ABSTRACT
GLOBAL. What we know: Demand for treatment services for childhood diseases (particularly malaria, diarrhoea and acute respiratory infection (ARI)) surge in response to seasonal changes and shocks. What this article adds: A broader Health Surge approach is emerging, prompted by health facility staff beginning to apply community-based management of acute malnutrition (CMAM) Surge principles to other childhood disease services. Lessons learned from implementing countries to date (Sierra Leone, Burkina Faso, Chad, Niger, Ethiopia and Mauritania), including during the COVID-19 response, have informed working definitions, key elements of a package and key principles of an approach currently modelled on the CMAM Surge steps. Health Surge can be viewed as a quality improvement approach that empowers health workers to better anticipate, prepare for and manage fluctuations in demand for essential nutrition and child health services at facility-level in real-time, in complement to wider disease surveillance and response mechanisms. Health facility staff set specific thresholds for single diseases of public health importance in their catchment area to inform decisions and action on health facility capacity;information can be aggregated at district or regional levels to reveal rising stress on the health system. Adaptability of the approach is key and should always consider the context, effectiveness, local and national ownership, process transparency and sustainability. Experiences indicate that the Health Surge approach should protect services for the most vulnerable and will benefit from local prioritisation of illnesses, the tailoring of threshold setting methods according to how local health services are organised and disease-specific surge actions. Digital monitoring approaches will help real-time monitoring. Existing global and regional technical working groups on CMAM Surge are now coordinating Health Surge efforts. Tools and guidance are currently being developed by Concern and will be piloted in Niger, Kenya and Mali by Concern and Save the Children from early 2021.