Abstract
The effective implementation of large-scale nutrition interventions in Africa is an ongoing challenge. This scoping review identifies and explores the barriers and facilitators to the implementation of large-scale nutrition interventions in the African region. We searched PubMed, EMBASE, Scopus, ERIC, and Web of Science using search terms focused specifically on barriers and facilitators to the implementation of nutrition interventions in Africa. To supplement the database search, reference lists in publications included for full-text review were also examined to identify eligible articles for inclusion. Eligible studies underwent quality assessment, and a directed content analysis approach to data extraction was conducted and aligned to the Consolidated Framework for Implementation Research (CFIR) to facilitate narrative synthesis. The search identified 1452 citations and following removal of duplicates and our inclusion/exclusion criteria, 34 papers were eligible for inclusion. More than half of included studies (n = 19) reflect research conducted in East Africa. Overarching thematic areas spanning the barriers and facilitators that were identified included policy and legislation; leadership management; resources mobilization; and cultural context and adaptability. Key activities that facilitate the development of successful implementation include (1) more supportive policy and legislation to improve government competency, (2) effective leadership, strategic partnership, and coordination across multiple sectors, (3) more effective resource mobilization, and (4) adequate adaptation of the intervention so that it is culturally relevant, tailored to local needs and aligned to research data. The barriers and facilitators identified under the CFIR domains can be used to build knowledge on how to adapt large-scale nutrition interventions to national and local settings.Registration Open Science Framework (https://osf.io/6m8fy).
Highlights
Large-scale health interventions aim to improve health outcomes for the general public and encompass a wide range of therapeutic procedures, drugs, and interventions geared towards improving clinical evaluation and treatment (Landefeld et al 2008; Crump 2008)
Global Implementation Research and Applications (2021) 1:38–52 interest in the implementation and scaling up of health interventions can be traced back to the HIV AIDS pandemic, where the “scale-up” of antiretroviral treatments proved to be effective in reducing HIV incidence (Mangham and Hanson 2010)
There remains a lack of comprehensive understanding of implementation factors related to large-scale nutrition interventions within the African context, where at regional level, progress on reducing undernutrition remains stagnant in contrast to most other global regions
Summary
Large-scale health interventions aim to improve health outcomes for the general public and encompass a wide range of therapeutic procedures, drugs, and interventions geared towards improving clinical evaluation and treatment (Landefeld et al 2008; Crump 2008). Many large-scale health interventions within the scope of global health fall under broad umbrellas such as HIV/AIDS, malaria, TB, and maternal or newborn health (Mangham and Hanson 2010). Global Implementation Research and Applications (2021) 1:38–52 interest in the implementation and scaling up of health interventions can be traced back to the HIV AIDS pandemic, where the “scale-up” of antiretroviral treatments proved to be effective in reducing HIV incidence (Mangham and Hanson 2010). There remains a lack of comprehensive understanding of implementation factors related to large-scale nutrition interventions within the African context, where at regional level, progress on reducing undernutrition remains stagnant in contrast to most other global regions. This review aims to explore such factors in more depth
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