Suchergebnisse

This report presents the findings of an operations research study conducted to assess the implementation of the Government of Bangladesh's National Nutrition Services Program (NNS) and to identify the achievements, determine the bottlenecks that adversely impact these achievements, and highlight potential solutions to ensure smooth delivery of the program. A mixed methods research approach was used to evaluate five major domains of the program: management and support services; training and capacity development; service delivery; monitoring and evaluation, and; exposure to interventions. The study found that the overall NNS effort is an ambitious, but valuable approach to support nutrition actions through an existing health system with diverse platforms. The results indicate that although the maintenance of strong and stable leadership of NNS is an essential element to ensure integrated and well-coordinated comprehensive service delivery for the line directorate, the current arrangement is unable to ensure effective implementation and coordination of NNS. Focusing on some of the critical challenges related to leadership and coordination in the first instance, and on embedding a small core set of interventions into well-matched (for scale, target populations, and potential for impact) health system delivery platforms is most likely to help achieve scale and impact. Strategic investments in ensuring transparency, engaging available technical partners for monitoring and implementation support, and not shying away from other potential high coverage outreach platforms like some NGO platforms also could prove fruitful. Moreover, although the Government of Bangladesh, and the health system in particular, must lead the effort to deliver for nutrition, it is clear that development partners who have expressed a commitment to nutrition must coordinate their own activities and provide the support that can deliver on nutrition's potential for Bangladesh.

Background In 2011, the Bangladesh Government introduced the National Nutrition Services (NNS) by leveraging the existing health infrastructure to deliver nutrition services to pregnant woman and children. This study examined the quality of nutrition services provided during antenatal care (ANC) and management of sick children younger than five years. Methods Service delivery quality was assessed across three dimensions; structural readiness, process and outcome. Structural readiness was assessed by observing the presence of equipment, guidelines and register/reporting forms in ANC rooms and consulting areas for sick children at 37 primary healthcare facilities in 12 sub-districts. In addition, the training and knowledge relevant to nutrition service delivery of 95 healthcare providers was determined. The process of nutrition service delivery was assessed by observing 381 ANC visits and 826 sick children consultations. Satisfaction with the service was the outcome and was determined by interviewing 541 mothers/caregivers of sick children. Results Structural readiness to provide nutrition services was higher for ANC compared to management of sick children; 73% of ANC rooms had >5 of the 13 essential items while only 13% of the designated areas for management of sick children had >5 of the 13 essential items. One in five (19%) healthcare providers had received nutrition training through the NNS. Delivery of the nutrition services was poor: <30% of women received all four key antenatal nutrition services, 25% of sick children had their weight checked against a growth-chart and <1% had their height measured. Nevertheless, most mothers/caregivers rated their satisfaction of the service above average. Conclusions Strengthening the provision of equipment and increasing the coverage of training are imperative to improve nutrition services. Inherent barriers to implementing nutrition services in primary health care, especially high caseloads during the management of sick under-five children, should be considered to identify alternative and appropriate service delivery platforms before nationwide scale up. ; IFPRI3; ISI ; DSGD; PHND; SAO ; PR