National-level actions can help strengthen nutrition services delivered by health systems. This includes developing a national nutrition strategy, strengthening leadership and governance, developing implementation plans, and including capacity building and ongoing monitoring in national plans. Convergence between health and nutrition services is important, as seen in India's National Nutrition Strategy which links nutritional interventions to essential health services. Kenya also developed a National Capacity Development Framework to comprehensively address capacity needs at multiple levels. However, challenges in establishing community-facility linkages and limited dedicated nutrition budgets remain barriers to sustainability.

1. Breaking Down Barriers to Improve
Health and Nutrition
What it will take to improve nutritional
status by strengthening health services
Global Health Practitioner Conference (GHPC)
May 8, 2019
Mandana Arabi, MD, PhD
Director, Nutrition and Health Systems, USAID Advancing Nutrition

2. Working at the National Level

3. National-level actions can help strengthen nutrition
services delivered by health systems:
Developing a national nutrition strategy/policy
identifies priority interventions according to the
context, situation assessment, and feasibility.
Strengthening national-level leadership and
governance provides the backbone for effective
coordination and integration of nutrition within
health care services.
Developing national (and sub-national) plans of
action identifies delivery channels, resources
needed, and resource mobilization activities.

4. National-level actions can help strengthen nutrition
services delivered by health systems:
Including capacity-strengthening as an
integral part of the national plan of action
enables health systems actors to integrate
and deliver nutrition and early childhood
services.
Making monitoring, evaluation, and review
of bottlenecks that affect nutrition services
an integral part of the heath system allows
for ongoing quality improvement.

5. Nutrition as Part of Health Systems Strengthening at the
National Level
Credit: Adapted from the
UNICEF IYCF
Programming Guide

6. Convergence between Health and Nutrition Services
at the National Level: India
Modifications to Make the
Integrated Child Development
Scheme (ICDS) More Effective
• Convergence is one of the key features
of the new ICDS Scheme, which includes
both health and nutrition services.
• The National Nutrition Strategy (NNS)
has been launched, which reflects a
renewed focus on nutrition.
Credit: USAID India

7. • The NNS framework
envisages specific nutritional
interventions closely linked
to, co-located, and delivered
together with essential health
services:
– infant and young child care
and nutrition
– adolescent care
– women’s nutrition and health
– addressing micronutrient
deficiencies, including anemia
– community nutrition together
with child health and maternal
care at facility level.
Credit: USAID India

8. Kenya: National Capacity Development Framework
Comprehensive approach to
address capacity at the system,
organizational, technical, and
community levels
Credit: USAID Kenya

9. National Capacity Development Framework
Important Findings
• National planners should set targets
for services and monitor success
achieved at the facility level.
• Planners should also improve
general staffing and training on
specific nutrition interventions.
Challenges to Sustainability
• facility-community linkages are
difficult to establish.
• lack of or limited separate budget
line for nutrition at the ministry level
leads to limited investments in the
nutrition activities/services.
Credit: USAID Kenya

10. Resources and References
• Nourishing India - National Nutrition Strategy | NITI Aayog,
(National Institution for Transforming India), Government of
India. Niti.gov.in. 2018
• Strengthening Partnerships, Results, and Innovations in
Nutrition Globally (SPRING)
• Kenya Nutrition Capacity Development Framework, 2014-2019
• Rasmi Avula, Edward A. Frongillo, Mandana Arabi, Sheel Sharma,
and Werner Schultink. “Enhancements to Nutrition Program in
Indian Integrated Child Development Services Increased Growth
and Energy Intake of Children.” J. Nutr. April 2011 141: 4 680-
684

11. Thank you!
For more info, please contact:
mandana_arabi@jsi.com
This document was produced for the U. S. Agency for International Development. It was
prepared under the terms of contract 7200AA18C00070 awarded to JSI Research &
Training Institute, Inc. The contents are the responsibility of JSI and do not necessarily
reflect the views of USAID or the U.S. Government.