Monitoring coverage helps to ensure that vulnerable individuals receive essential interventions and services, such as hygiene and sanitation services, micronutrient supplementation or food distribution. Achieving good coverage of any intervention or service relies on a delivery platform that supports good access and uptake.
Interventions might be delivered through multiple platforms, such as community–based nutrition programmes, health system platforms that integrate nutrition interventions and/or market–based interventions. Community–based platforms include community health workers, mobile clinics, community–based distribution, home based care, peer support groups, local partnerships, workshops and trainings, as well as school–based programmes.45 Health systems platforms can also include digital platforms. Financial platforms can be in the form of incentive programmes, cash–based interventions and others. Evidence on the effectiveness of various delivery platforms is lacking, and although merits of using specific platforms (eg, CHWs,46 cash transfers) for health and nutrition in humanitarian contexts are well described in the literature and have been demonstrated through efficacy studies, most nutrition–specific interventions rely on health systems more broadly for effective delivery.
Why is coverage important for the prevention of undernutrition in humanitarian contexts?
In humanitarian contexts, achieving high coverage of interventions and services is critical to effectively prevent undernutrition and improve health outcomes at population level.
Various examples illustrate the importance of coverage in achieving impact. For example, following extensive work done on the coverage of Community Management of Acute malnutrition (CMAM), it has been shown that high coverage enables programmes to treat severe acute malnutrition (SAM) cases earlier, leading to better outcomes and impacts.47
Some studies48 have demonstrated that coverage and quality of delivery are critical elements in achieving desired nutrition outcomes at population level. Alongside investments in “proven” interventions, knowledge of effective mechanisms for delivering those interventions to those most in need is essential as, without good coverage, even the most efficacious interventions will not achieve impact at scale.
Key Conditions and considerations
- Target population needs and focus on the demand side: focus the intervention on the characteristics of the target population, considering geopolitical, cultural and social factors. If possible, try to generate demand for health services, as this is essential for enhancing the uptake of interventions.
- Integrate nutrition interventions into existing health systems where possible to maximise coverage.
- Choice of delivery platforms: assess the comparative advantages of each, such as their accessibility, cost– effectiveness, and capacity for reaching hard–to–reach populations.
- Equity and access: Address disparities by tailoring interventions to be inclusive, sensitive to gender, ethnicity, and other social determinants. This can be done by reducing barriers to access such as distance, cost, cultural resistance, especially in vulnerable groups to increase services reach.
- Effective monitoring and data collection are essential for evaluating the impact of interventions, and assessing whether nutrition interventions are reaching the intended population to make necessary adjustments.
- Build partnerships and collaborations with different sectors, encourage the ownership of the government and policymakers to create supportive policies, ensure funding and integrate nutrition interventions into national health agendas.
Tools and Guidance
References
44 Gillespie S, Menon P, Heidkamp R, Piwoz E, Rawat R, Munos M, Black R, Hayashi C, Kumar Saha K, Requejo J. Measuring the coverage of nutrition interventions along the continuum of care: time to act at scale. BMJ Glob Health. 2019 Jun 24;4(Suppl 4):e001290. doi: 10.1136/bmjgh-2018-001290. PMID: 31297250; PMCID: PMC6590959.
45 Alive & Thrive. (2021) Ethiopia Adolescent Nutrition: A Review of the Evidence and Recommendations. (Accessed: 1 October 2024).
46 Lopez-Ejeda, N. and Guerrero, S., Effectiveness, cost–effectiveness, and coverage of severe acute malnutrition (SAM) treatment delivered by Community Health Workers (CHWs) in Mali and Niger: To investigate a modified protocol for treatment of severe acute malnutrition delivered by Community Health Workers (CHWs) and compare it to the current Community Management of Acute malnutrition (CMAM) protocol.
47 Guevarra, E., Norris, A., Guerrero, S. and Myatt, M., 2014. Assessment of Coverage of Community–based Management of Acute Malnutrition. Version 2. CMAM Forum Technical Brief, July 2012, Valid International, Action Against Hunger–UK, Brixton Health.