The Challenge: Improving Nutrition Outcomes
Over the past 20 years, only slow, modest gains have been made in coverage of life-saving nutrition interventions in comparison with the gains made more broadly within primary health care (PHC). For example, the coverage of maternal iron folic acid supplementation is significantly lower than that of antenatal care (four or more visits) in low- and middle-income countries; coverage of initiation of early breastfeeding (within 1 hour of delivery) is lower than that of delivery in a facility; and, while the coverage of community health has increased over time, screening for child wasting is often deleted from the long task list of community health workers.
Essential nutrition actions (ENAs) should be embedded within PHC to improve the quality of both health and nutrition services and to optimize health outcomes. However, integration of nutrition within PHC is not enough for progress in nutrition outcomes. Determining how PHC purchasing arrangements might incentivize or disincentivize improvements in nutrition service delivery could be a critical means for improving both health and nutrition outcomes.
The Opportunity: Strategic Purchasing for Nutrition
Strategic purchasing for nutrition in the context of strategic health purchasing for PHC could help countries improve the coverage and quality of nutrition services delivered within broader PHC services. It can help ensure that the priority placed on nutrition is clearly communicated to providers (through specification of benefits, contracts, provider payment systems and performance monitoring indicators) and that the incentives are aligned with national nutrition objectives. However, there is limited documentation about how nutrition is currently included within health purchasing arrangements and more guidance is needed around how nutrition purchasing could be made more strategic.
Our Work: Improving Strategic Purchasing for Nutrition within PHC
Results for Development (R4D) and the World Health Organization (WHO) developed a diagnostic approach which offers a practical framework to help governments and other stakeholders describe, assess, and improve strategic health purchasing for PHC. The intent is to better understand how nutrition fits into broader PHC purchasing arrangements with a tested, established PHC purchasing framework. This approach builds on the framework for tracking progress developed by the Strategic Purchasing Africa Resource Center and a recent WHO publication which provides an overview of strategic purchasing of nutrition services within primary health care.
