A review of SAM management in Afghanistan: Lessons from 2013-2015

Since 2013 the treatment of malnutrition in Afghanistan has seen significant changes, resulting in substantial increase in service availability and use. This has largely been down to the move to integrate malnutrition treatment services into the Basic Package of Health Services (BPHS). That said treatment services are still largely provided in a vertical manner independent of other health services) through both parallel funding and BPHS funding. This was bolstered by donor engagement following the 2013 National Nutrition Survey which showed alarming rates of global acute malnutrition (3.7%-21.6%2) as well as increased engagement from the Public Nutrition Department, the Nutrition Cluster and nutrition partners (both national and international). Since late 2014 Action Against Hunger (ACF) has supported a series of coverage assessments that have been able to establish the coverage of severe acute malnutrition (SAM) treatment services and, more generally, analyse programme performance. Working hand in hand with BPHS partners and Provincial Nutrition Departments these assessments have shed light on both the shortfalls in achieving high performing SAM treatment services and those factors that have allowed SAM treatment services to perform well.

This report seeks to first highlight the scale of the problem the SAM challenge presents in Afghanistan, second the status of SAM management services and third to present an analysis of the factors affecting coverage taken from the assessment reports. The report finishes by setting out a series of recommendations to improve SAM services, and in some cases integrated management of acute malnutrition (IMAM) as a whole4. These recommendations were developed by nutrition partners and serve as a blueprint for change.