Presenter name : Valerie Wambani Title : Experience in scaling up IMAM in Arid rural areas and urban settings

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1 KENYA CMAM/SUN Conference 14 th - 17 th November 2011 Addis Ababa, Ethiopia Scaling up Community Management of Acute Malnutrition and Scaling up Nutrition (SUN) Presenter name : Valerie Wambani Title : Experience in scaling up IMAM in Arid rural areas and urban settings Federal Democratic Republic of Ethiopia Ministry of Health Emergency Nutrition Network

2 KENYA Background/country information Total population: 39 M Prevalence of SAM in U5s: 6% Prevalence of MAM in U5s: 16% Number U5 s affected by SAM: 112,847 (WFH < - 3z scores) Other notable nutrition indicators : EBF 32%, anaemia in women 55%, VAD children 76% Population covered by IMAM: 250,000 Definition & degree of scale up: target 80% ASAL, 60% urban

3 Food security situation Food insecure population Increase from 3.5 to 3.75 M (Long rains assessment report July 2011) Pastoralists in emergency phase: 1.4 M

4 KENYA Scale up Timeframe 2007/2008: Consensus on guidelines for Kenyan context, printing IMAM. National coordinating structure - Nutrition Technical Forum Monitoring tools Capacity building of health workers, On Job Training tool Key terminology: Integrated Management of Acute Malnutrition (IMAM), OJT, HiNi Now part of the High impact Nutrition interventions (HiNi) being promoted

5 KENYA Policy & Strategy Environment Systems/structures to aid IMAM scale-up: Office of the President/ Prime Ministers office Kenya Food Security Steering Group, Crisis Response Centre, (multi-sectoral coordination) Nutrition Technical Forum (NTF), District Committees Financing IMAM: Government, UNICEF, WFP, Implementing Partners Coordination: National level: Nutrition Interagency coordinating committee reports to the Health Sector Steering Committee Linkages with other programmes: MCH, IYCN, Disease control, WASH

6 KENYA Results Indicators: Recovery rates >75% Death rates <5 % Defaulter rates <15% Average length of stay is <60 days Programme coverage : Jan Sept 2011: 54% MAM, 60% SAM of the expected caseloads Other: integration of services BSFP in 6 counties with GAM > 20 % from August to December 2011

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9 KENYA Factors Contributing to Success 1.Commitment from district health management teams to lead the process 2. Partner support for HR, M&E, On Job Training (OJT ), outreach sites 3.Strong coordination structure NTF with four working groups, Information WG Capacity development, Urban WG, ASAL WG

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11 KENYA Major Challenges & Obstacles 1. Inadequate capacity of health facilities to undertake full IMAM package- high staff turnover( OJT ongoing) 2. Integration within the health system is incomplete 3. Active case finding and poor referral system lack of reliable transport Pipeline breaks, storage, quality assurance ( aflatoxin in Unimix) local production of RUTF- stability of product??? Prolonged length of stay among pregnant women

12 KENYA Key Learning Points 1. Leadership and oversight for IMAM implementation by the Ministries of Health (MOPHS, MOMS)- monthly meetings 2. Partnerships and coordination at all levels, supported by the Health Sector strategy (SWAP) 3. community strategy implementation- use of CHWs for facility implementation of IMAM screening & recording Nutrition sector response plan: strategy for scale up focus on increasing outreach sites to improve coverage & systems strengthening for sustainability

13 KENYA Next Steps & Way Forward Foster integration of health services- update on RUSF Scale up on-the-job training /mentoring for health workers Linkages with other sectors WASH/livelihoods/ food security Urban nutrition strategy being formulated Obstacles: Government budget, Human resource gaps, Quality control of commodities, insecurity Somalia border infrastructure development National & international development: Home grown solutions possibilities of local production of RUTF: strengthen community surveillance and defaulter tracing

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15 KENYA Acknowledgements ASANTE SANA Government of Ethiopia, ENN team Ministry of Public Health and Sanitation: Permanent Secretary, Director, Head, Dept of Family Health, Head, Division of Nutrition, Monitoring and Evaluation Unit UNICEF, Kenya ( Noreen/Dolores) Concern Worldwide, Kenya World Food Programme, Kenya World Health Organisation ACF, Kenya Save the Children UK, Kenya Merlin, and all NTF members Emily Mates, Marie, Jeremy Distinguished Audience at CMAM meeting Health workers, caregivers and children in the programme

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17 Amaret Ekaliban, Lodwar District Hospital Stabilization Centre, Turkana County, 2011