RWANDA EXPANDED IMPACTCHILD SURVIVAL PROGRAM-

Integrating CMAM with C-IMCI

A Partnership of Concern Worldwide, International Rescue Committee and World Relief

CORE group meeting - May, 2011

1/5 of the total populationOver 300,000 children under five years

Direct Beneficiaries of the Program

Health center Manager /HC providers

Mother CHW-binome

Child

Strategic Objective

Reduce childhood mortality and morbidity

using community-based integrated case management

of diarrhoea, pneumonia (ARI), fever (malaria), and

nutrition (added later) reinforced by

social mobilization and behaviour change strategy

(Care Groups)

Level of Effort & Key Interventions

Diarrhoea35%

Pneumonia30%

Malaria35%

• ORT• Zinc• Feeding practices• Hygiene practices

• Prompt treatment• Early referral of newborns • Vitamin A , Zinc

• Prompt treatment • Bed nets

• OTP for SAM• CBNP – PD/H and

Com Kitchens• Small scale HH

food security support

• Technical Support to MOH

Nutrition

Why Integrate Nutrition?

– Malnutrition is known to be a contributing factor in over 35% of all child deaths in Rwanda

–  52% of children are stunted, one in five are underweight, and 4.6% are wasted

– Access to acute malnutrition services was poor– MoH recognized the need to identify and address

the management of acute malnutrition in the community

Integration at the program level-Community

Integration at the Program level-Health Facility

Management of Acute Malnutrition flowchart

CHW conducts home visit/community growth monitoring and assess

child with MUAC

Moderate (MAM)SAM without complications

SAM with complications

PD hearth/ Community kitchens

Refer to health centre for OTP

Referral to district hospital for stabilization

Health facility Community

SAM (Severe Acute)

Integration at national level – Advocacy

NATIONAL PROTOCOL FOR THE MANAGEMENT OF MALNUTRITION

Kigali, on May,2009

• CMAM in national nutrition protocol

• RUTF added into routine medical supply chain

Impact to Date A number of positive elements emerged from

integration of the CMAM approach with Com-IMCI

• Added value to CSHGP expanded impact• National nutrition protocol • CMAM services reached and treated over 8,000

Acute Malnourished children • Awareness of acute malnutrition (baseline- low in the

health agenda) Increased donor funding and available technical support

• MUAC screening included national vaccination campaigns

Elements & Factors that Facilitated Integration

• Strong Government commitment - “Emergency Plan to Eradicate Malnutrition” launched in May 2009.

• Existence of mobilized community network (30,000 non-salaried Community Health Workers)- 2 per village

• Existence of strong national level technical and policy working groups led by the MOH.

• Decentralized structure of governance maximized community involvement and mobilization to support integration.

Learning Highlights1. Although CMAM was developed for

emergency settings, it has proven to be equally effective in non-emergency

3. Network of CHWs integrated into the formal health system and implementing CCM

4. CSP strategy provided natural base for CMAM

5. No significant improvement in prevalence of acute malnutrition (baseline vs end of project nutrition survey)

What Needs to be Done to Improve Integration

• Data reporting and integration into national community HIS

• Collaboration to address the main problems causing malnutrition in the context of integrated approach

• Design strategies to address barriers to accessing services for malnourished children

Welcome to the Land of Thousand Hills!

Thank You