scholarly journals Public health nutrition capacity: assuring the quality of workforce preparation for scaling up nutrition programmes

2016 ◽  
Vol 19 (11) ◽  
pp. 2090-2100 ◽  
Author(s):  
Roger Shrimpton ◽  
Lisanne M du Plessis ◽  
Hélène Delisle ◽  
Sonia Blaney ◽  
Stephen J Atwood ◽  
...  
Keyword(s):  
Public Health ◽  
Child Nutrition ◽  
Task Force ◽  
Scale Up ◽  
Scaling Up ◽  
Public Health Nutrition ◽  
Middle Income ◽  
Nutrition Training ◽  
Service Training ◽  
Hybrid Distance

AbstractObjectiveTo describe why and how capacity-building systems for scaling up nutrition programmes should be constructed in low- and middle-income countries (LMIC).DesignPosition paper with task force recommendations based on literature review and joint experience of global nutrition programmes, public health nutrition (PHN) workforce size, organization, and pre-service and in-service training.SettingThe review is global but the recommendations are made for LMIC scaling up multisectoral nutrition programmes.SubjectsThe multitude of PHN workers, be they in the health, agriculture, education, social welfare, or water and sanitation sector, as well as the community workers who ensure outreach and coverage of nutrition-specific and -sensitive interventions.ResultsOvernutrition and undernutrition problems affect at least half of the global population, especially those in LMIC. Programme guidance exists for undernutrition and overnutrition, and priority for scaling up multisectoral programmes for tackling undernutrition in LMIC is growing. Guidance on how to organize and scale up such programmes is scarce however, and estimates of existing PHN workforce numbers – although poor – suggest they are also inadequate. Pre-service nutrition training for a PHN workforce is mostly clinical and/or food science oriented and in-service nutrition training is largely restricted to infant and young child nutrition.ConclusionsUnless increased priority and funding is given to building capacity for scaling up nutrition programmes in LMIC, maternal and child undernutrition rates are likely to remain high and nutrition-related non-communicable diseases to escalate. A hybrid distance learning model for PHN workforce managers’ in-service training is urgently needed in LMIC.

scholarly journals Public health nutrition in Afghanistan: policies, strategies and capacity-building: current scenario and initiatives

2021 ◽  
Author(s):  
Jyoti Sharma ◽  
Homayoun Ludin ◽  
Monika Chauhan ◽  
Sanjay Zodpey
Keyword(s):  
Public Health ◽  
Nutrition Education ◽  
Child Nutrition ◽  
Institutional Environment ◽  
Scale Up ◽  
Critical Issue ◽  
Noncommunicable Diseases ◽  
Public Health Nutrition ◽  
Weak Institutions ◽  
Training Programmes

Background: Afghanistan is grappling with high burden of malnutrition in women and children and a rising burden of noncommunicable diseases. Aims: A narrative review was conducted with the aim of mapping current nutrition policies and capacity development initiatives to assess policy and the institutional environment and identify gaps and opportunities. Methods: A comprehensive, broad based search was conducted, including databases and websites and policy and programme documents. Results: The policy focuses on multisectoral efforts to address nutrition challenges; however; implementation of nutrition-specific and nutrition-sensitive interventions is not delivered uniformly at the community level due to continued conflict situations and geographic inaccessibility, lack of availability of trained human resources and weak institutions. There is limited evidence on the effectiveness of nutrition programmes in Afghanistan. Limited policy provisions are available to address nutrition issues due to the rising burden of noncommunicable diseases, urbanization and changing dietary patterns. The shortage of skilled nutritional professionals is a critical issue. Lack of institutional capacity, educational standards and accreditation mechanism poses major challenges. Ongoing training programmes are fragmented and fail to meet the requirements of a professional nutrition workforce. Conclusion: The findings highlight that well-structured policies and strategies focusing on maternal and child nutrition provide an enabling policy environment to scale up nutrition interventions.Evidence on the implementation of programmes is needed to aid policy recommendations. The lack of an institutional mechanism for professional nutrition education highlights the great need for action in Afghanistan for public health nutrition and education.

scholarly journals Capacity for scaling up nutrition: a focus on pre-service training in West Africa and a Ghanaian case study

2015 ◽  
Vol 74 (4) ◽  
pp. 533-537 ◽  
Author(s):  
Richmond N. O. Aryeetey ◽  
Amos Laar ◽  
Francis Zotor ◽  
Keyword(s):  
West Africa ◽  
Capital Investment ◽  
Child Nutrition ◽  
Scaling Up ◽  
Poor Quality ◽  
The Sun ◽  
Child Undernutrition ◽  
Nutrition Training ◽  
Service Training ◽  
Training Programmes

The 2013 Lancet series on maternal and child nutrition is identified and advocated for improved institutional and human capacity in nutrition towards scaling up nutrition (SUN) in countries with high stunting rates. Of the fifty-four countries with high burden of child undernutrition who have committed to the SUN movement, thirty-six are in Africa. In the present paper, the academic platform of the SUN movement in Ghana presents an overview of nutrition pre-service capacity in West Africa with a focus on Ghana. The present paper is based on the findings of a sub-region-wide assessment of degree programmes in nutrition in West Africa, plus another report on pre-service nutrition capacity in diploma awarding nursing and nutrition programmes in Ghana. Although there is inadequate evidence on pre-service nutrition training in the sub-region, the two reports provide useful evidence for action, including inadequate number and distribution of pre-service nutrition training programmes, low nutrition graduate output, poor quality of the programme curriculum and instruction, and sub-optimal capital investment. The present paper calls for urgent action to improve pre-service nutrition capacity building as a critical step towards SUN in West Africa.

scholarly journals Factors influencing the scale-up of public health interventions in low- and middle-income countries: a qualitative systematic literature review

2019 ◽  
Vol 35 (2) ◽  
pp. 219-234 ◽  
Author(s):  
Susan E Bulthuis ◽  
Maryse C Kok ◽  
Joanna Raven ◽  
Marjolein A Dieleman
Keyword(s):  
Public Health ◽  
Scale Up ◽  
Scaling Up ◽  
Health Interventions ◽  
Public Health Interventions ◽  
Middle Income ◽  
Middle Income Countries ◽  
Factors Influencing ◽  
Low And Middle Income ◽  
The Way

Abstract To achieve universal health coverage, the scale-up of high impact public health interventions is essential. However, scale-up is challenging and often not successful. Therefore, a systematic review was conducted to provide insights into the factors influencing the scale-up of public health interventions in low- and middle-income countries (LMICs). Two databases were searched for studies with a qualitative research component. The GRADE-CERQual approach was applied to assess the confidence in the evidence for each key review finding. A multi-level perspective on transition was applied to ensure a focus on vertical scale-up for sustainability. According to this theory, changes in the way of organizing (structure), doing (practice) and thinking (culture) need to take place to ensure the scale-up of an intervention. Among the most prominent factors influencing scale-up through changes in structure was the availability of financial, human and material resources. Inadequate supply chains were often barriers to scale-up. Advocacy activities positively influenced scale-up, and changes in the policy environment hindered or facilitated scale-up. The most outstanding factors influencing scale-up through changes in practice were the availability of a strategic plan for scale-up and the way in which training and supervision was conducted. Furthermore, collaborations such as community participation and partnerships facilitated scale-up, as well as the availability of research and monitoring and evaluation data. Factors influencing scale-up through a change in culture were less prominent in the literature. While some studies articulated the acceptability of the intervention in a given sociocultural environment, more emphasis was placed on the importance of stakeholders feeling a need for a specific intervention to facilitate its scale-up. All identified factors should be taken into account when scaling up public health interventions in LMICs. The different factors are strongly interlinked, and most of them are related to one crucial first step: the development of a scale-up strategy before scaling up.

scholarly journals Assessing scalability of an intervention: why, how and who?

2019 ◽  
Vol 34 (7) ◽  
pp. 544-552 ◽  
Author(s):  
Karen Zamboni ◽  
Joanna Schellenberg ◽  
Claudia Hanson ◽  
Ana Pilar Betran ◽  
Alexandre Dumont
Keyword(s):  
Early Stage ◽  
Scale Up ◽  
Complex Interventions ◽  
Scaling Up ◽  
Outcome Evaluation ◽  
Assessment Tools ◽  
Assessment Process ◽  
Optimal Timing ◽  
Middle Income ◽  
Rigorous Research

Abstract Public health interventions should be designed with scale in mind, and researchers and implementers must plan for scale-up at an early stage. Yet, there is limited awareness among researchers of the critical value of considering scalability and relatively limited empirical evidence on assessing scalability, despite emerging methodological guidance. We aimed to integrate scalability considerations in the design of a study to evaluate a multi-component intervention to reduce unnecessary caesarean sections in low- and middle-income countries. First, we reviewed and synthesized existing scale up frameworks to identify relevant dimensions and available scalability assessment tools. Based on these, we defined our scalability assessment process and adapted existing tools for our study. Here, we document our experience and the methodological challenges we encountered in integrating a scalability assessment in our study protocol. These include: achieving consensus on the purpose of a scalability assessment; and identifying the optimal timing of such an assessment, moving away from the concept of a one-off assessment at the start of a project. We also encountered tensions between the need to establish the proof of principle, and the need to design an innovation that would be fit-for-scale. Particularly for complex interventions, scaling up may warrant rigorous research to determine an efficient and effective scaling-up strategy. We call for researchers to better incorporate scalability considerations in pragmatic trials through greater integration of impact and process evaluation, more stringent definition and measurement of scale-up objectives and outcome evaluation plans that allow for comparison of effects at different stages of scale-up.

scholarly journals Cost of scaling up mental healthcare in low-and middle-income countries

2007 ◽  
Vol 191 (6) ◽  
pp. 528-535 ◽  
Author(s):  
Dan Chisholm ◽  
Crick Lund ◽  
Shekhar Saxena
Keyword(s):  
Low Income ◽  
Scale Up ◽  
Mental Healthcare ◽  
Scaling Up ◽  
Psychosocial Treatment ◽  
Economic Evaluations ◽  
Middle Income ◽  
Middle Income Countries ◽  
Per Capita ◽  
Low And Middle Income

BackgroundNo systematic attempt has been made to calculate the costs of scaling up mental health services in low-and middle-income countries.AimsTo estimate the expenditures needed to scale up the delivery of an essential mental healthcare package over a 10-year period (2006–2015).MethodA core package was defined, comprising pharmacological and/or psychosocial treatment of schizophrenia, bipolar disorder, depression and hazardous alcohol use. Current service levels in 12 selected low-and middle-income countries were established using the WHO–AIMS assessment tool. Target-level resource needs were derived from published need assessments and economic evaluations.ResultsThe cost per capita of providing the core package attarget coverage levels (in US dollars) ranged from $1.85 to $2.60 per year in low-income countries and $3.20 to $6.25 per year in lower-middle-income countries, an additional annual investment of $0.18–0.55 per capita.ConclusionsAlthough significant new resources need to be invested, the absolute amount is not large when considered at the population level and against other health investment strategies.

scholarly journals Modelling the Prevalence of Hepatitis B Towards Eliminating It as a Major Public Health Threat in China

2021 ◽  
Author(s):  
Wenjun Liu ◽  
Tianyi Zhuang ◽  
Ruyi Xia ◽  
Zhuoru Zou ◽  
Lei Zhang ◽  
...  
Keyword(s):  
Public Health ◽  
Hepatitis B ◽  
Scale Up ◽  
Scaling Up ◽  
Status Quo ◽  
Antiviral Prophylaxis ◽  
Hbsag Prevalence ◽  
Health Threat ◽  
Public Health Threat ◽  
The Status

Abstract Background: The World Health Organization (WHO) requires a reduction in the prevalence of hepatitis B virus (HBV) surface antigen (HBsAg) in children to 0.1% by 2030, a key indicator for eliminating viral hepatitis as a major public health threat. Whether and how China can achieve this target remains unknown, although great achievements have been made. We aimed to predict the decline of HBsAg prevalence in China and identify key developments needed to achieve the target.Methods: An age- and time-dependent dynamic compartmental model was constructed based on the natural history of HBV infection and the national history and current status of hepatitis B control. The model was run from 2006 to 2040 to predict the decline of HBsAg prevalence under three scenarios including maintaining current interventions (status quo), status quo + peripartum antiviral prophylaxis (recommended by WHO in 2020), and scaling up available interventions.Results: Under the status quo, HBsAg prevalence would decrease steadily in all age groups, but the WHO’s target of 0.1% prevalence in children aged < 5 years would not be achieved until 2037. The results are robust according to sensitivity analyses. Under the status quo + antiviral prophylaxis, the HBsAg prevalence of children aged < 5 years would significantly decrease with the introduction of peripartum antiviral prophylaxis, and the higher the successful interruption coverage is achieved, the more significant the decline. However, even if the successful interruption coverage reaches 90% by 2030, the 0.1% prevalence target would not be met until 2031. Under the scaling up available interventions, combined with scale-up of current interventions, the WHO’s 0.1% target would be achieved on time or one year in advance if peripartum antiviral prophylaxis is introduced and the successful interruption coverage is scaled up to 80% or 90% by 2030, respectively.Conclusions: It is difficult for China to achieve the WHO’s target of 0.1% HBsAg prevalence in children by 2030 by maintaining current interventions. Peripartum antiviral prophylaxis may play an important role to shorten the time to achieve the target. A comprehensive scale-up of available interventions including peripartum antiviral prophylaxis will ensure that China achieves the target on schedule.

scholarly journals An implementation model for scaling up oral pre-exposure prophylaxis in Kenya: Jilinde project

2021 ◽  
Vol 5 ◽  
pp. 113
Author(s):  
Daniel Were ◽  
Abednego Musau ◽  
Mary Mugambi ◽  
Marya Plotkin ◽  
Mark Kabue ◽  
...  
Keyword(s):  
Scale Up ◽  
Scaling Up ◽  
Policy Coordination ◽  
Middle Income ◽  
Implementation Model ◽  
Middle Income Countries ◽  
Community Ownership ◽  
Exposure Prophylaxis ◽  
Oral Prep ◽  
Low And Middle Income

Oral pre-exposure prophylaxis (PrEP) is an efficacious way to lower the risk of HIV acquisition among high-risk individuals. Despite the World Health Organization’s 2015 recommendation that all persons at substantial risk of HIV infection be provided with access to oral PrEP, the rollout has been slow in many low- and middle-income countries. Initiatives for national rollout are few, and subtle skepticism persists in several countries about the feasibility of national PrEP implementation. We describe the conceptual design of the Jilinde project, which is implementing oral PrEP as a routine service at a public health scale in Kenya. We describe the overlapping domains of supply, demand, and government and community ownership, which combine to produce a learning laboratory environment to explore the scale-up of PrEP. We describe how Jilinde approaches PrEP uptake and continuation by applying supply and demand principles and ensures that government and community ownership informs policy, coordination, and sustainability. We describe the “learning laboratory” approach that informs strategic and continuous learning, which allows for adjustments to the project. Jilinde’s conceptual model illustrates how the coalescence of these concepts can promote scale-up of PrEP in real-world conditions and offers critical lessons on an implementation model for scaling up oral PrEP in low- and middle-income countries.

scholarly journals The impact of the timely birth dose vaccine on the global elimination of hepatitis B

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Margaret J. de Villiers ◽  
Shevanthi Nayagam ◽  
Timothy B. Hallett
Keyword(s):  
Hepatitis B ◽  
Horizontal Transmission ◽  
Scale Up ◽  
Scaling Up ◽  
World Health ◽  
Birth Cohorts ◽  
Middle Income ◽  
Hbv Vaccine ◽  
Birth Dose ◽  
The Impact

AbstractIn 2016 the World Health Organization set the goal of eliminating hepatitis B globally by 2030. Horizontal transmission has been greatly reduced in most countries by scaling up coverage of the infant HBV vaccine series, and vertical transmission is therefore becoming increasingly dominant. Here we show that scaling up timely hepatitis B birth dose vaccination to 90% of new-borns in 110 low- and middle-income countries by 2030 could prevent 710,000 (580,000 to 890,000) deaths in the 2020 to 2030 birth cohorts compared to status quo, with the greatest benefits in Africa. Maintaining this could lead to elimination by 2030 in the Americas, but not before 2059 in Africa. Drops in coverage due to disruptions in 2020 may lead to 15,000 additional deaths, mostly in South-East Asia and the Western Pacific. Delays in planned scale-up could lead to an additional 580,000 deaths globally in the 2020 to 2030 birth cohorts.

scholarly journals Towards a more nuanced global mental health

2014 ◽  
Vol 204 (6) ◽  
pp. 415-417 ◽  
Author(s):  
Ross G. White ◽  
S. P. Sashidharan
Keyword(s):  
Mental Health ◽  
Global Mental Health ◽  
Scale Up ◽  
Scaling Up ◽  
World Health ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Gap ◽  
Action Programme ◽  
Health Organization

SummaryThe World Health Organization has made concerted efforts to scale up mental health services in low- and middle-income countries through the Mental Health Gap Action Programme (mhGAP) initiative. However, an overreliance on scaling up services based on those used in high-income countries may risk causing more harm than good.

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