Unveiling Barriers and Boosters: Assessing Reach and Access of the Integrated Management of Acute Malnutrition Programme in Jhapa District, Koshi Province, Nepal

Background: Acute malnutrition is one of the leading underlying causes ofmorbidity and mortality among children under 5 years of age. To address this issue,Nepal Government introduced Integrated Management of Acute Malnutrition(IMAM) programme. However, limited evidence on its coverage and accessibilityraises serious concerns about effectiveness of the programme. The study aimedto identify the barriers and boosters affecting the programme coverage and toestimate the programme coverage of Jhapa district along with developing the planof action for improving the programme interventions to increase coverage andaccessibility of the programme.Methods: The study adopts a semi quantitative evaluation of access and coverage(SQUEAC), a mixed method which combines routine programme data, qualitativedata through interviews and focus group discussions, direct observations andsmall area surveys.Results: The assessment identified 17 boosters and 24 barriers. The barriersincluded poor coordination, outdated tools, poor record maintaining, lack ofrefresher training, and low community awareness, while boosters included,trained staff, effective counselling, and regular growth monitoring. Overallcoverage found to be 34.4%, with a confidence interval ranging from 23.2% to47.9%. Point and period coverage calculations based on survey data revealed apoint coverage of 15.8% and a period coverage of 27.3%.Conclusion: The IMAM programme in Jhapa shows the coverage is lower thanthe global benchmarks indicating that the programme needs the intervention toimprove the systemic challenges for increasing the coverage and access.