One of the most important elements behind the success of the Community-Based Management of Acute Malnutrition (CMAM) model of service delivery is its proven capacity for achieving and sustaining high levels of coverage over wide areas.

Two-stage cluster sampled surveys have been used to estimate the coverage of selective feeding programs. This approach suffers from several important limitations. In response, Valid International, Concern Worldwide, and the Food and Nutrition Technical Assistance Project (FANTA) developed a new survey method for estimating the coverage of selective feeding programs. This survey method, known as the Centric Systematic Area Sampling (CSAS) method, uses a combination of stratified and systematic area sampling and active and adaptive case-finding.

The CSAS survey method provides a rich set of information about program coverage. In particular, it provides a ‘headline’ estimate of overall program coverage, a map of the spatial distribution of program coverage (Figure 1), and a ranked list of program-specific barriers to service access and uptake (Figure 2).

 

 
The CSAS method is, however, resource intensive. This has led to a tendency for it to be used for program evaluation rather than for day-to-day program planning and program monitoring purposes. The results of CSAS surveys have, therefore, often been able to explain why a particular program failed to achieve a satisfactory level and spatial pattern of coverage, but this information has tended to arrive too late in the program cycle to institute effective remedial action.

The CMAM model of service delivery is now being adopted in developmental and post-emergency settings. Programs in these settings tend to suffer from considerable resource scarcity compared to emergency-response programs implemented by non-governmental organisations (NGOs). There exists, therefore, a need for low-resource methods capable of evaluating program coverage, identifying barriers to service access and uptake, and identifying appropriate actions for improving access and program coverage. This toolkit describes the semi-quantitative evaluation of access and coverage (SQUEAC) method and how it can be used to investigate and improve three aspects of CMAM programs: effectiveness, coverage, and ability to meet need.