By Anna Kotenko, Associate Director, Advocacy & Communications.
At the end of last year, Universal Health Coverage Day took place in light of the fact that, seven years ago, the world committed to achieving universal health coverage (UHC) as part of the United Nations Sustainable Development Goals by 2030. Today, millions of people still lack access to quality health care services, including access to vital nutrition services.
The idea of UHC is rooted in the fundamental right to health, which is laid down in article 25 of the Universal Declaration of Human Rights. Essentially, UHC necessitates a national health care platform, which usually delivers a person’s first point of contact within the health system.
While most countries have agreed on national commitments and goals for UHC, many country commitments lack reporting and a comprehensive strategy to enable quality delivery[i]. Similarly, many governments acknowledge the need to achieve equity in health care delivery, yet gender, poverty, socio-economic circumstances, and ethic differences continue to have impact people’s access to services[ii].
With a spotlight on UHC, there is an opportunity rally behind proven, cost-effective methods for improving health services – and one in particular: the integration of nutrition actions into existing health platforms. Put simply, investment in nutrition interventions delivered through national health services saves lives[iii], supports people’s overall health and resilience, and proves extremely cost efficient[iv].
The World Health Organization advocates for a package of essential nutrition actions to be integrated into health services as part of UHC plans and roadmaps.
Doing so uplifts the quality of care and accelerates the goals of both health and nutrition communities.
This is especially salient in the arena of maternal and new-born health. If a package of nutrition and health interventions were to be delivered to women already seeking care, we could cut maternal and new-born deaths by 28% and reduce stillbirths by 22%.[v] In part, this is because iron deficiency anemia is a leading cause of maternal death due to hemorrhage[vi], and poor maternal nutrition also increases the risk of eclampsia, another leading cause of maternal death.
Yet, despite decades of evidence, the reality is that nutrition is either not included or poorly integrated into health care in many countries. Often, frontline health care workers are often overworked and overwhelmed. Coherence between nutrition and health sectors can be thwarted by a distinct lack of incentives across all levels: community, district, and national. Nutrition counselling requires sufficient training and capacity building, while policy coherence demands leadership at the highest levels.
Carrying forth a strong message that we must work together to multiply impact therefore requires clarity over the ‘how’. Of course, this differs greatly according to the situation, however, implementation research is clear that nutrition services can be successfully scaled across diverse contexts to reach those who need them most.
At FHI Solutions, implementation research drives innovation management for the improvement of national systems and the betterment of nutrition outcomes.
Through Alive & Thrive, together with national governments and local partners, we have incorporated a range of nutrition interventions into antenatal and postnatal care services across multiple countries and geographies, including dietary counseling for healthy eating, multiple micronutrient supplementation for women during pregnancy, calcium supplementation, and balanced energy and protein supplementation for severely undernourished women, early initiation of breastfeeding and continued support for exclusive breastfeeding, alongside other supportive behavior change practices at the community level.
FHI Solutions’ Innovation Incubator, which originates with Alive & Thrive and operates in partnership with governments, universities, and local organizations, supports improvements in health care delivery. To date, we have developed trialed, tested, adapted, and scaled innovative methods to strengthen national systems.
In Viet Nam, the Mothers’ Experience Surveys provides an external monitoring system critical for establishing and maintaining quality care in our partnering hospitals. Through Alive & Thrive the surveys are operationalized in established Centers of Excellence for Breastfeeding (COE), which assess whether mothers are supported with early breastfeeding and promotion of skin to skin contact.
By giving women the opportunity to voice their experiences during this vulnerable and special time, improvements in health outcomes for mothers and new-borns are possible, further incentivizing the continuation of new practices and increasing demand.
Coherence between nutrition and health sectors also extends beyond immediate contact points in hospitals, clinics, or doctors’ surgeries. Momby has been developed in partnership with a women led tech start up, Momby Ltd, to provide personalized nutrition consultations through a digital assistant in Viet Nam. Timely follow-up consultations are based on the profile and feedback of each App user and the App has a referral function to health experts.
Momby’s evidence-based consultation span maternal health, breastfeeding practices, early essential new-born care, the postpartum diet, and complementary feeding to support families in ensuring good nutrition for mothers and children in line with targets in Viet Nam’s National Nutrition Policy. Our goal is to scale elsewhere in south Asia.
Ultimately, all people have the right to quality health care and good nutrition throughout the full course of their lives and achieving this goal necessitates far greater innovation and investment. In 2021, Japan hosted Nutrition for Growth, an international pledging moment, of which UHC was a core pillar for commitment making to this end. Governments, multilaterals, donors, civil society, and business all recognized the critical importance of strengthening policy coherence and delivering nutrition through improvements to health coverage.
This month, advocates for Universal Health Coverage Day insist that governments keep their promise. At FHI Solutions, we call upon governments and all stakeholders keep commitments made at Nutrition for Growth and to actualize ambitions laid down as signatories to the United Nations Sustainable Development Goals. On the cusp of 2023, with seven years until 2030, it is time that good nutrition – as a pillar of core health and resilience – becomes a universal reality.
[iii] PLOS Medicine, 2019. Estimating the global impact of poor quality of care on maternal and neonatal outcomes in 81 low- and middle-income countries: A modeling study.
[iv] The Lancet, Global health (2013); Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? https://www.sciencedirect.com/science/article/abs/pii/S0140673613609964
[v] PLOS Medicine, 2019. Estimating the global impact of poor quality of care on maternal and neonatal outcomes in 81 low- and middle-income countries: A modeling study.
[vi] The Lancet, Global Health (2018); Risk of maternal mortality in women with severe anemia during pregnancy and post partum: a multilevel analysis; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30078-0/fulltext?elsca1=tlxpr