Can Community Health Workers manage uncomplicated severe acute malnutrition? A review of operational experiences in delivering SAM treatment through community health platforms.

Community Health Workers (CHWs) play an important role in the detection and referral of children with severe acute malnutrition (SAM) in many countries. However, distance to health facilities remains a significant obstacle for caregivers to attend treatment services, resulting in SAM treatment coverage rates below 40% in most areas of intervention. The inclusion of SAM treatment into the current curative tasks of CHWs has been proposed as an approach to increase coverage. A literature review of operational experiences was conducted to identify opportunities and challenges associated with this model. A total of 18 studies providing evidence on coverage, clinical outcomes, quality of care and/or cost-effectiveness were identified. The studies demonstrate that CHWs can identify and treat uncomplicated cases of SAM, achieving cure rates above the minimum standards, and reducing default rates to less than 8%. Although the evidence is limited, these findings suggest that early detection and treatment in the community can increase coverage of SAM in a cost-effective manner. Adequate training and close supervision were found to be essential to ensure high quality performance of CHWs. Motivation through financial compensation and other incentives which improve their social recognition was also found to be an important factor contributing to high quality performance. Another common challenge affecting performance is insufficient stock of key commodities (i.e. ready-to-use therapeutic food). The review of the evidence ultimately demonstrates that the successful delivery of SAM treatment via CHWs will require adaptations in nutrition and health policy and practice.