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CMAM COVERAGE MONITORING

Improving nutrition programmes through the promotion of quality coverage assessment tools, capacity building and information sharing.

Preparation

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Completing a coverage assessment such a SQUEAC is known to be a valuable and effective tool for CMAM programmes to rapidly identify areas for improvement, increase programme performance and ultimately, save more lives. This page is designed to present guidance, based on many previous experiences, of essential steps needs to plan a SQUEAC (including a Community Assessment). The preparatory phase of a SQUEAC investigation sets into motion all support mechanisms allowing for the smooth implementation of an assessment. It should start four weeks before the start of the assessment to ensure that all preparatory steps are launched and completed before the start of the assessment.

1. Information:

a. Terms of Reference

A Terms of Reference (ToR) should be developed outlining the background of the programme, including justification for a coverage assessment as well as the assessment’s objectives, conditions and schedule of work, as well as all expected outputs. For an example of ToR, please click here. In some countries the ToR needs to be validated by state authorities before the onset of the investigation. Therefore, in these cases, it is necessary to prepare the ToR well in advance of the anticipated start date.

b. Area Map

A map of the working area is an essential requirement to conduct a coverage assessment. Ideally, the map will have the following specifications:

  • 1:50,000 scale
  • Indication of administrative divisions, village locations, roads and rivers
  • If possible, the map will be on A0 paper or, if not, on A1 .

If a detailed map is not available, the team should draw one at the start of the investigation. This can be done by projecting a map onto a wall, tracing the map out on flipcharts and then adding health centres, towns, villages and main roads to the map.

c. Programme data

The SQUEAC methodology relies on the availability of accurate and up-to-date programme data. The following programme data should be made available, in electronic format, at least two weeks before the assessment commences:

  • Routine programme data
    • Number of OTP and SFP sites in the working area
    • Monthly data, i.e. admission, cure, death, defaulter rates, length of stay, MUAC at admission etc. (Please refer to Data Collection Spreadsheet for full details of data).
  • Demographic data for target area
    • List of villages with village population figures and average percentage of children aged 6-59 months (<5 years) in the area

d. Qualitative data

If the lead investigators are unfamiliar with the area and communities to be surveyed, they should obtain and read as many of the following documents as possible:

  • national protocol for CMAM programmes;
  • strategy for nutrition programmes in country;
  • project proposal which includes comprehensive information about the CMAM program (Is it a short-term intervention to address a nutrition emergency or will it be a permanent part of PHC services? What is health system capacity to deliver the CMAM service? What support is needed?);
  • community mobilisation strategy and/or detailed presentation of community outreach activities (i.e. description of community volunteer networks, their activities and follow-up, description of other actors and their respective roles, description of available communication channels, examples of BCC/IEC materials, etc.)
  • reports of sociocultural studies and surveys linked to and/or having an impact on CMAM programme (i.e. SMART, RSCA, KAP-B, VCA, PRA, etc.) including, among others information on:
    • programme-specific contexts (historical, political, geographical, social, cultural and economic);
    • formal and informal community structure, organisation and institutions;
    • prenatal/postnatal & child care practices;
    • knowledge of childhood diseases and treatment preferences;
  • other programme documentation of qualitative nature and/or any anthropological/ socioeconomic/behavioural research.

They should also familiarise themselves with the community and map out existing community actors (i.e. community (opinion) leaders, health committees, CBOs, etc), list their initiatives and/or activities, target populations and coverage. They should pay special attention to activities with a health focus, identify potential strengths and weaknesses of these actors, if involved in CMAM community outreach and gather suggestions on the most appropriate groups and networks to carry out CMAM
community outreach activities.

2. Survey Team:

Carrying out a SQUEAC assessment requires a team of supervisors, enumerators and community mobilisation specialists (if any are available). Team selection should take place well in advance of the start of the assessment.

The team should comprise:

  • A lead investigator who has been previously received on-the-job training on carrying out a SQUEAC assessment.
  • Three or four supervisors who are computer literate and who are directly involved in the CMAM programme.
  • 12 to 16 additional participants to act as enumerators who can carry out the survey. Ideally these should be individuals who are involved in the delivery of the CMAM programme, from the host agency, the Ministry of Health and from partner organisations.
  • Any community mobilisation specialists involved in the CMAM programme.
  • All participants with computer access need to use it throughout the assessment period. They are also advised to download (for free) the following essential software needed for the assessment:

It is recommended that individual team members have a good understanding of the geographical, sociocultural and linguistic context of the area in which the study will be carried out. An experience with the implementation of surveys, such as SMART, KAP-B, RSCA or VCA, is an additional bonus. Special attention should be paid to the gender balance within the team, assuring a representation of women of at least 30%, aiming for 50%, if circumstances allow. The participation of community members and/or health district representatives will not only enrich the collection of data and the interpretation of results but it will also allow for a live transfer of competencies and spur follow-up actions within each party’s limits.

3. Training of participants:

The success of a SQUEAC investigation is directly proportional to the depth and quality of the training provided to a SQUEAC investigation team.

Once recruited, the participants should be trained during the first two days of the SQUEAC assessment on the following topics:

  • Overview of SQUEAC methodology
  • Qualitative data collection
  • Case definition and in-community case finding techniques

Training packages (including schedules, presentations and key messages) for these three areas will be added to the Training Centre by October 2015.

4. Finance/ Budget:

Costs for a coverage assessment vary according to the location. However a sample budget can be downloaded here.

5. Arrangements for external representatives:

  • An invitation letter for visa application or any other arrangements to obtain visa on arrival
  • Arrangements for internal flights from and to capital, if needed
  • Airport collection and drop-off
  • Accommodation (secure and suitable for expats)
  • Security briefing on arrival in field
  • Local SIM card for communication with the team

6. Timeframe:

Generally, the training and coverage survey take 10 to 20 working days, depending on conditions and the methodology used to conduct the survey. Below illustrates a typical schedule: 

Day Activity
Day 1 Travel to programme base
Day 2 - 3 Classroom training & field exercises: Classroom training: Opening session, including introductions and schedules; Methodology review; Distribution of tasks to the assessment team; Collection of some contextual data from the field; Analysis of Quantitative Data
Day 4 - 8 Stage One: Field data collection and analysis: OTP data collection for additional data; Contextual data analysis (qualitative); Identification of potential barriers and boosters of coverage; Mindmaps
Day 9 Data analysis in classroom: Preparation for Small Area Survey
Day 10 - 12 Stage Two: Field data collection: Conduct Small Area Survey in communities with active case findings
Day 13 - 14 Data analysis in classroom: Preparation for Wide Area Survey
Day 15 - 18 Stage Three: Field data collection: Conducting Wide Area Survey
Day 19 - 20 Data compilation of wide area survey: Estimations of coverage; Recommendations; Action plan
Day 21 Travel back to departure city

An example of a SQUEAC agenda can be found here in PDF. An excel version is available here

 

7. Logistics:

The following recommends, in detail, the practical provisions required for training, fieldwork and completion of a coverage assessment

a. Vehicles/transport

  • The assessment team will require drivers and vehicles to be available at all times for 10-12 days during the investigation (approx. 5 days for Stage One, 2-3 days for Stage Two and 3-4 days for Stage Three), depending on the terrain and conditions.
  • Each vehicle must carry a First Aid kit

b. Training venue/work facility

  • The assessment team will require a place for training and to work with survey data. This needs to be a room large enough for group work, with table and chairs, and with electricity and a power point projector.

c. Materials

For training/classroom work

  1. Power point projector
  2. Flip chart - for writing
  3. Marker pens-at least 4 different colours, (4 dozen)
  4. Stapler & staples
  5. Sticking tape and blu-tak
  6. Stick notes – in at least 4 different colours
  7. Notepads for the participants
  8. Pencils, sharpeners, erasers, rulers and drawing pins

For field work per team (approx. 8 teams of 2 people)

  1. Clip boards
  2. Plastic folder for loose papers
  3. MUAC bands
  4. RUTF packets
  5. Some OTP/SFP referral slips
  6. Any other logistics equipment necessary for the teams in the field (satellite telephones etc...)

d. Other provisions

  • Ample water should be made available for field and classroom work.
  • Lunch for training days and lunch allowance for surveyors during field work.

8. Notification to interested parties:

  • As a courtesy, and in the interests of ensuring those targeted by the survey are available at the time of the visit, it is important to notify village chiefs, camp leaders or other key community figures of the survey’s intention.
  • Arrange a debriefing with all key stakeholders (including donors) with the coverage advisor. 

 

9. Materials:

  • Terms of Reference (ToR) document describes the purpose and structure of a programme. For a sample ToR, click here  PDF logo
  • Costs for a coverage assessment include costs for field work. A sample budget can be found here PDF logo
  • An example of a typical schedule of training and coverage survey can be found here PDF logo
  • A summary of the main data and information needed in advance of a SQUEAC assessment can be downloaded from here