The Community-Based Management of Acute Malnutrition (CMAM) is one of World Vision’s core project models in nutrition. The CMAM approach enables community volunteers to identify and initiate treatment by referring children with acute malnutrition before they become seriously ill. Caregivers provide treatment for the majority of children with severe acute malnutrition (SAM) in the home using Ready-to-Use-Therapeutic Foods (RUTF) and receiving routine medical care at a local health facility. When necessary, severely malnourished children who have medical complications or lack an appetite are referred to in-patient facilities for more intensive treatment. CMAM programs also work to integrate treatment with a variety of other longer-term interventions such as Nutrition Education, Infant and Young Child Feeding and Food Security. These interventions are designed to reduce the incidence of malnutrition and improve public health and food security in a sustainable manner.
There are four key components to the CMAM approach: Community Mobilisation, Supplementary Feeding Program (SFP), Outpatient Therapeutic Program (OTP), and Stabilisation Centre/In-patient Care (SC). On the most part, World Vision does not set up Stabilisation Centres but instead works closely with existing local health institutions or medical NGOs to provide these services.
World Vision has been operational in Niger for almost two decades – implementing a wide range of long-term development activities across the country. Their work is structured alongside the model of comprehensive area development programs (known internally as ADPs). Each ADP has a Health & Nutrition component which seeks to deliver support through (while simultaneously strengthening) local health structures. In July 2005 and as a result of the 2005 food crisis in Niger that year, World Vision launched a community-based management of acute malnutrition (CMAM) program based on the National Protocol for the Management of Acute Malnutrition. At that time, contacts were made with Valid International – aimed at establishing a partnership for an effective and quality delivery of the CMAM program. An institutional agreement between World Vision and Valid International was reached in July 2006, thus paving the way for the provision of technical support to the Niger CTC (now called CMAM) program.
As a part of the national nutrition strategy, WV is currently implementing CMAM in many decentralized government health centers throughout the country, with the support of partner NGOs (ex. Medecins Sans Frontieres). From the onset of CMAM program implementation, It has been integrated within the Ministry of Health structures such as the CSIs (Integrated Health Centers) with regular trainings of MOH health staff at national, regional and CSI levels based on the most revised version of the National Protocol, ultimately leading to the final version (i.e. Protocole Nationale de prise en Charge de la Malnutrition. MOH Publique/UNICEF/OMS. Juin 2009).
Evaluation of World Vision Niger Emergency Nutrition Programme, Tillaberi and Niamey Regions (Jul 2010 - Jul 2011), Bernadette Feeney, Technical Advisor, Valid International.
Evaluation Semi-Quantitative de l’Accessibilité et de la Couverture (SQUEAC) CSI appuyés par World Vision ADP de Kornaka West, Gobir Yamma, Chadakori et Goulbi Kaba Région de Maradi, République du Niger, (22 mars au 15 avril, 2011), Allie Norris, Consultante Mobilisation, Valid International.
Rapport De La Mobilisation Sociale Dans Le Cadre Du Redémarrage des Activités Du Programme De World Vision de Prise en charge Communautaire de la Malnutrition Aiguë Régions de Zinder, Maradi et Tillabéri, Niger (13 Juin au 8 Juillet, 2010), Allie Norris et Gabriele Walz Techniciennes de Mobilisation Sociale, Valid International.
Formation sur la “Prise en charge Communautaire de la Malnutrition Aiguë” (PCMA) ADP de Zinder & de Tillabéri (20 juin au 19 juillet, 2010); ADP de Maradi (20 Juin au 8 Juillet, 2010), Lionella Fieschi, Consultante PCMA et Bernadette Feeneey, Valid International.
Evaluation Finale Du Programme CTC Dans La Région De Zinder World Vision, Niger (06 au 18 Juin, 2008), El Hadji Issakha Diop, CTC Advisor, Valid International.
Rapport De L’enquête De Couverture Du Projet CTC Exécuté Par World Vision ADPs De Kassama, DTk Et Gamou Région De Zinder Niger (Avril- Mai, 2007), Lionella Fieschi, Consultante CTC, Valid International.
Programme CTC de World Vision dans la région de Zinder, Niger : Evaluation à mi- parcours (11- 18 Mai, 2007), El Hadji Issakha Diop, Consultant CTC, Valid International.
Visite au programme CTC Région de Zinder (WV Niger), (13 – 24 Février, 2007) Montse Saboya, Valid International.
Mobilisation Communautaire Visite Technique au Programme de CTC Zinder, Niger, (20 février – 2 mars, 2007), Saul Guerrero & Nyauma Nyasani, Consultants de développement communautaire et social, Valid International.
Community Mobilisation aspects of the World Vision CTC Programme, Zinder Region, Niger (Aug 4 - 18, 2006), Saul Guerrero, Valid International.
Assessment for CTC World Vision in Niger (Jul - Aug, 2006), Valid International.
Community-based Management of Acute Malnutrition Model: http://www.wvi.org/nutrition/project-models/cmam
World Vision works with communities through Area Development Programs (ADPs) that have been identified and implemented based on a series of development criteria. The ADPs serve as the basic intervention unit of the WV's multi-sectoral programs/projects (e.g. in education, water and sanitation, health, income-generating activities and sponsorship of children etc.), but the geographical areas of the ADPs do not necessarily align with administrative boundaries of the country. The whole ADP and program management structure is geared toward long-term development programming, into which the nutritional activities/programs such as Community-based Management of Acute Malnutrition (CMAM) are integrated.
Since July/August 2005, WV Niger has been implementing and supporting the following four components of a CMAM program:
All programmatic activities are implemented through the local health structures and systems and their respective catchment areas. The majority of the OTP and SFP activities are implemented in the Integrated Health Centers (CSI) but in order to achieve greater coverage and to bring supplementary facilities closer to communities, WV has also implemented the programs in Health Posts (CS) which are satellites of CSI. Most OTP take place together with SFP in CSI but few are located in CS as well. The OTP activities, including the provision of Ready-to-Use Therapeutic Food (Plumpy Nut) and the systematic treatments are conducted on a weekly basis, whereas the SFP activities, including the distribution of Fortified Blended Food (Premix with CSB (Corn Soya Based), oil, sugar) for MAM children and moderately malnourished PLWs are carried out bi-monthly basis. The numbers of OTP and SFP sites and staff per ADP differ depending on the target population size and needs.
The technical (nutrition related) and managerial structure of WV in Niger (WVN) includes two nutrition coordinators (East and West) and six regional nutrition supervisor mangers (one per region) who coordinate and harmonize nutritional activities through the different locations. All of them are supported by a relief-nutrition country manager based in Niamey. In each ADP, there is also a health-nutrition manager who is responsible for overseeing ADP related health and nutrition programs and staff. As the national health system is WV's principle partner, WVN staff always work in partnership/collaboration with Ministry of Health (MOH) staff. Currently, WVN staff mainly act as technical facilitators and help with the general management of the program activities such as site organization, training of the community volunteers who help during distributions, channeling food and medical supplies coming from UNICEF and WFP, and program monitoring. Depending on the ADP, there is also either one or two nurses who provides support to the MOH staff in the field.
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