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Table 1 Integration level of acute malnutrition interventions and health outcome in Niger

From: Integrating acute malnutrition interventions into national health systems: lessons from Niger

Elements Indicator 2007 2010 2013
Health system functions     
Governance     
Policy setting National health and nutrition policies with the integrated management of acute malnutrition (IMAM) as part of child health care (i.e. integrated management of childhood illness (IMCI) and child hospital care) No Partial Full
National guidelines National guidelines for IMAM supporting comprehensive child health care No Partial Full
Technical leadership A technical advisory group for comprehensive child health care Partial Partial Partial
Regulation and coordination Regulation and coordination of health actors (including financial and technical partners, education and training institutions, professional associations, private and informal health sector, communities and champions) aligning with the national health and nutrition policy and implementation strategy Partial Partial Partial
Social participation Social participation of local and community actors in planning, implementing and monitoring child health care with a people-centred care approach No No No
Health financing     
Regular budget-pooled funding Regular budget from pooled funds with a sector-wide approach covering financing for IMAM No No Partial
Annual costed action plans Annual costed action plans of MOH covering IMAM interventions No No Partial
Health workers payroll Staff in national health facilities involved in IMAM on MOH payroll No No Partial
Financial risk protection Fee waiver system for children under 5 covering comprehensive child health care No Partial Partial
Health information     
Health information system (HIS) National HIS, including acute malnutrition indicators No Partial Full
Performance monitoring system Performance monitoring of comprehensive child health care No Partial Full
Contact coverage monitoring IMAM coverage monitoring as part of child health care coverage monitoring No No No
Health workforce     
Adequate coverage of health workers Adequate number of qualified health workers with geographic coverage for comprehensive child health care No Partial Partial
Competences of health managers and health workers Adequate technical and organizational management skills for comprehensive child health care Partial Partial Partial
Performance appraisal and motivation system Performance appraisal and career development opportunities as part of the human resources management system No Partial Partial
Pre-service education Modules of pre-service education curriculum on comprehensive child health and nutrition No Partial Partial
Continuing professional development Continuing professional development on comprehensive child health and nutrition No Partial Partial
Medical products     
Essential medicines and medical supplies list National essential drugs and medical supplies list, including for IMAM No Partial Partial
Procurement system National drugs and medical supply needs (forecasting and) procurement including for IMAM No No Partial
Logistic management system National logistic management system for drugs and medical supplies including for IMAM No Partial Partial
Service delivery     
Demand generation Demand generation by activating and informing communities for improved child health and nutrition No No No
Early case finding Early active (by volunteers in the community), systematic (by health workers at the health facility) and enhanced (by carer) case finding for selected child illnesses No Partial Partial
Community-based primary care Promotive and preventive community health and nutrition (and community case management) No Partial Partial
Outpatient care (facility-based primary care) Outpatient management of severe acute malnutrition (SAM) without complications and moderate acute malnutrition (MAM) as part of IMCI No Partial Partial
Inpatient care (child hospital care) Inpatient management of SAM with complications until stabilisation as part of child hospital care No Partial Partial
Health outreach Health outreach activities for selected child illnesses, including acute malnutrition No Partial Partial
Referral and tracing between services Referral and tracing system for detection and retention in treatment of selected child illnesses, including acute malnutrition No Partial Partial
Patient-centred continuity of care Comprehensive child health care tracked over time and place responding to individual preferences, needs and values No No Partial
Continuous quality improvement Continuous quality improvement of comprehensive child health care No Partial Partial
Health services performance     
Geographic service coverage Number of sites with SAM services 30 [13] (<5 %) 772 [26] (>70 %) 944 [15] (>95 %)
(Proportion (%) of primary health facilities offering SAM services)
  Number of sites with MAM services 610 [13] (<5 %) 850 [26] (>75 %) 1 180 [15] (>95 %)
(Proportion (%) of primary health facilities offering MAM services)
Access to treatment Annual number of children under 5 accessing treatment for SAM 60 843 [13] 330 000 [26] 406 327 [15]
  Annual number of children under 5 accessing treatment for MAM 275 030 [13] 257 000 [26] 520 398 [15]
Quality of care Annual overall SAM cure, case-fatality and defaulting rates Good [13] Good [26] Good [15]
  Annual overall MAM cure, case-fatality and defaulting rates Good [13] Good [26] Good [15]
Contact coverage Proportion of children under 5 diagnosed with SAM in the population receiving treatment Low [13] Low [27] Low [15]
Sustainability Sustainability based on financial and technical dependence of IMAM interventions Low [13] (NA) Low [14] (41 %; 13) Low [15] (60 %; 20)
(Proportion (%) of primary health facilities with IMAM services receiving technical partner support; number of technical partners)
Health status     
Prevalence of acute malnutrition Proportion (%) of children under 5 diagnosed with SAM in the population (confidence interval) 0.8 % [19] (NA) 3.2 % [17] (2.7–3.7) 2.6 % [1] (2.2–3.1)
  Proportion (%) of children under 5 diagnosed with overall acute malnutrition in the population (confidence interval) 11.0 % [19] (NA) 15.5 % [17] (14.2–16.8) 13.3 % [1] (12.3–14.3)
Under-5 mortality Probability of dying before 5 years of age expressed per 1000 live births 230 [19] (217–244) NA 127 [18] (119–136)
  Proportion of deaths of children under 5 in the population per 10000 children per day (confidence interval) 1.8 [20] (NA) 2.1 [17] (NA) 0.7 [1] (NA)
  1. IMAM: Integrated Management of Acute Malnutrition; IMCI: Integrated Management of Childhood Illness; NA: not available; MAM: Moderate Acute Malnutrition; MOH: Ministry of Public Health; SAM: Severe Acute Malnutrition