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Evaluation Synthesis Report

Feb 10, 2017

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  • EVALUATION OF COMMUNITY MANAGEMENT OF ACUTE MALNUTRITION (CMAM) Global Synthesis Report

    EVALUATION REPORT

    EVALUATION OFFICE

    MAY 2013

  • EVALUATION OF COMMUNITY MANAGEMENT OF ACUTE MALNUTRITION (CMAM) Global Synthesis Report

    EVALUATION REPORT

    EVALUATION OFFICE

    MAY 2013

  • ii

    Evaluation of Community Management of Acute Malnutrition (CMAM): Global Synthesis Report United Nations Childrens Fund, New York, 2013 United Nations Childrens Fund Three United Nations Plaza New York, New York 10017 May 2013 The purpose of publishing evaluation reports produced by the UNICEF Evaluation Office is to fulfil a corporate commitment to transparency through the publication of all completed evaluations. The reports are designed to stimulate a free exchange of ideas among those interested in the topic and to assure those supporting the work of UNICEF that it rigorously examines its strategies, results, and overall effectiveness. The report was prepared by independent consultants Sheila Reed and Camille Eric Kouam based on country case study reports on Chad, Ethiopia, Kenya, Nepal and Pakistan and data gathered through additional sources. Krishna Belbase, Senior Evaluation Officer, managed and led the overall evaluation process in close collaboration with the Nutrition Section, Programme Division, and selected staff from the participating county offices. The purpose of the report is to facilitate the exchange of knowledge among UNICEF personnel and its partners. The contents of the report do not necessarily reflect the policies or views of UNICEF. The text has not been edited to official publication standards and UNICEF accepts no responsibility for error. The designations in this publication do not imply an opinion on the legal status of any country or territory, or of its authorities, or the delimitation of frontiers. The copyright for this report is held by the United Nations Childrens Fund. Permission is required to reprint/reproduce/photocopy or in any other way to cite or quote from this report in written form. UNICEF has a formal permission policy that requires a written request to be submitted. For non-commercial uses, the permission will normally be granted free of charge. Please write to the Evaluation Office at the address below to initiate a permission request. For further information, please contact: Evaluation Office United Nations Childrens Fund Three United Nations Plaza New York, New York 10017 [email protected]

    mailto:[email protected]

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    PREFACE

    Despite the past and on-going efforts, undernutrition remains a major contributor to mortality of children under five years of age. Recent estimates suggest that undernutrition is associated with 3 million child deaths annually. Acute malnutrition measured as low weight-for-height is a commonly prevalent concern both in emergency and non-emergency situations in over 70 countries. Community management of acute malnutrition (CMAM) has evolved over the past decade as a viable approach to addressing acute malnutrition in young children. UNICEF is currently supporting more than 60 countries in implementing CMAM. Although the coverage and intensity of the programme varies considerably, this is an impressive progress given the fact that until a decade ago CMAM was confined mostly to emergency contexts and being implemented in only a few other countries. This first comprehensive evaluation of CMAM by UNICEF was commissioned in response to the need to examine the overall progress in implementing CMAM, the effectiveness and efficiency of its strategies and issue related to sustainability, equity and national ownership that are central to its expansion. To safeguard objectivity and independence, the evaluation was conducted by a team of international consultants who were recruited and managed by UNICEFs Evaluation Office. The team of international consultants was supported by national teams in each of the case study countries. The evaluation used an ambitious approach which included detailed case studies of five countries, namely Chad, Ethiopia, Kenya, Nepal and Pakistan with extensive assessment of CMAM and country-specific lessons and recommendations. Each participating country established a national reference group (or steering committee) which provided valuable guidance and support and national ownership to the evaluation. In view of the limited evaluation expertise available at the national level, the evaluation process which combined national teams with international experts has also contributed to capacity development for undertaking such evaluations. The evaluation would not have been possible without the active engagement and CMAM related technical support by Nutrition Section colleagues in the Programme Division, NYHQ and the respective programme staff in the country offices. The implementation of CMAM is evolving rapidly and it is our hope that the forward looking lessons and recommendations presented in this comprehensive evaluation will positively contribute to the strengthening of on-going efforts to improve the quality and coverage of CMAM, to the sustainability of the achievements made in various contexts and to the evolving partnerships to combat malnutrition among children. Colin Kirk Director Evaluation Office UNICEF

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    ACKNOWLEDGEMENTS

    This evaluation is the result of strong commitment, team work and contributions from a large number of individuals and institutions. The evaluation report was prepared by two international consultants, Sheila Reed and Camille Eric Kouam, who worked under the guidance and supervision of Krishna Belbase in the Evaluation Office. Erin Boyd in the Nutrition Section, Programme Division, provided substantive technical support throughout the evaluation and Ilka Esquivel and Dolores Rio made significant contributions in the early phases. The global synthesis draws heavily on five case study evaluations which included Chad, Ethiopia, Kenya, Nepal and Pakistan. The national team in Chad consisted of Philippe Djkaouyo Nadwai, Naiban Mingueyambaye, Jean Pierre Manssimadji and Salomon Allaramadji. In the UNICEF Country Office (CO), Roger Sodjinou, Marcel Ouattara and Yaron Wolman were the key counterparts. In addition, Mahamat Bechir, David Rizzi, John Ntambi, Augustin Ilunga, Bambe Lamtouin, Mr Beninga, Jean Luboya and Guy Yogo made significant contributions in various phases of the evaluation. In Ethiopia, the national team recruited through Breakthrough International Consulting PLC included Abebe Alebachew, Habtamu Fekadu and Meselech Roro. In the UNICEF CO, Daniel Tewoldeberehan, Sylvie Chamois, Roger Pearson, and Joan Matji were the main counterparts. Special recognition goes to Ferew Lemma for leading the National Steering Committee which played an instrumental role in providing guidance and support to the evaluation. The national team in Kenya included Lina Njoroge, Clare Momanyi, Haile Selassie Okuku and Geoffrey Onyancha. In the UNICEF CO, Mathieu Joyeux was the main counterpart. In addition, Noreen Prendiville, Grainne Mairead Moloney, Edward Kutondo, Marjorie Volege, Kibet Chirchir, Olivia Agutu, Margaret Nduati and Terry Wefwafwa made valuable contributtions. In Nepal, the national team inlcuded Devendra Chhetri, Pushpa Kamal Subedi, Prakesh Sapkota and Uddhav Sigdel. Saba Mebrahtu and Anirudra Sharma were the lead counterparts in the UNICEF CO. In addition, Misaki Ueda, Shyam Raj Uprety, Rajkumar Pokharel, Surendra Singh Rana, Gyan Bahadur Bhujel, Saraswati Khanal made important contributions. The national team in Pakistan consisted of Parvez Paracha, Zia-Ud Din, Niamat Ullah, Adil Saeed and Yasmin Asif. In the UNICEF CO, Silvia Kaufmann and Shahid Mahbub Awan were the lead counterparts. In addition, Sarita Neupane, Ruksana Shereen, Teshome Fekele, Abdul Jamil and Aien Khan Afridi provided valuable support. In the Evaluation Office in New York, Dalma Rivero dealt with numerous contracts and financial management issues, Sheila Reiss provided managerial support and Tina Tordjman-Nebe helped with substantive editing of the report. Finally, our appreciation and thanks goes to the hundreds of people, including central and local government officials, staff from UNICEF, WFP and various other UN agencies and NGOs, health workers and other professionals, and the parents, children and community members who participated in the interviews, meetings and focus group discussions conducted as part of the evaluation.

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    TABLE OF CONTENTS

    PREFACE ...............................................................................................................................................iii

    ACKNOWLEDGEMENTS ...................................................................................................................... iv

    TABLE OF CONTENTS .......................................................................................................................... v

    LIST OF TABLES .................................................................................................................................. viii

    LIST OF FIGURES ................................................................................................................................. ix

    ACRONYMS ........................................................................................................................................... x

    EXECUTIVE SUMMARY .......................................................................................................................xii

    RESUMEN EJECUTIVO..xx

    RESUME EXECUTIF.xxx

    1 Introduction .................................