F ROM V ERTICAL TO H ORIZONTAL : E XPERIENCES & R ECOMMENDATIONS IN I NTEGRATING SAM T REATMENT TO H EALTH S YSTEMS October 2013 SAM international Conference London, UK M Gallagher & A D Israel

P RESENTATION O UTLINE  Setting the context  Background  HSS & SAM treatment  Experiences – How does it look?  Strategic & practical implications  Conclusion

 Universal health coverage  Focus on design and implementation  Health systems strengthening (HSS) - -WHO 2007  Integration – ‘institutionalization’ of SAM treatment S ETTING THE C ONTEXT

 Changing landscape of treatment of acute malnutrition with huge advances the last 25 years  Coverage still low at between 8-13% globally  Need to strengthen treatment of SAM as a disease – linkage Nutrition & Health  Learning from experiences of Global Health Initiatives (GHI) shift from disease specific to health systems strengthening B ACKGROUND

Vertical Horizontal S HIFTING D YNAMICS OF HSS

N IGERIA Partner support Government support

DR-C ONGO Partner support Government support

W HERE SHOULD WE AIM TO GO ? Partner support Government support

 Bringing nutrition into health & working through the HSS building blocks to achieve sustainable availability & access to SAM treatment  Including SAM treatment as part of a minimum health package  Shift role of partners from ‘implementer’ to ‘facilitator’  Simplifying CMAM protocols, implementation and follow-up  Transitioning from donor financing to MoH financing basic minimum health package of which SAM treatment is part of S TRATEGIC I MPLICATIONS

General:  Identifying new ways of working from being model oriented to process oriented  Coordination of actors in working with one health system Design:  Comprehensive assessment of health system  Joint planning and implementation  Simplification of protocols and systems  Including strong component on community mobilization activities Implementation:  Working closely with authorities and communities to strengthen governance  Identifying financing gaps and mechanisms/timeframe  ‘Adaptive’ service delivery process  Human resources  Supply chain  Simplifying reporting and planning for integration of key indicators to the national information system P RACTICAL I MPLICATIONS

 Health System Strengthening Task Force ToR being developed with support of WHO & UNICEF  ACF finalizing the Health Systems’ Strengthening Guidelines for 2014  Health System Assessment tool being tested by UNICEF & partners  Experiences need to be further tested and documented in relation to quality of care and coverage N EXT S TEPS

There lies a significant opportunity ahead with the increasing MoH leadership and commitment to SAM treatment, and with the evolving role of partners in support of it, to ensure that SAM treatment is available as part of regular health services, moving towards quality global coverage for children with SAM. C ONCLUSION

T HANK YOU

Q UESTIONS ?