Integrating nutrition into health systems: What the evidence advocates

Abstract

There is considerable evidence of positive health and nutrition outcomes resulting from integrating nutrition‐specific interventions into health systems; however, current knowledge on establishing and sustaining effective integration of nutrition into health systems is limited. The objective of this review is to map the existing types of integration platforms and review the evidence on integrated health and nutrition programmes' impacts on specific nutrition outcomes. A literature search was conducted, and integrated nutrition programmes were examined through the lens of the six World Health Organization (WHO) building blocks, including the demand side. Forty‐five studies were included in this review, outlining the integration of nutrition‐specific interventions with various programmes, including integrated community case management and Integrated Management of Childhood Illness, Child Health Days, immunization, early child development, and cash transfers. Limited quantitative data were suggestive of some positive impact on nutrition and non‐nutrition outcomes with no adverse effects on primary programme delivery. Through the lens of the six WHO building blocks, service delivery and health workforce were found to be well‐integrated, but governance, information systems, finance and supplies and technology were less well‐integrated. Integrating nutrition‐specific interventions into health systems may ensure efficient service delivery while having an impact on nutrition outcomes. There is no single successful model of integration; it varies according to the context and demands of the particular setting in which integration occurs. There is a need for more well‐planned programmes considering all the health systems building blocks to ensure compliance and sustainability.

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

“…Collectively, the evidence presented in this special issue 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 all six building blocks identified by WHO (Salam et al, ). Although leadership/governance per se were not the single focus of any of the studies, it is clear that the engagement of the target communities (including children's fathers) and civil society organizations (e.g., NGOs) provides a powerful demand–generation component to health/nutrition efforts (Engmann, Khan, Moyer, Coffey, & Bhutta, ) and are central to the proper design and delivery of these services in partnership with governments (Segura‐Pérez, Grajeda, & Pérez‐Escamilla, 2016).…”

“…These building blocks are: financing, health information systems, health workforce, supplies and technology, governance, and service delivery (WHO, ). In this special issue, “How to Strengthen Nutrition into the Health Platform: Programmatic Evidence and Experience from Low‐ and Middle‐Income Countries” (commissioned by the United States Agency for International Development's Maternal and Child Survival Program), Salam et al build upon this WHO framework to map the current integration of nutrition services into health care systems platforms and to review the impact of integrated health and nutrition programs and their implications on diverse nutrition outcomes in low‐ and middle‐ income countries (Salam, Das, & Bhutta, ). In their scoping review, the authors define nutrition integration as “the extent of adoption and eventual assimilation of nutrition interventions into critical health system functions” taking heavily into account the health care systems building blocks identified by WHO.…”

“…This research is fundamental to better understand how the key building blocks of health systems need to interlock and communicate with each other to improve the policymakers' ability to integrate programmes and scale them up in a more timely and cost‐effective way (Alonge, Lin, Igusa, & Peters, ; Pérez‐Escamilla & Hall Moran, ). This research is also necessary to address the need for reaching consensus on standardized global health and nutrition definitions, and to provide a high‐resolution framework that includes minimum standards for integrating nutrition‐specific interventions into health service delivery (Salam et al, ).…”

Making the health system work for the delivery of nutrition interventions

“…In addition to strengthening health systems, we should also consider adjusting delivery processes to make better use of existing health systems as they are now (Salam et al, 2019). As seen in Second, for interventions that are currently delivered when people seek care for unrelated services (Figure 1b), programme implementers could initiate a shift in delivery process, to either encourage people to intentionally seek care for the intervention (Figure 1a) or to adopt a community-based, active-case-finding strategy for the intervention (Figure 1c or Figure 1d).…”

“…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).…”