1. Address high acute malnutrition among vulnerable populations affected by water logging through CMAM prog. Bangladesh 05 April 2012

2. Background & Context Analysis Prolonged water logging in south western districts of Satkhira, Khulna and Jessore in July/August 2011, affected the vulnerable population. WFP & ACF, with local partners, intervened with emergency interventions, focusing FS/livelihood, WASH & small nutrition surveillance to address their immediate needs A number of assessments and surveys (ACF’s nutrition surveillance, nutrition survey, HKI, FS assessment WFP, FAO and Shushilan, JNA for recovery) were carried in 2011, which showed deteriorated nutrition situation. Findings from those surveys/assessments led to the development of a nutrition programme to address acute malnutrition.

3. Objective of the Programme: Principal objective: To reduce the risk of mortality and morbidity among the most vulnerable population affected by water logging Specific objectives: To reduce the risk of mortality and morbidity linked to severe acute malnutrition among children under 5 years old in areas affected by water logging To prevent the deterioration of nutrition status of children (6-59) and maternal -Pregnant & Lactating Women (PLW) nutritional status in the most affected areas

4. Target Areas: 18 Unions in 4 Upazilas Upazilas TalaSatkhira SadarDehhataAssasuni Unions DhandiaBaliKuliaKadakati Islam KatiDhuliharParulia JalalpurLabsa KhalilnagarSatkhira Sadar Khalishkali Jhaudanga Khesra Kamira Nagarghata Tala Sadar Tentulia

5. Target beneficiaries: (6 – 59 months/PLW) Approximately, 2,500 children will be screened and among them, about 600 children aged 6-59 months are expected to be with Severe Acute Malnutrition (SAM) Complicated SAM and MAM cases will be referred to the three Upazila Health Complex (UHCs) and the District Hospital to receive inpatient treatment. All children aged 6-59 months with moderate acute malnutrition (MAM) will be identified– expected number 7,400 All PLW with moderate acute malnutrition (MAM) will be identified– expected number 6,300

6. Main activities of the current project Activity- 1 Training and coaching of national staff of Shushilan and GoB health structure staff-Community Clinic (CC) and Upazila Health Complex(UHC) for the implementation of the CMAM approach, including detection and treatment of MAM/SAM cases. Activity- 2 Community and center based screening for under five children and pregnant and lactating mothers for acute malnutrition and referral for appropriate treatment, depending on condition; community mobilization and health/nutrition education Activity- 3 Setting up and running of Outpatient Therapeutic Programme(OTP), Sterilisation Centre (SC) through partner and UHC; and of MAM centres in CC Activity- 4 Progress monitoring and reporting

7. Programme Approach Community-based Management of Acute Malnutrition (CMAM) CMAM has four components: Community mobilization (for early detection & referral of the malnourished, follow up at home, and prevention activities) Supplementary Feeding Program (SFP) to treat moderate acute malnutrition (MAM) - WFP will phase out from blanket feeding programme and phase into TSFP. Outpatient Therapeutic Program (OTP) to treat severe acute malnutrition without medical complications Inpatient care or Stabilization Centre (SC) to treat severe acute malnutrition with medical complications through Upazila Health Complex.

8. Why Choose CMAM approach? CMAM approach is chosen as it is recognised by WFP and other UN agencies as the best practice to treat acute malnutrition. Increased coverage of program Increased early detection of malnourished for treatment Reduced risk of cross infection Decreased default rates: caregivers continue economic and domestic activities while their children undergo treatment, or other CMAM activities High cure rate and low death rate Sustainable, if possible to integrate to national health system Increased communities’ ownership of the program

9. Implementation strategy ACF & WFP work through National NGO, Shushilan Shushilan will be in charge of screening children and refer them to the appropriate nutrition programme according to their MUAC measurements. ACF will take over the responsibility to assist and train Shushilan staff in the CMAM approach for treatment of acute malnutrition in children under 5 as well as of PLW in collaboration with WFP. With the approval of CS office, Shushilan and ACF will include some of the local health facility staff (CC and FW and health centres) into the capacity building approach as well as the staff of the UHCs in the four Upazilas where children suffering from SAM with complications will need to receive inpatient treatment.

10. Progress to date Funding has been secured from ECHO Some local Authorities has been informed of the 2 nd phase of the program including CMAM; Blanket Feeding for 6 – 59 months and PLW on-going (5,200 of 17,500) Draft FLA, including budget, prepared and shared with Shushilan; Shushilan in the process of recruiting staff (nutritionist, nurses etc.) First CMAM ToT training being conducted this week Preparatory meeting held for progressive phasing out of Blanket feeding to targeted feeding (CMAM) ACF perusing NGOB for FD6 approval, while processing to get specific nutritious food to treat SAM cases.

11. Thank you All