International Food Policy Research Institute, Washington, District of Columbia, USA.
International Food Policy Research Institute, New Delhi, India.
Matern Child Nutr. 2022 Jul;18(3):e13366. doi: 10.1111/mcn.13366. Epub 2022 May 4.
The National Nutrition Services of Bangladesh aims to deliver nutrition services through the primary health care system. Little is known about the feasibility of reshaping service delivery to close gaps in nutrition intervention coverage and utilization. We used a scenario-based feasibility testing approach to assess potential implementation improvements to strengthen service delivery. We conducted in-depth interviews with 31 service providers and 12 policymakers, and 5 focus group discussions with potential beneficiaries. We asked about the feasibility of four hypothetical scenarios for preventive and promotive nutrition service delivery: community-based events (CBE) for pregnant women, well-child services integrated into immunization contacts; CBE for well-children, and well-child visits at facilities. Opinions on service delivery platforms were mixed; some recommended new platforms, but others suggested strengthening existing delivery points. CBE for pregnant women was perceived as feasible, but workforce shortages emerged as a key barrier. Challenges such as equipment portability, upset children and a fast-moving service environment suggested low feasibility of integrating nutrition into outreach immunization contacts. In contrast, CBE and facility-based well-child visits emerged as feasible options, conditional on having the necessary workforce, structural readiness and budget support. On the demand side, enabling factors include using interpersonal communication and involving community leaders to increase awareness, organizing events at a convenient time and place for both providers and beneficiaries, and incentives for beneficiaries to encourage participation. In conclusion, integrating preventive and promotive nutrition services require addressing current challenges in the health system, including human resource and logistic gaps, and investing in creating demand for preventive services.
孟加拉国国家营养服务旨在通过初级卫生保健系统提供营养服务。人们对重塑服务提供方式以缩小营养干预覆盖和利用差距的可行性知之甚少。我们使用基于情景的可行性测试方法来评估加强服务提供的潜在实施改进措施。我们对 31 名服务提供者和 12 名政策制定者进行了深入访谈，并与潜在受益人进行了 5 次焦点小组讨论。我们询问了四种假设的预防和促进营养服务提供情景的可行性：为孕妇举办社区活动、将儿童健康服务纳入免疫接触、为健康儿童举办社区活动以及在医疗机构进行儿童健康访问。对服务提供平台的意见不一；一些人建议采用新平台，但另一些人则建议加强现有服务点。为孕妇举办社区活动被认为是可行的，但劳动力短缺成为一个关键障碍。一些挑战，如设备便携性、不安分的儿童和快速移动的服务环境，表明将营养融入外展免疫接触的可行性较低。相比之下，社区活动和医疗机构的儿童健康访问被认为是可行的选择，前提是拥有必要的劳动力、结构性准备和预算支持。在需求方面，有利因素包括利用人际沟通和社区领导来提高认识、为服务提供者和受益人方便的时间和地点组织活动、以及为受益人提供激励措施以鼓励参与。总之，整合预防和促进营养服务需要解决卫生系统中的当前挑战，包括人力资源和后勤差距，并投资于创造对预防服务的需求。
