Strengthening Implementation and Utilization of Nutrition Interventions through Research: A Framework and Research Agenda.

ABSTRACT

Objectives: Evidence-based solutions are available and there is global momentum for scaling up nutrition interventions. However, the impact of evidence-based interventions is limited by poor evidence on operational strategies for scaling up nutrition interventions. The objective of this work was to develop a framework to inform a larger research agenda around delivery and utilization of nutrition interventions. Methods: The paper draws on the deliberations of a high-level working group, a web-based econsultation, a conference of global nutrition experts and a review of the published literature. Based on these methods, the paper authors develop a framework and propose areas of research that have been quite neglected, and yet, are critical to enable better translation of global and national political momentum for nutrition into public health impact. Results: The framework includes distinct components, with embedded sub-elements 1) the logic of results frameworks (inputs, processes, outcomes and impacts); 2) Program Impact Pathways and program theory; 3) "implementation core" elements related to midstream implementation processes; 4) contextual factors at multiple evels; 5) the enabling policy environment and governance; and 6) strategic and management capacities for commitment-building, adaptive management and sustainability. Each framework component is expandable and the overall framework is adaptable to different nutrition interventions and settings. Examples are provided from behavior change communications and micronutrient interventions. Conclusions: A systematic and complete understanding of program implementation, service delivery and coverage, using the framework and research approaches identified in this review, can strengthen successful scale-up and sustain actions for nutrition.