14. Moderate acute malnutrition management recovery rate

14. Moderate acute malnutrition management recovery rate

VERSION

V5.0 - 2026.03 — Existing with revisions

INDICATOR CODE

14

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)

2. HIV/TB care and treatment (HIV/TB_C&T)

Note:

• This indicator should be separately reported for i) children 6-59 months and ii) pregnant and breastfeeding women and girls, using the COMET reporting combination.

• This indicator also covers nutritional recovery rate for Care & Treatment programme for Antiretroviral Therapy (ART), Tuberculosis (TB) services, and Prevention of Mother‑to‑Child Transmission (PMTCT) of HIV clients.

  
  

UNIT OF MEASUREMENT & ANALYSIS

Percentage of individuals

DEFINITION

This indicator measures the proportion of individuals enrolled in MAM management programmes who successfully recover and are discharged as cured according to established nutritional criteria.

Moderate Acute Malnutrition (MAM): classification should be based on national treatment protocols and criteria used during programme implementation. This is most common among children 6-59 months in the population classified with WFH Z-score of ≥-3 and <-2 and/or MUAC between 115-125 and absence of Oedema. Adults usually are classified as moderately acute malnourished when body max index (BMI) is >16 and <18.5. Pregnant and lactating women and girls (PLW/G) are classified as MAM when mid-upper arm circumference (MUAC) is below 23 or 21 cm.

Recovery rate: This indicator is one of four indicators (mortality rate, default rate, non-response rate, and recovery rate) based on SPHERE standards that are used to report on the performance of a MAM management programme.

The recovery rate is the number of individuals in a MAM management programme reaching criteria for discharge (i.e., cured) divided by the total number of discharged individuals (i.e., cured, deaths, defaulters, non-responders, and transfers in a set period (usually one month). This also applies to adults on Anti-Retroviral Therapy (ART), Prevention of Mother to Child Transmission (PMTCT) and/or Tuberculosis (TB) treatment.

Note: Discharge criteria can differ slightly, and definitions of national protocols need to be used to identify the type of discharge that has occurred.

RATIONALE

The recovery rate is a core performance indicator used to assess the effectiveness of MAM management programmes. It is one of the four globally recognized MAM management performance indicators established under the SPHERE standards and required for reporting within Community Management of Acute Malnutrition (CMAM). It measures the proportion of individuals with Moderate Acute Malnutrition who successfully reach nutritional recovery through programme support and is therefore a key indicator of effectiveness and quality of care.

However, the recovery rate on its own cannot fully explain how well a MAM programme is functioning. It must be interpreted together with the other three core performance indicators; mortality, defaulting, and non‑response—to provide a complete picture of programme performance. These indicators collectively reflect beneficiary continuity of care, adherence to treatment, access constraints, supply consistency, and the overall functioning of service delivery.

Used in combination, the four indicators allow programme teams to assess whether MAM services are meeting global standards and to identify where corrective actions are needed to improve treatment quality and outcomes.

DATA COLLECTION TOOL

Data Collection Tool: Beneficiary registers

Data source: Cooperating Partner Reports

Note: The indicator should be included in all Field-Level Agreements, memoranda of understanding and other partnership agreements.

SAMPLING REQUIREMENTS

All beneficiaries enrolled in a MAM management programme must be assigned a discharge outcome—recovered, died, defaulted, or non‑responsive. Because discharge status is recorded for every beneficiary, the recovery rate should be calculated using the full caseload and must not be derived from a sample.

INDICATOR CALCULATION FOR REPORTING

This indicator is calculated by dividing the number of recovered individuals by the total number of discharges, expressed as percentage.

Recovery rate:

To calculate the number of discharges:

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

Follow-up value is reported as: Numerator and Denominator, as per the below table.

Baseline and target values are reported as one overall value.

Mandatory disaggregation (for follow-up value only):

• Sex

Recommended disaggregation via the reporting combination in COMET (target group):

• Children (6-59 months)

• Pregnant Breastfeeding Women and Girls

• HIV/TB Clients

Recommended disaggregation for reporting outside of COMET based on programme needs:

• Geographical area

• Ethnicity

• Residence Status

• Other recognised vulnerabilities, including disability, when feasible

BASELINE

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

1. At the beginning of the CSP, or

2. When the indicator is selected for reporting after the commencement of the CSP; or

3. When a change in target, location and/or modality triggers a new reporting combination (target, location and modality) for an existing indicator.  

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

For the first year of reporting — baseline is not applicable. Please use the “no data” function and its sub-function “Not applicable”.

TARGET SETTING

Annual targets:

Programmes are expected to meet the SPHERE standards (at least 75% recovery rate) annually and represent the minimum standards. However, the annual targets are expected to show gradual improvement towards the end of the project / end of CSP.

End of CSP target:

At least 75% recovery rate, based on the SPHERE standards.

FREQUENCY OF DATA COLLECTION

Monthly

INTERPRETATION

The duration of the intervention, quantity of products, provision of related services, and frequency of the distribution for MAM management have been designed to achieve the programme’s impact. Non-recovery can also have many reasons such as treatment/supplementation might have been interrupted, SNF shared at household level, underlying medical conditions among others.

The inability to meet SPHERE recovery rate warrants actions to understand the origin and adapt programme strategies. The failure to meet SPHERE standards is a proxy for quality of care. Together with coverage, this indicator can be used to assess if the programme is achieving the intended result.

Consider external factors such as:

• Morbidity patterns

• Levels of undernutrition in the population

• Levels of food insecurity in the households and population

• Complementary interventions available to the population (including general food assistance or equivalent programmes)

• Capacity of existing systems for service delivery

REPORTING EXAMPLE(S)

In Mozambique, the MAM management programme is part of the National Nutrition Rehabilitation Programme which is a key component of the Government’s efforts to manage acute malnutrition. In 2020, WFP reached 30,627 children aged 6-59 months, with 53 percent girls and 47 percent boys. That year, the programme registered overall 89.2 percent of recoveries, 7.8 percent defaults, 0.1 percent of deaths, and 1.2 percent of no responses. Despite reaching fewer beneficiaries in comparison to 2019, the national programme met the minimum standards for MAM management performance.

INDICATORS COLLECTED & ANALYSED AT THE SAME TIME

The following indicators should be reported along with this indicator:

Individual level indicators:

• 15. Moderate acute malnutrition treatment mortality rate

• 16. Moderate acute malnutrition treatment default rate

• 17. Moderate acute malnutrition treatment non-response rate

The following indicators may also be reported along with this indicator:

• 7. Proportion of eligible people reached by nutrition preventive programme (coverage)

COMPLEMENTARY QUALITATIVE RESEARCH

Qualitative approaches should be used, including Focus Group Discussions to complement quantitative data to establish reasons for the performance of the indicator. Qualitative data can, in addition, inform required actions and recommendations for improvement and corrective action, to determine scale up, or to suggest follow up with beneficiaries.

DECISIONS DATA CAN INFORM

MAM management performance indicator can take several types of data-driven decisions to improve the management of MAM, including:

Program design: The indicator can help WFP to design more effective MAM management programmes. By analysing the data on the recovery rates of children who are being treated for MAM, WFP can identify the most effective treatments and adjust their programmes accordingly. This can include changes to the types of food provided, the duration of treatment, or the methods used to deliver the treatment.

Monitoring and Evaluation: The indicator can help WFP to monitor and evaluate the effectiveness of MAM management programmes. By collecting and analysing data on the number of children who are being treated for MAM, the recovery rates, and the overall impact of the program on the health of the children, WFP can identify areas for improvement and make data-driven decisions to adjust the programme accordingly.

Resource allocation: The indicator can help WFP to allocate resources more effectively. By analysing the data on the number of children who need management for MAM, the cost of treatment, and the expected recovery rates, WFP can make data-driven decisions on priority areas for resource allocation to maximize the impact of their MAM management programmes.

Overall, the indicator can provide valuable data for WFP to make informed decisions on how to improve the effectiveness of their MAM management programmes and ensure that children receive the care they need to recover from malnutrition.

VISUALIZATION

LIMITATIONS

Qualitative information related to underlying reasons for not meeting the SPHERE MAM management performance standard are not collected; and thus, the indicator does not state why the standard was not met.

FURTHER INFORMATION

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

WHO guideline on the prevention and management of wasting and nutritional oedema (‎acute malnutrition)‎ in infants and children under 5 years