The CMAM Surge approach uses eight steps to help government health teams respond to relative changes in capacity and caseloads.
These steps begin with an analysis of the local context, including a review of seasonal trends and known risk factors that drive child wasting (Step 1) and individual health facility cpacity (Step 2).
The analysis process culminates in the setting of health facility-specific thresholds that, when crossed, trigger a shift from normal implementation into a higher phase of action based on the severity of the situation (alert, serious, emergency) (Step 3).
Pre-agreed Surge actions and support from both governments and non-government actors are defined and costed (Step 4), and then formalised (Step 5). Actions in the normal and alert phases are generally managed within the health facility itself, often in collaboration with communities.
Thresholds are monitored on an ongoing basis by health facility staff using routine health facility data (Step 6), with actions activated as soon as a threshold is crossed (Step 7).
The capacity of the health facility, thresholds and Surge actions are reviewed on and ongoing basis and adapted as indicated (Step 8).
The status of each health facility is also monitored by the higher-level health authority (eg district health management team) that can, in turn, monitor trends across a wider geographic area and call for higher-level regional or national response if the situation continues to deteriorate. The same eights steps are used to set up Surge at a district level.