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(SQUEAC) Sokoto-South LGA CMAM Program Sokoto State, Northern Nigeria January-February 2015

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(SQUEAC) Sokoto-South LGA CMAM Program Sokoto State, Northern Nigeria January-February 2015 Semi-Quantitative Evaluation of Access and Coverage (SQUEAC) Sokoto-South LGA CMAM Program Sokoto State, Northern Nigeria January-February 2015 Ifeanyi Maduanusi, Chika Obinwa, Zulai Abdulmalik, Janet Adeoye and Francis Ogum Action Against Hunger | ACF International 1 ACKNOWLEDGEMENTS The Sokoto-South LGA SQUEAC assessment was conducted with funding from Children Investment Fund Foundation (CIFF). The Federal Ministry of Health (FMOH), through the Nutrition Division, Department of Family Health introduced the ACF Coverage Team to Sokoto State Primary Health Care Development Agency (SSPHCDA). The Executive Secretary SSPHCDA and Director Community Health Services gave authorization for the assessment to be conducted in Sokoto-South. The State Nutrition Officer –Ali Hamza provided the team much needed support and access to the routine program data. While the Sokoto-South PHC Coordinator and LGA Nutrition Focal Person assisted the coverage team by providing the client records as well other information for successful completion of the assessment. Center for Communicating Programs in Nigeria (CCPN) also provided information on social mobilization pilot project that was implemented for the Sokoto-South LGA CMAM Program. The efforts of Peter Magoh –the ACF Security Manager, and Abubakar Chiroma Kawu (Program Support Officer) who conducted a very helpful security and logistics assessment prior to the SQUEAC assessment to ensure smooth field activities are highly appreciated. Ifeanyi Maduanusi (ACF Coverage Deputy Program Manager) led the implementation of the SQUEAC assessment and compilation of the final SQUEAC report, while Zulai Abdulmalik and Francis Ogum (ACF Coverage Officers) supervised the Enumerator teams during field visits and were also very instrumental in writing of the SQUEAC report. Sophie Woodhead of Coverage Monitoring Network (CMN) and Diego Macias of ACF UK gave useful insights in compilation and validation of this SQUEAC report. The enumerators were instrumental in collecting data throughout the implementation of the assessment. All interviewees, including health workers, caregivers, traditional and religious leaders, traditional birth attendants, teachers, and other stakeholders who despite their busy schedule gave their time to be interviewed, and provided the coverage team with useful information regarding the CMAM Program in Sokoto-South LGA are appreciated. Coverage Assessment Team ACF international. 2 Table of contents 1. Executive summary ............................................................................................................................................................................................... 7 2. Introduction ........................................................................................................................................................................................................... 8 3. Objectives .............................................................................................................................................................................................................. 9 4. Methodology ......................................................................................................................................................................................................... 9 5. Description of planning and field activities ........................................................................................................................................................ 12 6. Results and findings ............................................................................................................................................................................................ 13 6.1. Stage 1: Routine monitoring data and beneficiary information ..................................................................................................... 13 6.1.1. Quantitative Analysis ........................................................................................................................................................................ 14 6.1.1.1. Admission trend ................................................................................................................................................................................ 14 6.1.1.2. Exit trends .......................................................................................................................................................................................... 15 6.1.1.3. MUAC at admission ........................................................................................................................................................................... 16 6.1.1.4. Length of stay from admission to cure ............................................................................................................................................. 17 6.1.1.5. Irregular rationing of RUTF to beneficiaries ..................................................................................................................................... 18 6.1.1.6. Number of visits before default........................................................................................................................................................ 18 6.1.1.7. Time-to-travel to CMAM HFs ............................................................................................................................................................ 19 6.1.2. Conclusion of quantitative data analysis ......................................................................................................................................... 20 6.2. Stage 1: Qualitative data-Investigation of factors affecting program and coverage. .................................................................... 20 6.2.1. Qualitative sampling Framework ..................................................................................................................................................... 20 6.2.2. Perception of Malnutrition and pathway of treatment .................................................................................................................. 20 6.2.3. Awareness and perception of CMAM program in communities ..................................................................................................... 21 6.2.4. Perception of RUTF in communities ................................................................................................................................................. 22 6.2.5. Availability of routine drugs ............................................................................................................................................................. 23 6.2.6. Health workers activities, training, and quality of service delivery of CMAM services ................................................................. 23 6.2.7. Referral mechanism and community volunteers activity; ............................................................................................................... 24 6.2.9. LGA Support ....................................................................................................................................................................................... 24 6.2.10. Data triangulation ............................................................................................................................................................................. 24 6.2.11. Concept map...................................................................................................................................................................................... 26 6.2.12. Study Type ......................................................................................................................................................................................... 27 6.2.13. Sampling Methodology ..................................................................................................................................................................... 27 6.2.14. Case Definition .................................................................................................................................................................................. 27 6.2.15. Result of Small Area Survey, small studies and observational study .............................................................................................. 27 6.2.16. Conclusion of small area survey ....................................................................................................................................................... 29 6.3. Developing the prior ......................................................................................................................................................................... 30 6.4.1 Concept Map ..................................................................................................................................................................................... 30 6.4.2 Un-weighted barriers and boosters .................................................................................................................................................. 30 3 6.4.3 Weighted barriers and boosters. ...................................................................................................................................................... 31 6.4.4 Histogram of Belief ...........................................................................................................................................................................
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