This document proposes a community health program in the Borena Zone of Ethiopia to prevent severe acute malnutrition (SAM). It involves training and certifying community health workers to identify and treat SAM at the community level through behaviors like exclusive breastfeeding. The program would partner with local organizations and facilities to train 30 community health workers per year over 3 years. It provides a proposed budget and timeline, and argues the program is feasible and sustainable because it employs local people and promotes community involvement and education to address a major public health problem in the region.

1. UAB Global Health Challenge
Team 8
February 20, 2010

2. UNICEF Conceptual Framework of Malnutrition
Prevention
2

3. Case for Prevention
• Epidemiological
Argument
– Direct Causes of Child
Deaths
• Economic Argument
– Prevention vs. Treatment
• Ethical Argument
– Reliance on Treatment is
Unethical
3

4. Case for Prevention
Women are a critical link, biologically and socially,
in the well-being of households and communities.
4

5. Objective
To develop a sustainable community health
program for prevention of severe acute
malnutrition in the Borena Zone of the
Oromiya Region, Ethiopa
5

6. Why the Borena Zone?
• Major drought affected area
– Resulting in food shortage
shortages and an increase in
SAM-related disorders
• Aid organizations currently facilitating
SAM treatment
– RUTFs, in clinic treatment
• Data is available for SAM within
region for comparison and analysis
• Infrastructures available
– Health centers, clinics
• Communities and Universities are
easily accessible

7. Collaborative Partners
• Ministry of Health
• Hawassa University
• VodaFone
• Hospitals and Clinics in Borena Zone:
– Negele Hospital, Yabello Health Center, Moyale Health
Center
• NGOs in Borena Zone

8. Qualitative research
Grant given to University and Clinics
Student Training
Certification Program Certification Program Certification Program
Community Health Workers
-Continuing Education (2 times per year)
Community Mobilization
Community Woman
Clinics Schools Churches
Leaders Organizations
8

9. CHW Certificate:
Identification and Diagnosis of SAM
• Identification and Diagnosis of SAM
– TALC Insertion Tape
• Green More than 135mm
– Reasonably Nourished
• Yellow 125-135mm
– Probably malnourished
• Red Less than 124mm
– Almost certainly malnourished

10. CHW Certificate:
Identification and Diagnosis of SAM
• Identification and Diagnosis of SAM
– Little energy

11. CHW Certificate:
Prevention
• Breastfeeding
– Exclusive breastfeeding for six months and continued
breastfeeding for the first year could avert 13% of the
more than 10 million deaths among children ever year
– Why exclusive breastfeeding
• Formula increases risk of illness and death
– Protection of the many essential
infection-fighting components of human milk
– Possible contamination of water and formula
– Diluting Formula

12. CHW Certificate:
Prevention
• Breastfeeding
– Diarrheal Control
• Needs assessment
– Asset mapping

13. Timeline Proposal
• Year 1:
– Qualitative Research
– Creation of Certification Program through HU
– Application processing of 30 CHW
– Training program for CHW
– Begin field work
– Monitoring
• Year 2 and 3:
– Continue field work
– Monitoring
– Continuing Education
– Assessing Model & Data Evaluation
– Recruiting & Training for 30 additional CHWs

14. Budget Proposal
• $200,000- Grant for the Hawassa University
• $150,000- Oromiya Regional Health Bureau for Funding to Clinics and
Hospitals in the Borena Zone
• $108,000- Community Health Workers Funding:
– Year 1: $18,000
– Year 2: $36,000
– Year 3: $54,000
• $100,000- Equipment and Supplies
– TALC Bands and Awareness Material, Mobiles
• $150,000- Costs For Initial Referrals
• $100,000-Evaluations
– Formative, Process, Outcome
• $92,000-Domestic Operating Costs
• $100,000- Discretionary Funding

15. Feasibility & Sustainability
• Partner with Local Organizations, NGOs, and facilities
already on ground
• Simple, focused, & not overly ambitious
• Employs locals and promotes community
involvement and mobilization
• Promotes education
• Easily expandable to include more areas and could
be applied to other diseases

16. References:
• http://www.path.org/files/IYCN_the_case_prev_mal.pdf
• http://www.unicef.org/nutrition/files/Community_Based_Management_of_Sever_
Acute__Malnutirtion.pdf
• http://www.unicef.org/sowc08/docs/sowc08_panel_4_1.pdf
• http://www.ajcn.org/cgi/reprint/81/4/864
• http://www.concernusa.org/media/pdf/2007/10/Sustainability%20of%20CTC_Gat
chell_WHO.pdf
• http://www.fantaproject.org/downloads/pdfs/FNB_27_3_2006_d.pdf
• http://www.ajcn.org/cgi/content/full/78/2/302
• http://heapol.oxfordjournals.org/cgi/reprint/12/2/115
• http://heapol.oxfordjournals.org/cgi/reprint/12/2/115
• http://fex.ennonline.net/34/effectiveness.aspx
• http://fex.ennonline.net/34/effectiveness.aspx
• http://www.maqweb.org/miniu/presentations/LCriglerCHW%20MiniU%202009v3.pdf
• http://www.plusnews.org/report.aspx?ReportID=85743
• http://www.most.gov.et/Health.htm#Hl6

17. Thank you for your attention! Questions?
17