FROM VERTICAL TO HORIZONTAL: EXPERIENCES & RECOMMENDATIONS IN INTEGRATING SAM TREATMENT TO HEALTH SYSTEMS

October 2013

SAM international Conference

London, UK

M Gallagher & A D Israel

PRESENTATION OUTLINE

Setting the context

Background

HSS & SAM treatment

Experiences – How does it look?

Strategic & practical implications

Conclusion

Universal health coverage Focus on design and implementation Health systems strengthening (HSS) - -WHO

2007

Integration – ‘institutionalization’ of SAM treatment

SETTING THE CONTEXT

Changing landscape of treatment of acute malnutrition with huge advances the last 25 years

Coverage still low at between 8-13% globally

Need to strengthen treatment of SAM as a disease – linkage Nutrition & Health

Learning from experiences of Global Health Initiatives (GHI) shift from disease specific to health systems strengthening

BACKGROUND

Vertical Horizontal

SHIFTING DYNAMICS OF HSS

NIGERIAPartner support

Government support

DR-CONGOPartner support

Government support

WHERE SHOULD WE AIM TO GO ?

Partner support

Government support

Bringing nutrition into health & working through the HSS building blocks to achieve sustainable availability & access to SAM treatment

Including SAM treatment as part of a minimum health package

Shift role of partners from ‘implementer’ to ‘facilitator’

Simplifying CMAM protocols, implementation and follow-up

Transitioning from donor financing to MoH financing basic minimum health package of which SAM treatment is part of

STRATEGIC IMPLICATIONS

General:Identifying new ways of working from being model oriented to process oriented Coordination of actors in working with one health system

Design:Comprehensive assessment of health systemJoint planning and implementationSimplification of protocols and systemsIncluding strong component on community mobilization activities

Implementation:Working closely with authorities and communities to strengthen governanceIdentifying financing gaps and mechanisms/timeframe ‘Adaptive’ service delivery processHuman resources Supply chain Simplifying reporting and planning for integration of key indicators to the national information system

PRACTICAL IMPLICATIONS

Health System Strengthening Task Force ToR being developed with support of WHO & UNICEF

ACF finalizing the Health Systems’ Strengthening Guidelines for 2014

Health System Assessment tool being tested by UNICEF & partners

Experiences need to be further tested and documented in relation to quality of care and coverage

NEXT STEPS

There lies a significant opportunity ahead with the increasing MoH leadership and commitment to

SAM treatment, and with the evolving role of partners in support of it, to ensure that SAM treatment is available as part of regular

health services, moving towards quality global coverage for children with SAM.

CONCLUSION

THANK YOU

QUESTIONS ?