⚡ Action Guide

Rapid Start Guide

What to do in the first 24 hours, first week, and first month when you need to launch or expand child nutrition interventions quickly.

What's Your Situation?

Choose the scenario that best matches where you are:

🚨
Emergency Response
Crisis situation, acute needs, children dying now. Need to act within days.
📈
Scaling Existing Program
You have a working program and funding to expand. Need structured scale-up plan.
🆕
Starting from Scratch
New program, new funding, planning phase. Have 1-3 months before launch.

🚨 Emergency Response Mode

⚠️ Critical First Decisions

In acute emergencies, speed matters more than perfection. Make these calls in the first 24 hours:

  • Triage: Who needs treatment NOW (SAM), who needs prevention (MAM), who can wait?
  • Treatment approach: Can you do community-based management, or do you need inpatient facilities?
  • Supply chains: Where will RUTF and supplies come from? How fast can they arrive?
  • Coordination: Who else is responding? Are you filling a gap or duplicating efforts?
⏱️
First 24-48 Hours
Immediate assessment and mobilization
  • Rapid Needs Assessment
    Screen sample of children for SAM/MAM using MUAC tapes. Don't wait for comprehensive surveys. Quick MUAC screening can be done in 1-2 days and tells you if there's a crisis.
  • Coordinate with Cluster/Sector Lead
    Contact nutrition cluster coordinator or health ministry. Report what you're seeing. Find out who's doing what where. Avoid gaps and duplication.
  • Secure RUTF Supply
    Contact UNICEF supply division, WFP, or commercial suppliers immediately. RUTF takes 4-8 weeks to arrive. If SAM prevalence is >2%, you need RUTF urgently.
  • Identify Treatment Sites
    Which health facilities or community sites can serve as distribution points? Need refrigeration? Secure storage? Trained staff? Map what exists before deciding approach.
  • Mobilize Emergency Funding
    Alert donors about the situation. Submit rapid response proposals. Many donors have emergency mechanisms for crises (CERF, START Fund, internal emergency funds).
📅
First Week
Stand up treatment capacity
  • Train Frontline Staff
    3-day crash training on SAM/MAM identification, MUAC measurement, RUTF distribution, referral protocols. Use WHO/UNICEF materials. Train 2x staff needed (attrition happens).
  • Set Up Registration System
    Even basic paper forms matter. Need to track: ID, MUAC/weight, date admitted, RUTF given, follow-up dates. Prevents duplicate treatment and tracks progress.
  • Establish Referral Pathways
    Children with complications (medical problems, oedema, very young) need inpatient care. Identify hospitals, arrange transport, brief hospital staff.
  • Community Mobilization
    Work with community leaders to announce screening. Explain what you're looking for and where treatment is available. Use mosques, churches, markets, schools.
  • Start Treatment (Even Without Perfect Setup)
    If RUTF arrives and staff are trained, start treating. Don't wait for perfect systems. Severely malnourished children die quickly. Improve systems while treating.

📖 Essential Emergency Resources

  • WHO/UNICEF CMAM Training Materials: Free downloadable curriculum
  • Sphere Standards: Minimum standards for humanitarian nutrition response
  • Emergency Nutrition Network (ENN): Technical guidance for acute situations
  • UNICEF Supply Catalogue: Pre-positioned RUTF stocks and lead times

📈 Scaling an Existing Program

🔍
Week 1: Assessment & Planning
Before you scale, understand what works and what doesn't
  • Analyze Current Program Performance
    What's the cure rate? Default rate? Coverage? Cost per beneficiary? Don't scale a broken program—fix quality issues first.
  • Identify Successful vs. Struggling Sites
    Which sites have best outcomes? Why? Document what high-performing sites do differently. Use their practices as your scaling model.
  • Calculate True Delivered Costs
    Include EVERYTHING: supplies, staff time, supervision, transport, overhead. Budget for new sites at 1.5-2x pilot costs (scaling is more expensive than you think).
  • Map New Coverage Areas
    Where are gaps? Where is need highest? Where do you have capacity? Prioritize areas with: high malnutrition, low current coverage, existing health infrastructure.
🚀
Month 1: Staged Rollout
Scale in waves, not all at once
  • Phase 1: Pilot New Sites (Week 1-2)
    Start with 2-3 new sites closest to existing successful sites. Use same staff to supervise. Test your systems before full expansion.
  • Phase 2: Near Expansion (Week 3-4)
    Add 5-10 sites in same region. Staff can still travel for supervision. Supply chains are similar. Learn and adjust before going further.
  • Phase 3: Geographic Expansion (Month 2+)
    Only after Phases 1-2 are stable, expand to new regions. Requires new supervisors, separate supply chains, adapted protocols for different contexts.
  • Build Supervision Capacity
    Your best frontline staff become trainers/supervisors. Budget 1 supervisor per 8-12 sites. Supervision is what separates successful scaling from quality collapse.

🛑 Common Scaling Mistakes to Avoid

  • Scaling before stabilizing: Fix quality at existing sites before adding new ones
  • Underestimating costs: Scaling is more expensive per beneficiary than pilots
  • Neglecting supervision: Quality collapses without adequate oversight
  • Assuming homogeneity: New areas have different contexts—adapt protocols
  • Speed over sustainability: Slow, solid scaling beats rapid expansion with collapse

🆕 Starting a New Program (1-3 Month Timeline)

First: What's Your Core Intervention?

Your timeline and approach depend on what you're doing:

What type of program are you starting?
→ SAM/MAM Treatment Program
Fastest to start (4-6 weeks). Main barrier is RUTF procurement. Partner with health facilities. Use Intervention Selector for details.
→ Supplementary Feeding / Prevention
6-8 weeks. Need targeting criteria, food supply, distribution infrastructure. Consider school feeding or community kitchens depending on context.
→ Cash Transfer for Nutrition
8-12 weeks. Need: beneficiary registration, payment mechanism (mobile money, banks, cash), market assessment. Simplest if piggybacking on existing social protection system.
→ Behavior Change / Counseling
8-12 weeks for quality implementation. Fast to start but takes time to train counselors well. Most effective when combined with food or cash interventions.
📋
Month 1: Foundation
Get the basics right
  • Baseline Assessment
    Measure malnutrition prevalence in target area using SMART survey methodology (if time allows) or rapid MUAC screening. Baseline lets you prove impact later.
  • Stakeholder Mapping & Engagement
    Meet: health ministry, local government, other NGOs, community leaders. Find out what exists, avoid duplication, identify partners. Get permissions/MOUs signed.
  • Hire Core Team
    Program manager, M&E officer, logistics coordinator FIRST. They hire the rest. Don't try to hire 20 people at once—build the team in stages.
  • Design M&E System (Before Implementation!)
    Decide what you'll measure, how, when. Design forms. Set up database or system. Use Metrics Builder. Much harder to retrofit measurement systems later.
  • Procurement Initiation
    Order long-lead-time items NOW: RUTF, equipment, vehicles. These take 2-4 months. Everything else can wait.
🛠️
Month 2: Setup & Training
Build capacity before launching
  • Staff Training (2-3 weeks intensive)
    Don't rush training. Well-trained staff are the difference between success and failure. Include: technical skills, data collection, beneficiary communication, safety protocols.
  • Pilot Test Everything
    Test forms, procedures, data flow, supply chains with small pilot (1-2 sites, 50 beneficiaries). Find and fix problems before full launch.
  • Community Sensitization
    Explain program to communities BEFORE launching. Use community meetings, radio, posters. Manage expectations—be clear about who qualifies and what benefits are.
  • Establish Feedback Mechanisms
    How will beneficiaries report problems or complaints? Hotline? Suggestion boxes? Community meetings? Build accountability from day one.
🎯
Month 3: Launch & Monitor
Start small, learn fast, adjust
  • Phased Launch (Not All Sites at Once)
    Start with 20-30% of planned sites. Get these working smoothly before adding more. Easier to fix problems with 3 sites than 30 sites.
  • Daily Monitoring First 2 Weeks
    Supervisors visit sites daily. Fix problems immediately. Are supplies reaching sites? Are staff following protocols? Are beneficiaries showing up?
  • Weekly Data Review
    Review numbers weekly: enrollment, attendance, stock levels, defaulters. Spot problems early. Data is useless if you don't act on it.
  • Rapid Adjustment
    Something not working? Change it. Now. Don't wait for "approval" or "the next review meeting." Field realities matter more than your original plan.

⚡ Quick Reference: What You Need When

Week 1 Essentials

  • MUAC tapes for screening
  • Program manager hired
  • Bank account opened
  • Initial stakeholder meetings
  • Office space secured

Month 1 Essentials

  • Core team hired
  • RUTF/supplies ordered
  • MOUs with partners signed
  • Data collection system designed
  • Target communities identified

Before Launch

  • Staff trained (not just briefed)
  • Supplies at distribution sites
  • Registration system tested
  • Community sensitization done
  • Supervision plan established

First Month Operations

  • Daily site visits
  • Weekly data review meetings
  • Bi-weekly stock checks
  • Monthly staff refresher training
  • Continuous problem-solving

🎯 Final Guidance: Principles for Moving Fast

✅ Do These Things

  • Start before you're ready: Severely malnourished children can't wait for perfect systems
  • Learn by doing: Pilot, learn, adjust, scale. Don't try to plan everything in advance
  • Prioritize quality over coverage: Better to reach 100 well than 1000 poorly
  • Build in flexibility: Plans will change—design systems that can adapt
  • Invest in supervision: This is what makes programs work at scale

🛑 Don't Do These Things

  • Wait for perfect data: Rapid assessments are good enough to start
  • Skip community engagement: Programs without community buy-in fail
  • Forget about sustainability: Build for handover from day one
  • Ignore staff wellbeing: Burned-out staff deliver poor quality
  • Scale success before understanding it: Know WHY it works before expanding