Nutrition Program Coverage Thresholds

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,

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