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Monthly program coverage calculation for TFP / SFP

This question was posted the Prevention and treatment of severe acute malnutrition forum area and has 3 replies. You can also reply via email – be sure to leave the subject unchanged.

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Hatty Barthorp

Global Nut Advisor / GOAL

Normal user

7 Feb 2011, 18:13

In order to track program coverage for a TFP (for example) on a monthly basis, I would use Mark M.s Indirect Method = No. of children attending SCs and OTPs / (Estimated prev' of SAM x Estimated population).
i.e. if we had 40 children in therapeutic care during Jan', a total population of 50,000 and U5 population of ~20% (10,000) and a 3% SAM, we would calculate the coverage as 40 / (3% x 10,000) = ~13% coverage during Jan'

In light of the above, should one use the total No. of children simply presenting at the end of the month (as a proxy indicator of the no. in the program on any given day), or should one use total end of previous month + all new admissions during the month? If it's the latter, then how do we correct for incidence of illness and expected duration of treatment?

I have been reading the link below with regards to calculating program incidence from program prevalence (http://www.en-net.org.uk/question/157.aspx) and wondered if this were a better way of getting a more realistic expected monthly program coverage figure.

As has been previously discussed, the actual number of children treated every year is higher than the point prevalence, as this is the prevalence at just one point in time on a certain day and therefore we would naturally expect it to be higher. We cannot simply multiply it by the no. of days in the year however, as we need to factor in illness and duration of treatment. As such, in order to get an incidence for the year, I think I am right in saying it is advised that the point prevalence is multiplied by a correction factor of either 1.6 (60% - according to Andre Briend) or roughly 2 (according to Mark M.) and also multiplied by expected program coverage (lets say 20% as is common for OTPs - see http://www.en-net.org.uk/question/157.aspx).

As such, if I were to use the above example again, the expected incidence for the year would be:
Popn x U5% x Expected Prev' x CF x ECov'
50,000 x 20% x 3% x 1.6 x 20% = 96 beneficiaries over the course of the year.
Assuming we didn't heave a flux in prevalence of MN during the course of the year (just to make the scenario simpler), this would equal an expected 8 children should be treated for acute MN each month over the course of the year. Therefore, if we had 40 children in the OTP at the end of the month (as per the original scinario), this would equate to a 500% program coverage.

In light of both the above examples, please can someone advise on how best to calculate proxy program coverage on a monthly basis for TFPs and SFPs.

Thank you so much

Mark Myatt

Consultant Epideomiologist

Frequent user

10 Feb 2011, 17:52

First ...

Please do not associate me with the "indirect method". It is not my method and it is not a method that I particularly approve of. It has many flaws which I discuss in:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2623458/pdf/15682245.pdf

There are problems with using this method to track coverage over time. The prevalence estimate quickly out of date and (related to this) the incidence of SAM usually changes throughout the year.

Second ...

I am glad to hear that you are paying attention to program coverage. It is the "Royal Road" to program effectiveness.

If you have time to devote to monthly coverage assessments then I suggest that you use the SQUEAC method. It will require, on occasion, a little more work than you are doing at present but it will give you a far better understanding of program coverage than is possible with the EPI-direct and EPI-indirect methods. The sorts of information that SQUEAC delivers is very useful for improving program coverage. The sort of work required is a few hours per week done in centres (most of this you may be doing already) and a few days per quarter fieldwork. New documentation of SQUEAC and SLEAC are being developed by FANTA-II and VALID International (VI). VI can provide training in SQUEAC if needed.

Hatty Barthorp

Global Nut Advisor / GOAL

Normal user

15 Feb 2011, 10:42

Hi Mark,

Thank you for your reply and apologies for associating you with the indirect method, I just lifted it from another ENN post where you'd copied both the indirect and direct examples within your response - I should have referenced it sorry. FYI: At present we are not using SQUEAC/SLEAC for program coverage in CMAM/IMAM supported sites, largely due to a lack of time. We conduct annual MICS or KAPBs in every program location systematically (+ some donors still insist on end line surveys irrespective of the time line of the program, so we might end up doing another survey after 9mths for example), plus sectors will also collect an assortment of key monitoring information through periodic assessments to help assess project 'impact(s)' over time. As such, it is felt that yet another 'survey' tool would be too much, when other issues such as ensuring program quality will be prioritised. In addition, most of our programs are focused on support and sustainability, whereby we aim to facilitate the MoH to provide CMAM/IMAM services (as an integrated part of their minimum package of services), trying to do as little direct implementation ourselves as poss'. As such, do you think that SQUEAC/SLEAC would be a viable tool for use by government bodies (not sure if there are any successful examples to date), or is it a tool designed more for NGOs, to help monitor programs for the duration of their support?

Although we are still using more inaccurate proxy methods of estimating program coverage, it is understood that it is one of the most important indicators in assessing CMAM/IMAM programs (especially when an ever increasing no. of govt bodies are appreciating it's benefits and subsequently supporting roll out) and as such it is great news that Fanta II and VI are developing new doc's on coverage methodology.

Mark Myatt

Consultant Epideomiologist

Frequent user

17 Feb 2011, 10:52

All the methods you mention (MICS, KAPBs, indirect coverage methods) are, IMO, pretty much a waste of time and resources. I would stop doing all of these as soon as possible. You would then have room for "yet another 'survey' tool" (as you put it) ... and SQUEAC is an effective tool for quality improvement. SLEAC is a very quick and simple tool (much quicker than a MICS or KAPB survey). I think that this is the minimum coverage work that you should do.

SLEAC and SQUEAC were designed for evaluating the coverage of CMAM programs. We did not (and do not) distinguish between MoH and NGOs when developing these methods. Our initial concern was that these methods would be beyond the wit of NGO (not MoH) workers. Development work and use-studies were undertaken in MoH and NGO run programs equally and these methods have been used successfully by both MoH and NGOs. We have gone to considerable lengths to make these methods accessible to the level of staff found in NGO and MoH run programs. If you feel that these methods are beyond current local capacity then capacity-building and support should be provided (that does seem to be your policy).

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