PT  - JOURNAL ARTICLE
AU  - Kauchali, Shuaib
AU  - Puoane, Thandi
AU  - Aguilar, Ana Maria
AU  - Kathumba, Sylvester
AU  - Nkoroi, Alice
AU  - Annan, Reginald
AU  - Choi, Sunhea
AU  - Jackson, Alan
AU  - Ashworth, Ann
TI  - Scaling Up Improved Inpatient Treatment of Severe Malnutrition: Key Factors and Experiences From South Africa, Bolivia, Malawi, and Ghana
AID  - 10.9745/GHSP-D-21-00411
DP  - 2022 Apr 28
TA  - Global Health: Science and Practice
PG  - e2100411
VI  - 10
IP  - 2
4099  - http://www.ghspjournal.org/content/10/2/e2100411.short
4100  - http://www.ghspjournal.org/content/10/2/e2100411.full
SO  - GLOB HEALTH SCI PRACT2022 Apr 28; 10
AB  - Key FindingsWe report our “how-to” approaches and lessons learned from scaling up implementation of the World Health Organization (WHO) guidelines on inpatient treatment of severe acute malnutrition within routine health services in 4 countries.Substantial improvements in survival were evident within a few months of guideline implementation, but it took many years to improve treatment practices at scale.We show that the WHO guidelines are scalable to a national level, and their effectiveness in improving survival appears to be retained at scale. Key features for success include collaborations to build capacity and undertake operational research and advocacy for guideline adoption; specialist teams to mentor and build confidence and competency through supportive supervision; and political commitment and administrative policies for sustainability.Key ImplicationsPolicy makers, health professionals, and their national societies should bring together all the talent available and establish alliances such as communities of practice to implement and scale up WHO malnutrition treatment guidelines and use new opportunities such as eLearning to build workforce capacity.Health educators should review medical and nursing curricula and re-align pre-service training so that it is fit-for-purpose and competency-based for effective practice.Severe acute malnutrition (SAM) can have high mortality, especially in very ill children treated in the hospital. Many medical and nursing schools do not adequately, if at all, teach how to manage children with SAM. There is a dearth of experienced practitioners and trainers to serve as exemplars of good practice or participate in capacity development. We consider 4 country studies of scaling up implementation of WHO guidelines for improving the inpatient management of SAM within under-resourced public sector health services in South Africa, Bolivia, Malawi, and Ghana. Drawing on implementation reports, qualitative and quantitative data from our research, prospective and retrospective data collection, self-reflection, and our shared experiences, we review our capacity-building approaches for improving quality of care, implementation effectiveness, and lessons learned. These country studies provide important evidence that improved inpatient management of SAM is scalable in routine health services and scalability is achievable within different contexts and health systems. Effectiveness in reducing inpatient SAM deaths appears to be retained at scale.The country studies show evidence of impact on mortality early in the implementation and scaling-up process. However, it took many years to build workforce capacity, establish monitoring and mentoring procedures, and institutionalize the guidelines within health systems. Key features for success included collaborations to build capacity and undertake operational research and advocacy for guideline adoption; specialist teams to mentor and build confidence and competency through supportive supervision; and political commitment and administrative policies for sustainability. For frontline staff to be confident in their ability to deliver appropriate care competently, an enabling environment and supportive policies and processes are needed at all levels of the health system.