title: Sustainability and scaling-up analysis of community-based management of acute malnutrition: lessons learned from Burkina Faso.
abstract: BACKGROUND
  Community-based management of acute malnutrition (CMAM) is an effective strategy frequently implemented by nongovernmental organizations, but handing CMAM over to national health systems and scaling it up remains a great challenge.
  
  
  OBJECTIVE
  To highlight the challenges to sustainability and scalability of a CMAM program in Burkina Faso.
  
  
  METHODS
  We conducted a review of program reports to evaluate program performance and conducted individual interviews with key informants (health system fieldworkers and officials and program staff members) and focus group discussions with beneficiaries (mothers whose children were attending the program, community volunteers, and village leaders) to analyze the required conditions for scaling up using ExpandNet recommendations.
  
  
  RESULTS
  The program coverage rate was 90% among children under 5 years of age in the 180 intervention villages. Between June 2007 and December 2010, 19,009 cases of acute malnutrition (AM) among children under 5 years of age were treated, of which 4,308 (22.7%) were cases of severe acute malnutrition (SAM). The recovery rate was 89.4% for moderate acute malnutrition (MAM) and 86.5% for SAM. The case-fatality rate was 2.8% for MAM and 4.2% for SAM. The default rate was 7% for all cases. The prevalence of SAM decreased between 2008 and 2009 from 5.4% to 1.8%. Barriers to sustainability and scaling up were underlined: management by external personnel from the health system, no financial support for the scaling-up process, insufficient national advocacy, and nonsustainable activities (e.g., free care).
  
  
  CONCLUSIONS
  The CMAM program was effective, but the handover conditions and scaling-up requirements were unsatisfactory. We identified poor integration into the health system, lack of resources, and insufficient advocacy.
authors.affiliation: Centre de Recherche en Politiques et Systèmes de Santé - Santé Internationale Ecole de Santé de Publique, Université Libre de Bruxelles, CP 594, Route de Lennik 808, 1070 Brussels, Belgium. ysomasse@ulb.ac.be
authors.forename: Yassimè Elysée
authors.initials: YE
authors.lastname: Somassé
authors.forename: Paluku
authors.initials: P
authors.lastname: Bahwere
authors.forename: Samia
authors.initials: S
authors.lastname: Laokri
authors.forename: Nazia
authors.initials: N
authors.lastname: Elmoussaoui
authors.forename: Philippe
authors.initials: P
authors.lastname: Donnen
mesh_terms: D000208:Acute Disease; D002050:Burkina Faso / Q000453:epidemiology; D002675:Child, Preschool; D003153:Community Health Services / Q000379:methods* / Q000706:statistics & numerical data; D006293:Health Promotion / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D044342:Malnutrition / Q000453:epidemiology* / Q000628:therapy*; D015397:Program Evaluation / Q000379:methods / Q000706:statistics & numerical data