Federal DemocraticRepublic of EthiopiaMinistry of Health
EmergencyNutritionNetwork
CMAM/SUN Conference14th - 17th November 2011
Addis Ababa, EthiopiaScaling up Community Management of Acute
Malnutrition and Scaling up Nutrition (SUN)
Malawi: CMAM PolicyEnvironment
Sylvester Kathumba, Principal Nutritionist
Background information• Total population: 14,214,677• Prevalence of SAM in U5s: 1.5%• Prevalence of MAM in U5s: 4.0%• Number U5’s affected by SAM: 66,693
• Ht-for Age (stunting): 47%• Rate of exclusive breastfeeding: 71%• Anaemia: 3% severe, 24% moderate
• Population covered by CMAM: 314, 131• Definition & degree of scale up:> 80% facility coverage by 2012 (currently at 73%)
Roll out of CMAM in Malawi
History of CMAM in Malawi
Malawi
Policy & Strategy Environment
• Political commitment and leadership
• Inclusion of nutrition in National Developmentpolicies (MGDS, EHP, ACSD )
• Development of guiding operational tools– National Nutrition Policy and Strategic Plan, CMAM
Guidelines, CMAM M & E tools, CMAM Training Manual
• Setting up committees to guide scale up and qualityimplementation– CMAM Steering Committee, CAS, TNP
• Local Production of RUTF
Policy & Strategy Environment contd
• Partnership in financing CMAM programme
– Procurement of RUTF: MoH, UNICEF, Irish Aid,CIDA, CHAI
– Other core CMAM activities: MoH, CWW, USAID
• Coordination
– CMAM Steering committee, CAS, TNP, CMAMStakeholders Committee
• Linkages
– CMAM integrated with other Child SurvivalProgrammes such as IMCI, HTC/ART, IMCI,PMTCT, IYCN
Coordination and Networking
LearningForum
TargetedNutrition
Programme
CMAMStakeholders
Committee
CMAMSteering
Committee
CMAM
Programme Indicators
indicator 2004 2005 2006 2007 2008 2009 2010 2011 Cum/Aver
Districts2 2 5 20 21 24 29 29
Sites 32 32 116 236 292 349 418 444
Admission
3489 5052 17308 32679 31874 105778 101637 62483 360300
Discharges
3172 4928 15649 28994 35112 107568 101854 64953 362230
CR 77.9% 82.9% 84.8% 85.9% 84.5% 85.9% 86.2% 89.0% 84.6%
Death Rate
2.7% 1.4% 1.7% 2.9% 2.4% 4.9% 5.1% 2.1% 2.9%
DefaultRate
17.9% 12.6% 11.7% 9.0% 11.6% 6.7% 6.2% 5.4% 10.1%
Factors Contributing to Success
• Political commitment
• Establishment of CAS in scale up, integrationand quality service delivery
• Effective coordination and networking –partners, relevant government departments
• Local production of RUTF
• Commitment for government to take overfinancing of CMAM programme
• Development of CMAM Operational Plan
Major Challenges & Obstacles
• Resource stability
• Volunteers retention
• Capacity building: pre- and in-servicetraining
• Monitoring challenges: delays inreporting
Key Learning Points
• Multi-sectoral and partnershipcoordination
• All child survival programmesengaged in initial phase ofintegration
• Include cost of core CMAMactivities in DistrictImplementation Plans (DIPs)
• MoH providing overall lead inintegration and scale up process
• Effective partnership, networkingand use of existing structures
Next Steps & Way Forward
• Strengthen domestic resource allocation - DIPs and budgets• Mobilise resources - non traditional donors• Strengthen institutional and human capacity• Strengthen district and community systems (Community
Nutrition and HIV Workers)
• Obstacles:Inadequate resources for capacity building and supplies
• National & international development :Commit resources for scale up and effective monitoring of theprogramme
Acknowledgements
Department of Nutrition, HIVand AIDS-OPC
CMAM Advisory Services (CAS)
Clinton Health Access Initiative(CHAI)
UNICEF-Malawi
VALID International
CIDA Malawi
Irish Aid-Malawi
Come and Enjoy the Beauty of Lake Malawi
