yacob yishak and regine kopplow contributing to resilience a model for nutrition surge capacity
TRANSCRIPT
Yacob Yishak and Regine Kopplow
Contributing to Resilience A Model for Nutrition Surge Capacity
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
5. Scaling down of surge support
4. Provision of surge support
3. Monitoring against thresholds/ triggering surge support
2. Threshold setting
Health system
(strengthening where needed)
Health system strengthening
Caseload
External support
Health System Capacity
Time
*Adapted from P. Hailey and D. Tewoldeberha, ENN, 2010, issue 39
Ongoing health systems strengthening efforts
Health system strengthening
Performance analysis
Has the health facility achieved the performance
indicator? (use
checklist)
No
Yes
Determine actual reasons for poor
indicators
Gap assessme
ntIdentified gaps
No technical staff/ staff shortage
Possible action(s)
Lack of reference materials
Inadequate supplies
Inadequate technical
knowledge
Inadequate working space at HF
Make request for staff
allocation
Request materials from
district
Purchase equipments
Train staff on knowledge gaps
Construct makeshift
shelter*On-Job Training Guide for High Impact Nutrition Interventions, Oct. 2011, MOPHS, Kenya
Mainly delivered through:
-On-the-job training
-Joint supportive supervision
What happens to the health system strengthening if an emergency strikes?
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
Government systems are usually resource constrained andlack the required flexibility
Systems often fail to respond when the need and potential public health impact is greatest
Health system strengthening
Caseload
External support
Health System Capacity
Time
*Adapted from P. Hailey and D. Tewoldeberha, ENN, 2010, issue 39
Strengthen the capacity of government
health systems to effectively manage
increased caseloads of severe acute
malnutrition without undermining on
going systems strengthening efforts.
Component 1: Risk analysis
Done by staff in Butiye Health Centre, Moyale District, Kenya
Analysis of the drivers of increased caseloads and delayed health
seeking behaviour
Understand what factors have an impact
Understand how these factors interlink
Model component 2: Threshold setting(Number of new admissions into nutrition treatment services per month; using the example
from Turbi health facility in Chalbi)
Emergency
Serious
Time
Cas
elo
ad
Normal
Alert
How many patients can the health facility cope with?
Severe malnutrition
Moderate malnutrition
0-10 0-20
11-15 21-30
16-20 31-50
>20>50
3a. Monitoring caseloads against thresholds
Butiye Health Centre, Moyale District, Kenya, photos by R.Kopplow
2012201
1
DiarrhoeaPneumoniaSevere malnutrition (SAM)
Model component 3b: Triggering surge support
Health systems strengthening
Monitoring of malnutrition and disease caseloads, the health seeking influencing factors and mobilisation activities carried out in the area
Caseload reaches threshold
Health facility contacts DHMT
During DHMT meeting issue is discussed and the scale up of
support approved
DHMT approaches NGO for additional support where
neededScale up
Model component 4: Provision of surge support
Emergency
Serious
Alert
Normal
e.g.>25 cases
e.g. 16-25 cases
e.g. 10-15 cases
e.g. <10 cases
Threshold Caseload Support provided
Mentoring continues plus direct implementation by
supporting NGO
Mentoring continues plus implementation of short-term solutions to overcome gaps
Intensified mentoring focuses on crucial gaps and hot
spot facilities
Health system strengthening through
mentoring approach
Make request for staff allocation under
MOH AWP
Example: shortage of technical staff
Follow up request & train non-clinical staff to fill gaps
Follow up request & secondment of 1
nurse from another clinic
Follow up request & secondment of 1 additional NGO
nurse
Surge support is:• Defined for district• Agreed in advance• Formalised in MoU
• Prepared • Funded
Model component 5: Scaling down of surge support
Health systems strengthening
Monitoring of malnutrition and disease caseloads, the health seeking influencing factors and mobilisation activities carried out in the area
Caseload reaches threshold
Health facility contacts DHMT
During DHMT meeting issue is discussed and the scale up of
support approved
DHMT approaches NGO for additional support (where
needed)
Caseloads go below pre-defined threshold
Health facility contacts DHMT
During DHMT meeting issue is discussed and the scale down
of support approved
DHMT with support of NGO scales down the support
Scale upScale down
Progress so far
1. Technical review around nutrition surge capacity
2. Development of a theoretical nutrition surge capacity model jointly with government and health staff
3. Transformed the theoretical model into a practical operational tool
4. District nutrition teams developed thresholds, activation mechanisms and drafted phased support packages
5. On-going pilot in 14 facilities in Chalbi, Sololo and Moyale
Next steps
1. Amend the MOU with the Ministry to include surge capacity– Agree on the surge support package– Cost the support package
2. Test the scaling up/ down of support
3. Conduct research to proof the concept
Where are the links to livestock?
Milk•availability for consumption•price
Animal body condition• price for animals & meat
Movement of animals:• proximity to health facilities• workload• decision making
1. Livestock impacts on malnutrition prevalence and health seeking behavior
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 status2. Workload (of women) influences health seeking, child
feeding and caring practices