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Nutrition Program Coverage Thresholds

This question was posted the Assessment and Surveillance forum area and has 5 replies.

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Damien Pereyra Ngono

Nutrition data specialist

Normal user

14 Jan 2022, 15:58

Dear All,

I am looking for any documentation about thresholds for interpreting Nutrition Program Coverage (especially CMAM; BSFP; Homefortification/MNPs; Cash assistance but any other are welcome)...

In some old Sphere guidance CMAM coverage proposed two different threshold:

Acceptable threshold:

>50% in rural areas
> 70% in urban areas
> 90% in a camp situation

Alarming threshold: < 40% (rural/urban/camp)

Thanks in advance

Happy new year for 2022

Damien

Kemal J. Tunne

Health and Nutrition Senior Officer at CRS

Normal user

14 Jan 2022, 19:35

We have these documents in Ethiopian contexts  for Nutrition Emergencies and as a National protocol for severe acute malnutrition  case management and treatment. I hope this may be of some help. Follow these links for WHO and UNICEF adopted National Protocol,

National guideline for the management of acute malnutrition in ...

http://repository.iifphc.org › handle

National guideline for the management of acute malnutrition in Ethiopia. Ministry of Health ... Name: Ethiopia Guidelines ... Size: 12.85Mb. Format: PDF.

Protocol for the Management of Severe Acute Malnutrition

https://motherchildnutrition.org › resources › pdf

PDF

Refer to national guideline for malaria treatment Malaria, Diagnosis and Treatment Guidelines for Health. Workers in Ethiopia, 2nd edition, Federal Ministry ...

National-Comprehensive-COVID19-Management-Handbook.pdf

https://covidlawlab.org › uploads › 2020/06 › Nat...

PDF

by E FMOH · 2020 · Cited by 10 — SECTION XIII: HEALTH CARE FACILITY COVID 19 PREPAREDNESS PROTOCOL . ... CoV-2 infection interim guidanceEthiopian National Infection Prevention and ...

National Guidelines for the management of acute malnutrition ...

https://www.humanitarianresponse.info › files › files

PDF

The National Guidelines for the Acute Management of Malnutrition among children under five, pregnant and lactating women have finally been approved by the ...

Ethiopia sets new standards for the management of acute ...

https://www.afro.who.int › news › ethiopia-sets-new-sta...

Jun 25, 2019 — The guideline replaces the 2007 protocol for management of acute malnutrition, and is based on the 2013 WHO global recommendation for the ...

For UN WFP Documents please follow this links,

National guideline for the management of acute malnutrition in ...

http://repository.iifphc.org › handle

National guideline for the management of acute malnutrition in Ethiopia. Ministry of Health ... Name: Ethiopia Guidelines ... Size: 12.85Mb. Format: PDF.

Protocol for the Management of Severe Acute Malnutrition

https://motherchildnutrition.org › resources › pdf

PDF

Refer to national guideline for malaria treatment Malaria, Diagnosis and Treatment Guidelines for Health. Workers in Ethiopia, 2nd edition, Federal Ministry ...

National-Comprehensive-COVID19-Management-Handbook.pdf

https://covidlawlab.org › uploads › 2020/06 › Nat...

PDF

by E FMOH · 2020 · Cited by 10 — SECTION XIII: HEALTH CARE FACILITY COVID 19 PREPAREDNESS PROTOCOL . ... CoV-2 infection interim guidanceEthiopian National Infection Prevention and ...

National Guidelines for the management of acute malnutrition ...

https://www.humanitarianresponse.info › files › files

PDF

The National Guidelines for the Acute Management of Malnutrition among children under five, pregnant and lactating women have finally been approved by the ...

Ethiopia sets new standards for the management of acute ...

https://www.afro.who.int › news › ethiopia-sets-new-sta...

Jun 25, 2019 — The guideline replaces the 2007 protocol for management of acute malnutrition, and is based on the 2013 WHO global recommendation for the ..

Damien Pereyra Ngono

Nutrition data specialist

Normal user

17 Jan 2022, 14:22

Thank you Kemal,

All those are usefull documents. However, I am not able to find any programe coverage thresholds in the documents shared (I am not looking for admission/discharge criteria or program performance thresholds :like cured and death rates). But looking for CMAM and others Nutrition programs threshold in term of population or geographical program coverage.

Hope this is clear

Thanks again

Damien

Anonymous 40872

Not employed at the moment

Normal user

17 Jan 2022, 15:10

Hope that these coverage survey guidelines help you as reference document. 

https://1drv.ms/b/s!AiCyQ7ECPglikyp2xgcvDJ27LmJn

Keep in mind that the targeted program opreational area context as well as national guidelines/protocols matters also.

Paul

Action Against Hunger UK

Frequent user

17 Jan 2022, 16:42

Hi Damien,

Your question doesn't have a straighforward answer. The standards you quote are the Sphere MINIMUM standards but even they are the subject of debate. The link below "Coverage Matters" references a 2014 compilation of issues around coverage, primarily related to CMAM programming, but the principles can be extrapolated. See the article on page 5 which discusses some of the issues around interpreting the Sphere standards.

https://www.ennonline.net/coveragematters

More important than the number (coverage survey result) are the questions around 'why' is the coverage x%? The SLEAC / SQUEAC reference provides a toolkit and a framework to understand the 'what' and the 'why' of coverage. Again, the focus is CMAM but the principles can be applied to other programming. 

https://www.fantaproject.org/monitoring-and-evaluation/squeac-sleac

I hope this helps,

Mark Myatt

Frequent user

18 Jan 2022, 10:10

Paul is right ... the coverage thresholds in the original question follow those given in the SPHERE minimum standards. There has been some "pushback" against these stadards and against the importance of coverage. I think this may be because some organisations who are proud of their programs repeatedly failing to meet minimum standards for coverage. Coverage cannot be assumed. We know that the coverage standards are achievable as some agencies have been consistently able to meet them.

Some of the issue with interpreting coverage estimates can be found in the ENN publication "Coverage Matters: A collation of content on coverage monitoring of CMAM programmes (June 2014)" referenced by Paul.

I also agree with Paul that methods that can provided answers to the question of why coverage is at a given level (e.g. CSAS, SQUEAC, SLEAC) are most useful as they can lead to program reforms that can improve coverage ... this is, I think, the most powerful interpretation.

WRT interpreting overall estimates ... it is important to realise that point and period coverage estimators measure different aspects of program performance and tend to give widely differing estimates of coverage:

* Point coverage reflects the ability of a program to find and recruit
cases. The point coverage estimator does not account for recovering cases and so does not directly reflect the programme's ability to retain cases from admission to cure.This means that it may give a misleading (i.e. downwardly biased) picture of program performance. This is a particular problem with programs that recruit cases very soon after they meet programme admission criteria and are likely to be treating large numbers of recovering cases. In these programs, the point coverage estimator will “penalise” good performance.

• Period coverage is intended to reflect the ability of a programme to find, recruit, and retain cases. The period coverage estimator does directly reflect the programme's ability to retain cases from admission to cure but tends to overestimate programme performance because the denominator does not include recovering cases that are not in the programme. The period coverage estimator also overestimates programme performance when cases are retained in a programme after meeting the criteria for being discharged as cured.

You might want to consider using the single coverage estimate which was developed to address this issue. See this FEX article (page 81).

https://www.ennonline.net/attachments/2341/FEX-49-Web-Update.pdf

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