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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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slide1

Community based Management of Acute Malnutrition

How we performed in

Khyber Pakhtunkhwa

Karachi June 3-4, 2010

community management of acute malnutrition
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
situation analysis
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
cmam coverage
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
how we proceeded
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
how we proceeded7
--------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
establishment of nutrition cluster
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
prepositioning of nutrition supplies
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
capacity building
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
establishment of cmam interventions
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
slide19

SFP Performance Indicators

  • Cure rate > 85 %(Sphere>75%)
  • Default rate < 13% (Sphere < 15%)
  • Death rate is < 1%
otp admission and exits 2009 10
OTP Admission and Exits 2009 & 10)
  • 9,819 SAM children treated in OTP
  • 3,687 SAM children are currently in
  • the program
slide21

OTP Performance Indicators

  • Cure rate > 80 % (Sphere > 75%)
  • Default rate > 15% (Sphere < 15%)
  • Death rate is < 1%
slide22

SC Performance Indicators

  • 1,449 children treated in SCs
  • Cure rate > 90%
  • Death rate = 5% (includes most deaths
  • in first few hours of admission)
nutrition education
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
multiple micronutrient supplementation
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
establishment nutrition information system
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.
slide26

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
slide27

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
slide28

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
slide29

After Treatment

Before Treatment

slide30

After Treatment

Before Treatment

slide31

After Treatment

Before Treatment

slide32

After Treatment

Before Treatment

slide33

After Treatment

Before Treatment

slide34

Grateful

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