Verification of the Integrated Management of Acute Malnutrition (IMAM) Programme in Sierra Leone. Extension of submission date to Tuesday 31st January 2017

1.   Background/Purpose of Assignment

Global acute malnutrition (GAM) rate in Sierra Leone was reported at 9 per cent Statistics Sierra Leone and UNICEF-Sierra Leone 2007. Sierra Leone Multiple Indicator Cluster Survey 2005, Final Report. Freetown, Sierra Leone: Statistics Sierra Leone and UNICEF-Sierra Leone. in 2005 which was considered as poor based on the World Health Organization (WHO) wasting cut-off values for public health significance. Acute malnutrition especially severe acute malnutrition (SAM) threatens the survival of children under 5 years of age both in emergency and non- emergency settings. Children with SAM are nine times more likely to die from all other causes than well-nourished children.

In order to curtail children’s deaths associated to acute malnutrition, the Ministry of Health and Sanitation (MoHS) implemented in 2007 the Integrated Management of Acute Malnutrition (IMAM) programme, a highly cost effective Bachmann MO. Cost effectiveness of community-based therapeutic care for children with severe acute malnutrition in Zambia: decision tree model. Cost Eff Resour Alloc. 2009; 7:2. programme to address acute malnutrition Global evidence proves that at least 80 per cent of children with severe acute malnutrition (SAM) can be successfully treated at home and that appropriate care management can lower case-fatality rates to as low as 5 per cent both in the community and in health care facilities. The programme was initially piloted in five PHUs (Peripheral Health Unit) in 4 selected districts since then the programme was gradually scaled up across the country covering all 14 districts. By the end of September 2016, there were approximately 609 functional OTPs and 20 IPFs nationwide. The national scale up of the IMAM programme contributed to the progressive reduction in GAM rate which was reported at 4.7 per cent Ministry of Health and Sanitation Sierra Leone and UNICEF Sierra Leone. 2014. Sierra Leone National Nutrition Survey 2014. Freetown, Sierra Leone. In 2014 prior to the Ebola Viral Disease (EVD) outbreak period.

However, there were concerns raised on the quality of the IMAM programme in Sierra Leone. Thus, an outpatient therapeutic programme (OTP) verification exercise was organized in order to build the foundation for programme quality improvement. The verification exercise was conducted from March to June 2015 in 7 districts (Bombali, Kono, Tonkolili, Kailahun, Koinadugu, Bonthe and Bo) and it covered the programme period of July 2014 to April 2015 when EVD was at its peak and the health systems in the country collapsed due to the fear of the epidemic.

Overall, the findings showed that the quality and provision of OTP services in the country was sub-optimal which implied that both adherence to IMAM protocol by health workers and enforcement of protocol standards by supervisors and district nutritionists were weak.