SQUEAC-Semi quantitative evaluation of access and coverage methodology for IMAM
programme coverage and evaluation
Coverage is a measure of how well a program is reaching an
intended target group. For this case, these are children below 5
years and who are suffering from acute malnutrition. It is
essential to measure coverage to see whether a programme is
functioning optimally and reaching the maximum number of
malnourished children in need. Even for a programme that is
achieving good clinical outcomes (high cure rates and low death
rates); impact is diminished if it only achieves low levels of
coverage
Coverage therefore is one of the most important indicators of how
well a service/programme is meeting the need. High-quality
services/programs have both high coverage and high cure rates.
The coverage of an integrated Management of Acute Malnutrition
service/programme is mapped and estimated using a populationbased coverage survey. known as Centric Systematic Area
Sampling (CSAS). However, such methods are resource intensive
and often only used for final program me evaluation meaning
results arrive too late for programme adaptation.
Current internationally accepted standards for coverage of IMAM
programs from SPHERE are 50% for rural areas, 70% for urban
contexts and 90% for camp settingIn the recent past,
 .
measurement of coverage has been mainly through two-stage
cluster sampled surveys either as part of a nutrition assessment
or through a specific coverage survey
What is SQUEAC methodology?
The Semi-Quantitative Evaluation of Access and Coverage (SQUEAC) is a low
resource method that can be used on a regular basis to monitor programme
performance, identify barriers to service access and uptake and hence evaluate
coverage. SQUEAC is an investigation rather than a survey and uses a mix of
quantitative (routine programme data and small and wide area surveys) and
qualitative data (anecdotal information from various relevant respondents).
What are the advantages of SQUEAC?
 It greatly reduces the demand placed on the quantitative data collected
given that much is already known about the survey area before the
exercise is implemented.
 SQUEAC’s reliance on existing routine data means that best practice in
data monitoring is a prerequisite to conducting a SQUEAC survey.
 The survey acts as a check on current data collection and monitoring
practices encouraging high quality data collection following the survey
and thus supporting and promoting essential follow-up activities.
 The SQUEAC method incorporates a thorough qualitative and
quantitative analysis of the main barriers to access as part of the survey
process, thus providing a detailed assessment of the remedial activities
necessary to further increase coverage in areas of relatively low coverage
and across the programme generally.
 Confidently establish barriers to service access as well as to identify
areas of unacceptable coverage and also identify the necessary actions to
increase that coverage with a minimum investment of resources.
 Consequently, once the method has been implemented in an area, it can
then be easily and effectively repeated either in the same area or in other
areas and be integrated into routine monitoring and evaluation activities.
Survey Methods for the Assessment of Coverage of Integrated Management of Acute Malnutrition (IMAM)
Programme Considerations SQUEAC /SLEAC
Programme Considerations
Size of programme (local, district, regional
or national)
Survey results reported (estimate or
classification
SQUEAC
Local area method for programme site catchment areas up to
district level programs
Estimate or classification of coverage
SLEAC
Wide area method used to classify and map survey results of
district level up to regional and national programs
Classification of coverage for each service delivery unit with
the possibility of reporting overall estimates depending on
sample size reached and homogeneity of results
Service delivery units and overall for the district, region or
country
Area level by which survey results are
applicable (overall, service delivery units,
catchment area of programme site)
Component methods
Catchment area of programme site and overall for the district
Quantitative data as part of the investigation process of
indicator of interest
• Mixed qualitative and quantitative approaches to data
collection and analysis
• Hypothesis-testing
• Snowball sampling (active and adaptive case finding) and
other high-sensitivity case-finding methods
• Lot quality assurance sampling (LQAS) methods
• Spatial mapping principles and methods
• Bayesian analysis
Area sampling methods using either quadrats or systematic
sampling using lists
• Snowball sampling (active and adaptive case finding) and
other high-sensitivity case-finding methods
• Lot quality assurance sampling(LQAS) methods
• Sample size calculations using hypergeometric probability
distribution principles
• Data mapping principles and methods
• Data collection using simple tally sheets and questionnaires
• Data analysis using simple estimators
Baseline information requirements
1. At least a complete list of villages/locations within each
catchment area of program sites (ideally good detailed maps
but optional)
2. Routine program monitoring data
3. Additional data from patient record cards
Expected Deliverables
1. Classification or estimate of overall coverage
2. List of boosters and barriers to coverage with detailed
information on how they affect coverage
1. At least a complete list of villages/locations within each
service delivery unit (detailed maps optional)
2. Rough estimates of population size (all populations and 659 month age group) of each service delivery unit
3. Prevalence estimate (ideally estimate for each service
delivery unit but aggregate figure acceptable)
1. Classification of coverage at level of service delivery unit
and overall
2. Mapping of classification of coverage at level of service
delivery unit
3. List barriers to coverage
New and updated documentation on SQUEAC and SLEAC are available for download:http://www.brixtonhealth.com/handbookSQUEAC/handbookSQUEAC.html