Special focus on nutrition-sensitive programming

Research
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
other sectors, such as agriculture and livelihoods.
Family planning and nutrition or food security
interventions are primarily built into programme
design from the onset as part of a larger health
package, especially maternal, newborn, and
child health; integrated management of childhood
illness (IMCI); or food security and livelihood
packages, rather than being integrated
aer programmes are already underway.
e authors identified three models of family
planning integration into nutrition and food
security programmes. ese include: (Model
1) family planning education (used in 18.6% of
programmes); (Model 2) family planning education
and counselling (used in 17.6% of programmes);
and (Model 3) family planning education,
counselling and commodity provision
(used in 63.7% of programmes). Referrals for
family planning services were also found in all
three models.
A range of platforms are used for integrated
service delivery across all three models identified.
For family planning services, examples of platforms
are mobile clinics and rally posts (central
spots where parents come with their children
for growth monitoring, immunisation, and
other basic services). Other kinds of platforms
include farmer field days and nutrition rehabilitation
sessions. Some family planning services
are targeted to specific lifecycle contact points,
for example during antenatal care, birth and
discharge, postpartum care, or childhood programmes.
More oen, however, programmes
adopt a continuum-of-care approach that targets
several or all contact points. A range of providers
are used in the delivery of integrated family
planning programmes, some of which are community-based
(e.g. community health workers,
volunteers and groups), and some of which are
facility-based (including private and government
health workers).
e authors recognise the limitations of the
documentation of integrated family planning
programmes. e review had a broad scope: to
carry out a landscape analysis of programme
efforts to integrate family planning with nutrition
and/or food security interventions. It captured
a broad range of integration strategies across
health and multi-sectoral programmes. However,
the large scope and the heterogeneity in the
types of programmes, including the interventions
and outcomes measured, posed challenges in
the analysis and synthesis of findings. Specifically,
the review revealed weak programme documentation
on the integration process; limited
information on the process of referral to family
planning services; variation in measurement
of family planning across programmes; and an
evidence gap on the effectiveness of different
family planning models. is underscores the
need for stronger programme documentation
on the integration process and more systematic
monitoring and evaluation efforts to capture
the success of integrated programmes.
e findings nevertheless reveal potential
promising practices for integration. Programmes
could build on existing platforms (such as
farmer field days, nutrition weeks and growth
monitoring sessions) to help reduce costs,
achieve rapid results, and prime communities
for expanded services. Programmes could <strong>focus</strong>
on the 1,000-day period (from pregnancy until
the child is two years old) through a continuum-of-care
model to allow programmes to
reach mothers at critical times for both nutrition
and family planning. e right timing of promotion
messages will ensure that messages are
not too early or too late for the behaviour being
promoted. Home visits offer an opportunity for
nutrition and family planning counselling that
can be tailored to individual needs and also
provide an opportunity to target and involve
family members who influence uptake of nutrition
and family planning practices being promoted.
Ensuring multiple contacts also seems
to be important. Multiple contacts must happen
at community and facility level to facilitate integration
by helping to reinforce consistent
messages, meet increased demand generated at
the community level, and enable provision of a
greater mix of contraceptive methods. Integrated
programmes should also engage men as well as
women. Gender integration is a critical component
to overcoming barriers women face not
only in using family planning but also in
adopting optimal nutrition behaviours and
reaching their full potential in the agricultural
and economic sectors.
e review findings point to several recommendations
for consideration by USAID in their
efforts to further strengthen and promote nutrition
and family planning integration or food
security and family planning integration more
systematically. Recommendations include: define
family planning and nutrition integration and
family planning and food security integration,
including success for this type of integration;
harmonise reporting requirements; ensure adequate
funding and time for implementation of
integrated programmes; fund rigorous research
<strong>focus</strong>ed on testing effectiveness of integration
models; develop guidance for and provide technical
assistance to programmes integrating family
planning with nutrition or food security interventions;
and promote dialogue and cross-learning
across health and multi-sectoral programmes.
Pathfinder International and John Snow, Inc. 2013.
Health extension worker explains
family health elements
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
36