Lessons learned from operationalizing the integration of nutrition-specific and nutrition-sensitive interventions in rural Ethiopia

Abstract

Background Undernutrition reduction requires coordinated efforts across sectors to address its causes. A multisectoral approach is important in diagnosing the problem and identifying solutions that would be implemented across different sectors. The study aims to explore the experience of health and agriculture extension workers in integrating nutrition services provided to households with children under two years of age at community level. Methods A qualitative study has been conducted in agrarian areas of Ethiopia in 2021 at the end of a large intervention program to reduce stunting. In total, 28 key informant interviews were conducted with health- and agriculture-extension workers and mothers. A framework analysis approach was applied to manage and analyze data using NVivo version 12 software. Results Community-level joint intervention is a feasible approach to integrating nutrition services. Farm gardening and cooking demonstrations were practiced jointly with extension workers and households. Because of service integration, extension workers perceived an improved father’s role in supporting mothers in childcaring and feeding nutritious diets to children, and decreased severe cases of undernutrition. Integration of health and agriculture sectors for nutrition intervention was challenged by the high workload on extension workers, poor supervision and leadership commitment, lack of appropriate agricultural inputs, and absence of clarity on sector-specific roles. In some areas nutrition services are not owned by the health and agriculture sectors, and it was overlooked. Conclusion Integrating existing community-level platforms are key entry points to address undernutrition and promote key agriculture and health interventions in Ethiopia. Empowering extension workers through training, monitoring, and supervision is part of ensuring the sustainability of integration between sectors.