Making the health system work for the delivery of nutrition interventions

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Research snapshot¹

The 2013 Lancet series on nutrition highlighted 10 nutrition-specific interventions that, if scaled up through national health systems, could significantly reduce child mortality associated with undernutrition. While there is substantial evidence of the efficacy and potential impact of nutrition-specific interventions, less is understood about how to deliver them at scale and the role of health systems in facilitating or hindering their success. 

This paper describes the health system components required for the delivery of nutrition-specific interventions and explores how the framework could be used to identify opportunities for increasing coverage of nutrition interventions. For each of the 10 nutrition-specific interventions, implementation guidance was reviewed and information on the nature of the intervention (provision of drugs/supplements or counselling), delivery level (facility or community), workforce cadre responsible for the intervention (doctor, nurse or occasional trained provider/peer) and required supplies (drugs/supplements or counselling materials) was extracted. Flow diagrams were then developed to illustrate the delivery process for each intervention. 

Nutrition-specific interventions were found to be delivered in one of four ways: (i) when nutrition interventions are intentionally sought out, (ii) when care is sought for other, unrelated interventions, (iii) at a health facility after active community case finding and referral and (iv) in the community after active community case finding. The nutrition community should consider the four health system components required for the success of its interventions: a skilled and motivated health workforce, an effective supply chain, demand for services and access to services. A strong health system can both provide health services and promote and facilitate care seeking for those services.

In addition to strengthening health systems, adjusting delivery processes to make better use of existing health systems as they are now should be considered by nutrition programmers. This may include increasing  the number and frequency of interactions (for any reason) that people have with the health system, improving demand for, and access to, health services in general and enhanced pre-service and in-service training of health workers to ensure they use every patient interaction to assess, treat and counsel on nutrition-related issues.

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Endnotes

¹ King, SE, Sawadogo Lewis, T, Black, RE, Roberton, T. Making the health system work for the delivery of nutrition interventions. Matern Child Nutr. 2020;e13056. https://doi.org/10.1111/mcn.13056