacity Externalsupport Ongoing health systems strengthening efforts Time *Adapted from P. Hailey and D. Tewoldeberha, ENN, 2010, issue 39

  8. Health system strengthening Performance analysis Gap assessment Identified gaps Possible action(s) No technical staff/ staff shortage Make request for staff allocation Mainly delivered through: -On-the-job training -Joint supportive supervision Has the health facility achieved the performance indicator? (use checklist) No Determine actual reasons for poor indicators Lack of reference materials Request materials from district Yes Inadequate supplies Purchase equipments Inadequate technical knowledge Train staff on knowledge gaps Inadequate working space at HF Construct makeshift shelter *On-Job Training Guide for High Impact Nutrition Interventions, Oct. 2011, MOPHS, Kenya

  9. What happens to the health system strengthening if an emergency strikes? If and when external support comes: - it is often late - not tailored to needs and existing capacity -if priority is given to treatment of acute malnutrition the delivery of other life-saving services (e.g. treatment of childhood illnesses or vaccination) is compromised Government systems are usually resource constrained and lack the required flexibility Systems often fail to respond when the need and potential public health impact is greatest

  10. Health system strengthening Strengthen the capacity of government health systems to effectively manage increased caseloads of severe acute malnutrition without undermining on going systems strengthening efforts. Caseload Health System Capacity Externalsupport Time *Adapted from P. Hailey and D. Tewoldeberha, ENN, 2010, issue 39

  11. Component 1: Risk analysis • Analysis of the drivers of increased caseloads and delayed health seeking behaviour •  Understand what factors have an impact •  Understand how these factors interlink Done by staff in Butiye Health Centre, Moyale District, Kenya

  12. Model component 2: Threshold setting(Number of new admissions into nutrition treatment services per month; using the example from Turbi health facility in Chalbi) Emergency Serious Caseload Alert Normal Time How many patients can the health facility cope with?

  13. 3a. Monitoring caseloads against thresholds Diarrhoea Pneumonia Severe malnutrition (SAM) Butiye Health Centre, Moyale District, Kenya, photos by R.Kopplow 2012 2011

  14. Model component 3b: Triggering surge support DHMT approaches NGO for additional support where needed Scale up During DHMT meeting issue is discussed and the scale up of support approved Health facility contacts DHMT Caseload reaches threshold Monitoring of malnutrition and disease caseloads, the health seeking influencing factors and mobilisation activities carried out in the area Health systems strengthening

  15. Model component 4: Provision of surge support • Surge support is: • Defined for district • Agreed in advance • Formalised in MoU • Prepared • Funded Emergency e.g.>25 cases Mentoring continues plus direct implementation by supporting NGO Follow up request & secondment of 1 additional NGO nurse Serious e.g. 16-25 cases Mentoring continues plus implementation of short-term solutions to overcome gaps Follow up request & secondment of 1 nurse from another clinic Alert e.g. 10-15 cases Intensified mentoring focuses on crucial gaps and hot spot facilities Follow up request & train non-clinical staff to fill gaps Normal e.g. <10 cases Health system strengthening through mentoring approach Make request for staff allocation under MOH AWP Threshold Caseload Support provided Example: shortage of technical staff

  16. Model component 5: Scaling down of surge support DHMT approaches NGO for additional support (where needed) Caseloads go below pre-defined threshold Scale down Scale up Health facility contacts DHMT During DHMT meeting issue is discussed and the scale up of support approved During DHMT meeting issue is discussed and the scale down of support approved Health facility contacts DHMT DHMT with support of NGO scales down the support Caseload reaches threshold Monitoring of malnutrition and disease caseloads, the health seeking influencing factors and mobilisation activities carried out in the area Health systems strengthening

  17. Progress so far Technical review around nutrition surge capacity Development of a theoretical nutrition surge capacity model jointly with government and health staff Transformed the theoretical model into a practical operational tool District nutrition teams developed thresholds, activation mechanisms and drafted phased support packages On-going pilot in 14 facilities in Chalbi, Sololo and Moyale

  18. Next steps Amend the MOU with the Ministry to include surge capacity • Agree on the surge support package • Cost the support package Test the scaling up/ down of support Conduct research to proof the concept

  19. Where are the links to livestock? Milk availability for consumption price Animal body condition • price for animals & meat Movement of animals: • proximity to health facilities • workload • decision making 2. Would a similar model be useful to scale up veterinary services to respond to disease outbreaks? 1. Livestock impacts on malnutrition prevalence and health seeking behavior

  20. Where are the links to agriculture? Food quantity and diversity impact on nutritional status Workload (of women) influences health seeking, child feeding and caring practices

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