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Dr. Kamal Raj

Regional Advisor for South Asia Welthungerhilfe

Normal user

9 Jan 2014, 08:44

The current CMAM program has just entered its third year, it has one more year to wrap up. One SMART and a KAP was conducted during the second half of the last year, NCA was also planned at the same time, I am not sure on the relevance and usability of the findings if we decide to conduct NCA at this stage of the project cycle, please advice. Thanks. Raj.

Mark Myatt

Consultant Epideomiologist

Frequent user

9 Jan 2014, 11:18

I am not sure what is meant by "NCA". Please explain.

Assuming (1) that "NCA" is a sensible approach to coverage assessment that can yield useful data on barriers / bottlenecks to coverage and (2) the implementing agency is both willing and able to reform the CMAM program based on this data then with a year to go you can still improve coverage and impact on child mortality.

Program impact is:

    impact = cure rate * coverage

There is not much that we can do to improve the cure rate of the CMAM protocol in uncomplicated SAM cases since it is already very close to 100%. The better CMAM programs achieve something like 90% cure-rates and 80% coverage giving an effectiveness of 72%. We seldom see cure-rates below 80% but often see coverage below 50%. This means that the main way we can improve impact of our programming is to improve program coverage.

At least about 25% of all SAM case will die without treatment. We can, in a well-run CMAM program, achieve a 90% or higher cure-rate. This means that we avert death in at least about 23% of beneficiary cohorts.

Here is a "back-of-the-envelope" cost-benefit calculation using made-up data ... if coverage increases as a result of the NCA so that your caseload increases from 700 to 1000 cases per year then, over a year, you would avert something like 300 * 0.23 = 69 additional deaths. Assuming that each death averted is equivalent to 35 DALYs averted and the NCA costs US$5,000 and reforms cost US$10,000 then you have a cost of 15000 / (69 * 35) = US$6.21 per DALY averted. That is value for money! Anything below US$100 per DALY averted is considered to be very good value for money. Someone should check my arithmetic.

Another consideration is that CMAM programs tend to continue and be taken up by other NGOs or by the local MoH. Many of the original CTC programs are still running after a decade since they were established. This means that coverage increases may have an impact long after the planned year. Also, you may learn something about coverage and program implementation that means that coverage is improved in subsequent programs that you implement.

Just my tuppence. I hope it is of some use.

Mark Myatt

Consultant Epideomiologist

Frequent user

24 Jan 2014, 13:01

Please advise ... what is NCA? This nagged at me and I think it might mean "nutritional causal analysis".

I think we should all try to avoid acronyms that we do not spell out the first time we use them,

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