Integrating Nutrition Actions in Service Delivery: The Practices of Frontline Workers in Uganda.

BACKGROUND: Integrating nutrition actions into service delivery in different policy sectors is an increasing concern. Nutrition literature recognizes the discrepancies existing between policies as adopted and actual service delivery. This study applies a street-level bureaucracy (SLB) perspective to understand frontline workers' practices that enact or impede nutrition integration in services and the conditions galvanizing them. METHODS: This qualitative exploratory study assesses the contextual conditions and practices of 45 frontline workers employed by the agriculture, health and community development departments in two Ugandan districts. RESULTS: Frontline workers incur different demands and resources arising at societal, organizational, and individual level. Hence, they adopt nine co-existing practices that ultimately shape nutrition service delivery. Nutrition integration is accomplished through: (1) ritualizing task performance; (2) bundling with established services; (3) scheduling services on a specific day; and (4) piggybacking on services in other domains. Disintegration results from (5) non-involvement and (6) shifting blame to other entities. Other practices display both integrative and disintegrative effects: (7) creaming off citizens; (8) down prioritization by fixating on a few nutrition actions; and (9) following the bureaucratic 'jobs worth'. Integrative practices are driven mostly by donors. CONCLUSION: Understanding frontline workers' practices is crucial for identifying policy solutions to sustain nutrition improvements. Sustaining services beyond timebound projects necessitates institutionalizing demands and resources within government systems. Interventions to facilitate effective nutrition service delivery should strengthen the integrative capacities of actors across different government levels. This includes investing in integrative leadership, facilitating frontline workers across sectors to provide nutrition services, and adjusting the nutrition monitoring systems to capture cross-sector data and support policy learning.

The framing of malnutrition by parliamentarians in Uganda.

The quest for political commitment to reducing malnutrition in sub-Sahara Africa draws attention to the role of national parliamentarians. Whereas parliamentarians have the authority to ratify legislation, monitor policies and budgets and transform behaviour, to date little is known about how malnutrition is understood and debated in sub-Saharan African political arenas. This study addresses that gap by exploring how (mal)nutrition has been framed by parliamentarians in Uganda between 2001 and 2017. Applying framing theory we performed a qualitative content analysis of 131 Parliament Hansards transcripts to determine the different meanings of nutrition. Our analysis distinguishes seven co-occurring frames that entail different, sometimes competing, understandings of the drivers and possible solutions of malnutrition. The frames are: (i) the emergency nutrition frame, (ii) the chronic vulnerability frame, (iii) the school feeding frame, (iv) the disease-related frame, (v) the diversification frame, (vi) the overnutrition (among politicians) frame and (vii) the poverty and inequality frame. These frames are sponsored by different groups of parliamentarians, most notably politicians representing constituencies with high degrees of malnutrition, the president, some ministers and politicians in parliamentary forums concerned with children and women issues. Our analysis helps to understand why policy measures get prioritized or disregarded by policymakers. Overall, we show that frame sponsors prioritize short-term tangible solutions, such as food assistance and agricultural inputs, over longer term solutions. We suggest that a more comprehensive policy frame is prerequisite to developing a more effective governance approach to malnutrition in Uganda.

Contribution of street foods to the dietary needs of street food vendors in Kampala, Jinja and Masaka districts, Uganda.

OBJECTIVES: To assess the contribution of street foods to the energy and nutrient needs of street food vendors. DESIGN: A cross-sectional descriptive study was conducted. Food intake for the street food vendors was measured using the 24 h recall method and a semi-quantitative FFQ with emphasis on the source of all foods consumed. SETTING: Kampala, Jinja and Masaka districts, Uganda. SUBJECTS: The study included 225 street food vendors trading in prepared cooked foods. RESULTS: The majority of vendors (87·6 %) were women with age range of 21-50 years. Traditional dishes were the most commonly prepared foods and classified into main meals, sauces, vegetables and snacks. The food groups consumed most commonly by street food vendors fall under energy-giving and body-building foods (0·26 (sd 0·81)). The mean daily intake of energy from street foods varied between 22·4 % and 25·6 % (2412 kJ). Carbohydrates contributed the highest proportion of energy (70·1 % to 93·4 %), followed by protein (38·6 % to 44·9 %) and fat (21·9 % to 26·3 %). Street food vendors obtained 24·0 % to 32·5 % of their RDA for Ca from street vended foods, with the lowest intake in Jinja (11·2 % to 23·9 %, P < 0·05). Niacin and thiamin intakes from street foods were respectively above 74 % and 150 % of the RDA. The contribution of street foods to the RDA for Zn ranged from 81·9 % to 190·9 %, and from 3·5 % to 4·9 % for retinol. Fe intake from street vended foods was 40·9 % to 49·7 % of the RDA. CONCLUSIONS: Street foods contribute to sources of dietary energy and other nutrients among street food vendors in Uganda.