Therapeutic feeding programme coverage assessment report Wadela woreda, North Wollo zone, Amhara Regional State, Ethiopia

Therapeutic feeding programme coverage assessment report Wadela woreda, North Wollo zone, Amhara Regional State, Ethiopia

Ethiopia has one of the highest under-five mortality rates, with malnutrition contributing to more than half of all child deaths. The 2005 Demographic and Health Survey revealed that, even when humanitarian requirements are at their lowest levels, over 300,000 children under the age of five are affected by severe wasting. To improve accessibility of services for malnourished children, the Federal MOH National Therapeutic Feeding Programme (TFP), which provides outpatient (OTP) and in-patient services (TFU) to treat and manage severe acute malnutrition (SAM), has been rolled out to Kebele level in circa 360 Woredas of the country. There are now an estimated 6,700 TFP sites (hospitals, health centres and health posts) providing OTP and/or TFU services. While the geographic coverage achieved is commendable, the challenge currently is to ensure continuous provision of quality services. It is also important to ensure that service uptake remains high in order for the TFP to effectively manage SAM.

The objectives of the assessment are to:

  • assess coverage and access to TFP in Wadela woreda using the Centric Systematic Area Sampling (CSAS) methodology
  • determine factors that affect OTP service uptake and programme impact
  • recommend aspects for improvement and disseminate findings to improve the performance of the TFP in Amhara region
  • train a core group of MoH/EHNRI staff on CSAS methodology

Reported barriers to accessing OTP services include:

  • inadequate supervision of the HEWs implementing the programme due to lack of adequate transport and lack of regular planning for supervision
  • community mobilisation efforts need strenghthening
  • caretakers misconceptions of the programme, for example where children had been previously turned away from the programme due to not fulfiling the admission criteria (either their own or neighbours), caretakers were then reluctant to take their child back to the health for treatment when they had deteriorated into SAM

To address these barries, the following recommendations are made:

  • as community involement is key to OTP success, community health workers involvement in active case finding and tracing defaulters must be established by woreda health officials, in order to improve service uptake and programme impact, particularly in areas with low coverage recorded
  • a system of regular supportive supervision for HEWs by their HEP supervisors and MCH local persons (woreda) should be established, to improve programme performance and enable/supervise routine drug administration at OTPs
  • intergration of the TFP with other heatlh/nutrition/food security programmes in the woreda is advised, for example, the formation of linkages to improve active case findings during the newly established monthly and quarterely screening (CNB and Community Health Days), house-to-house visits, routine sanitation activities (e.g. pit latrine construction), family planning services, etc.
  • OTP service delivery should follow a systematic approach with regard to supply management, record keeping, training, supervision and monitoring the progress of registered beneficiaries