Evidence map›Paper›PMID 35490257›Full record

ArticleInternational journal of health policy and management2022

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

Brenda Shenute Namugumya, Jeroen J L Candel, Elise F Talsma, Catrien J A M Termeer, Jody Harris

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Article in International journal of health policy and management, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

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0cells of the map it votes in
4citing papers in PubMed
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1 · What the graph read from it

What it found

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2 · The registry

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3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

5 authors.

Brenda Shenute NamugumyaPublic Administration and Policy Group, Wageningen University & Research, Wageningen, The Netherlands.ORCID 0000-0002-9653-3172
Jeroen J L CandelPublic Administration and Policy Group, Wageningen University & Research, Wageningen, The Netherlands.ORCID 0000-0003-2302-9159
Elise F TalsmaDivision of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands.ORCID 0000-0002-6034-4708
Catrien J A M TermeerPublic Administration and Policy Group, Wageningen University & Research, Wageningen, The Netherlands.ORCID 0000-0001-7396-1476
Jody HarrisInstitute of Development Studies, University of Sussex, Brighton, UK.ORCID 0000-0002-3369-1253

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIntegrating 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.

methodsThis 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.

resultsFrontline 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.

conclusionUnderstanding 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.

Indexed as

Delivery of Health CareGovernmentHumansOrganizationsQualitative ResearchUgandaNutrition PolicyNutrition PracticesPolicy IntegrationStreet-Level BureaucracyUganda

Identifiers

PMID35490257
PMCPMC10105165

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.