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) |