Table 3 Gaps in quality of nutritional services observed by capacity area
Capacity area | Observed issue |
|---|---|
Organisation of services | Nutrition services delivered “under the tree” |
Working hours unclear | |
Frequent service delays if rain | |
No triage | |
Chaotic organisation, no clear roles and responsibilities | |
No transport for children sent In-patient Therapeutic Care (ITC) | |
Working hours unclear | |
Case management | Triage not performed |
Mid Upper Aram Circumference (MUAC) not routinely done at all entry points (Out patients department -OPD, Tuberculosis and Anti retroviral therapy - TB/ART) | |
Mis-classification SAM/MAM | |
Z-score never used (only MUAC used) | |
No history taking | |
Comprehensive clinical examination as per the Integrated Management of Childhood Illnesses (IMCI) not performed | |
Treatment | Water with sugar not offered at admission |
10 key messages on RUTF not delivered | |
Individual counselling never performed | |
Amoxicillin, vitamine A, Iron and mebendazole not prescribed | |
MAM and SAM usually treated the same | |
Integrated Management of childhood Illnesses (IMCI) | HIV status often indicated as unknown despite availability of testing kits |
TB rarely assessed | |
Children at OPD not always assessed for nutritional status | |
Children with malnutrition not assessed according to IMCI | |
Staff working in out-patient care not trained in IMCI | |
Old IMCI job aids in some facilities | |
Supplies | Stock out of RUTF observed in many facilities |
Lack of mean of transport to facilities | |
Lack of timely request from facilities | |
Staffing | Lack of staffing with some facilities having no nutritional focal person appointed |
Lack of nutritional specific training | |
Poor practices even among trained staff | |
Village Health Teams (VHTs) usually not formally trained but doing the job at OTC in place of facility staff | |
Community linkage | VHTs screening reports not readily available |
Blank VHTs registers | |
No effective means of communication between facilities and village health teams (VHTs) | |
No incentives for the VHT | |
Quality improvement | Several supportive supervision activities are conducted on a quarterly basis, at facilities but only few are specific to nutrition |