Transcript Innovative Approaches to Tackling World Hunger

Contributing to Resilience
A Model for Nutrition Surge Capacity
Yacob Yishak and Regine Kopplow
Trends in Global Acute Malnutrition
2010 and 2011 nutrition surveys were conducted between April and June. Data from these surveys
was used to construct maps
Four Factors
1. Create resilience over the long term
2. Good coordination
3. Strengthen government capacity (e.g.
Health System Strengthening)
4. Early scaling up of food, nutrition and
livelihood interventions (including
water)
Creating Resilience
 Community involvement and
dialogue
 Switching to drought resistant
livestock
 Promoting diversified livelihoods
 Rangeland management
 Conflict mitigation
 Increasing water availability
 Early, gradually intensifying
emergency interventions in
health and nutrition, water, and
food security
Nutrition Surge Capacity
Strengthen the capacity of government health systems to effectively manage
increased caseloads of severe acute malnutrition without undermining on going
systems strengthening efforts.
The objective is not to reduce malnutrition!
Surge capacity model components
1. Risk analysis
2. Threshold setting
3. Monitoring against thresholds/
triggering surge support
Health system
(strengthening
where needed)
4. Provision of
surge support
5. Scaling down of
surge support
Health system strengthening
Caseload
Health
System
Capacity
External
support
Ongoing health systems
strengthening efforts
Time
*Adapted from P. Hailey and D. Tewoldeberha, ENN, 2010, issue 39
Health system strengthening
Performance
analysis
Has the health
facility
achieved the
performance
indicator? (use
checklist)
Gap
assessment
No
Yes
Determine
actual
reasons for
poor
indicators
Identified gaps
Possible
action(s)
No technical staff/
staff shortage
Make request for
staff allocation
Lack of reference
materials
Request materials
Mainly delivered
from district
through:
Inadequate supplies
-On-the-job
Purchase
training
equipments
Inadequate technical
knowledge
-Joint supportive
Train
staff on
supervision
knowledge gaps
Inadequate working
space at HF
Construct
makeshift shelter
*On-Job Training Guide for High Impact Nutrition Interventions, Oct. 2011, MOPHS, Kenya
What happens to the health system
strengthening if an emergency strikes?
Government
systems are
usually resource
constrained and
lack the required
flexibility
Systems often fail
to respond when
the need and
potential public
health impact is
greatest
If and when external support
comes:
- it is often late
- not tailored to needs and
existing capacity
-if priority is given to treatment
of acute malnutrition the
delivery of other life-saving
services (e.g. treatment of
childhood illnesses or
vaccination) is compromised
Health system strengthening
Caseload
Strengthen the capacity of government
health systems to effectively manage
increased caseloads of severe acute
malnutrition without undermining on
External
going systems strengthening
efforts.
support
Time
*Adapted from P. Hailey and D. Tewoldeberha, ENN, 2010, issue 39
Health
System
Capacity
Component 1: Risk analysis
 Analysis of the drivers of increased caseloads and delayed health
seeking behaviour
 Understand what factors have an impact
 Understand how these factors interlink
Done by staff in Butiye Health Centre, Moyale District, Kenya
Model component 2: Threshold setting
(Number of new admissions into nutrition treatment services per month; using the example
from Turbi health facility in Chalbi)
Severe
malnutrition
Caseload
Emergency
Serious
0-10
0-20
11-15
21-30
16-20
Alert
Moderate
malnutrition
31-50
>50
Normal
>20
Time
How many patients can the health facility cope with?
3a. Monitoring caseloads against thresholds
Diarrhoea
Pneumonia
Severe malnutrition (SAM)
2011
Butiye Health Centre, Moyale District, Kenya, photos by R.Kopplow
2012
Model component 3b: Triggering surge support
Scale up
DHMT approaches NGO for
additional support where
needed
During DHMT meeting issue is
discussed and the scale up of
support approved
Health facility contacts DHMT
Caseload reaches threshold
Monitoring of malnutrition and disease caseloads, the health seeking influencing factors
and mobilisation activities carried out in the area
Health systems strengthening
Model component 4: Provision of surge
support
Mentoring continues plus
direct implementation by
supporting NGO
Follow up request &
secondment of 1
additional NGO
nurse
Mentoring continues plus
implementation of short-term
solutions to overcome gaps
Follow up request &
secondment of 1
nurse from another
clinic
Intensified mentoring focuses
on crucial gaps and hot
spot facilities
Follow up request &
train non-clinical
staff to fill gaps
Normal
e.g. <10
cases
Health system
strengthening through
mentoring approach
Make request for
staff allocation under
MOH AWP
Threshold
Caseload
Support provided
Example: shortage
of technical staff
Emergency
Serious
Surge
e.g.>25
cases
e.g. 1625 cases
support
is:
•Defined for district
•Agreed in advance
10•Formalised
ine.g.
MoU
Alert
15 cases
•Prepared
•Funded
Model component 5: Scaling down of surge support
Scale up
DHMT approaches NGO for
additional support (where
needed)
Caseloads go below predefined threshold
Scale down
Health facility contacts DHMT
During DHMT meeting issue is
discussed and the scale up of
support approved
During DHMT meeting issue is
discussed and the scale down
of support approved
Health facility contacts DHMT
Caseload reaches threshold
DHMT with support of NGO
scales down the support
Monitoring of malnutrition and disease caseloads, the health seeking influencing factors
and mobilisation activities carried out in the area
Health systems strengthening
Progress so far
1.
2.
3.
4.
5.
Technical review around nutrition surge capacity
Development of a theoretical nutrition surge capacity model jointly
with government and health staff
Transformed the theoretical model into a practical operational tool
District nutrition teams developed thresholds, activation
mechanisms and drafted phased support packages
On-going pilot in 14 facilities in Chalbi, Sololo and Moyale
Next steps
1.
Amend the MOU with the Ministry to include surge capacity
–
–
2.
3.
Agree on the surge support package
Cost the support package
Test the scaling up/ down of support
Conduct research to proof the concept
Where are the links to livestock?
1. Livestock impacts on
malnutrition prevalence and
health seeking behavior
Milk
•availability for consumption
•price
Animal body condition
•
price for animals & meat
Movement of animals:
•
•
•
proximity to health facilities
workload
decision making
2. Would a similar model be
useful to scale up veterinary
services to respond to
disease outbreaks?
Where are the links to agriculture?
1. Food quantity and diversity impact on nutritional status
2. Workload (of women) influences health seeking, child
feeding and caring practices