Global CMAM Surge Approach:Operational Guide

2 CONCERN WORLDWIDE

Acknowledgments

This guide was written principally by Andi Kendle (consultant contracted by Concern for this purpose) with extensive input from Peter Hailey (co-consultant, who together with Daniel Tewoldeberha sparked the further development of the CMAM Surge Approach with their article in Field Exchange in 2010); Yacob Yishak and Weldon Ngetich (Concern staff in Kenya, who have been leading implementation of the Surge Approach); Regine Kopplow, Kate Golden, Margaret Bee, Suzanne Fuhrman and Sajia Mehjabeen (Concern HQ Advisers for nutrition and health); Nicky Dent, Erin McCloskey, Ciara Passmore and Celine LeSavre (consultants assisting on aspects of the guide and workshops) and Anne-Dominique Israel (Action Contre la Faim), Megan Gayford (Save the Children), and Marie-Sophie Whitney (ECHO) who make up the steering committee for this guide. A number of people also shared their relevant experience from different contexts: Hilda Kawuki and Joseph Odyek (Concern Uganda), Michele Seibou (Concern Niger), Sinead OMahony (ex-Concern, currently with GOAL), Rahab Kimani (Save the Children), and Constance Gathi, Daniel Muhinja, Jardine Wughanga (World Vision). Thank you all for you invaluable contributions.

We would like to particularly thank Amanda McClelland, who during her time on Concerns Emergency Response Team, first articulated the CMAM Surge Approach (2007/2008) and introduced core elements into Concerns programmes in Uganda (2008) and Niger (2010). We would also like to thank all the participants at the Kenya national CMAM Surge Approach workshop and the East Africa CMAM Surge Approach workshop (both in Nairobi), and the Francophone CMAM Surge workshop (in Niamey, Niger). These participants allowed us to pilot aspects of the guide and provided critical feedback for its finalisation.

We would also like to thank DFID for funding Concern to develop this guide in English and French.

Finally, we would like to thank all of the Concern staff and partners in Kenya, Uganda and Niger who have been working hard to refine the approach in their country contexts, including the Sub-County Health Management Team of Marsabit, Kenya (particularly Wako Banchale, formerly N.Horr Sub-County Public Health Nurse, who has championed the approach) and the District Health Management Teams in Moroto and Nakapiripirit Districts of Karamoja, Uganda.

To all: a huge thank you and congratulations for getting the approach and the guide this far, and we looking forward to working with you as it evolves and expands!

GLOBAL CMAM SURGE APPROACH: OPERATIONAL GUIDE 3

Acknowledgments ................................................................................................................................................................2

List of Figures, Tables and Tools .......................................................................................................................................5

Acronyms ................................................................................................................................................................................6

Glossary of Terms .................................................................................................................................................................7

PREFACE: THIS GUIDE ...............................................................................................................................................8

What is in the guide? .........................................................................................................................................................10

Who is this guide for? ........................................................................................................................................................10

Adapting the guide to different contexts .......................................................................................................................10

PART A: INTRODUCTION THE CMAM SURGE APPROACH ..............................................................11

What is the CMAM Surge Approach? ...........................................................................................................................11

Underlying principles ...................................................................................................................................................13

Specific objective of the CMAM Surge Approach ...............................................................................................14

Where has the surge approach come from? ................................................................................................................14

When should you use the CMAM Surge Approach? .................................................................................................15

What is the future of surge? .............................................................................................................................................15

PART B: IMPLEMENTING THE CMAM SURGE APPROACH FOCUSING ON THE HF ............16

Country level adaptations prior to set-up ......................................................................................................................16

Main actors ...........................................................................................................................................................................17

Stage 1: Setting it up - Analysing and planning for the HF level ..............................................................20

Preparation of data.......................................................................................................................................................20

Step 1: Trends and situational analysis ...................................................................................................................21

Step 2. Capacity review ..............................................................................................................................................26

Step 3. Threshold setting .......................................................................................................................................... 30

Step 4. Defining and costing of surge actions ..................................................................................................... 34

Step 5. Formalising commitments ........................................................................................................................... 39

Stage 2: Real-Time Monitoring and Action .........................................................................................................41

Step 6: Monitoring thresholds ...................................................................................................................................41

Step 7: Scaling up and scaling down surge actions ...........................................................................................45

Step 8: Reflect regular review and adaptation ..................................................................................................47

Table of Contents

4 CONCERN WORLDWIDE

PART C FOR PILOTING: THE SURGE APPROACH FOCUSING ON THE DHMT & RHMT .............................................................................................................................................................. 49

Stage 1: Setting it up Analysing and planning at the DHMT level ........................................................51

Step 1: Trends and situational analysis ...................................................................................................................51

Step 2: Capacity review .............................................................................................................................................51

Step 3: Threshold setting ...........................................................................................................................................53

Step 4: Defining and costing of surge actions ..................................................................................................... 54

Step 5. Formalising commitments ........................................................................................................................... 56

Stage 2: Real-time monitoring and action ...........................................................................................................57

Step 6: Monitoring thresholds ...................................................................................................................................57

Step 7: Scaling up and scaling down surge actions ...........................................................................................57

Step 8: Reflect regular review and adaptation ..................................................................................................57

PART D: OTHER CONSIDERATIONS ................................................................................................................ 58

Coordination and linkages ........................................................................................................................................ 58

Ongoing research/questions .................................................................................................................................... 58

Frequently Asked Questions ...................................................................................