Mallick, Lindsay, Gheda Temsah, and Rukundo K. Benedict. 2018. Facility-based Nutrition Readiness and Delivery of Maternal and Child Nutrition Services Using Service Provision Assessment Surveys. DHS Comparative Reports No. 49. Rockville, Maryland, USA: ICF.
Persistent malnutrition in low- and middle-income countries requires an exploration of nutrition-related services provided by health facilities in order to identify potential areas for future interventions. The Demographic and Health Surveys (DHS) Program Service Provision Assessment (SPA) surveys provide nationally representative facility data for such exploration. The SPA surveys provide key information about service readiness (availability of resources required to perform services) and service delivery (care and counseling that clients receive during consultations) within facilities.
This report identifies 40 indicators of nutrition intervention readiness and delivery as part of antenatal care (ANC) and sick child care according to SPA surveys conducted in 10 countries. We first describe the availability of ANC and sick child care at the national level. We then describe service readiness in terms of availability of commodities and provider training, service delivery, and, more specifically, counseling provided during ANC and sick child visits related to nutrition. We describe regional-level estimates for selected indicators, including the availability and provision of iron and folic acid (IFA) supplements and the availability of infant and child scales. Finally, we provide supplemental information on nutrition-related readiness according to facility background characteristics.
This report demonstrates variation in the availability of medication and equipment for pregnant women and children across countries. Supplement availability ranged from 58%-92% for IFA among women and from 4%-70% for iron among children. Availability of adult weighing scales was over 88% across countries, while availability of child and infant scales ranged from 35%-95%. Provider training for nutrition-related topics was low, ranging from 11%-25% for nutritional assessment in pregnancy to 14%-43% for training in infant and young child feeding practices. Observations of counseling on breastfeeding and maternal nutrition during ANC ranged from 1%-13% and 33%-48%, respectively. Overall, regional variation within countries was less than variation across countries, and there were no strong trends when comparing availability by facility background characteristics. However, a key finding of this study is that across all countries, there is considerable room for improvement in provider training and provider counseling on nutrition-related topics, particularly breastfeeding practices. This indicates a need for new or strengthened strategies to boost training among providers and further investigations into the extent that lack of provider training leads to poor nutrition practices.