The Surge Approach

This page was initially created as a point of reference on the ‘CMAM Surge’ approach, to support practitioners to adapt, set-up, and implement the approach. Given the rapid scale up of the approach across increasingly diverse contexts, there was a need to ensure that technical integrity of the approach was maintained and that learning was captured and used to further strengthen and refine the approach. In July 2023, an updated Orientation Guide was launched.

The 'Surge Approach' is the updated name for the Community Management of Acute Malnutrition (CMAM) Surge approach, reflecting how the approach can also be used to better manage peaks in other common child illnesses. This page aims to facilitate a community of learning; with access to tools, orientation guides, evaluations and publications. 

The ‘CMAM Surge’ approach was first proposed to help the health system more effectively deliver services for children with acute malnutrition during periods of peak demand/high caseloads. Since 2020, the same approach was applied in several contexts to better manage peaks in other childhood illnesses and referred to as ‘Health Surge’. The overall aim of the Surge Approach is to make the health system more resilient over time, equipping it to cope with periodic peaks in demand for essential nutrition and child health services - when the potential to save lives is often greatest - without undermining the capacity and accountability of government health actors. In this way, it can contribute to building health system shock responsiveness.

The Surge Approach complements routine child health and nutrition services by improving health staffs’ use of facility data and knowledge of the local context to better anticipate, plan for, respond to, and bounce back from these increases in demand for common child illness treatment services.

The terms ‘CMAM Surge’ and ‘Health Surge’ will be used if referring to specific learning related to either of these approaches; otherwise, the term ‘Surge Approach’ will be used going forward.

The Surge Approach uses eight steps to help government health teams respond to relative changes in capacity and caseloads. The eight steps are summarised below.

The status of each health facility is also monitored by the higher-level health authority (e.g. district health management team) that can, in turn, monitor trends across a wider geographic area and call for higher-level regional or national response if the situation continues to deteriorate. 

The ‘Health Surge’ approach was the term initially used when piloting the application of the eight ‘CMAM Surge’ steps to support the management of other common child illnesses. It was first piloted in Sierra Leone in 2017 to support health workers manage peaks of malaria consultations. Key learning documents on ‘Health Surge’ pilots can be found in the Learning and Evaluations section below.

The updated orientation guide is designed to promote flexibility and might add value in contexts where there are largely predictable, seasonal fluctuations in the number of children presenting to the health facility with common child illnesses, such as acute malnutrition, malaria, diarrhoea or acute respiratory infection.

‘CMAM Surge’ is currently being implemented in 12 countries with technical assistance to governments provided by multiple NGO and UN partners. Concern has introduced and supported implementation of the Surge Approach in more than six country programmes. The map below illustrates to the best of our knowledge where the ‘CMAM Surge’ approach has been implemented. Please contact [email protected] if you have any updated information.

Surge Approach: Orientation Guide (updated)

Incorporates learning from pilots and innovations based on ongoing work from Concern Worldwide and other actors including Ministries of Health and other non-governmental organisations. The guide and tools have been designed to promote flexibility to choose the components of the approach that add value based on the health system set up and existing resources.

Concern Worldwide welcomes feedback on the updated guide and comments can be sent to [email protected].

**Please note: Annex 3 and French version of the Orientation Guide will be available soon**

Since the first ‘CMAM Surge’ pilot in Kenya in 2012, a wealth of experience and learning across a variety of contexts has been generated. Concern has supported several learning reviews and evaluations of ‘CMAM Surge’ and ‘Health Surge’ in order to inform adaptations of the approach as well as investment in scale-up. Some key resources are available for download below.

In 2021, a series of articles were published on CMAM Surge in the Emergency Nutrition Network’s (ENN) Field Exchange journal. This seven article series summarises the key lessons learnt over the past eight years and the way forward for the Surge approach. The full articles can be found on ENNs website:

1. CMAM Surge – Setting the Scene
2. Implementing IMAM (CMAM) Surge approach – experience from Kenya
3. The role of coordination in CMAM Surge scale-up in West and Central Francophone Africa 
4. CMAM Surge – understanding costs and potential contribution to CMAM’s cost-effectiveness
5. Expanding CMAM Surge beyond nutrition – towards a broader Health Surge approach
6. CMAM Surge: lessons on the journey so far

In addition, Concern has provided technical support and collaborated with a number of key stakeholders in the production of other learning resources:

Concern chaired the Global CMAM Surge Technical Working Group (Global TWG). The purpose of the Global TWG was to ensure coordination of CMAM Surge activities to maximise quality, effectiveness, and learning. The membership included a diverse group of CMAM / Health Surge stakeholders including Ministry of Health representatives, donors, and non-governmental organisations. The Global TWG was established in October 2020, and reached the end of its term in May 2023. Going forward it is encouraged that, where relevant, the Surge Approach is included in other health and nutrition forums for discussion.

Concern is co-lead of the West Africa Region CMAM Surge Taskforce with the French Red Cross (CRF). The role of coordination in the CMAM Surge scale-up in West and Central Francophone Africa is described in an article for Field Exchange. Since 2021, rather than routine coordination meetings, learning webinars have been organised. A summary of the 2021 webinars is available below.

Concern is co-lead of the West Africa Region CMAM Surge Taskforce with the French Red Cross (CRF). The role of coordination in the CMAM Surge scale-up in West and Central Francophone Africa is described in an article for Field Exchange. Since 2021, rather than routine coordination meetings, learning webinars have been organised. A summary of the 2021 webinars is available below.

National level CMAM Surge Taskforces have also been established in Mali and Niger. Led by Save the Children and Concern Worldwide respectively, in collaboration with Ministries of Health. 

Contact us

If you have any question related to the Surge Approach, please contact: [email protected].

This publication covers aid activities implemented with the financial assistance of several donors, including the European Civil Protection and Humanitarian Aid Operations Department (ECHO), USAID, Irish Aid and others. The ideas, opinions and comments herein are entirely the responsibility of the author(s) and do not necessarily represent or reflect the policies of any donors.