MCHN Program Design, Implementation and M&E Improved. The 2008 Lancet Series on Maternal and Child Undernutrition highlights and deepens the evidence base for what program implementers and public health professionals have long known: Malnutrition is the single largest contributor to child mortality. USAID has made significant strides over the past decade in addressing malnutrition, not only through Title II programs but also through integrating nutrition into broader health programs. FANTA-2 works with sub-recipients to integrate proven approaches into national health systems, while continuing to innovate and adapt approaches to maximize impacts in various contexts. FANTA-2 provides specialized technical assistance in new areas, such as nutrition and tuberculosis (TB), supported by IR2 activities to strengthen the evidence-base for intervention design and development of global guidelines.
MCHN Program Design, Implementation and M&E Improved. Ghana has the world’s fifteenth-highest burden of severe wasting, however the management of XXX and the CMAM approach are relatively new to Ghana. Since FY 2008, at the request of USAID/Ghana, FANTA/FANTA-2 has been providing technical support to the Ghana Health Services (GHS) to integrate CMAM into the Ghanaian health system. In FY 2008, FANTA activities focused on initiating the CMAM integration process, which included introducing CMAM, putting appropriate structures in place, and fostering understanding and buy in for CMAM. In Project Year One, FANTA-2 continued to work with the GHS and partners to support the integration and scale up of CMAM into the health system, and further established health system structures to manage CMAM scale-up and integration. In Project Year Two, pending further discussion and agreement, FANTA-2 will carry out the following activities: • Through the GHS XXX Support Unit (XXX XX), FANTA-2 will strengthen the enabling environment for CMAM by developing a memorandum of understanding (MOU) between the GHS, FANTA-2 and UNICEF; strengthening the GHS national technical leadership role and national coordination role for CMAM; coordinating the integration of CMAM into health and nutrition policies and initiatives; working with the Regional Health Directorates to scale up CMAM in Upper West, Upper East, Northern, Central and Greater Accra Regions according to the national strategy and plan for scaling up CMAM in Ghana; and convening a national workshop on the integration of CMAM into the Ghanaian health system. The national workshop will present lessons learned from CMAM integration and effectiveness, which will be generated from a review of the existing nutrition rehabilitation centers to gain a better understanding of their role in nutrition within the GHS. Moreover, strategies for integrating the management of MAM will be explored. • FANTA-2 will strengthen CMAM in-service training by mentoring the regional CMAM Support Teams (CMAM STs), which plan, manage and provide technical support (i.e., training, monitoring and supervision, CMAM data management) at the regional and district levels. FANTA-2 will also mentor health managers and health care providers, supporting the learning sites for inpatient care, outpatient care and community outreach to accommodate trainees for learning visits and internships. Activities will include building CMAM ST capacity for CMAM planning, implementation, supervision and M&R; ensuring that new knowled...
MCHN Program Design, Implementation and M&E Improved. Malnutrition rates have soared in Southern Sudan as a result of the long civil war, destroyed infrastructure, poor water and sanitation conditions, and high poverty levels. The 22 percent prevalence of global acute malnutrition (GAM) (weight-for-height [WFH] Z-score ≤ -2) in children 6-59 months5 is significantly higher than the WHO 15 percent threshold for nutrition emergencies. The prevalence of GAM is reported to have decreased since the signing of the Comprehensive Peace Agreement in 2005, but data have not been compiled to substantiate this improvement. Additionally, although few data exist on the prevalence of vitamin and mineral deficiencies, such deficiencies are almost certainly widespread given the general malnutrition situation. Information gaps also exist on possible underlying factors associated with malnutrition, such as practices and beliefs related to IYCF, use of diversified foods, hygiene practices and health-seeking behaviors. In January 2008, the MOH established the Directorate of Nutrition (DN). The MOH/DN is currently continuing efforts to improve nutrition services for malnourished individuals, as stipulated in the Interim Health Policy. The aim is to increase access to nutrition services at all levels, from the community to health facilities, and to integrate those services into the Basic Package of Health Services (BPHS). Additionally, the MOH, in its new health policy, has begun to require that all primary health care providers integrate direct nutrition interventions into their services. Strategies for how this will be done will be developed over the remainder of 2009. In Project Year One, at the request of USAID/Sudan/Juba, FANTA-2 began providing TA to the MOH/DN to develop and strengthen health and nutrition policies and systems, coordination for nutrition and the management of XXX. FANTA-2 facilitated a three-day nutrition convention on April 6-9, 2009, bringing together national health and nutrition stakeholders, and helped the MOH re-establish coordination mechanisms, including the Nutrition TWG and Integrated Management of XXX (IM-XXX)6 Thematic Group. FANTA-2 also provided TA to strengthen IM-XXX capacities, including completing the national IM- XXX guidelines, developing job aids and training senior clinicians in the treatment of XXX in inpatient care. As part of the process, FANTA-2 posted a short-term nutrition advisor in the MOH/DN to help guide capacity strengthening activities.
