Day 4, Morning Sessions:
Focus on SUN (Scaling up Nutrition)
Last day of this very exciting meeting today. Yesterday ended the focus on CMAM and now we look at how it fits within the wider nutrition landscape – in particular the “SUN” (Scaling up Nutrition) movement. Eminent list of speakers again lined up – but I’m not convinced anybody can top yesterday’s surprise video message from Olympic champion and global superstar Haile Gabresellasie (check it out on conference website – the powerful bottom line - early nutrition matters). Let’s see…
Day begins welcoming Dr David Nabarro, Special Representative of the UN Secretary General for Food Security and Nutrition. Delegates from the 22 countries represented here greet him in national languages. Were regional languages and those of other delegates (NGOs, donors, private sector, academia) also included, could be here most of morning on greetings alone. Great to see the mix represented here – but hope the meeting doesn’t end in so many messages regarding ways forward. To make a difference to nutrition, we need to be speaking a much more common language. Feels like this meeting has been hugely helpful towards that – the outcomes arising that will tell.
First speech is by Dr Nadeera Hyatt, inspiring Deputy Minister of Health from Afghanistan. She summarizes some of the main themes and challenges arising so far: capacity constraints; financial barriers; the need to engage with local communities; the need for more local RUTF; the need for better integration; the need for decentralisation; the value of cross country learning; the need to bridge emergency/development divides. I like the fact that she also raises the need for evidence-based approaches. There’s too much at stake to squander precious resources on interventions and approaches that seem good on paper but are not so effective in practice.
Andres Mejia Acosta (Institute of Development Studies) now, analysing the “Political Economy of Nutrition scale-up”. He highlights good governance as key to success. Also the importance of political engagement and commitment to deliver. Goes through case histories of Brazil and Peru where such engagement has resulted in dramatic nutritional improvements. This is good stuff which everybody in the nutrition community needs to hear and take on board. No good having “magic bullets” in terms of efficacious treatments if the “magic guns” in terms of delivery systems don’t work.
Keynote from Dr Nabarro. An engaging speaker and great advocate for nutrition. SUN has huge potential with him at helm. Hope he can do for nutrition what he did for malaria – putting it firmly at the top of the international and national agenda. As an aside, interesting to hear what drives him – he started professional life as a medical doctor who realised the importance of nutrition as he saw the direct consequences of under-nutrition in the children he was treating. Such personal stories and experiences clearly matter in motivating us all to act. But in terms of what to do, again I like the fact that he’s rooted in evidence – though not bound by it (recognising its wider context). He highlights issues arising from the Lancet Nutrition Series 2008. Also discusses need to get nutrition high on the political ladder – and that once that happens, money to fund the work will start to flow. Another good thing in this talk is raising the issue of chronic disease linked to early malnutrition. Whilst acute malnutrition kills and is a clear short term priority, we mustn’t forget the long term implications of early child adversity. So many countries already have a “double burden” of both under and over-nutrition…
Bjorn Ljungqvist (REACH) follows on. Another great initiative and talk. REACH are a mechanism/resource who are invited in by governments to discuss problems and devise solutions together. They use a facilitation approach and have lots of useful materials including maps and performance “dashboards”.
Morning finishes with Q&A session. Another active discussion which could easily go on much longer. With the contacts and links made here, I’m sure the dialogue will continue – it’s an important outcome of meetings such as this and will help unite the nutrition community to move forward together.
Marko Kerac (University College London, UK)
Day 3, Afternoon Sessions:
Nicky Dent, CMAM Forum Chair
We all had a huge surprise with an inspiring short video by the international hero, Ethiopian Haile Gebre Selassie, former Olympic champion and world record holder of the 5,000/10,000 metre and marathon runner, bringing a clear advocacy message about the importance of nutrition and the role of CMAM…..
Then after a busy morning of lively group work following a looonnnngg! list of specific questions and with yet more networking and animated side discussions over lunch, group work continued into the afternoon. Feedback was comprehensive as three groups worked on each of the three topics of finance, capacity and governance. Hmmm… Where do I begin on summarising the huge ranges of responses from 9 groups…..don’t forget to read the conference summary to get the details, but key points (how to prioritise?!) that jumped out were….
FINANCING “Wealth is Health (rather than usual Health is Wealth!!)”
CMAM should be included in the National Development Agenda and operational Health and Nutrition strategies as a priority area of development with a well-defined budget line. Government leadership and collaboration and engagement with donors is critical. CMAM should be integrated in other health care system strengthening mechanisms. When emergency funding exists strong collaboration among stakeholders and mapping of roles and responsibilities and leadership is required.
The issue of supporting local RUTF production by Government (for example via tax/VAT exemption etc.), and promotion of production of raw materials came up, as did the suggestion to include RUTF in the Essential Health supplies list.
There was also discussion of the need to lobby for more resource allocation to CMAM by Governments as a comprehensive integrated nutrition package and to use multilateral funding facility to improve coordination and attract resources. The Scaling Up Nutrition movement has been mentioned as an opportunity for achieving this.
Use of the Health Systems building blocks (service delivery, workforce, HIS, access to essential medicines, health financing, leadership and governance) was recommended as a framework to consider capacity. The need to increase staffing levels of all cadres was underlined and ways to increase knowledge and capacity through in-service (immediate training) and pre-service training explored by all groups. Emphasis that any Trainer of Trainers (TOT) needs a clear associated “cascade” strategy to ensure knowledge is passed on…….this should be linked to practical training and clear on-the-job training and mentorship (incorporated into IMCI/ICCM). Discussions highlighted the continued need to reinforce the capacity to monitor and supervise (maybe using innovative technology) to get a quality service. Job descriptions and supervision should include CMAM.
Again it was emphasised that CMAM should not be vertical but part of a basic health package or existing IMCI/ICCM…and MUAC and oedema screening in IMCI should be a global initiative and not restricted to Africa. SAM is part of the Integrated Disease Surveillance and Response (IDSR) but only for Africa; this should be global.
Also don’t forget supply chain management….classifying RUTF as an essential item and reinforcing the procurement and logistics systems…and having a strategy for local production and supply chain…
Simplification appeared as a theme….in terms of which indicators to incorporate into HMIS/HIS, admission and discharge criteria (use of MUAC and oedema only).
How do we empower the community? The need for a Community Mobilisation (CM) strategy at country level and software on how to implement and use innovative ways to engage volunteers….was repeated as a challenge and moving beyond cash incentives to use of training, equipment, status and mass recruitment of volunteers to improve engagement.
An urgent need for more evidence around management of acute malnutrition kept arising…in terms of products, community mobilisation, etc…
An underlying theme was the volume of experience, tools and best practices available that are not currently being shared and need pulling together.
GOVERNANCE “Malnutrition is a reflection of poor governance”…cannot see nutrition in isolation….
CMAM should be part of the PHC package… we need to generate and sustain political will based on evidence, with leadership from the countries themselves and continuous dialogue between all stakeholders, including private sectors.
Better coordination and international coordination e.g. SUN, REACH should support national set up.
Policy needs commitment from champions; policy needs clear strategy…but having national policy is not enough for scale up…..we need links between technical depts. and states.
The theme of promoting local production of RUTF and the role of the private sector was highlighted and the question of RUTF as a food or a medicine was broached again…clarity and guidance appears to be needed on this issue….
Are multi-sectorial coordination bodies talking to each other…..?
Hmm…are principle UN agencies, donors and implementing agencies aligned to country led priorities to avoid duplication of efforts and contribute to scale up and continuum of care…
Advocacy, leadership, integration, policy, technical coordination, UN and donor alignment…..is this happening?
“Political will needs high level “champions” with quantifiable evidence in clear and simple language that appeals to political and developmental agenda” “….give nutrition “a human face”…..
REACH colleague summed up by saying CMAM is needed to be part of a coherent nutrition programme/strategy in each country, with clear performance indicators. Effective governance needs to be decentralised……but also wherever it “sits” it needs the authority and oversight of different government department.
Nigerian team asked where should the “desk” for nutrition be housed in a programme….under what umbrella or focus? The issue of where to “anchor” CMAM….president’s office, health sector…is still unclear…..debate continued……maybe more clarification tomorrow…..
One delegate summed up….“Nutrition everyone’s business but nobody’s responsibility”
The group feedback sessions finished with the donor group feedback:
Donor Group Discussion
Donors suggest that “scale out” not “scale up” CMAM is actually the goal. If we are successful in scaling up nutrition, the need for CMAM should fall……
Political economy, leverage (to improve coordination, alignment ad resource mobilisation), donor alignment, cross learning of donor best practice could all help…
Questions posed to donors on the focus of funds…. and for role of donors to be more involved in local production….
Prevention better than cure….perhaps better to put funding towards prevention of MAM rather than supplementary feeding programmes (SFPs) at scale which is not sustainable…..
Integration of CMAM into SUN….one of 13 components but CMAM getting more focus than some of the other components…..maybe can use what learn from scale up of CMAM for other activities…
Day 1-3 formally ended with a summing up from Dr Ferew Lemma, Federal Ministry of Health, Ethiopia, to take back home that drew on some wise words he shared…
If a man begins with certainties, he shall end in doubts,
but if he will be content to begin with doubts,
he shall end in certainties. Francis Bacon 1605
Before the feedback, an update on additional evening sessions was made to take advantage of the wide level of expertise at the meeting to share/update on new initiatives…phew it’s a packed schedule…..Sessions planned are:
i) CMAM Forum ii) Management of Acute Malnutrition in Infants/MAMI ii) SUN overview
Day 3, Morning Sessions:
The morning session starts well on time and all members of the audience carry a big smile this morning. Yesterday evening the Ethiopian Government invited us to a wonderful dinner and dancing performance, where we had the chance to socialize with each other. There is some dancing talent amongst the participants, I can tell you!
We started by watching a short film about CMAM produced for the conference. It shows experiences of CMAM in Ethiopia, DRC, Malawi, Bangladesh, Pakistan and others. Mothers, health workers, community workers , policy makers, researchers, briefly share some of their experiences or challenges dealing with severe acute malnutrition, the difference CMAM makes, and the challenges with scaling up CMAM. Watch the film; it is short but stunning.
Lola is now reminding us that the CMAM Conference Website is a great resource where all information, documents, films are posted. If you want to see the conference again, watch the presentations, browse the documents, and read this BLOG!
She has also presented a graph summarizing the prioritization of challenges to CMAM Scale up resulting from yesterday’s discussion. The top three priorities are: 1. Capacity, 2. Funding and 3. M&E.
We’ve now moved into our groups (12 in total) to tackle questions on Finance, Capacity, and Governance. I’m part of one of the groups tackling five questions on finance. To answer the first question we developed a matrix that gives weighted scores to the current funding source per CMAM components. Current funding modes are: Government budget funds versus extra-budgetary funds; development funds versus emergency funds; and fees paid by the user. We hope this afternoon to make a second matrix with scores showing ideal funding mechanisms for CMAM. Then both matrices can guide partners for future and sustainable planning and funding for CMAM.
This is it for this morning – lots more to do this afternoon and plenty to talk about over lunch.
Day 2, Afternoon session
By Rebecca Brown (Co-facilitator CMAM Forum)
We are starting the afternoon with a summary of lessons learned from the country case studies, presented by Jeremy, Carmel from ENN and Andres Mejia Acosta, a political economist from IDS. The session is being chaired by Anne Philpot from DFID in India.
Carmel is highlighting some of the common enabling factors and the real challenges we’re facing, by pulling out the common threads mainly from the 9 country case studies. This will all be presented in a synthesis report coming soon so watch this space, really useful learning
Jeremy has now taken the floor, and is reminding us of the importance of strengthening capacity, trying to balance scale up with quality, getting monitoring sorted by simplifying CMAM reporting and, as mentioned many times so far, how to figure out funding for longer term CMAM programmes. Is the Scaling up Nutrition movement the mechanism to solve this problem?
Andres Mejia Acosta is now talking about political economy, lots of complicated issues but in a nutshell, there’s a growing recognition that we need to pay more attention to create the right environment in terms of the political economy so that we can really move ahead with scaling up CMAM. Lot’s more to learn on this topic!
Peter Hailey and Dr Tewoldeberhan Daniel have now taken the floor to present a view of CMAM integration and scale up (from a paper published in Field Exchange issue number 39). They are explaining that the landscape of the management of malnutrition has changed, but that it is still often viewed as an emergency programme. Tewoldeberhan is describing the conventional start-stop CMAM model whereby NGOs intervene when the prevalence of acute malnutrition exceeds a particular threshold, and withdraw when the prevalence decreases to below the threshold. He is explaining that in many cases, this response ends up dealing with all cases of acute malnutrition (including ‘baseline’ cases), because of a lack of CMAM services, but often does little to build capacity to manage acute malnutrition in the longer term. He and Peter have developed an alternative model whereby emergency response is based on, and takes into account, the existing capacity to manage acute malnutrition rather than using fixed thresholds of the prevalence of acute malnutrition. Peter is explaining that CMAM provides unique experiences to link emergency and development programming as part of Disaster Risk Reduction strategies. Although the model has its complexities, it does seem to offer a way forward during these confusing times as CMAM transitions from a purely emergency programme to a development intervention. Definitely one to explore further!
We’re now in the plenary Q and A discussion and there are some really interesting questions and comments coming up! There is a lot of interest in how CMAM can be integrated as part of a broader nutrition package as well as this sticky issue of securing longer term funding. Again there is a reminder of the importance of communities for creating the demand for CMAM as well as other nutrition interventions. I’m sure these important questions will all continue to be debated over the next few days.
After a coffee to ensure we’re all still awake and engaged (we are, honestly!), we’re rounding off the day with a Q&A with a UN panel, composed of WHO, UNICEF, WFP and REACH.
Bjorn Lundquist has just provided a useful overview of REACH, which is a multi-agency body, composed of UN agencies and other partners working to accelerate the scale-up of food and nutrition actions at country level, by facilitating policy development and coordination between actors.
The UN panel are now being faced with some gritty questions such as why RUTF production is shifting to developed countries (apparently no it’s not!); how agencies are cutting the cost of RUTF (UNICEF have cut costs by increasing competition but further work is need to understand what contributes to the cost of the product); how do we get more sustainable funding for CMAM (still the big question!); and a whole host of questions about the mandates of the different UN agencies in relation to CMAM scale up…I’ll hold off giving the answer to that one, you’ll have to read the meeting report when it is release!
That’s it from me, we’re now off for a photo opportunity (no time given to put lipstick on, although Carmel has managed it!), and then off for a dinner reception hosted by the Ministry of Health of the Government of Ethiopia. It promises to be a treat! Tomorrow’s another day – let’s see what it brings…
Day 2, Morning Sessions
By Anne-Dominique Israel (ACF)
We started the day with a key note video from Dr Mary Robinson former prime minister Ireland (Mary Robinson foundation- Climate justice and child nutrition foundation) she particularly advocated for the actors to link climate change and nutrition (linking development, human rights and climate change) and the need to have a more “people centered approach”.
The conference facilitator, Lola Gostelow, presented then the day 2 objectives followed by the re-cap of the key points from day 1. She summarized all the important topics raised yesterday. It was indeed a very intensive first day (7 case studies presented!) with a lot of discussions and sharing… It gave us some food for thoughts and topics for side discussions, but also some homework: four of us volunteered for example to try to better define the notion of “integration” which is the word on everyone’s lips since yesterday, we will see what will come out of this (rendez-vous Wednesday morning in the blog!). Usefully Lola reminded us of the articulation of the CMAM components: SC; OTP; SFP fitting into a wider community mobilization sphere (the slide presented also highlighted the Local RUTF production and the FS and other sectoral interventions). She then listed key issues that came out yesterday: Understand local dynamic= to use capacity of the community/ Information management/ Local RUTF / Capacity gaps/ longer term funding/ Integration in Health systems/ government commitment.
Yesterday Lola explained us that day 1 was an absorption day and day 2 should be a digesting one (nice nutrition metaphors!) So let’s go for digestion! Today, in addition to the digestion work it seems that we are also expected to take part in a “cementing process”…
But for now let’s go back to country presentations; the famous André Briend (your blogger of yesterday) is chairing the session. We have started with a visit to Mozambique, went then to Pakistan.
A very interesting keynote speech about “CMAM in India: Challenges and opportunities” was proposed by Dr Biraj Patnaik (principal advisor of the Indian supreme court).This presentation gave another perspective of questions and challenges countries are facing in scaling up CMAM.
Biraj Patnaik first highlighted the disconnection between economic growth and under nutrition. He gave us an idea of the magnitude of the problem in India: Low Birth weight problem represents for example twice the average of African countries and 42% of the world severe wasted children are Indian. He briefly described the determinants of under nutrition (Sanitation/ low women literacy level / access to food/early pregnancy/ absence quality health services/ suboptimal care practices). He presented the key involvement of the supreme court in scaling up the Inter graded Child Development Services (ICDS) for example. Concerning CMAM in India, it seems that a consensus among civil society was difficult to achieve since CMAM using RUTF was perceived by donor as a “magic Bullet” with a little emphasis on the continuum of care for all children including prevention. Nevertheless a consensus on SAM treatment workshop was held in 2009 and brought together a wide range of actors. Strong concerns on the role of the private sector in CMAM were raised.
To illustrate how CMAM is now piloted and what are the challenges in India, Dr Manohar Agnani Director of the national and rural health mission of Madhya Pradesh state continued the presentation. 0.85 Million children are, at any point of time, suffering from SAM in this state, the current inpatient capacity is (with 100% occupation of bed) is 70 728 per year. It give us an idea of the great challenge India is facing in order to deliver treatment to all children suffering from SAM in the country. The illustration of the hundred thousands of community staff, for example, that need to be trained and supported in just one state of India gave us a pretty good idea of the level of challenge!!!
Questions and answers on the presentation were then followed by a deserved coffee break! The other countries that did not present so far a case study presented their CMAM experiences in 3 minutes (Afghanistan; Bangladesh; Cambodia; Liberia; Nepal; Nigeria; Sudan; Tanzania; Uganda; Zimbabwe)
After absorbing all the information coming out of the case studies and short country presentations it is now time to do a synthesis of the lessons learned. It is digestion time as the organizers said!
We finalized the morning in brainstorming on the key constrains to CMAM scale up. Each table had to identify 3-5 priority challenges that are faced in scaling up CMAM at country level.
Wrap up tomorrow! It is now time to eat and to handover the Blog to Rebecca!
Greetings from Addis!
Day 1, Afternoon Sessions:
“Le Niger nourrit les Nigeriens!”
By André Briend
Several points come up frequently this afternoon in case studies from Ethiopia, Niger, Malawi, Somalia, Sierra Leone and Ghana. First, the difficulty in finding a sustainable source of funding, securing an RUTF supply from local producers, the difficulty in setting up a referral system for complicated cases when the nearest hospital is hundreds of km away – the latter is seen as particularly difficult with lack of adequate transport and difficulty to predict demand.
An original point was made by the Ethiopian speaker. Timely and reliable reporting of the number of patients from CMAM program monitoring gives an early indication of a serious problem and this is more informative than traditional nutritional surveys, always heavy to carry out and time consuming.
The presenter also discussed the problem of unreliable (at times) reporting from the field in terms of monitoring and evaluation. Did they try to use cell phone technology to speed up reporting? Too many questions, I cannot ask mine! During the break, Dr Ferew (MoH), tells me that the national programme is considering this option and already uses it for other health activities. They are getting advice from the Gates foundation for this. Let us follow this up, maybe innovation to come here.
Next a presentation in French from Niger. SAM prevalence is 3,1 percent, particularly in the south. CMAM started after two food crisis in 2005 and 2009-10. The situation improved after the government prioritized nutrition and launched the 3N initiative which stands for: “Le Niger nourrit les nigeriens” (Niger feeds Nigerians) – What a good slogan ! In 2008, health care was made free for all under 5 children. A good initiative too. Challenges in Niger are common to other countries, including difficulty in maintaining quality of programmes, supply of RUTF. There is a RUTF factory in Niger, but its capacity is not sufficient to cover the needs of the country.
It was back to English for a presentation on Malawi, the country (with Ethiopia) where CMAM got an early start. CMAM started following a food crisis in 2001. Strange to hear again that a food crisis lead to initiatives to improve SAM treatment – why not before? Among factors of success, a strong government involvement – the Government has even committed to take over funding of the CMAM programme. This is really something.
Somalia, now, unfortunately so prominent in the headlines. A presentation from Leo, the enthusiastic nutrition coordinator for Somalia, based in Nairobi. Somalia is de facto divided into different regions ruled by independent administrations and it is easier to reach them from Nairobi than from Mogadishu. NGOs play a key role in CMAM and other nutrition activities, but there are so many of them that coordination is a real challenge. Actually, there are so many of them, that when a new one is being created, it is difficult to find a name or an acronym that has not already been used! Despite the situation, performance indicators in terms of cure rate, drop out etc are good, arguably better than in Malawi and Ethiopia. How can this be true? Maybe an issue with differences in definitions of the nutrition indicator they use. Or maybe this is true, and the programmes are incredibly effective in this context of food shortage where malnutrition is mainly due to lack of food and not associated complications.
Sierra Leone, like Niger, also has a ‘free health care initiative’ (FHCI) – CMAM has already been integrated into this initiative and this is seen to be a big plus for the success of the program. Many enabling factors for scale listed such as development of guidelines, good coordination between partners, government commitment from the highest level and a monitoring system that’s seen to be effective. Challenges are big however and include, amongst others, poor coverage in hard to reach areas (12%) – this is linked to inadequate resources invested in community mobilization – a key issue that I hope we’ll get more time to discuss!
Day 1, Morning Sessions:
The right group, in the right place, to learn about scaling up CMAM
By Kate Sadler
The aim of this conference (and I’m paraphrasing here) is to learn about enabling factors and challenges for successful scale up of CMAM across Africa and Asia. I’d say that the organizers have got just the group here to achieve this aim: from high level Government representation from Afghanistan to Ethiopia and Pakistan to South Sudan (22 countries in all!); to academics known for their work in this area; to key NGO and UN players in the fight against under nutrition; to a whole bevy of donors – it’s certainly the right mix of people to be debating solutions to difficult questions.
That the meeting is being held in Addis Ababa and hosted by the Government of Ethiopia is, as the State Minister of Health has just pointed out in his opening address, very apt. Ethiopia has been one of the first countries to embrace the CMAM approach and there have been big successes in demonstrating effectiveness of the approach here – treatment for SAM has been scaled up to over 8800 health posts to date across 200 ‘Woredas’ (Districts), quite an achievement! Yet there remains much work to be done on reaching those ‘hard to reach populations’ and creating the right policy environment if under nutrition is to be addressed effectively at scale. That there is commitment from the international community to get this work done is clear. It’s particularly striking to hear from the Minister of Health for the newest country on this planet: South Sudan, which currently suffers one of the highest child mortality rates in the world, about the work that they are doing to tackle malnutrition. He joins the Ambassador for Canada in highlighting the current significant inputs and global initiatives that all aim to contribute to achieving improved nutrition outcomes. As they point out, the challenge now is to work together to achieve that all-important MDG 1: to reduce the number of children suffering from undernutrition by half by 2015.
There’s also some work to be done at this meeting and beyond on ensuring that we all understand each other when we’re talking about these programs. The facilitator, in her introduction, has highlighted the breadth of terminology and acronyms that will be used over the next few days – from CMAM to IMAM to CTC, presenters and participants will need to be sure that they’re as precise as possible with terms and define exactly what each programming approach entails.
What is not in doubt, and that is communicated in an excellent keynote by Steve Collins, is that the potential for CMAM programs to address child mortality is huge (1-2 million deaths annually are currently associated with SAM). That, when designed with early presentation at its heart, it is feasible at community level and highly cost effective. A really important point that Steve makes is that the key to the success of this model is a focus on engagement at community-level and participation, it’s not just about supply of ready-to-use food. There are key threats too – most importantly managing the transition (for funding, staffing, logistics etc.) from emergency funded programs to a standard element of primary health care. Also the need for programs to be evidence-based – in the rush for scale up we can’t lose sight of the need to ensure and document access, coverage and cost effectiveness.
The country case studies in this morning’s session have started to articulate some of these challenges for their own contexts. The Federal Ministry of Health for Ethiopia talks about the problem of supply management and getting a supervision structure in place within PHC that can maintain high quality service delivery. Kenya’s Ministry of Public Health highlights the problem of human resources (high turnover and shortages) and the challenges around maintaining community-based mobilization for case-finding and support for referral, particularly of complicated cases. Key questions from the floor touch on how to engage existing community health practitioners (both formal and informal such as the traditional health practitioner) in CMAM programs. Crucial, as the response to these questions highlight, is the need to invest at the start of programs in mapping existing networks of health promoters at community level and maintaining a level of flexibility in how to engage them and the role that they might take. .. this could well be the key to some of the challenges listed by presenters around maintaining mobilization, referral and follow-up.
At the same time both case studies highlight some of the key factors that have supported successes around scale up in their countries. In Ethiopia, good consensus building among development partners and a supportive policy environment prior to scale up helped to secure the level and duration of funding that was needed for roll-out to date. In Kenya, strong commitment from the District Health Management teams and the sharing of information between National and District levels through a Nutrition Technical Forum has been key to support of IMAM. You can find all these case studies on this website in due course (and more summaries to come on this blog) – take a look; they are a fascinating and current perspective on CMAM programming across the world.
For the future, both country presentations this morning have highlighted the need to figure out mechanisms of strengthening domestic and international resource allocation to support the sustained future of CMAM programming – I have a feeling that this may be a common theme in presentations we see over the next few days.
That’s all from me – I’m really looking forward to a productive and enlightening few days .. oh, and to the great coffee too of course!