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Rationale for COVID 19 programme adaptations (escalated question to the Wasting TWG)

This question was posted the COVID-19 and nutrition programming forum area and has 1 replies.

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GTAM Wasting TWG

Emergency Nutrition Network

Frequent user

23 Jun 2020, 09:18

The rules of restriction or not of movement are very different in the different countries, and even in the same country, between the different provinces. Why are the recommendations based on the restrictions and not on the presence or absence of cases (for example the classification of the levels of the WHO), if the recommendations are made to avoid the contamination? 

GTAM Wasting TWG

Emergency Nutrition Network

Frequent user

23 Jun 2020, 10:26

The following answer was produced through consultation within the Wasting TWG:


This is an important point. While movement restrictions can determine whether standard delivery of services is possible, the level of COVID-19 exposure risk should also be seen as a critical factor in deciding where to apply the recommended adaptations versus continuing with standard protocols and practice.
• Using risk of transmission as criteria for programme adaptations
Although the WHO classification of levels of epidemics remains good reference point for decision-making, the classification is dependent on testing data. Currently COVID-19 testing data are quite limited in developing contexts and where such data do exist, information is often largely focused on the capital city and may not provide a strong picture of the sub-national/provincial situation.
If the level of testing was sufficient to provide a clear picture of the relative risk of COVID-19 infection in different locations, this could be used to make more nuanced decisions about which adaptations to apply in which locations. However, it is currently unclear how much testing information will improve over the coming months and at what point there may be sufficient information to support this type of decision-making.
An alternative when testing capacity is limited could be to use the WHO classification for levels of transmission which would be based on the number of suspected/reported cases and not on testing. The use of an existing classification system also provides a common framework for interagency planning.
This would also potentially be useful in allowing specific areas within countries to be able to relax movement restrictions while other parts of the country continue to require heavier restrictions. Where this was the case, advice would be based on the context. A matrix could be used that separates public health measures and infection control procedures from programme specific protocols to clearly identify which are applicable in each circumstance/phase.
Advice for the various protocols / procedures could also include preparedness measures to allow services to continue if the location was to evolve to the next level. The IASC document on preparedness and response gives an example for responses linked to the transmission level in the community (e.g. see page 6 of the guidance)
(https://interagencystandingcommittee.org/system/files/202005/IASC%20Interim%20Guidance%20on%20Public%20Health%20and%20Social%20Measures%20for%20COVID-19%20Preparedness%20and%20Response%20Operations%20in%20Low%20Capacity%20and%20Humanitarian%20Settings.pdf)

• Extent of movement restrictions as criteria for programme adaptations
Understanding the extent to which movement restrictions are in place is essential for decision-making about when to implement programme adaptations. Even where risks of transmission are believed to be low, if blanket restrictions are in place, then this will affect capacity to deliver nutrition services.
The opposite is also true where movement restrictions are not in place but there is risk of transmission through standard provision of services.
Ideally, both criteria should be taken into consideration in making decisions about how to and where to adapt programmes and it has been recommended that some basic decision trees would be helpful to outline under which conditions the different adaptations should be taken up.
The Wasting and COVID 19 brief developed in March 2020 provided ‘recommendations’ on adopting simplified approaches based on a “worse case scenario” concerning the epidemic in each country. It is now recognised that these need to be contextualised further to support countries to decide where and how to adapt nutrition programmes.

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