Oluchi Ezekannagha, Scott Drimie, Dieter Von Fintel, Busie Maziya-Dixon, Xikombiso Mbhenyane
{"title":"实施事项：对尼日利亚阿南布拉州和凯比州四个部门营养敏感型干预措施的方案影响路径分析。","authors":"Oluchi Ezekannagha, Scott Drimie, Dieter Von Fintel, Busie Maziya-Dixon, Xikombiso Mbhenyane","doi":"10.1080/16549716.2025.2519677","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Undernutrition in early childhood can be reduced when large-scale, nutrition-sensitive programs are delivered with adequate dose, reach, fidelity, and recruitment.</p><p><strong>Objectives: </strong>This study (i) investigates the implementation and impact pathways of four nutrition-sensitive programs in Kebbi and Anambra states, Nigeria: Early Childhood Development Education (ECCDE), Environmental Sanitation, Skills Acquisition, and Agricultural Transformation Support Program (ATASP-1) and (ii) identifies cross-sector factors that enable or hinder effective dose, reach, fidelity, and recruitment.</p><p><strong>Methods: </strong>The study employs qualitative methods such as document reviews, in-depth interviews, and site observations to explore the complexity of program delivery and the contextual factors that influence its outcomes.</p><p><strong>Results: </strong>All four programs showed dose-reach-fidelity-recruitment gaps in varying degrees: irregular training and equipment delayed dose; rural and low-income communities were least reached; weak quality control cut fidelity; and recruitment seldom penetrated remote areas. Barriers across sectors included insufficient infrastructure, shortages of trained personnel, and bureaucratic funding delays. Programs with robust community engagement, active multi-stakeholder collaboration, timely resource flow, and short 'reviewandadapt' cycles (ATASP1 in both states; ECCDE in Anambra) overcame many shortfalls, whereas those lacking these features underperformed (Environmental Sanitation in Anambra; Skills Acquisition in Kebbi).</p><p><strong>Conclusion: </strong>Closing Nigeria's nutrition-sensitive implementation gap demands a dual response: fix tangible barriers - staffing, infrastructure, and procurement - and institutionalize community-led planning and adaptive management to keep dose-reach-fidelity-recruitment on track. Doing so will improve program reach and quality and accelerate progress against child undernutrition.</p>","PeriodicalId":49197,"journal":{"name":"Global Health Action","volume":"18 1","pages":"2519677"},"PeriodicalIF":2.2000,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12203689/pdf/","citationCount":"0","resultStr":"{\"title\":\"Implementation matters: program impact pathway analysis of four sectoral nutrition-sensitive interventions in Anambra and Kebbi states, Nigeria.\",\"authors\":\"Oluchi Ezekannagha, Scott Drimie, Dieter Von Fintel, Busie Maziya-Dixon, Xikombiso Mbhenyane\",\"doi\":\"10.1080/16549716.2025.2519677\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Undernutrition in early childhood can be reduced when large-scale, nutrition-sensitive programs are delivered with adequate dose, reach, fidelity, and recruitment.</p><p><strong>Objectives: </strong>This study (i) investigates the implementation and impact pathways of four nutrition-sensitive programs in Kebbi and Anambra states, Nigeria: Early Childhood Development Education (ECCDE), Environmental Sanitation, Skills Acquisition, and Agricultural Transformation Support Program (ATASP-1) and (ii) identifies cross-sector factors that enable or hinder effective dose, reach, fidelity, and recruitment.</p><p><strong>Methods: </strong>The study employs qualitative methods such as document reviews, in-depth interviews, and site observations to explore the complexity of program delivery and the contextual factors that influence its outcomes.</p><p><strong>Results: </strong>All four programs showed dose-reach-fidelity-recruitment gaps in varying degrees: irregular training and equipment delayed dose; rural and low-income communities were least reached; weak quality control cut fidelity; and recruitment seldom penetrated remote areas. Barriers across sectors included insufficient infrastructure, shortages of trained personnel, and bureaucratic funding delays. Programs with robust community engagement, active multi-stakeholder collaboration, timely resource flow, and short 'reviewandadapt' cycles (ATASP1 in both states; ECCDE in Anambra) overcame many shortfalls, whereas those lacking these features underperformed (Environmental Sanitation in Anambra; Skills Acquisition in Kebbi).</p><p><strong>Conclusion: </strong>Closing Nigeria's nutrition-sensitive implementation gap demands a dual response: fix tangible barriers - staffing, infrastructure, and procurement - and institutionalize community-led planning and adaptive management to keep dose-reach-fidelity-recruitment on track. 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Implementation matters: program impact pathway analysis of four sectoral nutrition-sensitive interventions in Anambra and Kebbi states, Nigeria.
Background: Undernutrition in early childhood can be reduced when large-scale, nutrition-sensitive programs are delivered with adequate dose, reach, fidelity, and recruitment.
Objectives: This study (i) investigates the implementation and impact pathways of four nutrition-sensitive programs in Kebbi and Anambra states, Nigeria: Early Childhood Development Education (ECCDE), Environmental Sanitation, Skills Acquisition, and Agricultural Transformation Support Program (ATASP-1) and (ii) identifies cross-sector factors that enable or hinder effective dose, reach, fidelity, and recruitment.
Methods: The study employs qualitative methods such as document reviews, in-depth interviews, and site observations to explore the complexity of program delivery and the contextual factors that influence its outcomes.
Results: All four programs showed dose-reach-fidelity-recruitment gaps in varying degrees: irregular training and equipment delayed dose; rural and low-income communities were least reached; weak quality control cut fidelity; and recruitment seldom penetrated remote areas. Barriers across sectors included insufficient infrastructure, shortages of trained personnel, and bureaucratic funding delays. Programs with robust community engagement, active multi-stakeholder collaboration, timely resource flow, and short 'reviewandadapt' cycles (ATASP1 in both states; ECCDE in Anambra) overcame many shortfalls, whereas those lacking these features underperformed (Environmental Sanitation in Anambra; Skills Acquisition in Kebbi).
Conclusion: Closing Nigeria's nutrition-sensitive implementation gap demands a dual response: fix tangible barriers - staffing, infrastructure, and procurement - and institutionalize community-led planning and adaptive management to keep dose-reach-fidelity-recruitment on track. Doing so will improve program reach and quality and accelerate progress against child undernutrition.
期刊介绍：
Global Health Action is an international peer-reviewed Open Access journal affiliated with the Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine at Umeå University, Sweden. The Unit hosts the Umeå International School of Public Health and the Umeå Centre for Global Health Research.
Vision: Our vision is to be a leading journal in the global health field, narrowing health information gaps and contributing to the implementation of policies and actions that lead to improved global health.
Aim: The widening gap between the winners and losers of globalisation presents major public health challenges. To meet these challenges, it is crucial to generate new knowledge and evidence in the field and in settings where the evidence is lacking, as well as to bridge the gaps between existing knowledge and implementation of relevant findings. Thus, the aim of Global Health Action is to contribute to fuelling a more concrete, hands-on approach to addressing global health challenges. Manuscripts suggesting strategies for practical interventions and research implementations where none already exist are specifically welcomed. Further, the journal encourages articles from low- and middle-income countries, while also welcoming articles originated from South-South and South-North collaborations. All articles are expected to address a global agenda and include a strong implementation or policy component.
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