Financing the sustainable scale-up of CMAM in high-burden countries: with case studies from Nepal & Kenya
By Action against Hunger, International Medical Corps and Global Health Advocates
From one million in 2009, the number of children accessing treatment for severe acute malnutrition rose to 3.2 million in 2015.
This improvement in access to treatment is largely due to the development of the Community-based management of acute malnutrition (CMAM). However, this type of treatment is still underfunded, and 4 out of five affected children still have no access to treatment. So the rapid and sustained expansion of these programs is sorely needed. But how to finance it? This is what our report, launched today, has made possible to identify.
Until recently, children with severe acute malnutrition (SAM) could only be cared for in intensive care facilities, the “therapeutic feeding centers”. Similar to hospitals, they require children and their parents (or caretakers) to remain in hospital for the duration of treatment, ie one month.
Recent advances in ready-to-use therapeutic food have led to the development of CMAM: treating the child within the family and community. Under the supervision of health professionals, affected communities diagnose and treat nutritional problems within them.
The expansion of this approach, effective, more convenient for families and much less costly, is today hampered by several factors. The lack of funding for the treatment of malnutrition and the weakness of health systems are part of this. However, the vision and funding of acute malnutrition treatment as a short-term humanitarian action is another factor of failure.
Two case studies, conducted in Nepal and Kenya respectively, identified the factors that allowed these countries to move from pilot projects to national CMAM deployment within a few years.
A high-level political commitment, placing the reduction of malnutrition as a public health issue. This implies taking over this issue at the highest level of the State
Multi-sectoral coordination of strategies to combat malnutrition, involving several actors, in particular the Ministry of Health.
Sustainable funding based on perennial nutrition budget lines within the government budget.
These success factors are not only a result of internal conditions: countries affected by malnutrition are recipients of official development assistance, but this priority does not attract aid donors. The World Bank recently calculated that achieving the WHO’s goals of reducing undernutrition would require a 3.5-fold increase in current investments.
Undernutrition is the cause of 45% of the deaths of children under 5 years of age, or 3.1 million of children around the word. Facing this scourge, a global mobilization is necessary, today more than ever.