Evaluation Report. Evaluation of community management of acute malnutrition (CMAM) - Nepal country case study

Abstract

The Government of Nepal (GoN), Ministry of Health and Population (MoHP), and UNICEF have been piloting the Community-based Management of Acute Malnutrition (CMAM) program since 2008; it currently operates in five districts. The Nepal CMAM programme aims to improve access to treatment for acute malnutrition among children 6-59 months of age, to promote integration of the CMAM programme in regular health services, and to create effective treatment capacity of the health system. In 2012, the programme will be expanded to the Integrated Management of Acute Malnutrition including infants under six months of age (IMAMI) in six new districts. Other ongoing nutrition programmes include Infant and Young Child Feeding (IYCF), micronutrient supplementation to children and women, food fortification, and food distribution in food insecure areas. Wasting, a measure of acute malnutrition, has remained stagnant over the last decade in Nepal; it was estimated at 11% in 2001, 13% in 2006, and 11% in 2011. Currently Severe Acute Malnutrition (SAM) affects 2.6% of children under five years of age. The MoHP and UNICEF undertook this evaluation to assess CMAM programme performance and gather lessons to inform scaling-up of CMAM. The CMAM evaluation in Nepal is part of a global evaluation commissioned by UNICEF, which covers five country case studies and a synthesis report. The four CMAM components in Nepal are: (1) Community outreach (screening, referral, follow-up, and community mobilization); (2) Outpatient treatment (OTPs) for SAM children without complications; (3) Inpatient treatment in stabilization centres (SCs); and, (4) Management of moderate acute malnutrition (MAM) through IYCF counselling. The criteria of relevance and appropriateness, effectiveness and coverage, efficiency, and sustainability were applied to CMAM components and cross cutting issues. To accommodate time and budgetary limits, data were obtained from secondary sources, health system databases, visits to sample CMAM sites and interviews with stakeholders. Quantitative data on beneficiaries were analysed to determine whether programme targets had been met. Qualitative data also supported the analysis. Varying levels of programme maturity (from nine to 25 months) were factored in by creating reference periods for each district. This report is divided into seven chapters: 1. Introduction (with an overview of development and nutrition in Nepal) 2. Evolution of The Nepal CMAM Programme, CMAM Policy, Programme Design, Governance and Partnership and Past Evaluations and Reviews 3. Evaluation Scope and Methodology 4. Programme Effectiveness and Quality of Services 5. Cross-cutting Issues 6. Cost of the Programme, Sustainability and Scale Up 7. Conclusions and Recommendations