Final core group presentation luz
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Transcript of Final core group presentation luz
RWANDA EXPANDED IMPACTCHILD SURVIVAL PROGRAM-
Integrating CMAM with C-IMCI
A Partnership of Concern Worldwide, International Rescue Committee and World Relief
CORE group meeting - May, 2011
1/5 of the total populationOver 300,000 children under five years
Direct Beneficiaries of the Program
Health center Manager /HC providers
Mother CHW-binome
Child
Strategic Objective
Reduce childhood mortality and morbidity
using community-based integrated case management
of diarrhoea, pneumonia (ARI), fever (malaria), and
nutrition (added later) reinforced by
social mobilization and behaviour change strategy
(Care Groups)
Level of Effort & Key Interventions
Diarrhoea35%
Pneumonia30%
Malaria35%
• ORT• Zinc• Feeding practices• Hygiene practices
• Prompt treatment• Early referral of newborns • Vitamin A , Zinc
• Prompt treatment • Bed nets
• OTP for SAM• CBNP – PD/H and
Com Kitchens• Small scale HH
food security support
• Technical Support to MOH
Nutrition
Why Integrate Nutrition?
– Malnutrition is known to be a contributing factor in over 35% of all child deaths in Rwanda
– 52% of children are stunted, one in five are underweight, and 4.6% are wasted
– Access to acute malnutrition services was poor– MoH recognized the need to identify and address
the management of acute malnutrition in the community
Integration at the program level-Community
Integration at the Program level-Health Facility
Management of Acute Malnutrition flowchart
CHW conducts home visit/community growth monitoring and assess
child with MUAC
Moderate (MAM)SAM without complications
SAM with complications
PD hearth/ Community kitchens
Refer to health centre for OTP
Referral to district hospital for stabilization
Health facility Community
SAM (Severe Acute)
Integration at national level – Advocacy
NATIONAL PROTOCOL FOR THE MANAGEMENT OF MALNUTRITION
Kigali, on May,2009
• CMAM in national nutrition protocol
• RUTF added into routine medical supply chain
Impact to Date A number of positive elements emerged from
integration of the CMAM approach with Com-IMCI
• Added value to CSHGP expanded impact• National nutrition protocol • CMAM services reached and treated over 8,000
Acute Malnourished children • Awareness of acute malnutrition (baseline- low in the
health agenda) Increased donor funding and available technical support
• MUAC screening included national vaccination campaigns
Elements & Factors that Facilitated Integration
• Strong Government commitment - “Emergency Plan to Eradicate Malnutrition” launched in May 2009.
• Existence of mobilized community network (30,000 non-salaried Community Health Workers)- 2 per village
• Existence of strong national level technical and policy working groups led by the MOH.
• Decentralized structure of governance maximized community involvement and mobilization to support integration.
Learning Highlights1. Although CMAM was developed for
emergency settings, it has proven to be equally effective in non-emergency
3. Network of CHWs integrated into the formal health system and implementing CCM
4. CSP strategy provided natural base for CMAM
5. No significant improvement in prevalence of acute malnutrition (baseline vs end of project nutrition survey)
What Needs to be Done to Improve Integration
• Data reporting and integration into national community HIS
• Collaboration to address the main problems causing malnutrition in the context of integrated approach
• Design strategies to address barriers to accessing services for malnourished children
Welcome to the Land of Thousand Hills!
Thank You