The usual suspects: Barriers to access and its impact on SAM treatment coverage Jose Luis Alvarez Moran CMN project Coordinator London, UK October 18 th 2013

between July 2012 and June 2013 the CMN has supported Coverage Assessments in 23 countries… … and 58 of those coverage Assessments are available online and used in this presentation

Number of Coverage Assessments including a barrier within the top 5

How are these barriers being addressed? Programme implementers are often aware of these barriers, and coverage assessments are helping to clarify their impact on programme performance. But the question often remains – how do we address these? First by changing the perception that “if we build it they will come”. Improving coverage requires proactive measures and a commitment to understand and improve access. Coverage doesn’t just improve over time (we have data to prove this). It only changes when you make it your mission to change it. More detailed practical guidance can be given to achieve so. The body of evidence collected by the CMN has enable us to identify measures and activities that make a difference. We need to work with programmes to start integrating these measures (this justifies the focus of CMN 2 + you can use it to talk about the handbook of recommendations that Sophie has been talking about) Each service requires its own changes to improve coverage, but generally speaking there are two priority areas. The first is to improve awareness and the second is to reduce opportunity costs (give them easy messages to take home – and to me these are the two that we need to deal with the most. Also, they each as umbrella terms for a lot of ideas)

Improve Awareness What is the issue? In this case the fact that engagement with beneficiaries is limited, a one-off activity rather than a permanent engagement. An activitiy for which resources are always limited. This contrasts heavily with other public health interventions which have strong “social marketing” components/budgets, because they recognise that understanding and engaging with clients is the first step to improving service utilisation. What needs to be done?: In this case I would say that we need to recognise that integrated services will always struggle with this, and that NGOs can potentially play a key role. And for that to happen, donors need to recognise that improving awareness could very well be one of the most significant means by which to boost SAM treatment around the world.

Reduce Opportunity-Costs What is the issue? The issue is that although the decentralisation of care has significantly reduced opportunity costs, these costs remain prohibitive still for many people, partly because the service delivery model has changed little (weekly distribution at health centres, of which there is less now than we used to have when NGOs had OTPs). This compounded by seasonality, stigma, security, etc. makes access difficult What needs to be done? We need to explore ways of adapting service delivery to local needs. We need to be flexible and versatile, we need to offer bi-weekly distribution if safe/possible. But we will also need to ask ourselves – can SAM treatment services be decentralised even further? Can we make community-based SAM treatment TRULY community based? (plant the seed of CCM in their minds, in a subtle way, rather than coming out and saying that that is the magic answer. Because otherwise people will focus on trying to prove you wrong, and forget the important part – the need to solve this problem in whichever way we can?)

Thank you Jose Luis Alvarez Morán