Division of Woman and Child Health, The Aga Khan University, Karachi, Pakistan.
South Australian Health and Medical Research Institute; and University of Adelaide, Adelaide, Australia.
Matern Child Nutr. 2019 Jan;15 Suppl 1(Suppl 1):e12738. doi: 10.1111/mcn.12738.
There is considerable evidence of positive health and nutrition outcomes resulting from integrating nutrition-specific interventions into health systems; however, current knowledge on establishing and sustaining effective integration of nutrition into health systems is limited. The objective of this review is to map the existing types of integration platforms and review the evidence on integrated health and nutrition programmes' impacts on specific nutrition outcomes. A literature search was conducted, and integrated nutrition programmes were examined through the lens of the six World Health Organization (WHO) building blocks, including the demand side. Forty-five studies were included in this review, outlining the integration of nutrition-specific interventions with various programmes, including integrated community case management and Integrated Management of Childhood Illness, Child Health Days, immunization, early child development, and cash transfers. Limited quantitative data were suggestive of some positive impact on nutrition and non-nutrition outcomes with no adverse effects on primary programme delivery. Through the lens of the six WHO building blocks, service delivery and health workforce were found to be well-integrated, but governance, information systems, finance and supplies and technology were less well-integrated. Integrating nutrition-specific interventions into health systems may ensure efficient service delivery while having an impact on nutrition outcomes. There is no single successful model of integration; it varies according to the context and demands of the particular setting in which integration occurs. There is a need for more well-planned programmes considering all the health systems building blocks to ensure compliance and sustainability.
有大量证据表明,将营养专项干预措施融入卫生系统可带来积极的健康和营养成果;然而,目前对于如何建立和维持有效的营养融入卫生系统的知识有限。本综述的目的是绘制现有的整合平台类型,并审查综合卫生和营养方案对特定营养结果的影响证据。进行了文献检索,并通过世界卫生组织(WHO)的六个组成部分(包括需求方)的视角来检查综合营养方案。本综述纳入了 45 项研究,概述了营养专项干预措施与各种方案的整合,包括综合社区病例管理和儿童疾病综合管理、儿童健康日、免疫接种、早期儿童发展和现金转移。有限的定量数据表明,一些方案对营养和非营养结果有积极影响,且对主要方案的实施没有不利影响。通过 WHO 的六个组成部分的视角发现,服务提供和卫生人力的整合情况较好,但治理、信息系统、财务以及供应和技术的整合情况较差。将营养专项干预措施融入卫生系统可以确保高效的服务提供,同时对营养结果产生影响。没有单一的成功整合模式;它因整合发生的特定环境和需求的不同而有所不同。需要有更多精心规划的方案,考虑到所有卫生系统的组成部分,以确保合规性和可持续性。