CASE STUDY ON IMAM SURGE MODEL
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A case study is an individual’s story. It tells the reader how Save the Children’s work has
made a difference in the life of a child or his/her family.
1. Background: Please provide basic information about the interviewee(s).
Name(s), gender, age:
Dennis Orina
Location –village/town,
Nurse in charge Sarman Dispensary, Tarbaj Sub county,
district/province and country: Wajir County.
Keywords – themes:
USE OF HEALTH FACILITY BASED IMAM
SURGE MODEL AS AN EARLY WARNING TOOL
2. Summary: Please describe the interviewee’s day-to-day life and environment.
Dennis is the nurse in charge for Sarman dispensary in Tarbaj sub county. In addition to
Sarman community, he serves two outreach sites Kabatula and Berjanai on biweekly basis.
Sarman has for many years served as the settlement place for internally displaced persons
who flee their homes in Gunana, Burmayo, Dunto and many other places in Wajir county
has a result of inter clan conflicts. This was experienced last year (2014) where the IDPs
camped in the area until February this years (2015). As the only nurse in the facility, Dennis
served all these populations tirelessly ensuring each gets adequate basic health care.
3. The story: Interviewee’s story in his or her own words. Please use exact words
with direct quotes.
Surge model has increased awareness of our nutrition situation and enabled us to respond to situations
before they worsen. Now I’m able to interact with my data and interpret it according to the set thresholds.
The facility didn’t have a store for IMAM commodities but through surge support package SCI constructed
a store for the facility. We are very thankful. In terms of drawing the graphs, I’m very happy that not much
space will be occupied by the combined graphs. Everything is already done for me, all I need to do is plot
the cases, calendar of events and activities carried out.
Previously used manila papers which occupied lots of
space and took lots of time to draw
Modified three graphs in one
4. Wider context
4.1 Program summary and background information.
Save the Children in colaboration with the Department of Health visited Concern
worldwilde supported health facilities in Marsabit and Moyale on a learning mission in June,
2014. The main objective of the mission was to orient themselves on health facility IMAM
surge model concept which have been implemented in the area since 2011. The concept
aims at strengthening the capacity of government health facilties to handle increasing IMAM
cases without undermining undergoing services. It improves on preparedness and acts as an
early warning system where health workers are able to detect a deteriorating situation and
act before it gets out of hand. After the learning visit to Moyale and Marsabit, program staff
from Concern Worldwide trained county health management teams and sub county
management teams in Wajir county. During this training, 12 pilot facilties were selected in
Wajir Eas, Wajir South and Tarbaj sub counties. Sarman dispensary was selected as one of
the pilot facilties. SCHMTs and SCI representative visited the facility, took the nurse and
three CHWs through surge model and its components. Among them were risk analysis,
threshold setting, monitoring agaist the thresholds/triggering surge support, provision of
surge support and scaling down of surge support. Below are thresholds set at the facility
considering the number of staffs, catchemnt population, the capacity of health workers,
number of patients consulting per day and time take to consult with one client.
PHASE
NORMAL
ALERT
SERIOUS
OTP
0-5
6-10
11-15
SFP
0-5
6-10
11-15
EMERGENCY
>15
>15
4.2 Follow-up:
Is the individual in the beginning, middle or end of an
activity/program with Save the Children?
After pilot training, Save the Children and the DOH have been doing regular follow ups at
the facility to assess the progress of the program and provide surge support where required.
As a result of high number of IDPs in Sarman, during the months of September, October,
November, 2014, MAM cases went to emergency and SCI responded by constructing a store
to increase storage space to accommodate RUTF for the increasing cases. As a follow up the
cases for SAM, MAM, diarrhoea and pneumonia are as follows.
MONTH
2014/2015
August
September
October
November
December
January
February
March
April
SAM
MAM
Diarrhoea
Pneumonia
15
8
9
0
7
6
11
15
10
12
44
33
20
0
7
17
49
20
12
18
14
24
10
28
21
14
16
9
23
9
16
5
0
2
13
3
4.3 Family, community leader, health worker, teacher, partner etc. quotes.
Please ensure that you have the correct names, (job) title and organisation for
each person quoted.
“Before the concept of surge model was introduced, no one bothered to analyse their
results. I personally could compile my reports and sent to the SCHIRO and that’s the end.
With surge model, I am able to interrogate my reports and stay alert to changing situations.
When I communicated to SCHMTs and SCI representatives that my SFP cases are increasing,
they constructed a store for me and now I have enough space for my IMAM ration. When
surge model was piloted, manila papers were used for all graphs (calendar of events, monrhly
cases and MOH/SCI interventions). This consumed a lot of time and occupied a lot of space
in the facility. With the flossy paper graphs, only limited space is consumed since three
graphs are combined in one. Time spend drawing graphs is reduced the graphs are already
designed. Ours as health workers is just to plot’’.
5.1 Overall impact: Please explain how Save the Children addressed the
challenges/problem and describe the results.
Save the Children have established that each facility is different and is affected differently by
calamities. Malnutrition rates (GAM) have always been generalized per sub county. With
introduction of surge model, malnutrition rates are being monitored at the facility level.
Health facility staffs are able to assess their nutrition status and respond before the situation
gets out of hand. With the set thresholds at each health facility, health workers are aware of
the activities to conduct at each phase (Normal, Alert, Serious and Emergency).
5.3 Voice: Please describe if you have been able to advocate for better practices
and policies or ensure children’s voices are heard.
Children have always been at the centre stage for Save the Children’s agenda.
5.4 Partnerships: Please describe if you have been able to cooperate with or
build partnerships through this program.
Save the Children is doing indirect implementation through partnership with Department of
Health. In addition to DOH, other line ministries like Ministry of Agriculture and that of
water are among government partners Save the Children is working with. SCI also builds its
partnership through working with other NGOs like Islamic Relief Kenya.
6. Child protection and consent issues
6.1 Please confirm that you have followed Save the Children child protection policies and
have completed full consent forms for the child and/or family, and every individual you have
quoted and photographed.
Tick box to confirm: Yes
7. Case study reference information
Interviewer:
Angela Kithua
Photographer:
Angela Kithua
Humanitarian response code (if applicable)
Approved
for
use
by:
Approval for use is given by the Country Office.
Date:
8/06/2015
Instructions for further use/further permissions required: When using this case study, please
do not change any of what is written here.