13. Percentage of moderate acute malnutrition cases reached by management services (coverage)

13. Percentage of moderate acute malnutrition cases reached by management services (coverage)

VERSION

V5.0 - 2026.03 — Existing

INDICATOR CODE

13

TECHNICAL OWNER

PRG-S Nutrition

INDICATOR TYPE

Country Level Outcome Indicator

INDICATOR CLASSIFICATION

Mandatory

INDICATOR SCOPE

Programme specific

APPLICABILITY

The selection of this indicator is mandatory against the following sub-activities in CSPs logframes. Selection of the below sub-activities will trigger in COMET the mandatory selection of this indicator:

1. Management of moderate acute malnutrition/undernutrition (MAM)

   
   

UNIT OF MEASUREMENT & ANALYSIS

Percentage of individuals

DEFINITION

This indicator measures the coverage of management services for wasting by assessing the proportion of individuals identified with moderate acute malnutrition (MAM) who are receiving management services for wasting through WFP-supported programmes, relative to the total number of individuals eligible for such services within a defined geographic area and reporting period.

Below are some key terms for this indicator:

Coverage: Refers to the proportion of individuals identified with moderate acute malnutrition (MAM) who are receiving management services for wasting, compared to the total number of individuals estimated to be in need of such services within the target population and geographic area during the reporting period.

Eligibility: Determined according to the nationally endorsed MAM case definition, aligned with global guidance and based on approved anthropometric criteria and/or the presence of bilateral pitting oedema (where applicable), and consistent with national protocols for the management of wasting.

Total eligible: The estimated total number of individuals meeting the nationally approved MAM case definition within the defined population and geographic area. This figure is typically derived from population data and prevalence estimates (e.g., SMART surveys or other validated sources) and consolidated through national cluster coordination mechanisms.

Moderate Acute Malnutrition (MAM): A form of acute malnutrition (wasting) defined, for children 6–59 months, as weight-for-height z-score (WHZ) between -3 and -2 standard deviations and/or MUAC between 115 mm and 125 mm, without bilateral pitting oedema, or according to nationally approved criteria. For other population groups (e.g., pregnant and breastfeeding women, adolescents, adults), MAM is defined using context-appropriate anthropometric criteria as specified in national protocols.

Management services for wasting (MAM): A package of community-based or facility-based interventions for individuals diagnosed with MAM, implemented in accordance with national and cluster-endorsed protocols. These services typically include provision of specialized nutritious foods, routine medical screening, nutrition counselling, and follow-up monitoring, with the objective of promoting recovery, preventing deterioration to severe acute malnutrition (SAM), and reducing morbidity and mortality associated with wasting.

RATIONALE

The coverage indicator is used to assess how effectively moderate acute malnutrition (MAM) management services reach the individuals who need them. Measuring coverage is essential because it shows whether programme enrolment and service delivery are sufficient to meet population needs in targeted areas, and whether children and individuals with MAM are accessing the services required to support recovery. Without this indicator, programmes cannot determine whether gaps exist between needs and reach, limiting their ability to ensure equitable access to life‑saving nutrition services.

Coverage also serves as a proxy measure of service quality and accessibility, reflecting how well MAM management services are functioning in practice, including community outreach, referral pathways, supply continuity, and geographic accessibility. High coverage indicates that vulnerable individuals are being reached consistently, while low coverage signals potential bottlenecks in programme design, service delivery, or community‑level access.

To strengthen the validity and usefulness of coverage data, it is recommended that coverage surveys be conducted jointly by WFP, government partners, and nutrition actors. Joint implementation increases methodological rigor, builds national capacity, and reduces the financial and operational burden on any single agency.

This indicator directly supports WFP’s commitments to reduce undernutrition, prevent the deterioration of acute malnutrition, and ensure access to essential nutrition services, in alignment with global priorities and corporate strategies emphasizing the first 1,000 days, nutrition treatment pathways, and equitable access to quality care.

DATA COLLECTION TOOL

Data source:

1) Desk Review (Routine Programme and Secondary Data)

• Estimating the eligible population:
  This is done using the most recent census data, population projections, and other context‑relevant datasets. Where eligibility is based on food insecurity (e.g., targeting children or women in food insecure households in IPC 3+ areas), Food Security assessments and IPC AFI analyses are used to determine the number of individuals who meet the criteria.

• Estimating the population reached:
  Routine programme monitoring data, including Cooperating Partner (CP) reports and corporate reporting systems, provide the verified number of individuals who received prevention assistance.

2) Probabilistic Cross‑Sectional Survey

A probabilistic survey samples households across the entire catchment area using statistically representative methods, making this approach the most reliable for estimating coverage. Surveys generate direct, population‑based estimates of both eligibility and programme reach.

It is recommended that at least one probabilistic survey be conducted during the CSP cycle ideally near the beginning to strengthen the accuracy of coverage measurement and mitigate limitations inherent in routine data systems.

SAMPLING REQUIREMENTS

1. Desk Review

A desk review does not require sampling because it draws on complete programme and secondary datasets. All available information on programme reach and eligibility for the entire targeted population should be used.

2. Probabilistic Survey

If a probabilistic cross‑sectional survey is used to estimate coverage, a statistically representative sample must be drawn. The following parameters should guide sample size calculation for this indicator:

• Population size:
  The sampling frame is the total number of individuals eligible for the programme at the time of the survey (e.g., children 6-23 months/6-59 months/ PBWG)

• Expected coverage (prevalence of the indicator):
  A minimum expected coverage of 70% may be used as a starting point; however, the expected value should be adjusted based on:

• previous programme results

• anticipated constraints such as limited outreach or access challenges.

• Lower expected coverage should be used when substantial barriers are known.

• Non-response rate:
  A 10% non-response adjustment is recommended to account for households or individuals who cannot be reached or decline to participate.

• Design effect (DEFF):
  If cluster sampling is applied, the design effect must be incorporated.

• When previous data is available, DEFF should reflect observed variability.

• If no prior information exists, a default value of 1.5 may be used.

• The design effect should be increased or decreased depending on the homogeneity or heterogeneity of the surveyed population, following standard sampling guidance.

• Confidence level:
  A 95% confidence interval is strongly recommended to ensure statistical reliability.

INDICATOR CALCULATION FOR REPORTING

For any management services intervention, the following parameters are used to calculate the indicator:

Desk Review Calculation:

Calculation of the number of eligible individuals (6-59 months)

Number of eligible individuals (People in Need (PIN)) calculation = prevalence cases + incidence cases = (n x p) + (n x p x k)

N is the size of the target population in the program area (e.g., children 6-59 months)

P is the estimated prevalence of MAM

K is a correction factor to account for new (incident cases) over a given time period.

Note: People in Need (PIN) is determined through national coordination mechanisms and reported by the Global Nutrition Cluster (GNC).

Note: The k factor for MAM supplementation is 1.6.

Coverage Survey Calculation:

If using SLEAC/SQUEAC methods refer to the technical reference:

Semi-Quantitative Evaluation of Access and Coverage (SQUEAC)/ Simplified Lot Quality Assurance Sampling Evaluation of Access and Coverage (SLEAC) Technical Reference (fantaproject.org)

DATA ENTRY AND DISAGGREGATION IN CORPORATE SYSTEMS

Values are recorded in the logframe. Each value has a reporting combination which is created based on:

• Sub-activity

• Country

• Target Group

BASELINE

Baselines are set only once, at one of the following points:

Baselines remain fixed for the entire CSP period and are not recalculated annually, unless applicable as above.

For a new programme, if no information is available on the coverage of MAM management services from the government or partners in the previous year, the baseline should be set as zero for the first year. If such information exists, the baseline should reflect the most recent coverage estimate reported by the government or partners.

For programmes continuing for more than one year, the baseline should be based on the previous year’s coverage rate.

TARGET SETTING

Annual targets:

Annual targets should be set to meet the Sphere standard¹ (below) each year, as this represents the minimum acceptable performance threshold for the management of moderate wasting. At the same time, targets should reflect progressive performance improvement, particularly in contexts where baseline coverage falls below the Sphere standard. Annual targets should therefore demonstrate realistic, incremental gains over time, with the objective of achieving and consistently maintaining performance at or above the Sphere standard.

End of CSP target:

Targets should be established to ensure coverage reaches at a minimum the Sphere standards and progressively exceeds baseline performance, with the aim of sustaining results at or above the standard.

Sphere Standards:

FREQUENCY OF DATA COLLECTION

Desk review: Data collection from the programme related data sources is conducted once per month if admission and discharge data are available. Data should be entered monthly and reported quarterly.

Cross-sectional surveys: Data collection should be undertaken at least once a year. A minimum of one survey needs to be conducted during the implementation of a CSP, with a preference in the first years.

There may be a need to collect data more frequently if there is a massive change in the operating environment or a need to monitor unusual performance data or areas of poor coverage more closely.

INTERPRETATION

An increase in coverage indicates that a higher proportion of children and pregnant or breastfeeding women with moderate wasting are accessing MAM management services, suggesting improved programme reach, stronger referral pathways, and fewer access barriers. Sustained increases over time generally reflect effective service delivery, adequate supplies of specialized nutritious foods, functioning outreach systems, and strong collaboration with government and partners.

A decrease, or consistently low coverage, signals potential challenges in programme access or performance. These may relate to geographic barriers, limited community awareness, weak case‑finding or referral mechanisms, staffing shortages, pipeline breaks, or insecurity restricting movement. When coverage declines, further analysis is needed to determine whether the issue is due to service availability, programme quality, or barriers at community level.

Because coverage can be influenced by both supply‑side and demand‑side factors, different interpretations may be possible. For example, low coverage could reflect gaps in outreach and screening (fewer children identified), limited access to facilities (distance, cost, insecurity), or programme bottlenecks (stock‑outs, limited opening hours). Combining coverage results with other information, such as screening data, supply chain records, and community feedback, helps distinguish between these causes and identify appropriate corrective actions.

The indicator should be used to evaluate whether management services for wasting are reaching those who need them and to guide adjustments in programme design, outreach, and coordination to improve access and support recovery for individuals with moderate wasting.

REPORTING EXAMPLE(S)

The 2025 coverage assessment in DRC for moderate acute malnutrition (MAM) management services found that 52% of moderately wasted children and wasted pregnant or breastfeeding women and girls (PBWG) in the targeted districts received the required management services during the reporting period. Coverage was highest in District A (63%), where community outreach and active case‑finding were consistently implemented, and lowest in District C (38%), where difficult terrain and security restrictions limited access to health facilities.

The assessment also highlighted differences in service uptake between population groups. Coverage among children 6–59 months was 55%, compared with 47% among pregnant and breastfeeding women, suggesting that women may face additional access barriers such as workload, mobility constraints, or limited awareness of available services.

Overall, the results indicate that while MAM management services are reaching a significant proportion of the target population, further improvements are needed to meet Sphere standards. Strengthening community screening, improving referral links between outreach teams and treatment sites, and addressing logistical challenges—particularly in low‑coverage areas—will be essential to increase programme reach and ensure timely support for individuals with moderate wasting.

INDICATORS COLLECTED & ANALYSED AT THE SAME TIME

The following indicators may be reported along with this indicator:

• 14. Moderate acute malnutrition management recovery rate

• 15. Moderate acute malnutrition management mortality rate

• 16. Moderate acute malnutrition management default rate

• 17. Moderate acute malnutrition management non-response rate

COMPLEMENTARY QUALITATIVE RESEARCH

Qualitative approaches including Focus Group Discussions and Key Informant Interviews to complement quantitative data and establish reasons for performance should be utilised. Qualitative data can also inform required actions and recommendations for improvement.

DECISIONS DATA CAN INFORM

The coverage indicator helps determine whether MAM management services are reaching the individuals who need them. Higher coverage suggests strong outreach, functioning referral pathways, and good access to services, while low or declining coverage indicates barriers that require programme adjustments. Coverage results guide decisions on where to prioritise support geographically, how to strengthen screening and referral systems, and whether service delivery models need to be adapted to improve access. They also help determine if additional resources, staffing, or supplies are needed in specific areas. Ultimately, the indicator shows whether the programme is meeting needs and informs actions to improve reach, quality, and alignment with Sphere standards.

VISUALIZATION

Example:

LIMITATIONS

Coverage estimates derived from SQUEAC, SLEAC, or 3SM provide richer insight into programme performance by identifying barriers and enablers that influence access and use of MAM management services. In contrast, coverage calculated through a desk review is only a proxy estimate and offers limited understanding of the underlying reasons for low or high coverage. Desk reviews cannot identify behavioural, geographic, or system‑level factors affecting access, and therefore should be interpreted cautiously and, where possible, complemented with more detailed coverage assessments.

FURTHER INFORMATION

• Coverage Guidelines

• Nutrition M&E guidelines

• The Sphere Handbook: Humanitarian Charter and Minimum Standards in Humanitarian Response (Fourth Edition)