Formative evaluation of Integrated Management of Acute Malnutrition (IMAM) initiative

IMAM is a public health approach to address acute undernutrition emphasising community participation, active case finding and high treatment coverage enabling access to a continuum of care for children with severe (SAM) or moderate acute malnutrition (MAM) and for Pregnant and Lactating Women (PLW) with MAM. For children with acute malnutrition without medical complications treatment is given at community-based health facilities, and for those with complications at inpatient hospital facilities. Initially implemented as a vertical programme for the treatment of SAM within hospitals and community-based health facilities, IMAM was integrated into the Basic Package of Health Services in 2010 and Essential Package of Hospital Services in 2014, and implemented for the MoPH by local NGOs, the BPHS and EPHS contract holders. This integration into public health structures was accompanied by the development of national guidelines for IMAM. These integrated the treatment of children with MAM or SAM into OPD and IPD in 2014, and were endorsed by the Government of Afghanistan, UN agencies and BPHS / EPHS partners under the coordination.

This is the first formative evaluation of Integrated Management of Acute Malnutrition (IMAM) in Afghanistan. It has been undertaken to gather evidence on the processes and results of IMAM and serves the information needs of both primary and secondary audiences involved in the assessment and management of malnutrition in Afghanistan. The evaluation examines IMAM services from 2013 to 2019 which coincides with the IMAM scale-up and the National Public Nutrition Strategy 2015-2020. IMAM is evaluated for its relevance, efficiency, effectiveness, coverage and sustainability and provides recommendations to inform effective programme implementation.

The evaluation was conducted using mixed methods and participatory approach, generating quantitative and qualitative data and using a variety of sources to enable triangulation.