5
THE COVERAGE OF NUTRITION-SPECIFIC INTERVENTIONS NEEDS TO IMPROVE
C
OVERAGE OF NUTRITION INTERVENTIONS—THAT IS, THE NUMBER OF PEOPLE IN A PROGRAM COMPARED WITH THE NUMBER OF PEOPLE WHO SHOULD BE IN A
program—is a key indicator for accountability of service providers. This chapter re- views coverage of the set of nutrition-specific interventions described in Bhutta et al. (2013a) and identifies gaps in the data on coverage of those interventions. Next, it analyzes the coverage of a set of five undernutrition interventions for which data do exist. It reviews the coverage issues that are particular to severe acute malnutrition. Fi- nally, it briefly reviews new evidence on the predicted impacts of scaling up nutrition- specific interventions. This evidence suggests that more research on implementation is needed to show how to improve the effectiveness of existing proven interventions.
The coverage data in this chapter are primarily for nutrition-specific interventions that address undernutrition, rather than overweight and obesity.1
This is due to the
paucity of large-scale interventions to address overweight and obesity, even in high- income countries, as well as to the lack of an international database on the coverage of the interventions that do exist.
KEY POINTS
1. Coverage data for nutrition-specific interventions are sparse. This is often because the interventions themselves have yet to be scaled up. Of 12 key nutrition-specific interventions, many countries have national coverage data for only 3 (vitamin A supplementation, universal salt iodization, and zinc treat- ment for diarrhea). Data for practices relating to nutrition-specific interventions (exclusive breastfeed- ing and diets of 6- to 23-month-old children) are more available.
2. Only 37 countries have data on all five of the nutrition interventions and practices with the most extensive coverage data. Of these 37 countries, only one is above the 50 percent threshold for each intervention or practice. Seventeen countries are below 50 percent on three or more of the five inter- ventions or practices.
3. Geographic coverage of programs to treat moderate and severe acute malnutrition is poor, even in countries with large burdens of acute malnutrition. Direct coverage estimates are one critical com- ponent in properly assessing access to treatment for both moderate and severe acute malnutrition, but these data tend to be based on subnational stand-alone surveys. Coverage assessment should be integrated into institutionalized data collection, with frequency and methods tailored to country capacity.
4. Expanded program coverage is only valuable if it leads to expanded impact. It is thus important to fo- cus on maintaining and improving program effectiveness. Implementation research is important here.
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