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Scaling Up Community-Based Malnutrition Treatment

Over the past decade, there has been significant global scale-up of community-based treatment for Severe Acute Malnutrition (SAM), primarily transitioning from NGO activities to government-run health services. While there is a foundation for long-term service provision, there are still bottlenecks to overcome. This shift requires investments from various actors to improve prevention and treatment capabilities. Areas for action include creating both demand and supply, strengthening the continuum of care, integrating nutrition services into health systems, and addressing vulnerable groups. Quality of services, therapeutic supplies, and nutrition information also require attention to enhance delivery capacity, data collection methods, and evidence-based approaches. In summary, while prevention is crucial, urgent treatment is essential for malnourished individuals.

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Scaling Up Community-Based Malnutrition Treatment

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  1. 10 years of community-based treatment of SAM

  2. Global scale up

  3. Global scale up • National nutrition systems of variable strength • Primarily framed as humanitarian activity …..but increasing shift from NGO standalone activity into government public health service 3. Foundation for long term service provision is present ……but bottlenecks remain in application • Possible to scale up in a short period of time….requiring investmentsfrom a wide range of actors • Prevention first…..but treatment capacity for those that need it

  4. Expanding our understanding • Improved mapping data capture and technical support • Investments in national capacity for nutrition information • Review of availability, accessibility and coverage data • Geographic coverage: 43% • Treatment coverage: 7-13%

  5. Global burden of Severe Acute Malnutrition (2012) 0.2 0.2 1.5 1.4 1.8 3.0 5.1 9.2 17.3

  6. Equitable access Areas for action remain- creating demand • CHWs systems and beyond? • Creating a constituency by engaging civil society Areas for action remain- creating supply • Strengthening the continuum of care • Integration into health services (DHSS, ICCM, WHO/UNICEF Task Force on Integration) • Costings for SAM/nutrition and integration into government budget lines • Addressing vulnerable groups (including other age groups), technical issues and evidence gaps, methods to identify differing subnational needs

  7. Quality of services Areas for action: capacity to deliver • Critical role of supervision and investment in local capacity at facility and community level • Integration across nutrition and health (e.g. IYCF and HIV) Areas for action: Therapeutic supplies • Product specifications and reference standards limited, undermining national registration • Local production capacity and formulations more complex and expensive than anticipated • Supply chain management capacity • Sourcing routine medications

  8. NUTRITION INFORMATION Areas for action • Strengthen routine SAM management data by building off of existing systems • Address methodology issues- Capacity for collection, analysis and promotion of data use (supervision) • Innovation – rapid SMS and real time information • Strengthen Global SAM tool • Review and consolidate definition of geographic coverage • Improving treatment coverage methods • Strengthening the evidence base • Developing technical and operational framework for national treatment coverage estimates • Integrate coverage into routine nutrition information systems

  9. In summary Prevention first… …but treatment is urgently needed for those who are malnourished

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