Nutrition’s New Frontier: The Science of Scaling Up

A young girl has access to healthy, nutritious foods – thanks in large part to interventions being taken to scale across Africa. / Sight and Life.

We are in a new era for global nutrition.

The political will is here: 54 countries have committed to the Scaling Up Nutrition (SUN) Movement. The 1,000 Days partnership has created champions across business, government and civil society to promote action and investment in early nutrition. Governments, donors and businesses pledged $4.15 billion to support nutrition interventions around the globe at last year’s Nutrition for Growth Summit. And more than 170 governments and nutrition and development leaders met in Rome last week at the Second International Conference on Nutrition (ICN2) and agreed upon a framework for action to accelerate progress on nutrition.

The evidence is in: good nutrition improves health, saves lives and builds prosperity.

The landmark 2008 Lancet Series on Maternal and Child Undernutrition identified optimal nutrition during the critical 1,000 days between pregnancy and a child’s second birthday as key for both human and economic development. The 2013 Lancet Series on Maternal and Child Nutrition identified a package of nutrition interventions that could save 900,000 lives in 34 high-burden countries, equipping nutrition advocates and policymakers with the evidence and recommendations to create impact in the world’s poorest countries.

We know what to do, but we don’t yet know how to do it at scale. There are bottlenecks to scaling up any effort, and nutrition is no exception. The transition from efficacy trials to real-world settings has been slow, and global health research to date has not examined the relationship between demand for services and their delivery.

Implementation science in nutrition helps ensure optimal interventions reach vulnerable children at a young age, giving them adequate nutrients to grow and thrive. / Sight and Life.

Systematic research is needed to understand and resolve the challenges of scaling up nutrition—research into every stage along the continuum of a nutrition program, from program development to delivery to uptake to adherence.

Consider the twice-yearly administration of vitamin A capsules to children ages 6-59 months, recommended to improve immune systems and reduce death. Although policymakers can chart a course of action, it is the regional directors of services and program managers who are responsible for implementing.

But how?

Should they tack this intervention onto child vaccination days? Well-child visits? Other opportunities?

It is this process of adopting an evidence-based practice into existing services—or creating new pathways—and the appropriate utilization of the services that must be informed by science to deliver a public health nutrition impact.

Implementation science is nascent, especially in nutrition, but progress is being made. In 2012, the New York Academy of Sciences convened a working group on delivery science in nutrition. Since 2009, the USAID-funded TRAction project has supported implementation and delivery science related to maternal, newborn and child health.

And the recently-formed International Society for Implementation Science in Nutrition works to empower the “doers,” those professionals and practitioners who propose implementation plans, gather evidence for informed decision making and improve programs. As a convener of scientists, policy leaders and practitioners, the Society works alongside other global efforts and organizations to advance research on the delivery of nutrition interventions worldwide.

The global nutrition community needs donors, NGOs and governments to prioritize implementation science when funding program implementation on the ground because it is this type of science that places service delivery, capacity building and local context at the heart of global nutrition efforts.

For a woman in India, service delivery influences whether she has access to prenatal micronutrients that help her deliver a healthy baby. Adequate training of health workers can influence whether a mother in Cambodia feeds her newborn with infant formula, or knows to exclusively breastfeed for the first six months.

Understanding cultural and societal factors is necessary to ensure that our messages motivate mothers in Kenya to feed their daughters colorful fruits and vegetables to provide the nutrients the child needs. If we want people to demand good nutrition, we must deliver good nutrition.

We have the tools and the knowledge to change the future through the power of good nutrition. We know the interventions that work. Implementation science will help create a world where the effective nutrition interventions are affordable, accessible and adequately used.

A world where every child can grow to their full potential. A world free of malnutrition.

It’s time to invest in implementation science.