Development and use of the generic WHO/CDC logic model for vitamin and mineral interventions in public health programmes

Abstract

Objective: Nutrition interventions are critical to achieve the Millennium Development Goals; among them, micronutrient interventions are considered cost-effective and programmatically feasible to scale up, but there are limited tools to communicate the programme components and their relationships. The WHO/CDC (Centers for Disease Control and Prevention) logic model for micronutrient interventions in public health programmes is a useful resource for planning, implementation, monitoring and evaluation of these interventions, which depicts the programme theory and expected relationships between inputs and expected Millennium Development Goals. Design: The model was developed by applying principles of programme evaluation, public health nutrition theory and programmatic expertise. The multifaceted and iterative structure validation included feedback from potential users and adaptation by national stakeholders involved in public health programmes' design and implementation. Results: In addition to the inputs, main activity domains identified as essential for programme development, implementation and performance include: (i) policy; (ii) products and supply; (iii) delivery systems; (iv) quality control; and (v) behaviour change communication. Outputs encompass the access to and coverage of interventions. Outcomes include knowledge and appropriate use of the intervention, as well as effects on micronutrient intake, nutritional status and health of target populations, for ultimate achievement of the Millennium Development Goals. Conclusions: The WHO/CDC logic model simplifies the process of developing a logic model by providing a tool that has identified high-priority areas and concepts that apply to virtually all public health micronutrient interventions. Countries can adapt it to their context in order to support programme design, implementation, monitoring and evaluation for the successful scale-up of nutrition interventions in public health.

Predictors of micronutrient powder intake adherence in a pilot programme in Nepal

“…It is possible that some mothers retained the information of how to correctly prepare the food but still lacked the skills or motivation to overcome the barrier of child refusals and were unable to successfully operationalize this information into practice. This barrier highlights the intersection of knowledge (information), skills and motivation needed to support MNP intake adherence and shows that only one of these components is not sufficient, all three are required (12) . In addition to the child refusing food mixed with MNP, approximately 10-20 % of mothers whose children did not meet the criteria for high intake adherence reported additional reasons for the lower MNP intake.…”

Predictors of micronutrient powder sachet coverage in Nepal

“…), and practice‐based evidence, the WHO/CDC logic model for vitamin and mineral interventions in public health programmes outlines expected intervention processes and shows that establishing and maintaining high coverage of batches of MNP requires both well‐functioning logistics to ensure product availability – including effective MNP supply management, transportation and distribution – and effective behaviour change strategies aimed at promoting knowledge, skills and sustained MNP demand and motivation for use by participants (De‐Regil et al . ). Despite growing public health investment and programme growth, little is known about how different delivery models influence MNP coverage.…”

Monitoring and surveillance for multiple micronutrient supplements in pregnancy

“…Logic models are useful tools to structure and organize information, and they can be used to convey information and expected processes in ways that are simple or complex. The WHO/CDC logic model for micronutrient interventions in public health (Figure ) is a tool to assist countries in designing and implementing micronutrient programmes that are focused on achieving public health goals (De‐Regil et al, ). The logic model is organized according to four main hierarchical categories: inputs, activities, outputs, and outcomes (De‐Regil et al, ).…”

“…According to the WHO/Centers for Disease Control and Prevention (CDC) logic model for vitamin and mineral intervention in public health programmes (De‐Regil, Peña‐Rosas, Flores‐Ayala, & Jefferds, ), most micronutrient programmes are expected to follow particular intervention processes. These processes require inputs to support relevant policies, adequate production and supply, delivery of the programme, quality control, and behaviour change communication and intervention strategies in order to achieve expected outputs and outcomes (Figure ).…”

“…National and global monitoring and surveillance data on supplementation during pregnancy are primarily collected from cross‐sectional surveys and on a more routine basis through health and logistics management information systems. Some indicators for IFA supplementation exist (Bhutta et al, ; Tessama et al, ); however, based on the WHO/CDC logic model (De‐Regil et al, ), new indicators for MMN supplementation need to be incorporated, especially around policy development and inclusion of additional outcomes afforded by MMN compared to IFA supplements. Identifying key monitoring indicators that address barriers and support effective programmes is a priority as countries heighten their focus on supplementation during pregnancy and may potentially initiate or transition to MMN supplementation.…”