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Role play as part <strong>of</strong> the programme in Mukaram<br />
P Acharya/WFP, Sudan<br />
<strong>Field</strong> Article<br />
Improving<br />
blanket<br />
supplementary<br />
feeding<br />
programme<br />
(BSFP) efficiency<br />
in Sudan<br />
By Pushpa Acharya and Eric Kenefick<br />
Pushpa Acharya is currently working<br />
as Head <strong>of</strong> Nutrition for the<br />
World Food Programme in Sudan.<br />
She has a PhD in Human<br />
Nutrition from the University <strong>of</strong><br />
Massachusetts. She has over 21<br />
years <strong>of</strong> pr<strong>of</strong>essional experiences with national<br />
governments and UN agencies.<br />
Prevalence <strong>of</strong> acute malnutrition<br />
across Sudan is high and ranges from<br />
11 to 29% 1 . Specific causes <strong>of</strong> acute<br />
malnutrition are largely unknown.<br />
High rates are observed during both nonlean<br />
and lean seasons. Major efforts are being<br />
exerted by the Ministry <strong>of</strong> Health and<br />
humanitarian aid agencies to treat malnourished<br />
children with therapeutic programmes<br />
implemented through approaches involving<br />
in particular community based management<br />
<strong>of</strong> acute malnutrition (CMAM), in-patient<br />
care, and targeted supplementary feeding<br />
programmes. Additionally, in areas with<br />
higher acute malnutrition rates, blanket<br />
supplementary feeding programmes (BSFP)<br />
are implemented during lean seasons as a<br />
preventive approach. In spite <strong>of</strong> all these<br />
programmes, repeated survey results show<br />
that acute malnutrition rates remain<br />
unabated (see map).<br />
Pilot to improve BSFP performance<br />
In 2010, WFP’s targeted supplementary<br />
feeding programme (SFP) aimed at treating<br />
moderately malnourished children<br />
reached over 200,000 children. In addition,<br />
415,000 children aged 6-59 months were<br />
reached through a BSFP aimed at preventing<br />
the usual peak <strong>of</strong> acute malnutrition<br />
observed during lean seasons in Darfur.<br />
While the targeted SFP met the SPHERE<br />
standard for all performance indicators<br />
across Sudan, 2009 programme monitoring<br />
data <strong>of</strong> the BSFP led to questions about its<br />
efficiency in reducing rates <strong>of</strong> acute malnutrition<br />
usually observed during lean seasons.<br />
In order to improve efficiency <strong>of</strong> the<br />
BSFP in Sudan, means <strong>of</strong> improving<br />
performance <strong>of</strong> the programme were<br />
explored. A pilot was designed and implemented<br />
in one area in Kassala State.<br />
Kassala was selected because <strong>of</strong> WFP’s preexisting<br />
SFP programme, presence <strong>of</strong> a<br />
WFP nutritionist and the relative safety<br />
and accessibility <strong>of</strong> the area compared to<br />
Darfur and other areas <strong>of</strong> conflicts. The<br />
pilot programme began in March 2010 and<br />
is continuing until end <strong>of</strong> 2011.<br />
Nutritional and programming context<br />
Prior to the pilot, GAM prevalence rates in<br />
Kassala were usually high and similar to<br />
that seen in Darfur (19.2% SHHS 2006, 15%<br />
SMoH 2009, 16.7% SHHS 2010). Mukaram,<br />
one <strong>of</strong> the shanty towns on the outskirts <strong>of</strong><br />
Kassala town, was selected for the pilot by<br />
the State Ministry <strong>of</strong> Health (SMoH). The<br />
area is one <strong>of</strong> the poor neighbourhoods <strong>of</strong><br />
Kassala and is situated relatively near to<br />
the main town and hence easier for SMoH<br />
staff to monitor. Prior to the pilot study,<br />
mid upper arm circumference (MUAC)<br />
measurements <strong>of</strong> all children in the catch-<br />
1<br />
Sudan Household Health Survey 2010<br />
Eric Kenefick is current Head <strong>of</strong><br />
Programme for WFP in Sudan. He<br />
has spent the past 15 years working<br />
or WFP and UNICEF in<br />
vulnerability analysis and M&E.<br />
He is a graduate <strong>of</strong> Tulane<br />
University’s School <strong>of</strong> Public Health and Tropical<br />
Medicine.<br />
The project is implemented by the State Ministry<br />
<strong>of</strong> Health. The commitments <strong>of</strong> the Director <strong>of</strong><br />
Nutrition Ms Sit Eldat Ahmed Al, and Ms Khalda<br />
Khalafalla – WFP Kassala, were critical in the<br />
smooth functioning and success <strong>of</strong> the programme.<br />
Dr Amal Abdalla – WFP Sudan – coordinated the<br />
project and provided the technical guidance<br />
without which the intended results would not<br />
have been achieved.<br />
Map 1: Prevalence <strong>of</strong> acute malnutrition in Sudan<br />
Boundaries shown on <strong>this</strong> map do not imply <strong>of</strong>ficial endorsement or acceptance by the<br />
United Nations World Food Programme. This map is for planning purpose only. WFP can<br />
not guarantee that <strong>this</strong> map product is error free and therefore we accept no liability or<br />
consequential and indirect damages arising from use <strong>of</strong> <strong>this</strong> map product.<br />
Data Sources:<br />
VAM Unit: WFP Sudan<br />
Sudan Boundaries: Sudan Interagency Mapping (SIM)<br />
Table 1: Number <strong>of</strong><br />
children under 5 years<br />
enrolled in SFP in two<br />
PHCs, Mukaram,<br />
Kassala, 2009<br />
Month Number <strong>of</strong><br />
children<br />
January 137<br />
February 125<br />
March 20<br />
April 208<br />
May 227<br />
June 200<br />
July 156<br />
August 106<br />
September 129<br />
October 145<br />
November 55<br />
December 90<br />
59