Community-based management of acute malnutrition (CMAM) in sub-Saharan Africa: Case studies from Ghana, Malawi, and Zambia

Background. Recent success with community-based management of acute malnutrition (CMAM) has spurred interest on how to improve coverage while maintaining treatment outcomes. Objective. To document, as case studies, the experience of three African countries, Malawi, Ghana, and Zambia, in scaling up CMAM. Methods. Desk review using published and unpublished data and country programmatic data and key informant interviews. Results. All three countries, with different motivations for startup, have successfully integrated CMAM into their essential health packages for children under 5 years of age, at least in their policy and strategic documents. Strong leadership by the ministries of health has been instrumental, complemented by key stakeholders and donor partners. Implementation is at variable stages, depending on when the program rolled out, with Malawi having achieved the most integration, followed by Ghana and Zambia. Using CMAM, the three countries have significantly extended service coverage and improved treatment outcomes, with cure rates ranging from 73% in Ghana to 90% in Malawi, while maintaining very low death rates: 1.7% in Malawi, 2% in Ghana, and 5% in Zambia. Conclusions. CMAM is a viable option to improve service coverage and outcomes in health systems where inpatient therapeutic care alone cannot suffice.