For the past two decades, the nutrition situation in the Democratic Republic of Congo (DRC) has been critical. While national prevalence of global acute malnutrition (GAM) has fallen significantly from 16% in 2001 to 9% in 2014, there are areas of high wasting prevalence at provincial level, such as Maniema Province (22%), Bas-Congo (11%) and ranging from 3.5% to 9.8% in other provinces. About two million children aged 6 to 59 months are wasted (PRONAUT, 2015). An estimated 15% to 20% of severe cases are covered by the Integrated Management of Acute Malnutrition (IMAM) service available in 420 of 516 health zones (Ministère de la Santé Publique, 2016); IMAM is available in three to four out of 20 health centres in a given zone and service continuity may vary. There has been no evaluation of national SAM treatment coverage.
In order to better monitor the nutritional situation and promptly identify nutritional crises in the DRC, a system of nutritional surveillance, the Food Security and Early Warning system (SNSAP) was piloted in 2009 and established by the National Nutrition Programme (PRONANUT) at the end of 2010. In this context, from 2009 to 2010, COOPI managed an emergency intervention, the Nutritional Pool in DRC (PUNC), funded by UNICEF. This involved a mechanism to detect and quickly respond to a nutritional crisis, with a three-month follow-up/intervention period. This proved very difficult in practice, given the limited intervention period to treat malnourished children without a strong exit strategy. To address these obstacles a new project, Scaling up Nutrition, was developed in 2011, funded by UNICEF (UNICEF, 2013). This involved the use of SMART (Standardised Monitoring and Assessment of Relief and Transitions) surveys conducted by PRONANUT and an 18-month planned intervention period in all areas identified with a GAM prevalence >15%. However, this approach lacked the flexibility that characterised PUNC to react and scale up response to new nutritional crises.
Given this, the Rapid Response to Nutritional Crisis Project (RRCN) was established in 2013 by COOPI, funded by the Humanitarian Aid and Civil Protection of the European Commission (ECHO) through UNICEF, and has become part of the national health policy and strategy. Given that malnutrition is recurrent in several health areas, the RRCN integrates water, sanitation and hygiene (WASH) components (as reflected in the ‘Wash in Nut’ strategy that is national policy), and has a better exit strategy, which involves strengthening the capacity of the health authorities to treat and prevent SAM. The target population is acutely malnourished children aged six months to five years and adults (particularly pregnant and lactating women (PLW).