Appraisal on nutrition integration in health systems

Study to appraise nutrition integration in health systems:

It has been increasingly documented that lack of optimum functioning of health systems continue to pose a critical barrier to reaching health service to people. In this context effective delivery of nutrition interventions which are traditionally of low priority in comparison to popular vertical disease interventions pose an additional dilemma. The lancet series provide a synthesis of the evidence and illustrate some of the gaps in the published literature. The recommendations for national health systems to streamline their resources and competencies for specific and targeted interventions to address the disease burden due to undernutrition require further scrutiny by policy makers and implementer for adaptation within their contexts. To effective operationalize these recommendations at the country level, additional mechanisms are needed to measure and address the gaps in all dimensions of policy, planning and service delivery. Concurring with this need, one of the key activities of MNI is to conduct a global review that focuses on the principles of health systems integration of nutrition.
 

Methodology

The team at Johns Hopkins Bloomberg School of Public Health works collaboratively with the team at ICDDRB led by Dr Tahmeed Ahmed and their partners at Cornell and Aga Khan University to develop a Strategic framework to address the major issues illustrated in the Lancet series on the currently capacities of health systems for engaging in nutrition interventions.
The broad objectives are outlined below:

1. Examine the current evidence of the effectiveness of health system frameworks for implementing nutrition services/interventions from published and grey data. This would involve a desk top review of available health and nutrition frameworks and the effectiveness of strategies implemented to strengthen service delivery and integration.
2. Assess the performance of national policies and strategies for nutrition and determine the challenges and deficiencies in the execution of the policy guidelines. This will be performed through multiple assessment measures of review of policy documents, reports, semi-structured surveys of key stakeholders engaged in nutrition programs at the country level and formative research with policy makers, NGO’s academic nutrition experts, and the frontline providers in the primary health system. Uganda, Tanzania and Bangladesh were purposively selected to perform the country case studies based on the following criteria:
   • Included in the list of 20 countries with highest burden of under nutrition
   • Considerable investments in comprehensive nutrition interventions for the past decade
   • Existence of a national nutritional policy
   • Availability of data from health systems and national nutritional surveys
3. Draw out the key findings and practical recommendations which followed from the evidence. Determine the gaps in operationalizing policies into practice at the local and national level and provide appropriate recommendations for benchmarking strategies and successes from health systems that have demonstrated effective integration of nutrition programs. The analysis from the country case studies will also help determine the type and optimal level of nutritional services that must be undertaken by the heath system to streamline its efforts to target the Millennium Development Goals for poverty and under nutrition and those that need to be delegated or outsourced to other sectors or the effective engagement of community infrastructures to determine local solutions.
4. The structure of an effective nutrition system will be applied to each of these country case studies to study the stewardship, financing and role of international organizations to strengthen the capacity of national health systems for effective execution of nutritional services.