The Province of Huambo is one of the four provinces (together with Bié, Kwanza Sul and Zaire) where Word Vision (WV) runs a CMAM program in coordination with the Ministry of Health (MoH). The program, supported by UNICEF, has a strong community approach and is implemented in eight out of the eleven comunas
of the Province. The design of the SQUEAC investigation carried out in June 2013 was adapted to the very specific characteristics of the program.
Research during stage 1 resulted in the identification of boosters and barriers to coverage as well as three main kinds of zones within the project area:
1) Areas where World Vision implements SAM treatment which is decentralized at community level so Community Health Workers (CHW) do not only screen and refer children (SAM with complications) but also provide treatment for SAM cases without complications and do weekly follow-up visits in the villages.
2) Areas where MoH implements SAM treatment is provided by health staff at the HC for those villages close to the Health Centres.
3) Areas where neither WV nor MoH work and there is no CMAM programme.
The qualitative work confirmed the high level of patchiness/heterogeneity in terms of coverage with regards to the 3 aforementioned zones. As the diagram below, taken from the SQUEAC/SLEAC Technical Reference, demonstrates clearly, obtaining a coverage rate for a region with heterogeneous coverage becomes meaningless as the overall rate does not apply to any one area.
It is for this reason that normally assessments do not advance to stage 3 when there are high levels of patchiness. However, in this instance it was of real interest to advance with the investigation for a variety of reasons:
1) For training purposes. The overall objective of the SQUEAC conducted in Huambo was not only the result of the investigation itself but also the training exercise for the participants coming from the four different provinces of the program.Participants’ skills needed to be built onto the whole process, especially those who would be soon replicating the investigation in the three other provinces (Bié, Kwanza Sul and Zaire).
2) To quantify an innovative approach. Through stages 1 and 2 of the investigation it became evident that the use of CHWs to screen and administer treatment was a very innovative and effective approach that would achieve a high level of coverage.
In line with the above and in order to see the maximum value of coverage such an approach could reach, a wide-area survey was conducted in the World Visions zones identified and confirmed by means of stage 2 of having a satisfactory coverage rate.
Therefore, it is important to interpret the final global estimation of coverage resulting from the conjugate analysis (period coverage 82.1% [95% CI: 74.3% - 87.8%] carefully. The estimation of 82% of coverage only reflects coverage of SAM in the areas classified as having the best coverage of the whole program areas. What it does show however is the potential that innovative approached to service delivery can achieve!