An Assessment of the Coverage, Boosters and Barriers of the Out-patient Therapeutic Care for Severe Acute Malnutrition in Albay Province, Philippines
Creators: name: Calleja, Arlene P.
Publisher: name: Zenodo
Year: 2021
Subjects: Severe Acute Malnutrition
Community-based Management of Acute Malnutrition
Out-patient Therapeutic Care
program evaluation
access and coverage
boosters and barriers

description: Background: Severe acute malnutrition prevents a child from developing<br> normally and increases mortality risk. It remains to be a major global health<br> problem in children under 5 years of age. The community-based management<br> of acute malnutrition (CMAM) is a nutrition intervention aimed at the early<br> diagnosis and management of these children at the community level through<br> the provision of therapeutic foods coupled with facility-based management for<br> those with medical complications. In 2015, the Philippine Integrated<br> Management of Acute Malnutrition (PIMAM) program was established to<br> manage acute malnutrition in Filipino children of less than 5 years of age.<br> Evaluating coverage which is one of the important indicators of CMAM<br> program performance as well as identifying its boosters and barriers were<br> imperative. The study aimed to assess the coverage, boosters, and barriers of the PIMAM Out-patient Therapeutic Care (OTC) in the province of Albay,<br> Philippines. Methods: This is a mixed method explanatory sequential research design<br> adopting the Semi-Quantitative Evaluation of Access and Coverage<br> (SQUEAC) tool. Accrual period was from January 2019 to present. Collection<br> and analysis of quantitative routine program data from all the cities and<br> municipalities of Albay followed by qualitative data collection through<br> community assessment, key-informant interviews, informal group discussions<br> and directly observing OTC processes were done. A small area survey to<br> validate hypotheses regarding areas with high or low coverage was<br> subsequently conducted. Results: Analyses of secondary routine program data showed that only two<br> out of the 18 cities and municipalities in Albay had complete program data<br> where Municipality C had high coverage and Municipality K had low coverage<br> in 2019. Qualitative methods identified the main boosters to program<br> coverage which include (1) support from the Local Government Unit and the<br> Municipal Health Officer; (2) presence of a well-trained OTC personnel; (3) OTC services are made available at the barangay level; (4) provision of door-<br> to-door screening, follow-up and dispensing of nutrition commodity; (5) community health workers’ willingness to learn and be trained; (6) supervision<br> of the community health workers by the OTC personnel; (7) presence of<br> community mobilization practices; (8) support of the barangay council; (9)<br> acute malnutrition is not stigmatized; and (10) caregivers’ awareness and<br> acceptance of the PIMAM program. Barriers on the other hand appeared to<br> be more significant which include (1) limited budget from the Local<br> Government Unit; (2) Ready-to-Use Therapeutic Food (RUTF) stockouts; (3)<br> inadequate number of trained OTC personnel; (4) gaps in anthropometric<br> measurements; (5) insufficient community mobilization; (6) community health<br> workers’ lack of knowledge and training on PIMAM; (7) community’s lack of<br> knowledge on malnutrition and the PIMAM; (8) caregivers’ laziness and<br> indifference on their child’s condition; (9) RUTF feeding difficulties; and (10)<br> COVID-19 pandemic stopped community mobilization and OTC admissions.<br> The small area survey results showed low coverage in both near and far<br> barangays in Municipality C. Conclusions and Recommendations: The study was able to present the<br> level of PIMAM implementation in the different municipalities in Albay and was<br> able to evaluate program data completeness and accuracy. Boosters can be<br> considered as groundworks where opportunities to strengthen program<br> access coverage rest. Barriers which validate coverage failure shall be<br> addressed such that bridging gaps and augmenting inadequacies, together<br> with adaptations to program protocols must be prioritized for an effective<br> program implementation. The unavailability of RUTF and the COVID-19<br> pandemic could have explained the low coverage in both near and far<br> barangays in Municipality C in the small area survey. The study therefore<br> recommends the following: (1) provide measures to improve program data<br> quality; (2) strengthen ownership of the PIMAM program by the Local<br> Government Unit; (3) increase the number of PIMAM-trained personnel; (4)<br> intensify OTC services at the barangay level together with the training of the<br> community health workers on PIMAM; (5) increase the number and quality of<br> community mobilization activities; (6) address shortage of RUTF; (7) consider<br> program adaptations to PIMAM implementation during the COVID-19<br> pandemic; and (8) more research on the evaluation of the PIMAM in other<br> regions of the country.