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