Name of Sector: CMAM
Date of Deployment: 27 October to 8 December 2019
Reason for request:
Angola is currently (2019) implementing a national programme for the integrated management of acute malnutrition (IMAM). The IMAM program has had a history of challenges affecting the quality of service delivery leading to poor program performance. The challenges include:
- Limited community mobilization system,
- Uncoordinated and ineffective supply chain management,
- Sub-optimal quality of IMAM services offered,
- Limited volunteer engagement and support for outreach services,
- Lack of proper follow up system of patients,
- Dual but not consistent monitoring and evaluation systems through the DHIS2,
- Insufficient funding allocated to IMAM,
- A weak enabling environment for IMAM implementation.
Furthermore, there is no systematic way of identifying, prioritizing and addressing bottlenecks to access, coverage and quality of care of the IMAM program.
Due to these challenges, UNICEF commissioned Professor Mike Golden and Dr Yvonne Grellety to conduct a 2-week mission in April 2019. The mission involved an evaluation of several health facilities that deliver care for severely malnourished children in Luanda. The assessment found the current protocol was not being applied properly and the reasons for its provisions are not understood by many of the staff. In addition, in May 2019, an initial bottleneck analysis (BNA) stakeholder workshop of the national SAM programme was conducted. Data was collected in 18 provinces during a 2-month period.
Key results achieved were as follows:
- Introduced the concepts and methodology/tools for Evidence-Based Planning Programming and Monitoring for the Integrated Management of SAM,
- Built the technical capacity of UNICEF and MOH on undertaking the bottleneck analysis (identifying bottlenecks, root causes and solutions),
- Reviewed and endorsed the draft contextualized indicators for BNA of SAM management services based on the program’s implementation modalities,
- Explored the data sources and agreed on the methodology of collection of additional data for the BNA exercise,
- Utilized the DHIS2 nutrition data to obtain performance of SAM coverage determinants.
Although the BNA has the potential to provide evidence-based indication as to where the SAM programme requires reform, the analysis was not finalized due to the limited time. Therefore the identification of the root causes and relevant solutions was not performed. Despite this, supply chain challenges were identified as a critical inhibiting factor for the SAM programme.
The focus of the Tech RRT Deployment was to directly support the scale up of quality CMAM services at national level with a strong focus in the drought affected areas, to be delivered through the health system in order to meet the increasing needs of the affected populations.
- Train CMAM partners on BNA analysis and facilitate a collaborative analysis of BNA data collected in 2018.
- Support the finalization and documentation of SAM BNA exercise.
- Conduct field visits in one province (Cunene) to further understand the challenges identified in the BNA, and to inform action and training plan.
- Provide technical input and work with the UNICEF Supply Unit on the nutrition supply chain with recommendations to ensure more effective delivery of key commodities.
- Support planning of SMART surveys and develop of protocols for implementation in Huila and Cunene.
- Handover organisation of SMART surveys to in-coming Tech RRT Assessment Advisor
- Support Tech RRT Assessment Advisor in training for SMART survey.
- Handover work to in-coming UNICEF surge team member.
- Bottle Neck Analysis training report and SAM Programme Bottle Neck Analysis report for Cunene
- SMART protocols for Huila and Cunene with an implementation strategy.
- Report on recommendations for improving the quality of CMAM program in Angola that can direct future work on a scale up plan for CMAM in country once the surge team member arrives.
Name of Sector Assessment
Date of Deployment: 24 November to 20 December 2019
Reason for request:
As a logical development following the declaration of states of emergency in 3 provinces by Civil Protection services in January 2019, the concordance of nutrition, health and food security information depict a deteriorating situation in 4 provinces and observations coming from experts and the national BNA data collection, a need for up-to-date and reliable prevalence information is required. This information will support advocacy efforts both in-country towards the national government and to potential donors to support the response.
The survey is required to take place before the end of 2019 in order to 1) reflect the lean season (October-December) in the results thereby capturing the most severe nutritional situation and 2) ensure data is available for advocacy efforts in January 2020.
Given the lack of expertise to implement SMART surveys in Angola, request for the in-country support of a Tech RRT Assessment Advisor was submitted along with this detailed ToR. The focus of the ToR is to directly support the implementation of two SMART surveys in two drought-affected provinces to provide information on the nutritional status and therefore increasing needs of the affected populations.
- Provide technical support in developing and finalising the SMART survey protocol, and support UNICEF in obtaining technical validation of the SMART survey from the INE.
- Plan the SMART survey in close collaboration with UNICEF partners especially Ministry of Health (MoH), National Statistics Institute (INE) and World Vision (WV). This may include but not be limited to: initial planning, selection of tools and methods, sampling, writing guidelines and set up time frame, planning enumerator training and developing materials, budget and logistics planning and any special tools and equipment needed. Identification and design of assessment activities may be started by UNICEF in country team before the Tech RRT Advisor arrives given the time constraints.
- Lead the implementation of the SMART survey with the close support of UNICEF. Manage all aspects of the SMART survey including team recruitment, training of enumerators and supervisors, standardization test, survey pilot, supervise data collection and ensure data quality, logistics, budgeting, and coordination with partners.
- Monitor data quality, analyse results, manage the dissemination of preliminary results, and prepare final SMART survey report.
- Finalised and validated (by INE) SMART survey protocol
- End of Mission report outlining activities undertaken to support the design and planning of the upcoming SMART.
- Final SMART survey report