The CMAM Surge Approach

23 April 2021

What is CMAM Surge? The Community-based Management of Acute Malnutrition (CMAM) Surge Approach was designed to help health systems more effectively deliver services for children with acute malnutrition. The approach is based on the observation that in many contexts the number of children seeking treatment for acute malnutrition tends to peak during certain months of the year.

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Mothers waiting with their children to be seen by the health worker during the annual peak in SAM and malaria service demand (September). Affala Health Centre in Tahoua District, Niger 2018. Photo: Concern Worldwide.
Mothers waiting with their children to be seen by the health worker during the annual peak in SAM and malaria service demand (September). Affala Health Centre in Tahoua District, Niger 2018. Photo: Concern Worldwide.
Consultation room at the Integrated Health Centre (CSI) Koufan, Tahoua. Photo: Ollivier Girard/Concern Worldwide
Consultation room at the Integrated Health Centre (CSI) Koufan, Tahoua. Photo: Ollivier Girard/Concern Worldwide
CMAM Surge chart in Selate Health post in Ethiopia. Photo: Concern Worldwide.
CMAM Surge chart in Selate Health post in Ethiopia. Photo: Concern Worldwide.
Rafaida, one and a half years old, having her MUAC measurement taken by her mother Khamissa in Doroti, Chad, 2018. Khamissa is a Concern-trained Community Health Volunteer. Photo: Lucy Bloxham / Concern Worldwide.
Rafaida, one and a half years old, having her MUAC measurement taken by her mother Khamissa in Doroti, Chad, 2018. Khamissa is a Concern-trained Community Health Volunteer. Photo: Lucy Bloxham / Concern Worldwide.
The CMAM Surge Approach: Eight key steps. Image: Concern Worldwide.
The CMAM Surge Approach: Eight key steps. Image: Concern Worldwide.
CMAM Surge status of implementation based on known partner (NGO, UNICEF or WFP) support as of end 2020. Image: Concern Worldwide.
CMAM Surge status of implementation based on known partner (NGO, UNICEF or WFP) support as of end 2020. Image: Concern Worldwide.

A closer look at the CMAM Surge approach

The CMAM Surge approach uses eight steps to help government health teams respond to relative changes in capacity and caseloads. The scale up of CMAM Surge has led to new learning and context-specific adaptations of the approach. Several learning reviews and evaluations have been completed. Adaptation of the approach includes expanding the approach to other childhood illnesses - other innovations and scale up continues.

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Introduction to the CMAM Surge Steps

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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.

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CMAM Surge Implementation Guides

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Evaluations of the CMAM Surge approach

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CMAM Surge and Cost-effectiveness

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CMAM Surge Field Exchange Series

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CMAM Surge Coordination Mechanisms and Technical Working Groups

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