1. Innovating the measurement of humanitarian impact
Valid International
Innovating the measurement of humanitarian impact
The case of coverage assessment of community-based management of acute malnutrition (CMAM) programmes

2. Humanitarian Impact of CMAM: Meeting Need
Efficacy – Effectiveness - Coverage
Valid International
22/02/2019

3. Efficacy of CMAM protocol
Efficacy is about how well the CMAM protocol works in ideal or controlled settings
This is measured by cure rate of CMAM and estimated through a clinical trial
The CMAM protocol, cure rate is close to 100% in uncomplicated cases in ideal or controlled settings
Little room for significant improvement in efficacy
Uncomplicated cases – cases at or just below MUAC admission criteria or mild oedema
Valid International
22/02/2019

4. Effectiveness of the CMAM protocol
Effectiveness is the cure rate of the CMAM protocol in a normal patient cohort under programme conditions
In programme conditions, normal varies hence effectiveness varies
Varying severity of cases – less severe cases, better effectiveness
Varying compliance to treatment – better compliance, better effectiveness
Varying attendance to health facility – less defaults, better effectiveness
Effectiveness can be improved!
Valid International
22/02/2019

5. Coverage Coverage is the capacity to meet need Crudely, coverage =
no. in the programme / no. who should be in the programme
Good coverage depends on
Thorough case-finding and early treatment-seeking
Good retention from admission to cure
Coverage and effectiveness are linked
They depend on the same things
Good coverage  Good effectiveness
Valid International
22/02/2019

6. Meeting Need
Meeting need requires both high effectiveness and high coverage:
Met need = Effectiveness x Coverage
Since effectiveness and coverage are linked, then
Maximising coverage maximises effectiveness and met need
Valid International
22/02/2019

7. Measuring Coverage Method Date Description Modified EPI method
Before 2002
Uses nutrition survey data. Problems with heterogeneity and sampling bias. No information on barriers to coverage.
CSAS
2002
Spatial sample. Coverage estimated locally (mapped) and globally. Some information on barriers to coverage. Bit too expensive for routine M&E.
SLEAC
2008
Rapid method. Classifies coverage at SDU level. Some information on barriers to coverage. Can estimate and map coverage over wide areas (e.g. national coverage surveys). Designed for low cost M&E at clinic or district level.
SQUEAC
Semi-quantitative method. In-depth analysis of barriers and boosters to coverage. Mapping of coverage using small area surveys. Estimation of coverage using Bayesian techniques. Designed for routine program monitoring tool (intelligent use of routine monitoring data / other data may be collected on a “little and often” basis).
S3M
2010
Wide-area version of CSAS using improved spatial sampling and more efficient use of data. Some information on barriers to coverage. Pilot currently ongoing.
Valid International
22/02/2019

8. SLEAC / CSAS Mapping Coverage
Valid International
22/02/2019

9. SLEAC / CSAS Barriers
Valid International
22/02/2019

10. SQUEAC Concept Map of Barriers and Boosters
Valid International
22/02/2019

11. Policy Implications
Experience over the past decade has shown that investigation of coverage and factors affecting coverage using these methods informs programme reforms and improves coverage and effectiveness.
Programmes that audit coverage using these methods commonly achieve coverage within Sphere minimum standards (i.e. > 50%).
The greater accessibility of the new methods allows coverage audits to be done regularly. This in turn potentially ensures more programmes to achieve minimum standards.
The current challenge is ensuring that these levels of performance are achieved in national CMAM programmes.
Valid International
22/02/2019