1. SMC AND COMBINED PREVENTIVE STRATEGIES
The MSF Experience
Joint Consultation on SMC, Ouagadougou, Feb
Estrella Lasry, MSF

2. 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

3. COMBINED INTERVENTIONS-NUTRITION
NUT SCREENING KOUTIALA, MALI
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 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

4. 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 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

5. 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

6. 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

7. 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?