Landscape analysis of nutrition services at Primary Health Care Units (PHCUs) in four districts of Ethiopia

Abstract

Background Good nutrition and healthy growth during the first 1000days have lasting benefit throughout life. For this, equally important is the structural readiness of health facilities. However, structural readiness and nutrition services provision during the first 1000 days in Ethiopia is not well understood. The present study was part of a broader implementation research aimed at developing model nutrition districts by implementing evidence based, high impact and cost-effective package of nutrition interventions through the continuum of care. This study was aimed at assessing structural readiness of health facilities and the extent of nutrition service provision in the implementation districts. Methods This assessment was conducted in four districts of Ethiopia. We used mixed method; a quantitative study followed by qualitative exploration. The quantitative part of the study addressed two-dimensions, structural readiness and process of nutrition service delivery. The first dimension assessed attributes of context in which care is delivered by observing availability of essential logistics. The second dimension assessed the service provision through direct observation of care at different units of health facilities. For these dimensions, we conducted a total of 380 observations in 23 health centers and 33 health posts. The observations were conducted at the Integrated Management of Neonatal and Childhood Illnesses unit, immunization unit, Antenatal care unit and Postnatal care unit. The qualitative part included a total of 60 key informant interviews with key stakeholders and service providers. Result We assessed structural readiness of 56 health facilities. Both quantitative and qualitative findings revealed poor structural readiness and gap in nutrition services provision. Health facilities lack essential logistics which was found to be more prominent at health posts compared to health centers. The process evaluation showed a critical missed opportunity for anthropometric assessment and preventive nutrition counselling at different contact points. This was particularly prominent at immunization unit (where only 16.4% of children had their weight measured and only 16.2% of mothers with children under six month of age were counselled about exclusive breastfeeding). Although 90.4% of pregnant women who came for antenatal care were prescribed iron and folic acid supplementation, only 57.7% were counselled about the benefit and 42.4% were counselled about the side effect. The qualitative findings showed major service provision bottlenecks including non-functionality of the existing district nutrition coordination body and technical committees, training gaps, staff shortage, high staff turnover resulting in work related burden, fatigue and poor motivation among service providers. Conclusion We found a considerable poor structural readiness and gaps in delivering integrated nutrition services with a significant missed opportunity in nutrition screening and counselling. Ensuring availability of logistics and improving access to training might improve delivery of nutrition services. In addition, ensuring adequate human resource might reduce missed opportunity and enable providers to provide a thorough preventive counselling service.

Quality of nutrition services in primary health care facilities of Dhaka city: State of nutrition mainstreaming in urban Bangladesh

“…Similar high satisfaction scores for health and nutrition services have been reported in other studies despite gaps in facility readiness and quality of implementation [ 15 , 32 ]. Researchers have observed that behaviour of the service providers play a greater role in client satisfaction rather than actual quality of service [ 33 , 34 ].Cleanliness of waiting area and waiting time received the lowest mean score similar to finding from other studies in Bangladesh and elsewhere [ 15 , 24 , 34 ]. Pregnant women’s satisfaction was significantly greater with increasing number of nutrition services received.…”

“…Healthcare providers had more knowledge about nutrition topics to include during counselling mothers of young children than pregnant women. Similar gaps in structural readiness of health facilities for nutrition service delivery have been observed in Bangladesh and other low-and middle-income countries (LMICs) [15,24,25]. Addressing…”

Effective Coverage of Management of Wasting in Ethiopia

“…Clean water is vital for procedures such as the appetite test, which is a cornerstone of SAM management. The findings of studies in Ethiopia that detailed gaps in structural readiness align with this observation, signaling that infrastructural readiness lags [35,36].…”

“…In our study, a significant number of facilities had high availability rates of RUTF (79.2%) and RUSF (59.7%), suggesting an effective supply chain for supporting nutritional interventions. Compared with the findings of Esete et al, in which 75% of the surveyed health facilities had essential supplies such as the RUTF [35], the results align, further emphasizing the overarching efficiency of the supply chain. However, this benchmark standard of care seems somewhat disparate when considering our observed complete intervention score for SAM of just 32.4%.…”

Barriers and facilitators to the implementation of nutrition interventions at primary health care units of Ethiopia: A consolidated framework for implementation research

“…The revised National Nutrition Programme of Ethiopia aims to strategically address nutrition problems in the first 1000 days through implementation of these high‐impact evidence‐based interventions (Government of Ethiopia, 2016 ). However, landscape analysis of nutrition services in four regions of Ethiopia reveale‐d poor implementation of nutrition interventions (Fenta et al, 2020 ). Therefore, understanding the factors that influence implementation is crucial to improve the uptake of nutrition interventions in Ethiopia.…”