Innovation history of the CMAM Surge approach - Towards a shock-responsive health system in Kenya

Abstract

Executive summary Given the increasing incidence of shocks, from droughts to COVID-19, and the weak capacity of most health systems to adequately respond to them, there is an urgent need to develop and scale up health system innovations that build shock-responsiveness. The Community-based Management of Acute Malnutrition (CMAM) Surge approach is one such innovation that aims to build the responsiveness of government health systems to seasonal and shock-related surges in demand for nutrition services in low-income contexts. Essentially, CMAM Surge involves health facilities setting thresholds (‘normal’, ‘alert’, ‘alarm’, and ‘emergency’) for acute malnutrition caseloads, based on a self-diagnosis of their capacity; monitoring trends in caseloads against these thresholds; and actioning internal health facility surge actions or seeking support from higher levels of government, the United Nations Children’s Fund (UNICEF), or non-governmental organisations (NGOs) when higher thresholds are crossed. This working paper advances the current knowledge on CMAM Surge (which is limited to country evaluations and perspective articles) by conducting an innovation history analysis of the approach, to understand the enablers of, and barriers to, its emergence and development; and its perceived potential (and limits) for building health system shock-responsiveness in Kenya. Developing this innovation history involved analysing the memories, reflections (through interviews), and documents of key implementing stakeholders in Kenya and internationally. Data were analysed using a widely applied social innovation conceptual framework that identifies six phases to a social innovation (Murray et al., 2010): diagnoses and prompts; proposals; piloting; scale-up; sustaining; and system change (towards a shock-responsive health system). The findings provide critical insights that can inform the scale-up of CMAM Surge to new contexts, improve the shock-responsiveness of CMAM Surge in Kenya, and guide the development of emerging adaptations to CMAM Surge, such as Health Surge, which seeks to adapt the surge approach principles and tools to build the shock-responsiveness of the entire health system.