From vertical to horizontal: Experiences & recommendations in integrating SAM treatment to health systems

Maureen GallagherSAM International conference

London, Oct 17, 2013

Presentation Outline

• Setting the context• Background• HSS & SAM treatment • Experiences – How does it look? • Strategic & practical implications• Conclusion

Setting the context • Universal health care • Focus on design and implementation• Health systems strengthening (HSS) - -WHO 2007

• Integration – ‘institutionalization’ of SAM treatment

Background

• Changing landscape of treatment of acute malnutrition with huge advances the last 25 years

• Coverage still low at between 8-13% globally• Need to strengthen treatment of SAM as a

disease – linkage Nutrition & Health • Learning from experiences of Global Health

Initiatives (GHI) shift from disease specific to health systems strengthening

Shifting dynamics of HSS

Vertical

(from Wilson, U of Colorado)

Horizontal

Vertical HorizontalShifting dynamics of SAM treatment

Partner support Government supportNIGERIA

Partner support Government supportDR CONGO

Partner support Government supportWhere should we aim to go

Strategic Implication

• Bringing nutrition into health & working through the HSS building blocks to achieve sustainable availability & access to SAM treatment

• Including SAM treatment as part of a minimum health package

• Shift role of partners from ‘implementer’ to ‘facilitator’• Simplifying CMAM protocols, implementation and follow-

up• Transitioning from donor financing to MoH financing

basic minimum health package of which SAM treatment is part

Practical ImplicationsGeneral:• Identifying new ways of working from being model oriented

to process oriented • Coordination of actors in working with one health systemDesign:• Comprehensive assessment of health system• Joint planning and implementation• Simplification of protocols and systemsImplementation:• Human resources • Supply chain

Next steps

• Health System Strengthening Task Force ToR developed with support of WHO & UNICEF

• ACF finalizing the CMAM Integration Guidelines• Health System Assessment tool being tested by

UNICEF & partners • Experiences need to be further tested and

documented in relation to quality of care and coverage

Conclusion

There lies a significant opportunity ahead in the increasing MoH leadership and commitment in

SAM treatment with the evolving role of partners in support of it to ensure that SAM

treatment is available as part of regular health services, moving towards quality global

coverage.

Thank you