INTEGRATING CTC INTO NATIONAL HEALTH SYSTEM IN MALAWI

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INTEGRATING CTC INTO NATIONAL HEALTH SYSTEM IN
MALAWI

• THERESA W. BANDA
• MINISTRY OF HEALTH

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INTRODUCTION

• Poor Health and nutritional status
• IMR 104/1000 live births
• UMR 189/1000 live births
• 49 chronic malnutrition
• Malnutrition among the ten leading causes of
  death in health facilities
• Severely malnourished children especially
  admitted in the health facilities

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MANAGEMENT OF SEVERE MALNUTRITION

• Nutrition rehabilitation units
• Pediatric wards
• Specialized buildings (NRU)
• High Energy milk- DSM,
• High energy protein foods e.g Likuni Phala
• Use of Specialized milk formulations
• Adaptations from WHO guidelines
• Introduction and Expansion of CTC
• Southern region projects(sites)
• Dowa district
• Other Districts

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CTC IN MALAWI SUCCESSES
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Community sensitisation, case finding and
referral

• Understanding of Traditional Authority networks
• TA, TBA, CHV, Religious Leaders
• Roles and responsibilities
• Understanding of carers with malnourished
  children
• Farmers, marital status, value for family, HIV
  and AIDS
• Communities mobilized, participate in analysis,
  design, implementation and handover of CTC
  program
• Communities, care givers satisfied with CTC

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Screening, assessment referral and treatment at
health centres

• Use of existing structure and staff with initial
  technical back up
• Screening motivated HSAs able to measure acute
  malnutrition
• Initial assessment and treatment 1 trained
  clinical staff
• Screening, assessment referral treatment is
  part of routine work by the health workers
• Workload
• Taken as normal routine procedure

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Delivery of RUTF and medicines to health centres

• District implementation plans include treatment
  of severe malnutrition
• District requests RUTF systematic medical
  treatment with essential drugs
• RUTF and essential drugs are delivered to health
  centres
• Normal delivery of essential drugs

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Follow up assessment and treatment at health
centres

• HSAs implement basic beneficiary monitoring
  weight, appetite, simple clinical signs
• Referral to MA and nurse in case of problem or
  deterioration for further clinical review
• Treatment
• Referral

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Follow up and support at home

• HSAs and community volunteers follow up
  defaulters report outcome to health centre
  staff
• Where possible, support provided to children not
  responding to treatment
• Links with other sectors
• Agriculture
• Community Development
• Traditional practitioners, healers
• Religious groups

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Reporting Systems

• At Health Centre
• Basic food and medicine stock reports in line
  with District stock systems
• collation of basic monitoring data in line with
  District HIS and national guidelines
• At District Health Office
• Collation of both programme monitoring and stock
  reports and feed back to relevant authorities-
  output monitoring
• For annual reporting and budgeting, demonstration
  of how CTC fits into the DIP

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Training supervision

• Supported by Concern during transition in
  partnership with DHO. Takes many forms
• Directed by DHO/centre requirements
• On the job mentoring
• Use of model health centres staff
• MCH coordinator District nutritionist plan
  supportive supervision into work timetable in
  the DIP

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Connections with other programming

• National Safety Nets Program
• Targeted Nutrition Program
• Targeted Input program
• Targeted Public Works program
• Targeted Income transfer program
• Malawi Social action fund
• HIV and AIDs programs
• VCT
• ART,
• Supportive programs
• Essential Health care programs
• Malawi Vulnerability Assessments targeting

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Advocacy Lobbying

• Implementation of CTC in Malawi in full districts
• Agreement to scale up CTC in other districts
• Other NGOs support other districts to implement
  CTC( in partnership or their own)
• Districts Health officers eager to implement CTC
  in their districts
• CTC adopted for nutritional management of PLWHA
• Government considers CTC one of the approaches to
  fight malnutrition in MW
• Govt. plans to review guidelines based on more
  districts experiences

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CTC IN MALAWI challenges
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CHALLENGES

• Staffing
• District level Nutritionists, DHMT, MCH
  coordinators overwhelmed by activities- routine
  monitoring
• Health centre Nurses and MAs understaffed- Most
  facilities do not have minimum staff levels.
• LOGISTICS
• Availability and Distribution of supplies
• Drugs availability and funding(CMS)

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CHALLENGES

• Production and Availabilty of RUTF
• Sustained local production availability of RUTF
  -Slowed down adoption of CTC- arrangements are
  being made for continued production through
  Peanut Butter Project
• Supplies not integrated in normal procurement
  distribution of drugs system

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CHALLENGES

• Use of community Structures
• HSAs catchment areas still too big for effective
  monitoring supervision
• Volunteers need incentives to continue
• HIV AIDS
• Increase cases of severe malnutrition
• Affecting health workers and community structures

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CHALLENGES

• Resources Available at district level
• Financial and material resources
• Skilled capacity of staff
• Need to build capacity of staff institutions
  for continued support

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CTC IN MALAWI opportunities
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OPPORTUNITIES

• Management of severe malnutrition govt. Priority
• Approaches that reduce case fatality rates
• Reduced financial and material resources
• Decentralization process
• District allocation of resources decision
  making
• Sector Wide Approach
• Basket funding might improve the situation

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OPPORTUNITIES

• Human resource
• Review of cadres and numbers- Nutritionists,
  community nutrition officers etc
• Increased training of staff MA, CO, nurses, HSA
• New government
• Desire to make a difference in major indicators
• Establish linkages to other programmes
• Interest of Donors in nutrition and HIV/AIDs
• Utilize the opportunity
• Partnerships- NGOs, Govt. UN, donors

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Zikomo