Linking Health Systems and nutrition

Kim_Sunny_webSunny Kim, Research Fellow at IFPRI writes from the Third Global Symposium on Health Systems Research in Cape Town (September 29-October 3, 2014), and asks ‘How do the proposed actions from this conference bear on food and nutrition interventions, which are often delivered through health systems?’

In the wake of the Third Global Symposium on Health Systems Research in Cape Town, there is greater awareness of the continued challenges to building sustainable, equitable, and responsive health systems toward health for all.  In addition to proposed actions, the Cape Town Statement (www.healthsystemsglobal.org/Portals/0/files/Cape-Town-Statement.pdf) includes recommendations for research: promote understanding of civil society and social movements; further develop understanding of health workers, particularly mid-level health workers; allow the experiences of communities and health workers be heard through use of innovative research methods; and understand scaling-up of health programs in different contexts.

How then does this bear on food and nutrition interventions, which are often delivered through health systems as well as in conjunction with other sectors and systems?

The global vision in the Cape Town Statement reads similar to the post-2015 development agenda of the Scaling-Up Nutrition (SUN) Movement, i.e. food and nutrition security, or simply good nutrition, for all (www.scalingupnutrition.org/wp-content/uploads/2013/05/Joint-Statement-on-Food-and-Nutrition-Security-in-the-Post-2015-Development-Agenda.pdf).

Whether it be distribution of prophylactic supplements or foods for mothers and children, treatment of severe or moderate acute malnutrition, or behavior-change communication on maternal nutrition and child feeding, nutrition interventions involve systems of social structures (institutions and organizations) and people (policy-makers, managers, providers, and beneficiaries) across various sectors (health, social welfare, child development/education, agriculture, water, sanitation and hygiene, etc.).  Similar to the public health sector, the provision of good nutrition for all also faces challenges of making effective interventions/services sustainable, equitable, and at-scale.

There are some clear links in the research areas for health systems and nutrition, from policy analysis to service delivery and utilization:

  • ·         There is a need to develop methods of participatory policy analysis to understand how decisions, policies, and directive instruments are developed and may be influenced.
  • ·         With the advent of “implementation science”, there is a strong call for process-oriented research that elucidates quality and efficiency (cost) of service delivery or program implementation, including the process of working across sectors.
  • ·         Within this scope, we must understand the recruitment, work capacities, and retention of frontline workers through study of their workload and structures, skills development, and motivation.
  • ·         Insofar as impact is limited by the uptake of inputs by targeted individuals, households, and communities, there is a need for understanding service demand and utilization.
  • ·         The culmination of a global vision for health or good nutrition for all calls for understanding of scaling up and sustainability of effective interventions/services.

Moving forward the nutrition research agenda translates into advancing in health systems research priorities as well as in the research areas of other sectors.

Further reading:

Menon, P., Covic, N. M., Harrigan, P. B., Horton, S. E., Kazi, N. M., Lamstein, S., Neufeld, L., Oakley, E. and Pelletier, D. (2014), Strengthening implementation and utilization of nutrition interventions through research: a framework and research agenda. Annals of the New York Academy of Sciences. doi: 10.1111/nyas.12447

Gillespie S., Haddad, L., Mannar., V, Menon P., Nisbett N., The politics of reducing malnutrition: building commitment and accelerating progress The Lancet, Volume 382, Issue 9891, Pages 552 – 569, 10 August 2013