This document summarizes strategies for strengthening health services to deliver improved nutrition. It outlines that while evidence-based interventions exist to address persistent nutrition issues like stunting and anemia, they require an equitable and high-quality delivery system. This involves developing the nutrition workforce through appropriate policies, training, supervision and resources. It also stresses the need to build community demand for better services and coordinate delivery across sectors through multi-level strengthening of health systems and partnerships with frontline workers. The goal is to systematically support service providers and empower communities to drive improved nutrition outcomes.

1. Strengthening health
services for the delivery of
nutrition services
Core Group, Spring 2017 Meeting
April 20, 2017
Sascha Lamstein, PhD
Technical Advisor and “Systems Thinking for Nutrition” Team Lead
SPRING

2. Globally, nutrition-related health issues persist.
% children
under 5
% children
under 5
of women of
reproductive age have
anemia (2011)
29%
only
43%of infants are exclusively
breastfed for 6 months
(2015)
Source: World Bank Databank: UNICEF
36
33
29
26
23
1995 2000 2005 2010 2015
According to most recent data, stunting
remains a major challenge.
44 44 43 43 43
2007 2008 2009 2010 2011
Anemia also persists as a major problem for
children.

3. We know evidence-based, cost-effective
interventions can improve nutrition
outcomes.
It is estimated that the following 10 evidence-based, nutrition-
specific interventions, if scaled to 90 percent coverage, could
reduce stunting by 20 percent and severe wasting by 60 percent.
Source: Bhutta et al. 2013.
• Management of severe acute
malnutrition
• Preventive zinc supplementation
• Promotion of breastfeeding
• Appropriate complementary
feeding
• Management of moderate
acute malnutrition
• Peri-conceptual folic acid
supplementation or fortification
• Maternal balanced energy
protein supplementation
• Maternal multiple micronutrient
supplementation
• Vitamin A supplementation
• Maternal calcium
supplementation

4. We also know nutrition-sensitive
interventions that can indirectly affect
nutritional status.
• Agriculture and food security
including availability, economic
access, and use of food
• Social safety nets
• Child protection
• Access to and use of health
services, a safe and hygienic
environment
• Classroom education
• Health and family planning
services
• Early child development,
including feeding and caregiving
resources (maternal, household,
and community levels)
Source: Ruel et al. 2013.

5. These interventions
require the
equitable provision
of high-quality
services provided
by community
leaders, teachers,
extension workers,
and health workers.

6. Bringing about meaningful change in the
delivery of nutrition services will require a
systematic and
sustainable
change
process.

7. Processes and procedures for information
collection and use, supervision, monitoring,
and human resource management
Training curricula and materials for a
range of actors
National indicators, guidelines, and protocols
Multi-sectoral national nutrition policies
and plans
Essential underpinnings of successful efforts to reduce malnutrition include:
How to build a foundation

8. To support the nutrition workforce we
must understand it.
See: www.advancingpartners.org/resources/chsc

9. Community health workers can provide
between 14 and 35 of 38 priority
nutrition tasks, according to the
policies reviewed.
30
35
24
31
26
24
30
32
30
24
29
25
30
26
14
Afghanistan
Ghana
Haiti
India
Liberia
Madagascar
Malawi
Mali
Nepal
Nigeria
Pakistan
Philippines
Senegal
SouthSudan
Zambia
 14 out of 15
countries
examined
include
nutrition in
national
training
curricula for
CHWs.
 14 out of 24
national
nutrition
policies
reviewed
reference
CHWs and
their role in
providing
nutrition
services.

11. Policies, systems, protocols,
guidelines, and curricula are of
little use if they are not
communicated properly to
service providers and if service
providers are not supported in
carrying out the tasks expected
of them.

12. To provide appropriate support we must
assess needs and plan actions.

13. Providing support means systematically
addressing these factors…,

15. Building demand
It is not enough to establish a strong foundation or even to support
service providers; men, women, and children must also
demand better nutrition-related
services.

16. Increasing demand through data and
conversation
With the right information, communities can
take ownership of their own improvement.

18. Strengthening health services for the delivery of
nutrition services needs to happen at all levels
and…
coordinate
with frontline
workers across sectors.

19. Thank you for listening!
Learn more at:
www.spring-nutrition.org
This presentation was made possible by the American people through the U. S. Agency for
International Development (USAID) under Cooperative Agreement AID-OAA-A-11-00031, the
Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project.