SMC AND COMBINED PREVENTIVE STRATEGIES The MSF Experience Joint Consultation on SMC, Ouagadougou, Feb 15 2017 Estrella Lasry, MSF Estrella.Lasry@barcelona.msf.org

SMC & OTHER INTERVENTIONS IN MSF MALI CHAD (Moissala) NIGER GUINEA BISSAU NIGERIA 2012 SMC 2013 SYSTEMATIC NUTRITIONAL SCREENING (MUAC) 2014 VACCINATION: EPI reinforcement Pentavalent - NUTRITIONAL SCREENING (MUAC) -SMC IN PREVENTIVE PACKAGE -PPDoz DISTRIBUTION -ALBENDAZOL DISTRIBUTION 2015 Koutiala: MUAC Ansongo: NUT SCREENING+ VACCINATION VACCINATION: EPI reinforcement Pentavalent, OPV, measles -NUTRITIONAL SCREENING -VACCINATION 2016 SMC+vacci Kidal: SMC remote VACCINATION NUT SCREENING NUTRITIONAL SCREENING Borno (IDP camps): NFI distribution, Nut screening Yobe (IDP camps): NFI distribution

COMBINED INTERVENTIONS-NUTRITION NUT SCREENING KOUTIALA, MALI 2013-2014 Mali: >160,000 children screened in 2013 >172,000 children screened in 2014 >187,000 children screened in 2015 Niger : ->415,000 children screened in 2014 in 5 districts -Distribution of PlumpyDoz in 6 health areas Number of children referred decreased. 172000 children screened in Mali, 416,000 in Niger Support to the Nat program to improve the nutrition coverage and supply Distrib of PPDz: deterrent for mothers to bring children outside of 6-23m age

COMBINED INTERVENTIONS-NUTRITION ADVANTAGES DISADVANTAGES -Avoid missed opportunities on comorbidities -Same age group -Relatively simple: MUAC screening (can be done in Fixed site and Door-to-door) -Continued screening can reduce levels of malnutrition (by increasing children in programs) -Need to train staff and supervise activity -Need specific tally (increase of paperwork) -Need to ensure staff and supplies at Health center level in order to ensure compliance -Financing for nutrition comes from different actors Number of children referred decreased. 172000 children screened in Mali, 416,000 in Niger Support to the Nat program to improve the nutrition coverage and supply Distrib of PPDz: deterrent for mothers to bring children outside of 6-23m age

COMBINED INTERVENTIONS-VACCINATION EPI REINFORCEMENT, MOISSALA, CHAD 2014, 2015 Number of children referred decreased. Support to the Nat program to improve the nutrition coverage and supply

COMBINED INTERVENTIONS-VACCINATION ADVANTAGES DISADVANTAGES -Avoid missed opportunities on comorbidities -Increased vaccination coverage in areas of poor EPI coverage (13-80% increase) -SMC can increase adherence to vaccination -Intense specific training and supervision needed: need of medical staff for injectable vaccines -Different age groups for different vaccines -Substantial increase in HR needs (difficulty in D2D approach) -Need specific tally (increase of paperwork) -Logistics: Cold chain and waste disposal issues -Duration of SMC cycles increases (distribution days) -Significant increase in cost: Financing for vaccination comes from different actors -Little communication at capital level between different programs Number of children referred decreased. Support to the Nat program to improve the nutrition coverage and supply

CONCLUSIONS -COMBINED STRATEGIES CAN INCREASE COVERAGE OF INTEGRATED CHILD PREVENTIVE PACKAGES -NUTRITIONAL SCREENING IS A QUICK WIN AND EASY TO INTEGRATE BUT REQUIRES ENSURING A CAPACITY AT REFERRAL FACILITY (OUTPATIENT AND INPATIENT) -SOME VERY CONTEXT-SPECIFIC: NFI distribution -OTHER POSSIBLE INTERVENTIONS: LLIN distribution, Pneumococal vaccine, Ivermectine distribution, intervention on adults/caretakers… -COST-ANALYSIS SHOULD BE DONE INCLUDING COSTS OF DIFFERENT PROGRAMS -NEED FOR CENTRALIZED COORDINATION: UNICEF?