Introduction
This review is concerned with the financing arrangements for programmes that address acute malnutrition at scale through the community-based management of acute malnutrition (CMAM). The CMAM approach is geared towards the early detection, treatment and counselling of moderately and severely acutely malnourished children, in the community, by community agents.
Until the late 1990s, treatment of severe acute malnutrition (SAM) was through therapeutic feeding centres in hospitals and healthcare centres. Performance was poor, coverage was extremely limited (less than 5% of the SAM population), mortality was often in excess of 30% and recovery rates were low. The CMAM approach was first piloted in Ethiopia in 1999 as an alternative to the centre-based model.
Development of the approach offered the prospect of dramatically increased access to successful treatment and coverage.
CMAM has been adopted in over 65 countries. In 2011, just under two million children under five years of age with SAM were reported as being admitted to CMAM programmes, compared with just over one million in 2009.1 While this large increase partly reflects improved reporting, it is also indicative of the ongoing scaling up of treatment of SAM. Even so, total reported admissions represent just 10–15% of the estimated 20m global SAM cases annually.