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Treating the Severely Malnourished: The Community Therapeutic Care (CTC) Approach
What is CTC?
CTC is a community-based approach of care for managing large numbers of acutely malnourished people in times of stress. The CTC approach treats the majority of the severely malnourished at home and uses outreach teams to promote community participation and behavioral change. CTC aims to build community capacity to manage and to better respond to repeated cycles of relief and recovery. Providing appropriate therapeutic foods containing the right mix of nutrients that will aid in recuperation is central to the home-based care of the severely malnourished. Ready to use therapeutic foods (RUTF) have been specially designed for the treatment of severe acute malnutrition. RUTF can be manufactured locally thereby increasing availability and reducing costs.
What is the CTC program?
The CTC program is a three year, multi-donor funded program. The donors include Irish AID, Concern Worldwide, the Canadian International Development Agency (CIDA), the World Health Organization of the United Nations (WHO), and the US Agency for International Development (USAID) through FANTA. The CTC program is managed by Valid International. In the field, the CTC program is implemented by NGOs such as Concern Worldwide and Save the Children in three countries (Sudan, Malawi, and Ethiopia). As part of this program, a multi-disciplinary team working under the direction of Valid International is conducting operational research (also known as Monitoring Effectiveness). Valid and its partners are conducting specific studies to:
Monitor factors affecting quality, impact, efficiency, effectiveness and cost of the CTC model in different contexts;
Collect quantitative and qualitative data that will allow evaluation against internationally recognized standards as well as to highlight critical implementation issues;
Investigate the feasibility of local production of RUTF to reduce costs and increase sustainability;
Research alternative culturally appropriate RUTF formulations; and
Compare the CTC model with standard TFC models of care for managing acute malnutrition.
Why is there a need for a new approach to managing acute malnutrition?
Most nutrition programs typically depend on in-patient Therapeutic Feeding Centers (TFCs) as the sole mode of intervention for managing the acute malnutrition. However, inpatient care is not needed for the majority of cases without complications. It is important to recognize that acute malnutrition is not only a clinical condition but a problem with economic, psychological and social elements. The medical emphasis in the TFC model of care does not take account of these aspects of the problem and thus may inadvertently aggravate the situation. TFCs are difficult to establish, expensive to operate, and they often have very limited coverage. TFCs do not build on the capacity of the community, and at times, they can undermine traditional coping strategies. Mothers or caregivers are often required to stay with their malnourished children for 3 weeks or longer in the TFC. Such a demand has tremendous opportunity costs and disrupts family life. The congregation of people in and around feeding centers can lead to the spread of infection, an important cause of mortality and morbidity during famine. The CTC model aims to address these issues by providing outpatient care when medical complications are not present.
Community-based Therapeutic Care (CTC): A Field Manual, October 2006
Community Therapeutic Care PowerPoint presented by Dr. Steve Collins, Valid International
Community Therapeutic Care (CTC) Workshop in Dublin, October 2003
ENN's Field Exchange, Issue 19/July 2003
