An evaluation of aspects of the PEM (protein energy malnutrition) Scheme for malnourished children in Gauteng Province

Abstract

This study assessed aspects of targeting of the PEM scheme in Gauteng province. This food supplementation scheme targets beneficiaries including children 0-6 years, using largely anthropometric criteria. Routine provincial intervention data was analysed and related to available data cm expenditure, population and indices of socio-economic need. Only 28% were children in the critical 7-36 month age group; and coverage was very low, with no correlation between indices of need and programme implementation by area. An exit interview to a sample of caretakers of 0-6 year old children in four clinics (two Local Authority, two provincial) examined the process of identification of beneficiaries. Low attendance by children over 1 year and 40% errors in growth monitoring, more frequent among sick children, effectively reduced screening coverage among the most at-risk. Health worker misclassification resulted in an 81% exclusion error among those meeting entry criteria, while 4% of the total were wrongly enrolled. Advice and nutrition promotion to caregivers was inadequate. Recommendations include service re-organisation, community-based initiatives and better monitoring.