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Abstract:
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.
Facility-based Nutrition Readiness and Delivery of Maternal and Child Nutrition Services using Service Provision Assessment Surveys (PDF, 2359K)