Community-Based Management of Acute Malnutrition (CMAM) Surge

This page has been created as a point of reference on the CMAM Surge Approach, to support practitioners to adapt, set-up, and implement the Surge approach. It includes tools, orientation guides, evaluations and publications. Given the rapid scale up of the approach across increasingly diverse contexts, there is a need to ensure that technical integrity is maintained and that learning is captured and used to further strengthen and refine the approach. This repository of information aims to facilitate this community of learning, which is supported by taskforces/technical working groups at a global, regional and national level.  

The CMAM Surge Approach was designed to help health systems more effectively deliver services for children with acute malnutrition. The approach is based on the observation that in many contexts the number of children seeking treatment for acute malnutrition tends to peak during certain months of the year. These seasonal ‘surges’ in demand are driven by many overlapping factors, including, for example, the pre-harvest hunger gap, increased incidence of malaria or diarrhoea during the rainy season, women’s workload patterns, and movements associated with grazing livestock. It is during these caseload surges that the potential to save lives is greatest, yet government health systems and the wider humanitarian sector are often not able to provide timely, effective response.

The CMAM Surge approach complements routine CMAM services by improving health staffs’ use of facility data and knowledge of the local context to better anticipate, plan for, respond to, and bounce back from these increases in demand for acute malnutrition treatment services. 

The CMAM Surge approach uses eight steps to help government health teams respond to relative changes in capacity and caseloads. The eight steps are summarised below.

The status of each health facility is also monitored by the higher-level health authority (e.g. district health management team) that can, in turn, monitor trends across a wider geographic area and call for higher-level regional or national response if the situation continues to deteriorate. The same 8 steps can be used to set up Surge at a district level.

The Health Surge approach aims to strengthen health facilities management capacity and contribute to reinforcing health systems. It applies the 8 CMAM Surge steps to other morbidities and was first piloted in Sierra Leone in 2017. The focus is largely on managing caseloads of child wasting, malaria, diarrhoea, and acute respiratory infection (ARI), as these tend to fluctuate most throughout and between years.

Health Surge supports the real-time monitoring by MoH staff of their health facility data of key illnesses and capacity changes so that the planning and allocation of resources to address caseload and capacity fluctuations can be flexible and occur before a health facility is overwhelmed.

Key learning documents on the Health Surge approach, outlining progress and countries of implementation, can be found in the Learning and Evaluations section below.

CMAM Surge is currently being implemented in 12 countries with technical assistance to governments provided by multiple NGO and UN partners. Concern has introduced and supported implementation of the CMAM Surge approach in more than six country programmes. The map below illustrates to the best of our knowledge where the CMAM Surge approach has been implemented. Please contact cmam.surge@concern.net if you have any updated information.

Concern developed CMAM Surge Global Guidance documents in 2016 to support the implementation of CMAM Surge. The core knowledge documents are available for download below.

It is strongly recommended that the tools are adapted to the local context, and align with pre-existing health and nutrition guidance. It is planned that these global guidance documents will be updated in 2022. Please refer to the learning documents for additional considerations and lessons learned in setting up CMAM Surge.  

Since the first CMAM Surge pilot in Kenya in 2012, a wealth of experience and learning across a variety of contexts has been generated. Concern has supported several learning reviews and evaluations of the CMAM Surge approach in order to inform adaptations of the approach as well as investment in scale-up. Some key resources are available for download below. 

In 2021, a series of articles were published on CMAM Surge in the Emergency Nutrition Network’s (ENN) Field Exchange journal. This seven article series summarises the key lessons learnt over the past eight years and the way forward for the Surge approach. The full articles can be found on ENNs website:

1. CMAM Surge – Setting the Scene
2. Implementing IMAM (CMAM) Surge approach – experience from Kenya
3. The role of coordination in CMAM Surge scale-up in West and Central Francophone Africa 
4. CMAM Surge – understanding costs and potential contribution to CMAM’s cost-effectiveness
5. Expanding CMAM Surge beyond nutrition – towards a broader Health Surge approach
6. CMAM Surge: lessons on the journey so far

In addition, Concern has provided technical support and collaborated with a number of key stakeholders in the production of other learning resources:

Concern chairs the Global CMAM Surge Technical Working Group (Global TWG). The purpose of the Global CMAM Surge Technical Working Group is to ensure coordination of CMAM Surge activities to maximise quality, effectiveness, and learning. The membership includes a diverse group of CMAM / Health Surge stakeholders including Ministry of Health representatives, donors, and NGOs. The Global TWG was established in October 2020, and will remain operational until September 2022. 

Concern is co-lead of the West Africa Region CMAM Surge Taskforce with the French Red Cross (CRF). The role of coordination in the CMAM Surge scale-up in West and Central Francophone Africa is described in an article for Field Exchange. Since 2021, rather than routine coordination meetings, learning webinars have been organised. A summary of the 2021 webinars is available below.

National level CMAM Surge Taskforces have also been established in Mali and Niger. Led by Save the Children and Concern Worldwide respectively, in collaboration with Ministries of Health. 

Contact us

If you have any question related to CMAM Surge, please contact: cmamsurge@concern.net 

This publication covers aid activities implemented with the financial assistance of several donors, including the European Civil Protection and Humanitarian Aid Operations Department (ECHO), USAID, Irish Aid and others. The ideas, opinions and comments herein are entirely the responsibility of the author(s) and do not necessarily represent or reflect the policies of any donors.