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Simplified protocol

This question was posted the Simplified Approaches for the Management of Acute Malnutrition forum area and has 1 replies.

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Consultant en SRMNEA-Nut

Normal user

29 Jul 2020, 23:56

1. The simplified approaches aim to increase the coverage of management of SAM children and reduce costs. What should be put in place for this approach in countries like the DRC where nutritional inputs are almost absent in health facilities? (untimely ruptures). Do you think that countries that will not be able to make inputs available will be able to expand coverage?

2. The few inputs available in some countries are diverted and sold on the market for consumption by non-malnourished children and even adults. If to date, countries are unable to control the inputs managed by health providers in health structures, how will we manage with CHWs who are difficult to control (because they are not linked to the constraints of the employer (the State)?

Mark Manary

Washington University School of Medicine

Technical expert

22 Sep 2020, 16:41


I have never worked in DRC, but I have been working  for 35 years, on the ground, hands dirty, in sub-Saharan Africa.  What you describe is unfortunately the case in a variety of places.  I think  a totally broken health care delivery system cannot manage a simplier or more complex SAM management protocol.  But a simplier program is better, and there are less pieces that need to some together for success.  If less RUTF is used to treat a SAM child, then there should be some RUTF left to treat other chidlren.  I would look at the supply chain for other essential health care inputs, such as drugs, wound care supplies, stethescopes are seen what works.  Can RUTF be added to the supply chain of these.

International agencies are willing to donate inputs, but the local/ regional/ national health care systems must manage these.  

Perhaps look to non-governmental healthcare faciliites, do these do a better job of managing inputs?  If so how does this happen?

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