Semi-Quantitative Evaluation of Access and Coverage (SQUEAC) Damaturu LGA CMAM Program Yobe State, Northern Nigeria May-June 2014 Action Against Hunger | ACF International 1 ACKNOWLEDGEMENTS The SQUEAC1 assessment in Damaturu has been completed through the support from the Children Investment Fund Foundation (CIFF). The Yobe State Primary Health Care Board (YSPHCB) gave authorization for conducting the survey in Damaturu. Mr. Usman Adams, the Assistant Director Primary Health Care (PHC) was very supportive throughout the exercise, acting as the link between YSPHCB and the CMAM Coverage assessment team. Ms. Aisha Abdu Salle, the Acting PHC Coordinator and Ms. Fatima Mustapha the Nutrition Focal Person (NFP) for Damaturu LGA are appreciated for providing the team with client records, anecdotal program information and security information during the stage 2 and 3 of the assessment. The ACF Damaturu base team led by the Head of Base Ibrahim S. Adamu, is acknowledged for the information they provided and other support they gave to the SQUEAC team in the course of SQUEAC implementation. This include but not limited to the Community based Management of Acute Malnutrition (CMAM) program team led by Stella Esedume, and the Water Sanitation and Hygiene (WASH) team led by Bwakat Hollong. Peter Magoh, the security manager of ACF; Morris Ramnaps, the Flying Logistic Officer; and Abubakar Kawu, the Program Support Officer; conducted security and logistics assessments prior to the SQUEAC assessment to ensure the team settled comfortably before beginning the work. The mentioned persons especially Abubakar, stayed with the team and gave support during the implementation period. Joseph Njau (ACF Coverage Program Manager) provided technical support during the implementation of the assessment while Coverage Monitoring Network team (CMN) gave useful insights in compilation and validation of this SQUEAC report. Ifeanyi Maduanusi (ACF Coverage Deputy Program Manager) led the coverage assessment team in training enumerators, supervision of the assessment and writing of the SQUEAC report. The ACF CMAM Program Coverage Officers (Chika Obinwa, Zulai Abdulmalik, Janet Adeoye and Francis Ogum) led the enumerator teams and were instrumental to ensure the quality of daily SQUEAC study activities. The effort of the enumerators -‘the foot soldiers’ in collecting information during the study despite the security challenges in Damaturu LGA cannot be overemphasized. Finally, all the health workers, caregivers, traditional and religious leaders, traditional birth attendants and other interviewees who freely gave very useful information regarding the CMAM Program in Damaturu LGA are highly appreciated. Joseph Njau & Ifeanyi Maduanusi 1 Semi Quantitative Evaluation of Access and Coverage 2 Table of contents 1. Executive summary ....................................................................................................................................................................................... 6 2. Introduction .................................................................................................................................................................................................. 6 3. Objectives ..................................................................................................................................................................................................... 7 4. Methodology ................................................................................................................................................................................................ 7 5. Description of field activities ......................................................................................................................................................................... 9 6. Results and findings ...................................................................................................................................................................................... 9 6.1. Stage 1: Routine monitoring data-identifying potential areas of low and high coverage. ....................................................................10 6.1.1. Routine monitoring of Beneficiary cards and performance data ......................................................................................................10 6.1.1.1. Program exits (discharge outcomes) .............................................................................................................................................10 6.1.1.2. Admission trends ..........................................................................................................................................................................10 6.1.1.3. MUAC or oedema at admission ....................................................................................................................................................11 6.1.1.4. Length of stay from admission to cure ..........................................................................................................................................12 6.1.1.5. Number of visits before default ....................................................................................................................................................13 6.1.1.6. Time to travel to CMAM HFs- plot of distance to treatment centre ..............................................................................................13 6.1.1.7. Distribution of villages across the HFs providing CMAM services .................................................................................................14 6.1.2. Conclusion of the routine monitoring (beneficiary cards) analysis ...................................................................................................14 6.2. Stage 1: Qualitative data-Investigation of factors affecting program and coverage. ............................................................................15 6.2.1. Qualitative sampling Framework ......................................................................................................................................................15 6.2.2. Qualitative information ....................................................................................................................................................................15 6.2.2.1. Health seeking behaviors in the communities ..............................................................................................................................15 6.2.2.2. Community Sensitization, mobilization and awareness of the program .......................................................................................15 6.2.2.3. Community Volunteer (CV) activity and trainings .........................................................................................................................16 6.2.2.4. Community perception about the program and RUTF ..................................................................................................................16 6.2.2.5. Activity of Health workers ............................................................................................................................................................16 6.2.2.6. Generalized stock-out of routine drugs.........................................................................................................................................16 6.2.2.7. Stock-out of RUTF due to unsustainable supply chain management ............................................................................................16 6.2.2.8. Insecurity in Damaturu LGA ..........................................................................................................................................................17 6.2.3. Data triangulation ............................................................................................................................................................................17 6.2.4. Concept map.....................................................................................................................................................................................19 6.3. Stage 2: Confirmation of areas of high and low coverage. ....................................................................................................................19 6.3.1. Study Type ........................................................................................................................................................................................19 6.3.2. Sampling Methodology .....................................................................................................................................................................19 6.3.3. Case Definition .................................................................................................................................................................................19 6.3.4. Result of Small Area Survey ..............................................................................................................................................................19 6.3.5. Conclusion of small area survey........................................................................................................................................................21 6.4. Developing the prior. ............................................................................................................................................................................21