Sanghvi Tina, Martin Luann, Hajeebhoy Nemat, Abrha Teweldebrhan Hailu, Abebe Yewelsew, Haque Raisul, Tran Ha Thi Thu, Roy Sumitro
Alive & Thrive FHI 360, Dhaka, Bangladesh.
Food Nutr Bull. 2013 Sep;34(3 Suppl):S156-68. doi: 10.1177/15648265130343S203.
Systems strengthening is essential for implementation of large-scale nutrition interventions, including infant and young child feeding (IYCF), since rapid geographic expansion places additional burdens on service delivery systems.
To document approaches for building capacity and supporting programs to scale up IYCF counseling in three different country contexts.
Situational assessments, stakeholder consultations, formative research, household and frontline health worker surveys, other related studies, and program monitoring in three countries identified gaps and opportunities for strengthening IYCF service delivery.
Variations in program platforms, level and roles of service providers, places of service delivery, community factors, and the needs of managers and frontline workers influenced the intervention mix used for strengthening IYCF services. The programs ranged from a highly structured and standardized package of IYCF counseling services in Vietnam delivered through government health facilities to counseling delivered at the doorstep by incentivized nongovernmental organization volunteers in Bangladesh. In Ethiopia, government health extension workers based at health posts conducted outreach visits with support from volunteers.
Guidelines and standards of care, training, job aids, supportive supervision, incentives, and monitoring data can enhance performance and strengthen systems for delivering IYCF counseling services in the community or at health facilities. Leadership, financing, partnerships, and logistics support are essential to support large-scale implementation of the IYCF counseling package in diverse service delivery environments.
系统强化对于实施大规模营养干预措施至关重要，包括婴幼儿喂养（IYCF），因为快速的地理扩张给服务提供系统带来了额外负担。
记录在三种不同国家背景下建设能力和支持项目以扩大婴幼儿喂养咨询服务规模的方法。
通过在三个国家进行情况评估、利益相关者协商、形成性研究、家庭和一线卫生工作者调查、其他相关研究以及项目监测，确定加强婴幼儿喂养服务提供方面的差距和机会。
项目平台、服务提供者的水平和角色、服务提供地点、社区因素以及管理人员和一线工作人员的需求各不相同，影响了用于加强婴幼儿喂养服务的干预措施组合。这些项目范围广泛，从越南通过政府卫生设施提供的高度结构化和标准化的婴幼儿喂养咨询服务包，到孟加拉国由受激励的非政府组织志愿者上门提供的咨询服务。在埃塞俄比亚，卫生站的政府卫生推广工作者在志愿者的支持下进行外展访问。
护理指南和标准、培训、工作辅助工具、支持性监督、激励措施以及监测数据可以提高绩效并加强在社区或卫生设施提供婴幼儿喂养咨询服务的系统。领导力、融资、伙伴关系和后勤支持对于在不同服务提供环境中支持大规模实施婴幼儿喂养咨询服务包至关重要。
