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Evaluation database

Evaluation report

2013 Sierra Leone: Evaluation of integrated management of acute malnutrition (IMAM) & infant and young child feeding (IYCF) programs



Author: Yvonne Grellety – Hélène Schwartz

Executive summary

"With the aim to continuously improve transparency and use of evaluation, UNICEF Evaluation Office manages the "Global Evaluation Reports Oversight System". Within this system, an external independent company reviews and rates all evaluation reports. Please ensure that you check the quality of this evaluation report, whether it is “Outstanding, Best Practice”, “Highly Satisfactory”, “Mostly Satisfactory” or “Unsatisfactory” before using it. You will find the link to the quality rating below, labelled as ‘Part 2’ of the report."

Background:

UNICEF Sierra Leone has promoted the participation of NGOs in the implementation of development programmes in the country. Since 2009, UNICEF supported the Ministry of Health and Sanitation in Sierra Leone to scale-up high impact nutrition interventions in the country. Given the nature and constraints of governmental Human Resource the involvement of NGOs was crucial if the scale-up was to be a success. Since 2009, UNICEF has engaged 14 NGOs across the country and provided over USD 3,700,000 to partners to implement nutrition projects.

Since 2009, Infant and Young Child Feeding (IYCF) and Integrated Management of Acute Malnutrition activities (IMAM) activities are part of a single package promoted by UNICEF and partners in all districts. An evaluation of the IMAM program was conducted in March 2010 [2] followed by a review of the existing comprehensive framework for large scale promotion of adequate IYCF practices in Sierra Leone in May 2010 [3]. These evaluation / review provided recommendations to improve both IMAM and IYCF programs, in terms of implementation and scaling-up.

Purpose/Objective:

The objectives of the evaluation were:

  • To identify and understand the achievements and constraints of the UNICEF funded Nutrition programme including the challenges faced by the implementing partners
  • To assess the quality, effectiveness and sustainability of the programmes funded by UNICEF and implemented by partners.

Methodology:

The evaluation used a combination of methods. These were; Literature review, Individual interviews, Mother Support Group interview, and Observations.

The literature review included national documents including the nutrition policy, strategy and implementation plans and documents held by the UNICEF Country Office. The interviews and observations were done directly in the field and allowed us to triangulate these data with those obtained from the literature review and the analysis of the quantitative data.

Study districts were selected by UNICEF Sierra Leone, based on the level of scale-up for both IMAM and IYCF activities, the presence or not of an implementing partner with a signed PCA with UNICEF and community activities on-going until April 2013. In addition to the health facilities included in this evaluation, one SC and one OTP were also visited in Freetown.

Selection of study  health facilities was done by UNICEF together with the district nutritionists and implementing partners, depending on the day of evaluation visit and days which OTP was operational. If no OTP was working in the district on the day of the visit, the evaluation team focused on checking the charts, the knowledge of the officer-in-charge or nurse-aid and the stock of the nutrition products and materials. PHU and MSG in both hard to reach areas and easy to reach areas were selected.

The two first days were dedicated to the literature review and briefing sessions with UNICEF staff and partners supporting the four selected districts. The evaluation team met with ACF, CAUSE-Canada, HEDO and WHI. The meeting focused mainly on activities, opportunities, challenges and constraints faced by the implementing partner. The field visit lasted 9 days.  In each district visited, the evaluation team first met with the DMO and/or the District Nutritionist to collect general information on the implementation of the activities and the constraints and challenges faced by the district level.

Findings and Conclusions:

Findings

Since 2009, UNICEF supported the Ministry of Health and Sanitation in Sierra Leone to scale-up high impact nutrition interventions in the country. Implementing partners were involved in the scaling-up of IMAM and IYCF activities since the beginning but due to funding constraints, UNICEF Sierra Leone stopped the partnership with most of the NGOs in April 2013. This will certainly have a significant impact on the programs, but it is too early now to assess the magnitude of this impact.

In this part of the report, we will try to answer the questions raised in the ToR namely achievements, constraints and challenges faced by the IP on one hand and quality, effectiveness and sustainability of these activities on the other hand.

Read more in chapter V.

Conclusion

This report is not a verification report, but also not a detailed in-depth evaluation of each centre visited due to the short time - but it gives an overview of the IMAM programme, its strength and weaknesses and gives specific recommendations.

The IMAM activities are now well accepted by the community and health professionals, even though the frequent stock-outs that occurred during these last 2 years have severely disrupted the program. It is extraordinary to see the small effect that a stock-out has on the recorded gains of weight of the SAM children. This is completely unexpected – but given the gross unrealistic variation of the recorded weights (up to 2kg gains and losses each week!) it is impossible to tell whether these are real figures or the result of poor measurements/recording.

The other bottleneck is the leakage of RUTF which has detrimental effect on the moral of the nutrition team at national level as well as within the partners and the donor; the direct consequence is a stock out of the different nutrition products and drugs at district level; it is almost happening every 2 months in the visited districts. This can really be the failure of a programme like this.

In term of IYCF, a lot of work has been done since 2009 and the strategy designed for the MSG seems to be the right one. Even if these groups still need to be empowered to become sustainable and autonomous, it seems that they could make a difference in term of prevention of malnutrition. However, for this to happen an equal focus should to be put on PHU and hospitals to ensure that all levels disseminate the same messages to the community.

Read more in chapter VI.

Recommendations:

  • Revision of the IMAM protocol
  • Scale-up will only be successful if the problems identified in this report are first addressed
  • Retrain all the staff involved in IMAM to the revised protocol and the use of the tools
  • Revise the method of verification involving all levels
  • Revise and finalize the IYCF national strategy
  • Train health workers on IYCF. The training should start with health workers already engaged in IYCF activities
  • In districts with high micronutrients deficiencies, IYCF activities must be coupled with distribution of micronutrients powders (MNPs)
  • Continue supporting the IP for implementation of the IYCF strategy


Full report in PDF

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Report information

Year:
2013

Country:
Sierra Leone

Region:
WCARO

Theme:
Nutrition

Type:
Evaluation

Partners:
UNICEF, Ministry of Health and Sanitation

Language:
English

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