Table 2 bottle neck and opportunities associated with best practices on integration model with applicability to fragile context
Study ID/Country | Integration program/ Intervention | Key findings/ Recommendations | Barriers and opportunities for improvement |
|---|---|---|---|
Armstrong et al. 2004 [15] Tanzania | Nutrition into IMCI/ICCM Intervention: Counselling of mothers on breastfeeding and appropriate complementary feeding, local feeding practices, growth monitoring, supplementary nutrition, vitamin A supplementation, and screening, management and referral for malnutrition | There were few differences between IMCI and comparison districts in the level of health system support for child health services at facility level. | Opportunities: IMCI, in the presence of a decentralized health system with practical health system planning tools, is feasible for implementation in resource poor countries and can lead to rapid gains in the quality of case-management. |
Bhandari et al. 2012 [16] India | Implementation of the IMNCI resulted in substantial improvement in infant survival and in neonatal survival in those born at home. | Opportunities: High quality training, ensuring adequate supervision, timely supplies, and task based incentives to community health workers was critical for the observed effect. | |
Aguayo et al. 2013 [26] India | SAM/MAM into Health Services Intervention: Community and facility-based management of SAM and MAM. | The survival rates in the integrated model for the management of SAM (IM-SAM) program were very high | Opportunities: Existing health systems can be strengthened with feasible adjustments i.e. integrated model that comprises facility- and community-based therapeutic care |
Amadi et al. 2016 [27] Zambia | Comprehensive community malnutrition programme, incorporating HIV care, can achieve low mortality | Opportunities: Community-based screening may seem like a resource-intensive approach but the result is justified | |
Brits et al. 2017 [28] South Africa | Half of the children improved from severe malnutrition to underweight or exited at target weight | Barriers observed include; obstacles in implementing the guidelines correctly and lack of monitoring of the integrated program. | |
Deconinck et al. 2016 [29] Niger | Key hindering factors identified were not fully understanding severity, causes and consequences of the problem | Barriers: lack of information on burden of acute malnutrition, recognition of the public health priority, leadership for policy adaptations and implementation, technical and financial resources, effectiveness of the intervention and capabilities and motivation of health actors. | |
Baqui et al. 2008 [38] India | Nutrition into Immunization Intervention: Vitamin A supplementation, early and exclusive breastfeeding, infant and young child feeding practices and growth monitoring. | Most of the reduction in mortality was in the group who were visited within the first 3 days of birth | Opportunities: Reaching newborn babies at the community level is crucial in settings where the availability and utilization of facility-based care is low. Systems must also be put in place to ensure that these workers visit neonates at home during the first hours and days after birth and provide a link to competent health services Barriers: Workers’ competency in the new neonatal component of the programme, their workload and inadequate management and supervision were possible barriers to higher coverage. |
Fagerli et al. 2017 [48] Kenya | Nutrition into Other Programs Intervention: Infant and young child feeding practices and micronutrient supplementation. | The study shows multi-sectoral integration including hygiene, nutritional, clean delivery incentives, higher education level, and geographical contiguity to health facility were associated with increased use of maternal health services by pregnant women. | Barriers: low education level, distance from health facilities, and poor socioeconomic status. |