CMAM/SUN conference14th – 17th November 2011

Addis Ababa, EthiopiaScaling up Community Management of Acute

Malnutrition and Scaling up Nutrition (SUN)

MOZAMBIQUE

Edna Germack Possolo

Nutritionist and Head of Department of Nutrition/MoH

Background/country information

Total population: ~23 million

Prevalence of SAM in U5s: 1.3%

Prevalence of MAM in U5s: 2.9%

Chronic Food Insecurity: 35%

EBF: 37%; ACF: 37%

Gaza

Manica

Tete

NiassaCabo

Delgado

Nampula

Zambezia

Inhambane

Maputo

Maputo City

Sofala

1.3%

3.8%

2.6%

5.2%

3.5%

8.7%

5.1%

2.8%

2.1%

1.8%

3.2%

Acute malnutrition rates (2008 MICS)

PRN: Nutrition Rehabilitation Programme

UnderweightStuntingAcute Undernutrition

Story of CMAM Scale up

• 2002-2004: Standard inpatient treatment for SAM

• 2004: Outpatient treatment for SAM without complications for children with HIVintroduced in Maputo City

(2007) Began to expand to general health services and provinces

• 2005: Food Supplementation Programme to treat MAM introduced in emergencyaffected areas and expanded through country

• 2007-2010: Integration of the different components of treatment andrehabilitation linked as one unique programme:

Nutrition Rehabilitation Programme (PRN)

Extension of the target group

• August 2010-now:

• Approval of the new protocols

• Developed training materials

• Started training

• Implementation process

nutrition education

Nutrition Rehabilitation Programme (PRN)

Children 0-15 years

Policy & Strategy Environment

Relevant Policies / Strategies:

• National Nutrition Strategy

• Multisectoral Action Plan toReduce Chronic Undernutrition

• PRN is incorporated in HealthSector Plans and the IntegratedPlan to Achieve MDGs 4&5

IMCD Package(Health Center &Community)

HIV/AIDS & TB services

Medical Supply System

APEs curriculum(Community Health Workers)

National Health Weeks(MUAC assessment, 1x/year)

Social ProtectionProgrammes

(Nutrition Counselling)

Emergency preparedness andresponse plans

NutritionRehabilitation

Programme

Coordination and funding

Coordination:

• Swap group

• Nutrition Working Group (MoH & partners)– Aim: to improve nutrition programs by

strengthening the partnership withdonors and implementation partners

Financial Support:

• Government, UNICEF,WFP, USAID,Clinton Foundation

Strong focus placed on training of full PRN package

• Facility-based health workers

• CHWs

• Community leaders andtraditional healers

• Provincial-level health staff

Several programme monitoring tools developed:

• Individual- and programme-level monitoring forms

• Database to track admissions and outcomes

• Database to manage stocks of RUTF, CSB Plus and therapeuticmilks

Training and monitoring

Geographical coverage: out of approx. 1,280 health facilities:

• 191 provide inpatient treatment for SAM using newprotocols!

• 229 provide outpatient treatment using new protocols!

Performance:

• By mid 2011, 6,319 children <5 were admitted for in-patienttreatment for SAM, of which 11% (701) died

• In 2010, 31,503 children treated for MAM (using CSB orRUTF-based ration)

Facility based mortality of children under 5 due to SAM:

Year 2005 2006 2007 2008 2009 2010

Facility based deaths in children

under 5 due to SAM

15.2% N/A 11.5% 10.5% 11.8% 9.3%

Results

Successes

Success 1:

• Strong commitment by government and SWAP (at alllevels)

Success 2:

• Good integration in health programmes; increasinginterest and support from the communities

Success 3:

• Successful set-up of local production of RUTF,supported by Government and UNICEF (local RUTFnow procured from JAM by Clinton Foundation)

• Maintaining quality of training at all levels

• Recording and reporting

• Supply chain management

• Short funding cycles of donors (e.g. could affect support tolocal production of RUTF)

• Ensuring appropriate nutritioncounselling in all componentsof the programme

Challenges

• Essential to have all 4 components of the CMAM ‘model’ insame area

• Good partnership with donors, other sectors andimplementing partners is important

• Integration of PRN in key health programmes

• Establishing a link with social protection programmes

Key learning

• Finalise Volume Two of the Manual for the treatment of acutemalnutrition for adults (priority: pregnant & lactating women,HIV/AIDS, TB)

• Establish supportive supervision systems and ensure they areroutinely applied

• Prioritize community involvement and initiate in places whereit does not exist

• Introduce the new protocols inpre-service training of health andnutrition workers of all levels

• Advocate for Government policyto ensure ingredients for RUTFand other supplements comefrom local farmers/producers

Way forward

• Leonardo Chavane: National Directorate for Public Health

• Department of Nutrition

• Alison Tumilowicz, Melanie Remane, Dulce Nhassico, ArlindoMachava: FANTA-2/FGH360

• Tina Lloren, Vasconcelos Muatecalene, Isaltina Roque: Savethe Children

• Maaike Arts, Sónia Khan, Manuela Cau: UNICEF

• Nádia Osman, Gilberto Muai: WFP

• Other implementing partners

• Maria Pinto: USAID

• Kirsten Havemann: DANIDA

• Emily and Abi: ENN

Acknowledgements

Thank you