The Community Assessment carried out during Stage 1 of a SQUEAC assessment will generate much information about the weaknesses and strengths of a CMAM programme. This information is validated during Stage 2 and the likelihood survey further adds to it by providing programme practitioners with information about the main barriers to access faced by caregivers. However to improve coverage requires proactive measures and a commitment to understand and improve access.

Based on all of this information, the final (and essential) part of a SQUEAC assessment should therefore be to formulate a community mobilization effort to increase access and uptake to CMAM services in tandem with strategies to improve quality health services. This should be in the form of an action plan which should target both community mobilization strategies and the service components of the CMAM program.

Formulating an action plan to improve coverage:

The action plan is a tool used to build the capacity of host partner, local health system and community members to take action in accordance with the barriers, needs and potential of the community that are identified by the community assessment. It is a road map for implementing the community assessment’s recommendations to improve community access to and uptake of the CMAM services by clarifying what will be done, who will do it and how it will be done.

This page outlines the nine steps to take to devise the action plan:

1. Establishing a planning team
2. Synthesis and articulation of the findings
3. Define overall goals and objectives
4. Set priorities and select interventions
5. Define performance indicators and targets
6. Define responsibilities and timeline
7. Define resource needs and sources
8. Advocacy
9. Follow up

The Tools section contains useful templates used during the action plan formulation process.

1. Establishing a planning team:

The following individuals should be the principle actors involved in preparing an action plan:

• The enumerators/ programme staff who participated in the SQUEAC assessment
• Key community figures and members
• Representatives from local health offices and facilities
• Representatives from local stakeholders

This will help to create more culturally-appropriate CMAM interventions which will maximize the positive impacts for local people and minimize the opportunity costs to them. Involving the community as early as possible in the planning stage will empower the community and increase their participation in the CMAM program, consequently increasing community ownership of the CMAM program.

Instructions:

• Work with host partner coordinator to assemble a good planning team before the start of planning exercise.
• Facilitate the planning process and empower the planning team to create their action plan. This will help to build the capacity of local staff.

2. Synthesis and articulation of the findings:

The second step in the planning process is to synthesize and articulate the community and SQUEAC assessment findings in order to answer the two core questions of the planning process: Where are we? And what do we have to work with?

Answering these questions will guide the team to understand the communities, context and the status of community mobilization activities and services of the CMAM program.

Instructions:

• Divide the participants into two groups and ask the participants to answer the core questions (i.e., where are we? And what do we have to work with?) by looking into the information from the assessment.
• Clarify core questions by asking additional straight forward questions (e.g., what is the OTP coverage rate? What is the status of community mobilization activities? What should it be? What is working well? What is not working well? What are the available local resources, systems and structures to be used for community mobilization? What the potential actors and network of community outreach workers can be involved in community outreach activities for the CMAM program?). Advise participants that most of the answers should come from the community assessment findings.
• Provide the matrix formats (available in Tools) and ask the participants to synthesize and add information to the matrix, (e.g., SWOT matrix of the current community mobilization activities for the CMAM program)
• Compile the workings of the groups into matrices and use the information to determine the next steps.

3. Define overall goals and objectives:

Using the collective thinking about CMAM programming and information from second step, determine the third core question in the action plan development process; where do we want to be? (I.e., what the host partner and local health office with community want to achieve?) These answers to this question should be the overall goals of the action plan.

Instructions:

• Guide discussion by recalling the findings /baseline information from step 2 and compare the findings against global targets for CMAM program SPHERE standard, e.g., coverage rates
• Ask the participants to define the overall goal(s) that they would like to achieve in the specified period, e.g., 1) increase OTP coverage rate from 45 to 70% by end of 2015 , 2) reduce the percentage of defaulter rate to less 10% by end of 2015 etc
• Then guide the participants to develop SMART Objectives for five community mobilization strategies (timely case finding and referral, sensitization, home visit follow-up, community participations, and coordination and technical support) to achieve the overall goal. e.g., increase the proportion of children who are detected for SAM in a timely manner and referred by volunteers by 50 % by end 2015 , decrease the percentage of defaulters and non-respondent SAM children by 60% by Dec 2015 etc.
• Use logical framework to write up the goals and objectives (template available in Tools).

4. Set priorities and select interventions:

Once it is clear “where we are today” and “where we want to go," the subsequent step is to address the question; “How do we get there?" I.e., by what the means will we achieve the goal? I.e., what are the detailed interventions required to achieve the goals and specific objectives?

Instructions:

• Ask the participants to identify key interventions for each objective
• The interventions/ activities should be constructed based on the basic strategies for effective community mobilization for the CMAM program as follow:

1) Assign community mobilization focal persons from the district to community level to coordinate the community participation and mobilization activities in the areas;
2) Link or integrate the community mobilization for CMAM with existing community mobilization mechanisms for other health and non-health programs in the area;
3) Ensure there is community participation in the planned outreach activities for the CMAM program in order to address caregivers’ barriers to access the services, and health facility’s challenges to deliver the services e.g., transport of RUTF;
4) Develop standardized sensitization messages on CMAM and produce materials;
5) Three outreach strategies: Early and active case-finding and referral of children with SAM for treatment; Follow-up home visits for problem cases; and sensitization (Health education and SBCC) about CMAM and malnutrition;
6) Technical and supportive supervision to nutrition workers and community outreach workers
7) Coordination of the community mobilization activities at all levels

• Identify which interventions/ strategies with will address the identified barriers to access and uptake of the CMAM services
• Then prioritise the list of interventions and activities that are feasible and can be implemented by the local health system, community and the stakeholders with the help of the host partner when necessary.
• The prioritization of activities should be based on the organization’s capacity, available local structures and resources, including community contribution, and possibly external support
• Consider the boosters to accessing the CMAM service, and the strength and opportunity of the current community mobilization activities for CMAM.
• Explain and link how each intervention is expected to work to support the community participation.

5. Define performance indicators and targets:

For each intervention/activity, the expected change to be achieved for the target population should specified and quantified within a given time frame. This will be done by defining performance indicators for each activity and target setting.

The performance indicators and targets will help the local stakeholders to track the progress of the actions towards to the overall goals and objectives of the plan. The source of the information /indicators, and the monitoring and evaluation mechanisms should be integrated into a logical frame.

Documents containing examples of indicators and activities for action plans are available in Tools.

6. Define responsibilities and timeline:

The sixth step in the planning process is to define the location where the activity will be implemented. Depending on the community assessment findings and resources, some of the activities may need to be focused in specific locations within the project area, and resource directed to the most needy communities.

Once it is clear what and where these should be implemented, the next step is to set the specified timeline for each activity, when it should be done and who should be responsible for carrying out the activity.

7. Define resource needs and sources:

Any action plan without sufficient resources is ineffective. The required budget for each objective and intervention should be estimated and indicated by the planning team. The source of resource should also be identified. They can include internal and external sources and community contributions. The budget can be refined further by the host partner later.

At this stage, it is useful to classify the interventions into two groups: short term and long term interventions. The short term interventions are activities that can be implemented by the host partner and/or local health system using the available resources in project year. The long term interventions require additional resources, which can be generated from internal and external sources and are likely to be implemented beyond the current project /budget year.

8. Advocacy:

Advocacy with donors in-country will be helpful for the host partner to raise additional resources for the implementation of the action plan. This can be done by debriefing and sharing the assessment findings and actions needed with UNICEF and donor representatives in the country.

9. Follow up:

It is very important for the host partner and local health services to follow up the implementation of the action plan. The follow up can be done with quarterly updates. The involvement of the donors would strength the follow up and the likelihood of the implementation of the action plan. A template for updates is available in Tools.

• Formulating a Strategy & Action Plan 
• Matrices for action plan data
• Common action plan indicators
• Common action plan activities
• Action plan update reporting form
• Action plan log frame template

Resources francaises:

• Suivi des plans d’action et indicateurs de la Mobilisation communautaire