Policies and Program Implementation Experience to Improve Maternal Nutrition in Ethiopia

2012 ◽  
Vol 33 (2_suppl1) ◽  
pp. S27-S50 ◽  
Author(s):  
Lisa S. Saldanha ◽  
Laura Buback ◽  
Jessica M. White ◽  
Afework Mulugeta ◽  
Solomon G. Mariam ◽  
...  
Keyword(s):  
Program Implementation ◽  
Maternal Nutrition ◽  
Health Workers ◽  
Background Information ◽  
Nutrition Interventions ◽  
District Health ◽  
Community Based ◽  
Maternal Undernutrition ◽  
Health And Nutrition ◽  
Nutrition Service

Background Maternal undernutrition persists as a serious problem in Ethiopia. Although there are maternal nutrition interventions that are efficacious and effective in improving maternal, neonatal, and child health (MNCH) outcomes, implementation has been limited. Objective This study explored needs, perceptions, priorities, facilitating factors and barriers to implementation of relevant policies and programs to find opportunities to improve maternal nutrition in Ethiopia Methods Background information was compiled and synthesized for a situation analysis. This informed focus group discussions and in-depth interviews with mothers, community leaders, health workers, and district health officials in four woredas (districts) in Tigray and Southern Nations, Nationalities and Peoples Region. Results Findings focused on three priority issues: maternal anemia, intrauterine growth retardation (IUGR), and maternal thinness and stunting. Community-level investigations found that women's low status, food insecurity and poverty, and workload were key factors perceived to contribute to women's undernutrition. Awareness of and demand for services to improve women's nutrition were low, except for high demand for supplementary food. On the supply side, barriers included low prioritization of maternal nutrition in health and nutrition service delivery and weak technical capacity to deliver context-sensitive maternal nutrition interventions at all levels. Conclusions Community-based health and nutrition services were promising platforms for expanding access to interventions such as micronutrient supplements and social and behavior change communication. Investments are needed to support these community-based programs, including training, supplies, supervision and monitoring. To address IUGR at scale, increased access to cash or food transfers could be explored.

scholarly journals Understanding How the Strategic Use of Data Can Improve the Implementation of Maternal Nutrition Interventions in Uttar Pradesh (UP), India

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 945-945
Author(s):  
Ahad Bootwala ◽  
Phuong Nguyen ◽  
Shivani Kachwaha ◽  
Rasmi Avula ◽  
Sebanti Ghosh ◽  
...  
Keyword(s):  
Maternal Nutrition ◽  
Data Use ◽  
Nutrition Interventions ◽  
District Health ◽  
Monthly Review ◽  
Maternal Undernutrition ◽  
Use Of Data ◽  
District Government ◽  
The Government ◽  
The Impact

Abstract Objectives Maternal undernutrition remains high in India and is associated with maternal mortality and adverse birth outcomes. To address this challenge, Alive & Thrive (A&T) aimed to strengthen interpersonal counseling, micronutrient supplement provision, and community mobilization through the government antenatal care (ANC) platform in UP. The nutrition-intensified ANC (I-ANC) intervention facilitated regular use of data to enable corrective actions. We aimed to understand how maternal health data was used for improving the delivery of maternal nutrition services and to identify factors associated with data use. Methods In-depth interviews (N = 35) were conducted among sub-district government staff, frontline worker (FLW) supervisors and A&T staff in two districts in UP. Systematic coding of verbatim transcripts and detailed summaries was undertaken to elucidate themes and patterns related to data use and facilitators and barriers. Results Sub-district government staff reported using government data (i.e., HMIS) to estimate demand for prenatal supplements. Sub-district government staff, FLW supervisors and A&T staff used government and intervention monitoring data to understand the impact and reach of services delivered to women. Key indicators on the attendance of pregnant women at community health events and number of women receiving adequate supplements was discussed with FLWs in monthly review meetings. Data review guided identification of areas of low FLW performance (i.e., monitoring weight gain) and prompted refresher trainings. Facilitators of data use included collaboration between sub-district health department officials on data analysis and monthly review meetings to provide feedback on improving performance (including counseling topics and stock of supplements). Barriers to data use included staff vacancies, education level of FLWs and conflicts between FLWs and supervisors. Conclusions Use of data for decision making is critical for supporting intervention planning and providing targeted supervision and support for FLWs. Collaboration facilitated the use of data, but structural barriers such as staff vacancies need to be addressed to improve the implementation of maternal nutrition interventions. Funding Sources Bill & Melinda Gates Foundation (through Alive & Thrive, managed by FHI 360) and Emory University.

scholarly journals Scoping Review of Intervention Strategies for Improving Coverage and Uptake of Maternal Nutrition Services in Southeast Asia

2021 ◽  
Vol 18 (24) ◽  
pp. 13292
Author(s):  
Kauma Kurian ◽  
Theophilus Lakiang ◽  
Rajesh Kumar Sinha ◽  
Nishtha Kathuria ◽  
Priya Krishnan ◽  
...  
Keyword(s):  
Nutrition Education ◽  
Scoping Review ◽  
Maternal Nutrition ◽  
Health Workers ◽  
Protein Energy Malnutrition ◽  
Conditional Cash Transfer ◽  
Cash Transfer ◽  
Micronutrient Deficiencies ◽  
Nutrition Interventions ◽  
Maternal Undernutrition

Maternal undernutrition can lead to protein-energy malnutrition, micronutrient deficiencies, or anemia during pregnancy or after birth. It remains a major problem, despite evidence-based maternal-nutrition interventions happening on ground. We conducted a scoping review to understand different strategies and delivery mechanisms to improve maternal nutrition, as well as how interventions have improved coverage and uptake of services. An electronic search was conducted in PubMed and Google Scholar for published studies reporting on the effectiveness of maternal-nutrition interventions in terms of access or coverage, health outcomes, compliance, and barriers to intervention utilization. The search was limited to studies published within ten years before the initial search date, 8 November 2019; later, it was updated to 17 February 2021. Of 31 studies identified following screening and data extraction, 22 studies were included for narrative synthesis. Twelve studies were reported from India and eleven from Bangladesh, three from Nepal, two from both Pakistan and Thailand (Myanmar), and one from Indonesia. Nutrition education and counselling, home visits, directly observed supplement intake, community mobilization, food, and conditional cash transfer by community health workers were found to be effective. There is a need to incorporate diverse strategies, including various health education approaches, supplementation, as well as strengthening of community participation and the response of the health system in order to achieve impactful maternal nutrition programs.

Public Health Interventions, Barriers, and Opportunities for Improving Maternal Nutrition in India

2012 ◽  
Vol 33 (2_suppl1) ◽  
pp. S71-S92 ◽  
Author(s):  
Usha Ramakrishnan ◽  
Alyssa Lowe ◽  
Sheila Vir ◽  
Shuba Kumar ◽  
Rani Mohanraj ◽  
...  
Keyword(s):  
Public Health ◽  
Program Implementation ◽  
Tamil Nadu ◽  
Maternal Nutrition ◽  
Phase 1 ◽  
National Level ◽  
Monitoring And Evaluation ◽  
Resource Scarcity ◽  
Maternal Undernutrition ◽  
Nutrition Programs

Background Inadequate nutrient intake, early and multiple pregnancies, poverty, caste discrimination, and gender inequality contribute to poor maternal nutrition in India. While malnutrition is seen throughout the life cycle, it is most acute during childhood, adolescence, pregnancy, and lactation. Although nutrition policies are on the books and interventions are in place, child malnutrition and maternal undernutrition persist as severe public health problems. Objective To evaluate the implementation of maternal nutrition programs in India. Methods The research was conducted in two phases. Phase 1 consisted of a desk review of national and state policies pertinent to maternal nutrition and national-level key informant interviews with respondents who have a working knowledge of relevant organizations and interventions. Phase 2 utilized in-depth interviews and focus group discussions at the state, district, and community levels in eight districts of two states: Tamil Nadu and Uttar Pradesh. All data were analyzed thematically. Results India has a rich portfolio of programs and policies that address maternal health and nutrition; however, systematic weaknesses, logistical gaps, resource scarcity, and poor utilization continue to hamper progress. Conclusions Elevating the priority given to maternal nutrition in government health programs and implementing strategies to improve women's status will help to address many of the challenges facing India's nutrition programs. Programs can be strengthened by promoting integration of services, ensuring effective procurement mechanisms for micronutrient and food supplements, establishing regional training facilities for improved program implementation, and strengthening program monitoring and evaluation.

scholarly journals PENERAPAN LAYANAN KESEHATAN DAN GIZI DALAM PENYELENGGARAAN PAUD HOLISTIK INTEGRATIF DI TK ALAM PELOPOR RANCAEKEK

Edukid ◽  
2020 ◽  
Vol 17 (1) ◽  
pp. 50-64
Author(s):  
Ghina Salamatu Sadiah ◽  
Nur Faizah Romadhona ◽  
Asep Deni Gustiana
Keyword(s):  
Data Analysis ◽  
Health Workers ◽  
Case Study Research ◽  
Education Institution ◽  
Local Health ◽  
Design Data ◽  
Additional Food ◽  
Nutrition Services ◽  
Health And Nutrition ◽  
Nutrition Service

Abstrak: Penelitian ini dilatar belakangi oleh situasi dilapangan, dimana layanan kesehatan dan gizi dalam penyelenggaraan Paud Holistik Integratif ini masih jarang diterapkan di setiap lembaga pendidikan anak usia dini, sehingga kebutuhan esensial anak khususnya dalam aspek kesehatan dan gizi belum terpenuhi secara optimal. Tujuan penelitian ini untuk mengetahui penerapan layanan kesehatan dan gizi dalam penyelenggaraan Paud Holistik Integratif di TK Alam Pelopor Rancaekek. Penelitian ini menggunakan pendekatan kualitatif dengan desain penelitian studi kasus. Teknik pengumpulan data menggunakan, wawancara dan studi dokumentasi, dengan narasumber dari kepala sekolah, dua guru dan satu orangtua murid. Analisis data menggunakan analisis data tematik.  Hasil Penelitian menunjukan : pertama perencanaaan pelaksanaan layanan kesehatan dan gizi di TK Alam Pelopor Rancaekek dimulai dengan membuat pedoman pelaksanaan program layanan Holistik Integratif yang didalamnya mencangkup pelaksanaan layanan kesehatan dan gizi, rangsangan pendidikan, pembinaan moral-emosional, pengasuhan dan keamanan. Kedua,  pelaksanaan layanan kesehatan dan gizi di TK Alam Pelopor dilaksanakan dengan menyesuaikan dana operasional yang ada di sekolah. Bentuk layanannya terdiri dari pemeriksaan kesehatan secara rutin oleh petugas kesehatan setempat maupun oleh gurunya sendiri, pemberian makanan tambahan bagi peserta didik, dan pembiasaan hidup sehat di kalangan peserta didik. Melalui pemberian layanan tersebut dapat meminimalisir permasalahan kesehatan dan gizi yang biasa terjadi pada anak, sehingga tingkat kesakitan anak dapat berkurang. Ketiga, evaluasi layanan kesehatan dan gizi yang telah dilaksanakan di TK Alam Pelopor Rancaekek dilakukan berdasarkan indikator pencapaian yang telah dibuat dari pedoman pelaksanaan program Holistik Integratif. Kata Kunci: Layanan kesehatan dan gizi, penerapan Paud Holistik Integratif.  Abstract: This research is motivated by the situation in the field, where health and nutrition services in the implementation of Integrative Holistic Paud are still rarely applied in every early childhood education institution, so that the essential needs of children, especially in aspects of health and nutrition have not been optimally fulfilled. The purpose of this study was to determine the application of health and nutrition services in the implementation of Integrative Holistic Paud at TK Pelopor Rancaekek. This research uses a qualitative approach with a case study research design. Data collection techniques using, interviews and documentation study, with speakers from the principal, two teachers and one parent of students. Data analysis uses thematic data analysis. The results of the study show: first the planning of the implementation of health and nutrition services in Alam Pelopor Rancaekek Kindergarten begins by making guidelines for the implementation of the Integrative Holistic service program which includes health and nutrition service implementation, education stimulation, moral-emotional development, care and security. Second, the implementation of health and nutrition services at Alam Pelopor Kindergarten is carried out by adjusting the operational funds available at the school. The form of service consists of routine health checks by local health workers and by the teacher himself, providing additional food for students, and the habit of healthy living among students. Through the provision of these services can minimize health and nutrition problems that commonly occur in children, so that the level of child pain can be reduced. Third, evaluation of health and nutrition services that have been carried out at Alam Pelopor Rancaekek Kindergarten are based on achievement indicators that have been made from the guidelines for the implementation of the Integrative Holistic program. Keywords: Health and nutrition services, application of Holistic Integratif PAUD.

scholarly journals ‘If he sees it with his own eyes, he will understand’: how gender informed the content and delivery of a maternal nutrition intervention in Burkina Faso

2020 ◽  
Vol 35 (5) ◽  
pp. 536-545 ◽  
Author(s):  
Jasmin Isler ◽  
N Hélène Sawadogo ◽  
Guy Harling ◽  
Till Bärnighausen ◽  
Maya Adam ◽  
...  
Keyword(s):  
Burkina Faso ◽  
Maternal Nutrition ◽  
Health Workers ◽  
Nutrition Intervention ◽  
Nutrition Interventions ◽  
Group Discussions ◽  
Intervention Delivery ◽  
Meal Preparation ◽  
And Gender ◽  
Two Stages

Abstract A growing body of literature urges policymakers, practitioners and scientists to consider gender in the design and evaluation of health interventions. We report findings from formative research to develop and refine an mHealth maternal nutrition intervention in Nouna, Burkina Faso, one of the world’s most resource-poor settings. Gender was not an initial research focus, but emerged as highly salient during data collection, and thus guided lines of inquiry as the study progressed. We collected data in two stages, first using focus group discussions (FGD; n = 8) and later using FGDs (n = 2), interviews (n = 30) and observations of intervention delivery (n = 30). Respondents included pregnant women, breastfeeding mothers and Close-to-Community (CTC) providers, who execute preventative and curative tasks at the community level. We applied Morgan et al.’s gender framework to examine intervention content (what a gender-sensitive nutrition programme should entail) and delivery (how a gender-sensitive programme should be administered). Mothers emphasized that although they are often the focus of nutrition interventions, they are not empowered to make nutrition-based decisions that incur costs. They do, however, wield some control over nutrition-related tasks such as farming and cooking. Mothers described how difficult it is to consider only one’s own children during meal preparation (which is communal), and all respondents described how nutrition-related requests can spark marital strife. Many respondents agreed that involving men in nutrition interventions is vital, despite men’s perceived disinterest. CTC providers and others described how social norms and gender roles underpin perceptions of CTC providers and dictate with whom they can speak within homes. Mothers often prefer female CTC providers, but these health workers require spousal permission to work and need to balance professional and domestic demands. We recommend involving male partners in maternal nutrition interventions and engaging and supporting a broader cadre of female CTC providers in Burkina Faso.

scholarly journals District health managers perspectives of introducing a new service: a qualitative study of the community-based newborn care programme in Ethiopia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Della Berhanu ◽  
Iram Hashmi ◽  
Joanna Schellenberg ◽  
Bilal Avan
Keyword(s):  
Qualitative Study ◽  
Health System ◽  
Community Health ◽  
Health Workers ◽  
Newborn Care ◽  
District Level ◽  
District Health ◽  
Community Based ◽  
Care Programme

Abstract Background The planning, resourcing, implementation and monitoring of new programmes by district health managers is integral for success and sustainability. Ethiopia introduced the Community-Based Newborn Care programme in 2014 to improve newborn survival: an innovative component allowed community health workers to provide antibiotics for young infants with possible serious bacterial infection when referral was not possible. Informed by the World Health Organization health system building block framework, we aimed to study the capacity and operational challenges of introducing this new health service from the perspective of programme implementers and managers at the district level 20 months after programme initiation. Methods This qualitative study was part of a programme evaluation. From November to December of 2015, we conducted 28 semi-structured interviews with staff at district health offices, health centres and implementing Non-Governmental Organisations in 15 districts of four regions of Ethiopia. Verbatim transcripts were analysed using a priori and emerging themes. Results In line with the government's commitment to treat sick newborns close to their homes, participants reported that community health workers had been successfully trained to provide injectable antibiotics. However, the Community-Based Newborn Care programme was scaled up without allowing the health system to adapt to programme needs. There were inadequate processes and standards to ensure consistent availability of (1) trained staff for technical supervision, (2) antibiotics and (3) monitoring data specific to the programme. Furthermore, Non-Governmental Organizations played a central implementing role, which had implications for the long-term district level ownership and thus for the sustainability of the programme. Conclusion In settings where sustainable local implementation depends on district-level health teams, new programmes should assess health system preparedness to absorb the service, and plan accordingly. Our findings can inform policy makers and implementers about the pre-conditions for a health system to introduce similar services and maximize long-term success.

scholarly journals The HIV SEERs Project: A Qualitative Analysis of Program Facilitators’ Experience

2019 ◽  
Vol 18 ◽  
pp. 232595821882230 ◽  
Author(s):  
Tiffany Chenneville ◽  
Kemesha Gabbidon ◽  
Hunter Drake
Keyword(s):  
Program Implementation ◽  
Health Workers ◽  
Community Based Participatory Research ◽  
Retention In Care ◽  
Lessons Learned ◽  
Community Based ◽  
Stigma Reduction ◽  
Sustainability Strategies ◽  
Related Stigma ◽  
Future Program

HIV-related stigma creates barriers to HIV testing, medication adherence, and retention in care. Guided by the principles of community-based participatory research (CBPR) and in collaboration with community health workers (CHWs), the Stigma-reduction through Education, Empowerment, and Research (SEERs) project was developed with and for youth living in Nakuru, Kenya to reduce HIV-related stigma. The purpose of this qualitative study was to examine the experiences of the CHWs serving as SEERs facilitators. To evaluate SEERs, 37 facilitators completed open-ended survey questions to gather their experiences and recommendations for future program implementation and sustainability. Participants’ mean age was 30.58 (standard deviation = 9.62), ranging from ages 18 to 53. Thematic content analysis was used to categorize (a) facilitators’ experiences and the community impact of the SEERs project, (b) lessons learned, and (c) challenges to sustainability. Recommendations will be used to modify the SEERs project, improve implementation and sustainability strategies, and may provide guidance for similar CBPR projects.

scholarly journals P.3.11 Implementation of community-based occupational health programs for informal workers in indonesia

2019 ◽  
Vol 76 (Suppl 1) ◽  
pp. A99.2-A99
Author(s):  
Astri Ferdiana ◽  
Fahmi Baiquni ◽  
Dhiya Ur Rahman ◽  
Awalia Febriana ◽  
Siti Solikhah ◽  
...  
Keyword(s):  
Occupational Health ◽  
Rural Areas ◽  
Social Protection ◽  
Health Workers ◽  
Group Discussion ◽  
District Health ◽  
Community Based ◽  
Informal Workers ◽  
Program Managers ◽  
Occupational Risks

Informal workers account for 60% of workforce in Indonesia. Most do not have access to occupational health and safety (OHS) services. The study aims to explore the implementation of community-based OHS program consisting of OHS post and cadres (referred to as UKK program) among informal workers in rural areas in Indonesia. This study was an implementation research using focus group discussion (FGDs) and key informant interviews (KIIs) to workers, primary health care (PHC) staff, and provincial and district program managers. Thematic analysis was used to identify barriers and enablers of UKK implementation at intrapersonal, interpersonal, community, organizational and policy level.A total of 10 FGDs with informal workers from different areas of occupation, two FGDs with PHC staff and 6 KIIs with program managers were conducted. Informal workers faced various occupational risks yet personal protective equipment were rarely available or used. OHS was perceived as important, however, participation in UKK was low because of lack of time and information. There was lack of workers empowerment, resulting in top-down planning of activities by PHC. Informal workers expected PHC health workers to provide OHS services rather than UKK cadres. Not all PHCs have implemented UKK. Few programmers were trained on OHS. The program was assigned low priority and resource allocation by PHC and District Health Office. The absence of OHS regulation for informal workers offered little incentive for government departments to implement OHS programs and services for informal workers.Informal workers had unmet needs of OHS. Substantial efforts are needed to implement UKK, especially investment in financial and human resources. UKK establishment should be focused at workplace with the highest occupational risks. Technical capacity of programmers responsible for health promotion and OHS should be improved. Local policy on social protection and OHS services for informal workers should be developed.

scholarly journals Analisis pelaksanaan program indonesia sehat dengan pendekatan keluarga (PIS-PK) pada Puskesmas di Kabupaten Nagan Raya

2022 ◽  
Vol 3 (1) ◽  
pp. 85
Author(s):  
Darmansyah Darmansyah
Keyword(s):  
Program Implementation ◽  
Health Workers ◽  
Human Resources For Health ◽  
Community Support ◽  
Monitoring And Evaluation ◽  
Government Support ◽  
District Health ◽  
Cross Sectional ◽  
Significance Level ◽  
Family Approach

Background: The achievement indicators of the healthy Indonesia program with a family approach (PIS-PK) at the Nagan Raya District Health Center was still low. The implementation of the PIS-PK program was only training, preparation, analysis of the initial healthy family index. In contrast, further intervention and analysis have not run optimally, so the existing data has not been used appropriately.Objective: The purpose of the study, to analyze the implementation of the healthy Indonesia program with a family approach at the Public Health Centers (PHC) in Nagan Raya Regency.Method: This research design is a cross sectional study conducted in Nagan Raya Regency in 2021. The data were collected using a questionnaire with a sample size of 70 officers. The measurement of the variables of government support, infrastructure, community support, human resources for health workers, monitoring and evaluation, was measured using a questionnaire sheet. Data analysis used Chi-Square statistical test and Binary Logistic Regression with a significance level of 95%.Results: The results was showed that there was a relationship between community support (p= 0.010, OR = 3.72), facilities and infrastructure (p= 0.019, OR= 3.2),, government support (p= 0.00, OR= 6.15), health personnel resources (p=0.008, OR= 4.8), monitoring evaluation (p= 0.007, OR= 4.52) with the implementation of the PIS-PK program. Based on the multivariate test, the dominant variable associated with the PIS-PK program was government support.Conclusion: The good government support is 6.15 times related to the success of the PIS-PK program implementation program compared to less government support.

scholarly journals Scaling community-based services in Gauteng, South Africa: A comparison of three workforce-planning scenarios

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Rod Bennett ◽  
Tessa S. Marcus ◽  
Geoff Abbott ◽  
Jannie F Hugo
Keyword(s):  
Community Health ◽  
Burden Of Disease ◽  
Current Practice ◽  
Health Workers ◽  
Workforce Planning ◽  
Multidimensional Poverty ◽  
Full Time ◽  
District Health ◽  
Community Based ◽  
Community Based Services

Background: The introduction of community-based services through community health workers is an opportunity to redefine the approach and practice of primary health care. Based on bestpractice community oriented primary care (COPC), a COPC planning toolkit has been developed to model the creation of a community-based tier in an integrated district health system.Aim: The article describes the methodologies and assumptions used to determine workforce numbers and service costs for three scenarios and applies them to the poorest 60% of the population in Gauteng, South Africa.Setting: The study derives from a Gauteng Department of Health, Family Medicine (University of Pretoria) partnership to support information and communication technology (ICT)-enabled COPC through community-based health teams (termed as ward-based outreach teams).Methods: The modelling uses national census age, gender and income data at small area level, provincial facility and national burden of disease data. Service calculations take into account multidimensional poverty, demand-adjusted burden of disease and available work time adjusted for conditions of employment and geography.Results: Assuming the use of ICT for each, a health workforce of 14 819, 17 925 and 7303 is required per scenario (current practice, national norms and full-time employed COPC), respectively. Total service costs for the respective scenarios range from R1.1 billion, through R947 million to R783 million.Conclusion: Modelling shows that delivering ICT-enabled COPC with full-time employees is the optimal scenario. It requires the smallest workforce, is the most economical, even when individual community health worker costs of employment are twice those of current practice, and is systemically the most effective.

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