Uwimana Sebinwa shares her experiences from a follow-up SQUEAC carried out in Senegal.

1. Please tell us a little about the context of the area and the CMAM programme

This SQUEAC assessment was carried out in the Matam region, located in eastern Senegal, along the border with Mauritania. This area is part of the Sahel belt, and is experiencing high levels of acute malnutrition affecting both pastoralist and agriculturalist populations.

Following the results of a nutrition survey reporting high rates of acute malnutrition in the Matam region, ACF began supporting the Ministry of Health in April 2012 to provide SAM treatment in health facilities. The program is implemented in partnership with a local NGO involved in community mobilization activities and community based MAM treatment.

1. When did you travel for the 1^st time to this area and how long after did you carry out the 2^nd SQUEAC?

As part of the monitoring plan, a first SQUEAC was undertaken in September 2012 with the aim of identifying barriers to access and react accordingly. Six months after, the process was renewed to monitor progresses and identify needs for readjustments.

2. Was the process of planning made easier by the fact that you already were already familiar with the location?

I had the opportunity to support both assessments, which was very interesting with regards to planning as well as investigation findings. While the planning process for the first assessment was quite challenging due to long distances, difficult accessibility, high number of health facilities and limited availability of program staff and partners, lessons learnt from these challenges made it easier to plan for the second one. Logistics were adapted accordingly and we could plan in advance for local partners and key staff to participate. Following the first SQUEAC, a special focus was made by the team to better monitor the quality of the data, which also made it easier regarding data collection and analysis. This was a great example illustrating how SQUEAC is not only an evaluation method but also a great monitoring tool very useful to improve program quality.

4. For this SQUEAC what, if anything, was different in terms of the process and steps you took for the different stages?

Both assessments followed the three stages of a SQUEAC; however the process was slightly different for the second one. Stage one included a review of recommendations made during the first SQUEAC and actions undertaken so far. This first analysis further guided the investigation process to explore their effect on coverage as well as possible new barriers and boosters through interviews and group discussions with key informants. The process of building the prior was also adapted by using the results of the previous SQUEAC as a first step when using prior information to build a picture on coverage. Although investigation did not show any improvement regarding overall coverage, this second SQUEAC proved to be very useful with regards to the progresses made on barriers previously identified and identifying new barriers, allowing timely reforms in order to improve coverage.