Food Security Unit –PLG Feb 2004Presentation by :Dr Roohullah Shabon Emergency Health & Nutrition SpecialistSave the Children,Emergency and Protection Unit, Washington DC
SC Emergency Health & NutritionProgram in EthiopiaTens of thousands ofpeople are estimatedto have died fromthe food crisis inEthiopia and over 13million are stilldependent on foodaid for survival.
SC Emergency Health & NutritionProgram in Ethiopia Save the Children-US Emergency Health and Nutrition Program (EHNP) aims at developing its activities in an integrated approach including health and nutrition. All program activities are undertaken with the goal of both immediate humanitarian relief and long term sustainable development.
Activities: Together with Governmentand other agencies. Early Warnings System Collected, compile and analysis nutrition surveillance and food security data. Revise and standardize early warning indicators and parameters Conduct one-week rapid assessment of early warning system. Rapid Assessments Conducted 13 Rapid Assessments and participated in two Consolidated Appeals. Development of “Rapid Health, Nutrition and Food Security Assessment Tools” , Rapid Assessments guideline and train the staff.
Cont. Activities: Together withGovernment and other agencies.Nutrition Surveys Development of nutrition survey guidelines, training of the staff and technical and/or financial support provided to 17 Nutrition SurveysSub granting of Funds Funding has been provided to a total of 9 NGOs and 3 government agencies
Cont. Activities: Together withGovernment and other agencies. Rapid Nutrition Response Programs At present running 6 TFCs, 1 NRU, 4 SFPs and 2 OTPs (Outpatient Therapeutic Programme). A total of 4 CTC programs has been established by the EHNP in Arbegona, Aroresa, Bensa and Hulla woredas. Admitted a total of 3,307 patients, of which 78.04% were cured. From March up to October 2003 , there were 725 severely malnourished children in treatment. Handed over 5 TFCs; four to the government and two to local NGOs. Health Unit and W/S Units The Units will strengthen the EHNP Project Units’ health promotion efforts and build the local capacity of the regional/zonal MOH in terms of therapeutic/supplementary feeding management, health & nutritional surveillance, health and sanitation education and malaria control.
Therapeutic Feeding Centre The objective of TFC is to reduce morbidity & mortality associated with severe malnutrition & restore health promptly in a population of affected areas. As soon as the numbers of severely malnourished cases are more than the capacity of the health facility, specific structure like Nutrition Rehabilitation Unit (NRU) is set up within the health facilities. When this is not
The decision to open TFC is based on: Result of Nut. Survey and Rapid Assessment. The prevalence of Severe Acute Malnutrition (SAM) in a random survey among children under five years old is more than 3%. The prevalence of Global Acute Malnutrition (GAM) is more than 10%. Under-five mortality rate is more than 2/10000 per day. The absolute number of severely malnourished is over 20 cases
Closure of TFC Decrease in TFC admissions over 2 consecutive months, and average number of patients for the last two consecutive weeks (14 days) less than 20 inpatients in TFC Under five mortality rate < 2/10000 per day Prevalence of Severe Acute Malnutrition (SAM) < 3% Prevalence of Global Acute Malnutrition (GAM) < 10 %
STAFFING PATTERN of TFC Nutritionist Nutrition workers Health workers Logisticians Cooks, cleaners, guards Outreach workers Health educators/social workers
Community-based Therapeutic Care(CTC) Start with supplementary feeding from Sudan, Ethiopia and Malawi, CTC is the best means to quickly respond to an emergency situation where there are high or increasing levels of severe malnutrition. The CTC concept aim to integrate emergency nutrition with long-term programs by establishing structure that can be re- activated in future emergencies.
The main principles of CTC are Coverage Access Timeliness Sectoral integration Capacity building
CTC has the following elements: Therapeutic Feeding Centre (known as a Stabilisation Centre (SC) in our program): The TFC will be only for severely malnourished children who are not well enough to be treated at the OTP site. They will be treated as inpatients until their condition is stable enough for them to be discharged home (normally 5-10 days). Some children will not respond to treatment at the TFC and will need to be referred to hospital. Supplementary Feeding Programmed (SFP): This is made up of a two-weekly dry ration of Famix or CSB, health education and very basic medical care in collaboration with existing health facilities
CTC has the following elementscontinue: Outpatient Therapeutic Programme (OTP): There will be an OTP at every SFP distribution site. This is where the majority of severely malnourished children will be assessed and treated. Outreach work. The community element of the CTC program must be strong in order to mobilize mothers/caretaker to bring their child to the SFP/OTP for screening.
Management Phases of CTC: Stabilisation phase This is the initial phase of treatment of severe malnutrition with complications as inpatient in stabilisation centre (previous TFC): life-threatening problems are identified and treated specific deficiencies are corrected metabolic abnormalities are
Stabilisation phase Target group: Children with severe malnutrition with complications Treatment According to WHO protocols for the initial phase of the treatment of severe malnutrition with complications
Outpatient Therapeutic Programme(OTP) 2 groups of admissions: Direct OTP Indirect OTP Direct to OTP People with severe malnutrition with no complications Admitted directly into OTP with no stabilisation phase Indirect to OTP People who previously has severe malnutrition with complications admitted into OTP after discharge from Stabilisation Centres
OTP treatment RUTF (Ready Use Therapeutic Feeding) every week or two weeks Systematic medication Direct OTP Amoxicillin Vitamin A, Folic Acid Mebendazole Anti-malarial Vaccination
Supplementary Feeding Programme (SFP) Dry take home supplementary ration Basic health care De-worming Vit A Measles Consultation and appropriate referral if necessary Admission criteria same as WHO
Advantage of CTC CTC programs bring treatment out of the center and to the peripheral areas. Thus greatly increasing coverage. CTC programs are not meant to replace TFCs but to complement and integrate them into a larger, more accessible, and holistic program that allows better follow- up of patients.
Contin. Advantage of CTC Integrates with food security programmes Shared trainings, workers Demonstration gardens Promotion of crops for local RUTF Includes local production of RUTF where appropriate Wide range of linkages to key social structures, key individuals Mother to mother techniques for education and increasing participation
3. What is the difference of CTC & TFC TFC 24 care centre based Food targeted to the child Use F100 and F75 Close/continuous follow- up Quick weight gain More widely understood & accepted High cost Cross infection Decrease household economy-mothers away 20 days Good for patients with complication dehydration and septicaemia.
What is the difference of CTC & TFC CTC Stay in the household and community based Empowering the family Mother to mother support with PDI approach Use Ready to Use Therapeutic Food (RUTF) Treating malnutrition where it occurs More Coverage Community awareness and participation lead to address food insecurity Evolvement from emergency to development and vice versa Study/Sphere:85% (75) Cure,4.1(10) Death,4,7(15) Default
Challenges to the CTC approaches : Logistics-distance, weather, etc making outreach somewhat difficult Lack of capacity and understanding in the government makes sustainability & exist strategy shaky Resource intensive operation and need functional health centres system CTC being new approach acceptability by partners is questioned