1. Food and Nutrition Technical Assistance II Project (FANTA-2) Academy for Educational Development 1825 Connecticut Ave., NW Washington, DC 20009 Tel: 202-884-8000 Fax: 202-884-8432 E-mail: fanta2@aed.org Website: www.fanta-2.org Integration CMAM into National Health Systems Serigne M. Diene FANTA-2 Senior HIV and Nutrition Advisor

2. PLAN Background Analytical framework for integration Integration CMAM into national health systems: country experiences and challenges Key lessons learned Enabling environment Competencies for CMAM Access to CMAM services Access to CMAM equipments and supplies Quality of CMAM services Way forward 2

3. BACKGROUND Review CMAM program implementation and its integration into national health systems Countries : Burkina Faso, Mali, Mauritania, Niger Highlight lessons learned and make recommendations on challenges, best practices, gaps Methods : documents review, country visits 3

4. ANALYTICAL FRAMEWORK 4 KEY ELEMENTS OF CMAM FALL IN FIVE DOMAINS

5. ANALYTICAL FRAMEWORK (2) 5 COMPONENTS OF CMAM

6. Integration into routine health and nutrition services: Examples Burkina Faso Essential Nutrition Actions (ENA) (same CHW) Growth Monitoring and Promotion (GMP) Community IMCI not evident Mali ENA 12 Family Practices GMP (?!) SIAN (Week of Intensified Nutrition Activities) 6

7. Integration into routine health and nutrition services: Examples (2) Mauritania CMAM linked with Child Survival Weeks CMAM linked with IMCI CMAM linked with Reproductive Health initiatives Niger Great political will and support for integration Focus on activities only (not yet resources not) GMP (?!) Baby Friendly Hospital Initiatives (BFHI) IMCI 7

9. Insufficient training for health workers

10. Inadequate supply flow

11. Need to integrate at clinical levels as well as Community-IMCI8

12. KEY LESSONS LEARNED Enabling Environment High level commitment not yet translated into concrete action plans for scale up and quality improvement Community outreach components to be strengthened: role of community health workers to be defined and structured Specific CMAM technical expert/unit/system needed for strong institutional capacity and quality services, including MOH technical leadership 9

13. KEY LESSONS LEARNED (2) Competencies for CMAM Training skills, quality of training tools, mentoring to be improved for in-service training Financial and technical support for pre-service training Need for effective learning sites and national high-level expertise for CMAM quality improvement Formalized documentation and dissemination of Best practices and lessons learned 10

14. KEY LESSONS LEARNED (3) Access to CMAM services Sustainable and affordable community outreach is still missing. Need for shared experiences on most promising approaches M-MAM increasingly linked to food security and prevention services and not always with M-SAM Human resource shortage limits high coverage in Outpatient Care Importance of good referral and counter referral system, need to be part of training Linkage with informal health sector as part of training, supervision and mentoring

15. KEY LESSONS LEARNED (4) Access to CMAM equipment and supplies Improving and integrating CMAM procurement and supply systems should be a priority Quality of CMAM services Support of national and international experts (academic and practical) for standardized guidelines based on best practices (Ex : Issues of use of MUAC as admission criteria, Vitamin A administration, early referral to outpatient care after stabilization ) Standardized training materials and job aids to be made available Systems of quality improvement to consider

16. WAY FORWARD Improve quality of services delivery and access, building on decentralization of process Use of integrated approach is gaining momentum that should be boosted Linking in-service to pre-service training resources and competencies should be a more common practice 13

17. This presentation is made possible by the generous support of the American people through the support of the Office of Health, Infectious Disease, and Nutrition, Bureau for Global Health, and the Office of Foreign Disaster Assistance, Bureau for Democracy, Conflict and Humanitarian Assistance of the United States Agency for International Development (USAID) under terms of Cooperative Agreement No. GHN-A-00-08-00001-00, through the Food and Nutrition Technical Assistance II Project (FANTA-2), managed by the Academy for Educational Development (AED). The contents are the responsibility of AED and do not necessarily reflect the views of USAID or the United States Government. Food and Nutrition Technical Assistance II Project (FANTA-2) Academy for Educational Development 1825 Connecticut Ave., NW Washington, DC 20009 Tel: 202-884-8000 Fax: 202-884-8432 E-mail: fanta2@aed.org Website: www.fanta-2.org