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Integrating Nutrition Actions in Service Delivery: The Practices of Frontline Workers in Uganda

Background: Integrating nutrition actions into service delivery in different policy sectors is an increasing concern. Nutrition literature recognizes the discrepancies existing between policies as adopted and actual service delivery. This study applies a street-level bureaucracy (SLB) perspective to...

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Autores principales: Namugumya, Brenda Shenute, Candel, Jeroen J.L., Talsma, Elise F., Termeer, Catrien J.A.M., Harris, Jody
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Kerman University of Medical Sciences 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10105165/
https://www.ncbi.nlm.nih.gov/pubmed/35490257
http://dx.doi.org/10.34172/ijhpm.2022.5898
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author Namugumya, Brenda Shenute
Candel, Jeroen J.L.
Talsma, Elise F.
Termeer, Catrien J.A.M.
Harris, Jody
author_facet Namugumya, Brenda Shenute
Candel, Jeroen J.L.
Talsma, Elise F.
Termeer, Catrien J.A.M.
Harris, Jody
author_sort Namugumya, Brenda Shenute
collection PubMed
description Background: Integrating nutrition actions into service delivery in different policy sectors is an increasing concern. Nutrition literature recognizes the discrepancies existing between policies as adopted and actual service delivery. This study applies a street-level bureaucracy (SLB) perspective to understand frontline workers’ practices that enact or impede nutrition integration in services and the conditions galvanizing them. Methods: This qualitative exploratory study assesses the contextual conditions and practices of 45 frontline workers employed by the agriculture, health and community development departments in two Ugandan districts. Results: Frontline workers incur different demands and resources arising at societal, organizational, and individual level. Hence, they adopt nine co-existing practices that ultimately shape nutrition service delivery. Nutrition integration is accomplished through: (1) ritualizing task performance; (2) bundling with established services; (3) scheduling services on a specific day; and (4) piggybacking on services in other domains. Disintegration results from (5) non-involvement and (6) shifting blame to other entities. Other practices display both integrative and disintegrative effects: (7) creaming off citizens; (8) down prioritization by fixating on a few nutrition actions; and (9) following the bureaucratic ‘jobs worth’. Integrative practices are driven mostly by donors. Conclusion: Understanding frontline workers’ practices is crucial for identifying policy solutions to sustain nutrition improvements. Sustaining services beyond timebound projects necessitates institutionalizing demands and resources within government systems. Interventions to facilitate effective nutrition service delivery should strengthen the integrative capacities of actors across different government levels. This includes investing in integrative leadership, facilitating frontline workers across sectors to provide nutrition services, and adjusting the nutrition monitoring systems to capture cross-sector data and support policy learning.
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spelling pubmed-101051652023-04-16 Integrating Nutrition Actions in Service Delivery: The Practices of Frontline Workers in Uganda Namugumya, Brenda Shenute Candel, Jeroen J.L. Talsma, Elise F. Termeer, Catrien J.A.M. Harris, Jody Int J Health Policy Manag Original Article Background: Integrating nutrition actions into service delivery in different policy sectors is an increasing concern. Nutrition literature recognizes the discrepancies existing between policies as adopted and actual service delivery. This study applies a street-level bureaucracy (SLB) perspective to understand frontline workers’ practices that enact or impede nutrition integration in services and the conditions galvanizing them. Methods: This qualitative exploratory study assesses the contextual conditions and practices of 45 frontline workers employed by the agriculture, health and community development departments in two Ugandan districts. Results: Frontline workers incur different demands and resources arising at societal, organizational, and individual level. Hence, they adopt nine co-existing practices that ultimately shape nutrition service delivery. Nutrition integration is accomplished through: (1) ritualizing task performance; (2) bundling with established services; (3) scheduling services on a specific day; and (4) piggybacking on services in other domains. Disintegration results from (5) non-involvement and (6) shifting blame to other entities. Other practices display both integrative and disintegrative effects: (7) creaming off citizens; (8) down prioritization by fixating on a few nutrition actions; and (9) following the bureaucratic ‘jobs worth’. Integrative practices are driven mostly by donors. Conclusion: Understanding frontline workers’ practices is crucial for identifying policy solutions to sustain nutrition improvements. Sustaining services beyond timebound projects necessitates institutionalizing demands and resources within government systems. Interventions to facilitate effective nutrition service delivery should strengthen the integrative capacities of actors across different government levels. This includes investing in integrative leadership, facilitating frontline workers across sectors to provide nutrition services, and adjusting the nutrition monitoring systems to capture cross-sector data and support policy learning. Kerman University of Medical Sciences 2022-04-24 /pmc/articles/PMC10105165/ /pubmed/35490257 http://dx.doi.org/10.34172/ijhpm.2022.5898 Text en © 2022 The Author(s); Published by Kerman University of Medical Sciences https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0 (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Namugumya, Brenda Shenute
Candel, Jeroen J.L.
Talsma, Elise F.
Termeer, Catrien J.A.M.
Harris, Jody
Integrating Nutrition Actions in Service Delivery: The Practices of Frontline Workers in Uganda
title Integrating Nutrition Actions in Service Delivery: The Practices of Frontline Workers in Uganda
title_full Integrating Nutrition Actions in Service Delivery: The Practices of Frontline Workers in Uganda
title_fullStr Integrating Nutrition Actions in Service Delivery: The Practices of Frontline Workers in Uganda
title_full_unstemmed Integrating Nutrition Actions in Service Delivery: The Practices of Frontline Workers in Uganda
title_short Integrating Nutrition Actions in Service Delivery: The Practices of Frontline Workers in Uganda
title_sort integrating nutrition actions in service delivery: the practices of frontline workers in uganda
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10105165/
https://www.ncbi.nlm.nih.gov/pubmed/35490257
http://dx.doi.org/10.34172/ijhpm.2022.5898
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