1. Food Security Unit –PLG Feb 2004
Presentation by :
Dr Roohullah Shabon
Emergency Health & Nutrition
Specialist
Save the Children,
Emergency and Protection Unit,
Washington DC

2. SC Emergency Health & Nutrition
Program in Ethiopia
Tens of thousands of
people are estimated
to have died from
the food crisis in
Ethiopia and over 13
million are still
dependent on food
aid for survival.

3. SC Emergency Health & Nutrition
Program in Ethiopia
Save the Children-US Emergency
Health and Nutrition Program
(EHNP) aims at developing its
activities in an integrated approach
including health and nutrition. All
program activities are undertaken
with the goal of both immediate
humanitarian relief and long term
sustainable development.

4. Activities: Together with Government
and other agencies.
 Early Warnings System
 Collected, compile and analysis nutrition surveillance and
food security data.
 Revise and standardize early warning indicators and
parameters
 Conduct one-week rapid assessment of early warning
system.
 Rapid Assessments
 Conducted 13 Rapid Assessments and participated in two
Consolidated Appeals.
 Development of “Rapid Health, Nutrition and Food Security
Assessment Tools” , Rapid Assessments guideline and train
the staff.

5. Cont. Activities: Together with
Government and other agencies.
Nutrition Surveys
 Development of nutrition survey guidelines, training
of the staff and technical and/or financial support
provided to 17 Nutrition Surveys
Sub granting of Funds
 Funding has been provided to a total of 9
NGOs and 3 government agencies

6. Cont. Activities: Together with
Government and other agencies.
 Rapid Nutrition Response Programs
 At present running 6 TFCs, 1 NRU, 4 SFPs and 2 OTPs (Outpatient Therapeutic
Programme). A total of 4 CTC programs has been established by the
EHNP in Arbegona, Aroresa, Bensa and Hulla woredas.
 Admitted a total of 3,307 patients, of which 78.04% were cured.
 From March up to October 2003 , there were 725 severely malnourished
children in treatment.
 Handed over 5 TFCs; four to the government and two to local NGOs.
 Health Unit and W/S Units
The Units will strengthen the EHNP Project Units’ health promotion
efforts and build the local capacity of the regional/zonal MOH in
terms of therapeutic/supplementary feeding management, health
& nutritional surveillance, health and sanitation education and
malaria control.

7. Therapeutic Feeding Centre
The objective of TFC is
to reduce morbidity &
mortality associated
with severe
malnutrition & restore
health promptly in a
population of affected
areas.
As soon as the
numbers of severely
malnourished cases
are more than the
capacity of the health
facility, specific
structure like Nutrition
Rehabilitation Unit
(NRU) is set up within
the health facilities.
When this is not

8. The decision to open TFC is based on:
 Result of Nut. Survey and Rapid Assessment.
 The prevalence of Severe Acute Malnutrition (SAM)
in a random survey among children under five years
old is more than 3%.
 The prevalence of Global Acute Malnutrition (GAM) is
more than 10%.
 Under-five mortality rate is more than 2/10000 per
day.
 The absolute number of severely malnourished is
over 20 cases

9. Closure of TFC
 Decrease in TFC admissions over 2
consecutive months, and average number
of patients for the last two consecutive
weeks (14 days) less than 20 inpatients in
TFC
 Under five mortality rate < 2/10000 per
day
 Prevalence of Severe Acute Malnutrition
(SAM) < 3%
 Prevalence of Global Acute Malnutrition
(GAM) < 10 %

10. STAFFING PATTERN of TFC
 Nutritionist
 Nutrition workers
 Health workers
 Logisticians
 Cooks, cleaners, guards
 Outreach workers
 Health educators/social workers

11. Community-based Therapeutic Care
(CTC)
 Start with
supplementary feeding
from Sudan, Ethiopia
and Malawi, CTC is the
best means to quickly
respond to an
emergency situation
where there are high or
increasing levels of
severe malnutrition.
 The CTC concept aim to
integrate emergency
nutrition with long-term
programs by establishing
structure that can be re-
activated in future
emergencies.

12. The main principles of CTC are
 Coverage
 Access
 Timeliness
 Sectoral integration
 Capacity building

13. CTC has the following elements:
 Therapeutic Feeding Centre (known as a
Stabilisation Centre (SC) in our program):
 The TFC will be only for severely malnourished
children who are not well enough to be treated at
the OTP site. They will be treated as inpatients until
their condition is stable enough for them to be
discharged home (normally 5-10 days). Some
children will not respond to treatment at the TFC
and will need to be referred to hospital.
 Supplementary Feeding Programmed (SFP):
 This is made up of a two-weekly dry ration of Famix
or CSB, health education and very basic medical
care in collaboration with existing health facilities

14. CTC has the following elements
continue:
 Outpatient Therapeutic Programme
(OTP): There will be an OTP at every SFP
distribution site. This is where the
majority of severely malnourished
children will be assessed and treated.
 Outreach work. The community
element of the CTC program must be
strong in order to mobilize
mothers/caretaker to bring their child to
the SFP/OTP for screening.

15. Management Phases of CTC:
 Stabilisation phase
 This is the initial
phase of treatment of
severe malnutrition
with complications as
inpatient in
stabilisation centre
(previous TFC):
 life-threatening
problems are
identified and treated
 specific deficiencies
are corrected
 metabolic
abnormalities are

16. Stabilisation phase
 Target group:
 Children with
severe malnutrition
with complications
 Treatment
 According to WHO
protocols for the
initial phase of the
treatment of
severe malnutrition
with complications

17. Outpatient Therapeutic Programme
(OTP)
 2 groups of admissions:
 Direct OTP
 Indirect OTP
 Direct to OTP
 People with severe
malnutrition with no
complications
 Admitted directly into OTP
with no stabilisation phase
 Indirect to OTP
 People who previously has
severe malnutrition with
complications admitted into
OTP after discharge from
Stabilisation Centres

18. OTP treatment
 RUTF (Ready Use
Therapeutic
Feeding) every
week or two weeks
 Systematic
medication
 Direct OTP
 Amoxicillin
 Vitamin A, Folic
Acid
 Mebendazole
 Anti-malarial
 Vaccination

19. Supplementary Feeding Programme (SFP)
 Dry take home supplementary ration
 Basic health care
 De-worming
 Vit A
 Measles
 Consultation and appropriate referral if
necessary
 Admission criteria same as WHO

20. Advantage of CTC
 CTC programs bring treatment out of the
center and to the peripheral areas. Thus
greatly increasing coverage.
 CTC programs are not meant to replace
TFCs but to complement and integrate
them into a larger, more accessible, and
holistic program that allows better follow-
up of patients.

21. Contin. Advantage of CTC
 Integrates with food security programmes
 Shared trainings, workers
 Demonstration gardens
 Promotion of crops for local RUTF
 Includes local production of RUTF where
appropriate
 Wide range of linkages to key social
structures, key individuals
 Mother to mother techniques for
education and increasing participation

22. 3. What is the difference of CTC & TFC
 TFC
 24 care centre based
 Food targeted to the child
 Use F100 and F75
 Close/continuous follow-
up
 Quick weight gain
 More widely understood &
accepted
 High cost
 Cross infection
 Decrease household
economy-mothers away
20 days
 Good for patients with
complication dehydration
and septicaemia.

23. What is the difference of CTC & TFC
 CTC
 Stay in the household and
community based
 Empowering the family
 Mother to mother support
with PDI approach
 Use Ready to Use Therapeutic
Food (RUTF)
 Treating malnutrition where it
occurs
 More Coverage
 Community awareness and
participation lead to address
food insecurity
 Evolvement from emergency
to development and vice
versa
 Study/Sphere:85% (75)
Cure,4.1(10) Death,4,7(15)
Default

24. Challenges to the CTC approaches :
 Logistics-distance, weather, etc making
outreach somewhat difficult
 Lack of capacity and understanding in the
government makes sustainability & exist
strategy shaky
 Resource intensive operation and need
functional health centres system
 CTC being new approach acceptability by
partners is questioned