What is the bottleneck analysis approach to the management of severe acute malnutrition?

There is a range of surveys and tools that help to understand a nutritional situation, the performance of service delivery, bottlenecks and the coverage of IMCI (Integrated Management of Acute Malnutrition), e.g., MICS/DHS/SMART, coverage assessments [including SQUEAC and SLEAC], routine data and surveillance, etc. However, at present, information systems relating to severe acute malnutrition (SAM) do not, in most cases, enable the systematic, structured and logical identification of bottlenecks (barriers) to the effective coverage of the services provided. There is a need for tools and approaches to support the structured identification of bottlenecks, the determination of causes and solutions, and the routine monitoring of corrective actions.

To address this gap, we propose adopting a bottleneck analysis approach to facilitate the monitoring of bottlenecks and support decision-making by programme managers and supervisors of SAM. Within a broader framework of promoting equitable coverage of service provision, this approach is based on conceptualising service coverage from the perspective of the health system. It is also a systematic way of considering the key determinants of effective coverage for interventions in order to identify problems and resolve them deliberately and in a timely manner.