Support systems required to ensure effective management of SAM
Dear Colleague
There have been some interesting discussions following the report of the IMTF study carried out at the 3rd ANEC conference in Cairo last October. Some important questions have been asked from the contributions and comments over the past weeks. We are therefore starting new discussions to specifically address these questions.
If you have not been part of the discussions so far, it is not too late. You can contribute to the current topic. Your comments are very important and absolutely necessary. These are the questions for the current discussion:
1. What kind of resources and support systems will we need to put in place to ensure effective management of SAM?
2. How can we form an active and effective network of Nutritionist that could serve as catalysts to move the agenda on SAM forward?
3. What role can the IMTF play in building such network?
The subject of health support systems is of vital importance in health service management.
Lack of appropriate health infrastructure continues to hamper progress in health care delivery in many developing countries and facilities based management of SAM is one of the obvious casulties. I would cite examples from Ghana in west Africa. We have recently been carrying out a needs assessment in order to ascertain the current level of health systems support structures as part of an attempt to map out the extent of the resource challenges relating to current management of SAM in Ghana.
It might interest colleagues to learn that through the efforts of African nutrition pioneers and paediatricians like Prof. FT Sai and Ofosu-Armaah, there were nutrition rehabilitation centres developed in a number of regions and districts of Ghana in the 1960s and 70s. Yes, it might surprise some, but over 40 years ago, these experts understood the importance of tackling SAM. These centres were for treatment and educating mothers who went there and were taught how to prepare "home-made" balanced diets to help support infants and young children.
Although the infrastructure (building) still exist in some cases, there was no sustained training of trainers in nutrition to provide a sustainable programme of management. Nutrtition Technical Officers were (and are still) trained to deal with SAM and other problems!!! Although the Universities are now providing degree level training in nutrition, the focus is not in clinical nutrition, nor is SAM training a priority focus.
In short, human capacity, foresight, structured training and the right infrastructure and tools for management of SAM as part of a coninuum of training is essential to success. Moreover, physicians, nurses, pharmacists and other middle and senior level allied health professionals require but do not receive training in the science of nutrition and its application as a central part of patient management. Herein lies the problem. Systems, focusing on harnessing and nurturing human resource adequately and examining structural issues and what is available even before resorting to external support will go a long way.
My suggestion is for the IMTF is to form partnerships with various health services in "malnutrition hot spots" and work with them to assess need and to find joint mechanisms to help strengthen their capacity and outputs. The Health fraternity and regulating bodies e.g. Medical Colleges need to be persuaded to come on board any planned programmes to ensure that these extra skills and know how become part of continuing professional development for the relevant professions.
Paul Amuna .........
Comment by Paul Amuna — 2009-04-21 17:45 | # - re
The comments by Bolatito Ogunbiyi are very useful coming from someone with hands-on experience eith regards to SAM. However I want a bit of clarification or expansion on the specific 'capable human resources' referred to. Does the list include nutritionists or is it restricted to the 'health professional'? Secondly it would be very informative and beneficial if you could provide a list of the therapeutic products that are used in the health centres. I genuinely want to know these things and I hope my intentions are not misconstrued.
Comment by Paul Aryee — 2009-02-27 14:04 | # - re
I applaud the researchers who took time to carry out the survey among nutritionists at the recent ANEC event in Cairo. The statistics for SAM in Sub Saharan Africa (SSA) are staggering and as pointed out by both Folake Samuel and Paul Amuna equally worrying are the unreported cases of moderate malnutrition. The IMTF has a tall order especially because about over a third of the nutritionists who were surveyed know little or next to nothing about the prevalence of SAM in their respective countries. What then shall we expect of non nutritionists?? In my view eliminating SAM is too ambitious a goal as set out by the IMTF and do not see that happening in the near future. Reducing the levels to appreciable margins, sure that is a plausible attempt and unless we nutritionists especially those involved in work in SSA are prepared to join forces with the IMTF to get our hands dirty such as forging real strong partnerships to address the problems at hand, we would be only scratching the surface with any other prescriptive talk of what should be done. There are lessons we can learn from partner countries who may have found effective strategies to tackle SAM in their countries and which can certainly be applied within the contexts of other situations. Tackling childhood malnutrition should be a priority and we must find ways to work together to give our next generation both hope and a future they can look forward to.
Comment by Francis B Zotor — 2009-02-27 13:33 | # - re
There is usually a gap between the information on intervention strategies and acessibility to such information by those people that make policy. In most instances, information available does not get through to people who have the resources to assist or implement programmes. Nutritionists should endeavour to design mechanisms of making their research findings available and accessible to those in authority and with resources for implementation. If policy makers or community stakeholders are provided with evidence-based information, the likelihood of successive intervention will be positively remarkable
Comment by Dr Oyewole Oyediran — 2009-02-27 09:00 | # - re
From my experience in the nutritional rehabilitation of malnourished children in Republic of Niger where I currently work, what works is the dynamic patnership between the government and the NGOs. This is manifested through the availability of capable human resources (including volunteers at the community level), an efficient referral and counter-referral system and the availability of therapeutic products at the district hospital and integrated health centers.
Comment by Bolatito Ogunbiyi — 2009-02-26 08:34 | # - re