Public Administration and Policy Group, Wageningen University & Research, Wageningen, The Netherlands.
Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands.
Int J Health Policy Manag. 2022 Dec 19;11(12):2895-2906. doi: 10.34172/ijhpm.2022.5898. Epub 2022 Apr 24.
Integrating nutrition actions into service delivery in different policy sectors is an increasing concern. Nutrition literature recognizes the discrepancies existing between policies as adopted and actual service delivery. This study applies a street-level bureaucracy (SLB) perspective to understand frontline workers' practices that enact or impede nutrition integration in services and the conditions galvanizing them.
This qualitative exploratory study assesses the contextual conditions and practices of 45 frontline workers employed by the agriculture, health and community development departments in two Ugandan districts.
Frontline workers incur different demands and resources arising at societal, organizational, and individual level. Hence, they adopt nine co-existing practices that ultimately shape nutrition service delivery. Nutrition integration is accomplished through: (1) ritualizing task performance; (2) bundling with established services; (3) scheduling services on a specific day; and (4) piggybacking on services in other domains. Disintegration results from (5) non-involvement and (6) shifting blame to other entities. Other practices display both integrative and disintegrative effects: (7) creaming off citizens; (8) down prioritization by fixating on a few nutrition actions; and (9) following the bureaucratic 'jobs worth'. Integrative practices are driven mostly by donors.
Understanding frontline workers' practices is crucial for identifying policy solutions to sustain nutrition improvements. Sustaining services beyond timebound projects necessitates institutionalizing demands and resources within government systems. Interventions to facilitate effective nutrition service delivery should strengthen the integrative capacities of actors across different government levels. This includes investing in integrative leadership, facilitating frontline workers across sectors to provide nutrition services, and adjusting the nutrition monitoring systems to capture cross-sector data and support policy learning.
将营养行动融入不同政策领域的服务提供中是一个日益受到关注的问题。营养文献认识到政策的采纳与实际服务提供之间存在差异。本研究应用街头官僚机构（SLB）的视角来理解一线工作人员在服务中实施或阻碍营养整合的实践以及激励他们的条件。
这项定性探索性研究评估了在乌干达两个地区的农业、卫生和社区发展部门工作的 45 名一线工作人员的背景条件和实践。
一线工作人员在社会、组织和个人层面上承受着不同的需求和资源。因此，他们采用了九种共存的实践，最终塑造了营养服务的提供。营养整合是通过以下方式实现的：（1）例行公事地完成任务；（2）与既定服务捆绑；（3）在特定的一天安排服务；（4）在其他领域的服务上搭便车。整合的反面是（5）不参与和（6）将责任推卸给其他实体。其他实践则表现出整合和分裂的双重效果：（7）挑选出特定的公民；（8）通过关注少数营养行动而将其优先级降低；（9）遵循官僚主义的“工作价值”。整合性实践主要是由捐助者推动的。
了解一线工作人员的实践对于确定维持营养改善的政策解决方案至关重要。要使服务超越有时间限制的项目，就需要在政府系统内使需求和资源制度化。为促进有效营养服务提供的干预措施应加强不同政府层面的行为者的整合能力。这包括投资于整合性领导，促进不同部门的一线工作人员提供营养服务，以及调整营养监测系统以捕捉跨部门数据并支持政策学习。
