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Community based Management of Acute Malnutrition How we performed in Khyber Pakhtunkhwa

Community based Management of Acute Malnutrition How we performed in Khyber Pakhtunkhwa Karachi June 3-4, 2010 Community Management of Acute Malnutrition Community is essential part Management by community Community understand the nutrition issues and available solutions

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Community based Management of Acute Malnutrition How we performed in Khyber Pakhtunkhwa

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  1. Community based Management of Acute Malnutrition How we performed in Khyber Pakhtunkhwa Karachi June 3-4, 2010

  2. Community Management of Acute Malnutrition • Community is essential part • Management by community • Community understand the nutrition issues and available solutions • Leads to permanent solution • Owned by the community • Sustainability is achieved

  3. Situation Analysis • Child Malnutrition rates in Pakistan, significantly high • NNS (2002) reveals 13% global acute malnutrition (GAM) • FATA MICS (2007) indicated 13% GAM • Nutrition surveys in IDPs camps and hosting districts (April 2009) showed 8% GAM, • Same survey, showed high prevalence of malnutrition by lower age group and low diversity of food consumption • MaCRAM indicates much higher figures among conflict affected population • Programme assessments (2009 &10) revealed 9-11% GAM

  4. CMAM Coverage • Started CMAM from flood affected areas of Peshawar in September 2008 • Have now spread to 14 districts and One Agency in FATA • Provided Services to more than 2.5 million population

  5. How we proceeded?-------- • Established Nutrition Cluster • Prepositioned supplies • Capacity building activities • Establishment of CMAM sites • Community Outreach • Community Mobilization, Stakeholders meetings and seminars • Screening of all eligible children and PLW using MUAC and • Referral to CMAM sites

  6. --------How we proceeded? • Registration of beneficiaries in appropriate feeding and treatment programs • SFP • OTP • SC • Nutrition education of caretakers (Focusing IYCF, Hygiene promotion & appropriate use of supplies) • Ensuring follow up of beneficieries • Nutrition Surveys and surveillance • Establishment of Nutrition Information System • Monitoring and Reporting of activities

  7. Establishment of Nutrition Cluster • Established in 2008 during floods emergency, fully functional Purposed to ensure timely, predictable, effective and well coordinated humanitarian response during emergencies. • Had 67 meetings conducted so for (11 meetings this year) • Started with two partners, have 20 regular partners now • Cluster jointly developed: Cluster strategy, ToRs, improvement plan, Emergency Response Plans- (CERF, PHRP-2009,10 and Joint Assessments-CERENA) • 3Ws updated regularly, projects allocations PHRP/CERF/EPF decided in the cluster • No duplication but shared responsibilities

  8. Prepositioning of Nutrition Supplies • Timely availability and distribution of nutrition supplies worth US$ 3.5 million • Supplies Included • Equipments [Anthropometric measurement kits, weighing scales, height boards, MUAC measuring tapes…] • Food [Supplementary: HEBs, FBF (UNIMIX) and Therapeutic (RUTF-Plumpynuts, F-100 & F-75 milk)] • Multi-micronutrients [MM Sachets, MM tablets, Folic Acid and Iron supplements) • Essential medicines [Analgesics-Paracetamol, β-Lactans-Amoxicillin, Anti-malarial-Chloroquine, Antihelmentics-Mebendazole, Antifungal-Nystatine, Antiprotozoals- Metronidazole) and ReSoMal • IEC material

  9. Nutrition Supplies

  10. IEC Material

  11. Capacity Building • 312 HCPs of govt. and 327 of IPs trained on CMAM • Additional 500 HCPs to be trained by the end 2010 • 272 outreach Workers of IPs and 321 LHWs trained on screening and referrals of malnourished clients • Many & many LHWs are wished to be trained in year 2010 • 93 enumerators trained on nutrition survey • 127 members of IPs trained on M&E, NIS • Countless “On Job trainings” on CMAM

  12. Capacity Building

  13. Establishment of CMAM Interventions • Agreements (MoUs and PCAs) • 10 MoUs signed with 10 hospitals for SC (US$ 100,000) • More than 20 PCAs signed with 15 IPs (>US$ 2 million) • Monitoring support provided to DoH • CMAM Centres • SFP/OTP centers established in 24 IDP camps & 265 UCs in 10 IDPs hosting districts, 4 conflict affected districts and one Agency in FATA • 10 Stabilization Centers are currently operational in 5 teaching and 5 DHQ Hospitals

  14. Nutrition Centres

  15. Screening using MUAC

  16. SFP Admissions and Exits 2009&10

  17. SFP Performance Indicators • Cure rate > 85 %(Sphere>75%) • Default rate < 13% (Sphere < 15%) • Death rate is < 1%

  18. OTP Admission and Exits 2009 & 10) • 9,819 SAM children treated in OTP • 3,687 SAM children are currently in • the program

  19. OTP Performance Indicators • Cure rate > 80 % (Sphere > 75%) • Default rate > 15% (Sphere < 15%) • Death rate is < 1%

  20. SC Performance Indicators • 1,449 children treated in SCs • Cure rate > 90% • Death rate = 5% (includes most deaths • in first few hours of admission)

  21. Nutrition Education • IYCF (Infant and Young Child Feeding) • 75,158 mothers/caretakers reached with messages on IYCF through breastfeeding corners and community sessions • Widely disseminated the national guidelines to promote and protect breastfeeding • Global Breastfeeding Week Celebrated in all camps and 6 IDPs hosting districts (More than 10,000 mothers reached) • (Radio messages, seminars, baby shows, awareness sessions conducted, IEC material distributed and displayed) • IEC material and messages distributed through CMAM centers Global Breastfeeding Week

  22. Multiple Micronutrient Supplementation • 44,075 children provided MM sachets and 18,989 PLW provided MM tablets in CMAM. • 52,794 children and 16,029 pregnant ladies were provided MM supplements through MCDs. • 52,135 children (2-5 yrs) dewormed through MCDs and MCWs

  23. Establishment Nutrition Information System • Followed by all nutrition cluster partners • A web based NIS which gives an updated status of the nutrition interventions in the province • Appreciated worldwide • Two of the regional offices (Kathmandu and Bangkok) have requested for sharing to replicate in other countries • Reports generated biweekly/monthly and regularly posted on One-Response Website.

  24. Challenges • Low priority for nutrition services • Ownership • Capacity of counterparts and IPs • High Expectations of service providers • Nutrition Supplies (Local production) • Difficulty in deployment of female service providers • Monitoring/supervision • NIS in HMIS

  25. Achievements (Khyber Pakhtunkhwa) • In Nutrition we started from ZERO and reached 20 partners • Started Nutrition services from scratch and expanded to more than 265 union councils in 14 districts and one Agency of FATA (keeping in mind its sustainability-Integration) • Reached to 544,538 children and 211,703 mothers • Established Nutrition Information System (NIS), proposed to be replicated globally • Strengthened capacities to respond to nutritional needs in emergencies and development settings

  26. Thanks • Partners • Government: DoH (Provincial/FATA/Districts), LHWs, EPI Programs, Tertiary Care Hospitals • NGOs: CERD, RAHBAR, FPHC, Abaseen Foundation, CDO, Salik Foundation, Relief Pakistan, PEACE, NRSP and FPHC • INGOs: Merlin, Relief International, Johanniter International and Save the Children, Maltesar Intl • UN: WHO, WFP, IOM, UNOCHA

  27. After Treatment Before Treatment

  28. After Treatment Before Treatment

  29. After Treatment Before Treatment

  30. After Treatment Before Treatment

  31. After Treatment Before Treatment

  32. Grateful • All those communities who gave us access to children and mothers • and • to children and mothers for accepting our services

  33. Grateful

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