ObjectivesThe many factors underlying malnutrition highlight the need for nutrition strategies that are comprehensive and multi-sectoral. Within a multi-sectoral approach, the health system is uniquely placed to deliver ten nutrition-specific interventions, which, if scaled up, could substantially reduce under-5 deaths in high-burden countries (Bhutta et al, 2013). This study aims to clarify the role of key health system components, illuminating opportunities for increased uptake of nutrition-specific interventions and potential bottlenecks and challenges for programs and policies. MethodsWe reviewed existing nutrition frameworks to develop a comprehensive logic model illustrating the causal pathways by which health system components influence household-level determinants of nutrition and individual-level health outcomes. Concurrently, we reviewed literature on health and nutrition interventions that have a proven, quantifiable impact on morbidity and mortality in low- and middle-income countries. We mapped data from the gathered literature onto the logic model, allowing us to identify key causal pathways for the delivery of nutrition-specific interventions, and highlighting areas where evidence is lacking. ResultsThere exists a large gap in the literature about how health system components influence the ability to delivery appropriate and high-quality nutrition care. Based on the nature of the intervention (i.e., supplement delivery, counselling, SAM/MAM management) several unique delivery pathways were identified and three common themes cut across all interventions: namely, the importance of a motivated and trained health workforce; reliable and efficient supply chains; and generating demand and increased care-seeking for nutrition interventions. Evidence from the broader health systems literature supports the importance of these three themes; however, this remains a research gap in the nutrition literature. ConclusionsThree core health system components - a health workforce, supply chain and demand generation - play a pivotal role in the delivery of nutrition interventions. A better understanding of these components in relation to nutrition, based on evidence, will help to improve the design and implementation of future nutrition programs. Funding SourcesGlobal Affairs Canada, under the project “Real Accountability: Data Analysis for Results”.
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