(download Guerrero-Access for All-2013)

“In little over four decades, SAM treatment has gone from a small-scale clinical endeavour to a global public health service reaching over two million cases a year. Much of this scale-up has occurred in the last decade following the introduction of community-based SAM treatment approaches.

“Since the rapid-scale up of such community-based approaches, however, there have been few overarching reviews of their performance over time. This report, the first in a three part series, offers a comparative assessment of the performance and effectiveness of the model during two distinct periods of its development: from 2001-2006 when the majority of community-based treatment projects were implemented by NGOs; and from 2007-2013 when many community-based treatment programmes were integrated by ministries of health into regular health services.

“For each period, three components of the community-based treatment model are assessed: the capacity of treatment services to successfully cure SAM cases, their capacity to reach the highest proportion of the affected population (coverage) and their cost-effectiveness.

“The report has Three main conclusions:

• “Community-based treatment models deliver exceptional clinical outcomes. The median cure rates of community based models in the 2001-2006 and 2007-2013 periods were 80% and 84% respectively. SAM cases admitted into treatment services today are as likely to be successfully cured today as they were a decade ago.

• “In areas where SAM services are available, only a third of affected cases actually access treatment. The analysis shows that whilst high coverage can be achieved by community- based SAM treatment, the conditions necessary to do so are seldom met. The capacity of treatment services to meet global SAM needs depends on coverage being significantly and consistently improved.

• “Community-based models are more cost-effective than in-patient models. Cost-effectiveness analyses show that some community-based models were two times more costeffective than in-patient models. In spite of their dependency on context-specific operational factors, recent evidence suggests that MoH delivered community-based SAM treatment services continue to be cost-effective interventions.”