Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA.
J Nutr. 2012 Jan;142(1):178S-85S. doi: 10.3945/jn.110.137182. Epub 2011 Nov 30.
This article reviews the potential of four broad types of platforms, health, agriculture, market-based, and social protection programs, to deliver multiple micronutrient (MMN) interventions (supplementation, fortification, and dietary modification). We assessed the platforms' potential based on seven performance criteria related to programs within these platforms: 1) targeting, 2) efficacy of interventions, 3) quality of implementation, 4) utilization, 5) impact, 6) coverage, and 7) sustainability. We highlight one type of program per platform to illustrate strengths and weaknesses for delivering MMN interventions, identify critical knowledge gaps, and highlight what is needed to increase effectiveness for delivering MMN interventions. We found that all four platforms have the potential to effectively deliver MMN interventions if the following key program elements are addressed: 1) strong behavior change communication strategies to increase demand and proper utilization of services/products; 2) supply side interventions to ensure consistent availability of high quality interventions, products, and well-trained staff; 3) rigorous evaluations of effectiveness, quality of delivery, and impact pathways to generate best practices for replication and scale-up; and 4) timely dissemination of evaluation results to ensure use by program implementers and policy makers. The diversification of delivery platforms, which simultaneously addresses multiple determinants of MMN deficiencies and expands coverage, is needed to accelerate progress in reducing MMN deficiencies.
本文综述了四大类平台(卫生、农业、市场和社会保护项目)在实施多种微量营养素(MMN)干预措施(补充、强化和膳食调整)方面的潜力。我们根据这些平台内的项目的七个绩效标准评估了平台的潜力:1)针对性,2)干预措施的效果,3)实施质量,4)利用率,5)影响,6)覆盖范围和 7)可持续性。我们突出了每个平台的一种项目类型,以说明提供 MMN 干预措施的优势和劣势,确定关键知识差距,并强调为提高提供 MMN 干预措施的效果所需的条件。我们发现,如果能解决以下关键项目要素,所有四个平台都有潜力有效地提供 MMN 干预措施:1)强化行为改变沟通策略,以提高服务/产品的需求和适当利用;2)供应方干预措施,以确保高质量干预措施、产品和训练有素的工作人员的持续供应;3)对有效性、提供质量和影响途径进行严格评估,为复制和扩大规模提供最佳实践;4)及时传播评估结果,以确保项目执行者和决策者使用。需要多样化的提供平台,同时解决 MMN 缺乏的多个决定因素,并扩大覆盖范围,以加快减少 MMN 缺乏的进展。