Integrating nutrition services into health care systems platforms: Where are we and where do we go from here

Abstract

Integrating maternal-child nutrition into health care services is a desirable but complex task that requires implementation research studies. This special supplement, entitled "How to Strengthen Nutrition into the Health Platform: Programmatic Evidence and Experience from Low-and Middle-Income Countries" presents a collection of mixed-methods research and case studies mostly conducted in sub-Saharan Africa that help us gain a better understanding of the barriers and facilitators for this integration to happen. Collectively, the evidence confirms that integrating nutrition services as part of health care systems and other platforms is feasible, but for that to be successful, there is a need to address strong barriers related to all six key health care systems building blocks identified by the World Health Organization. These include financing, health information systems, health workforce, supplies and technology, governance, and service delivery. Moving forward, it is crucial that more robust implementation science research is conducted within the rough and tumble of realworld programming to better understand how to best integrate and scale up nutrition services across health care systems and other platforms based on dynamic complex adaptive systems frameworks. This research can help better understand how the key health care systems building blocks need to interlock and communicate with each other to improve the policymakers' ability to integrate and scale up nutrition services in a more timely and cost-effective way. KEYWORDS complex adaptive systems, health care systems, maternal and child health, nutrition programs

Micronutrient powder programs: New findings and future directions for implementation science

“…Those changes, in turn, will pose new challenges and opportunities for implementation science to support the effort by studying various aspects of the implementation systems themselves and doing so in ways that meet the needs and timetables of implementers and policy makers. Some excellent examples of the latter are available in a recent supplement focused on the challenges of integrating and sustaining nutrition interventions within health platforms in low‐ and middle‐income countries (Pérez‐Escamilla & Engmann, ).…”

Making the health system work for the delivery of nutrition interventions

“…A strong health system is essential for the delivery of nutrition‐specific interventions (WHO, 2019). Many nutrition programmes fail to anticipate health system bottlenecks, resulting in poor implementation strength and low population coverage (Jennings, Gillespie, Mason, Lotfi, & Scialfa, 1991; Neufeld, Baker, Garrett, & Haddad, 2017; Pérez‐Escamilla & Engmann, 2019). There is much evidence for the efficacy of nutrition interventions, but there is less evidence on the implementation of nutrition programmes at scale to achieve meaningful impact (Garrett, 2008; Leroy & Menon, 2008; Weber, Galasso, & Fernald, 2019).…”

“…While there is substantial evidence for the efficacy and potential impact of nutrition‐specific interventions, less is understood about how to deliver the interventions at scale, much less the role of health systems in facilitating or hindering nutrition programmes (Pérez‐Escamilla & Engmann, 2019). There is increasing emphasis on implementation research in the nutrition community to understand how to deliver interventions with high fidelity, dose and sustainability (Garrett, 2008; Leroy & Menon, 2008; Menon et al, 2014; Paina & Peters, 2012; Pérez‐Escamilla & Engmann, 2019; Salam, Das, & Bhutta, 2019). Successful implementation requires intentional changes to current processes within the existing systems (Damschroder et al, 2009).…”

Impact evaluation of immunisation service integration to nutrition programmes and pediatric outpatient departments of primary health care centers in Rumbek East and Rumbek Centre counties of South Sudan

“…Since nutritionists assessed the immunisation status of the children before enrolling them in the nutrition programme, this ensured that missed opportunities for immunisation were assessed and counselled. Also, integration has been successful other way around as well when other interventions such as vitamin A supplementation to immunisation campaigns have improved immunisation coverage (45).…”