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OBJECTIVES: As nutrition programs become increasingly integrated and multi-sectoral, effectively implementing evidence-based interventions at scale, and measuring their impact becomes complex. Given this complexity, a framework and analytical method linking multi-sectoral planning, coordination and implementation processes at core program level with their ultimate nutrition impact is a critical tool for understanding what works and why under real world conditions.This study aims to propose a method for adapting an implementation science approach to define and assess effectiveness in the specific context of large, donor-funded, integrated health and nutrition programs. METHODS: Applying 3 key nutrition implementation frameworks across 5 large-scale integrated programs (SPRING, FANTA, SAFANSI, MCSP and the USAID Advancing Nutrition), we define measures and compare models for effectiveness in complex projects. As part of this effort, we map activities that ensure effectiveness measures are captured when integrating, co-locating, or combining nutrition-sensitive and -specific interventions. RESULTS: Effectiveness in such programs is defined at both the core or planning/strategy level, and at the field level where implementation occurs. Effectiveness at the planning/strategy level is assessed by outcomes like contribution to global learning, new methods, and tools, co-location of skills and services, collaboration, coordination, communication, and sustainability. Effectiveness also entails more conventional program effectiveness measures, such as nutrition outcomes, influenced by the enabling environment factors such as systems, capacities, and policies. CONCLUSIONS: The framework and analytical assessment method in this study identifies process milestones and links them to measurable outcomes at the core program level alongside conventional nutrition effectiveness measures, highlighting factors in the enabling environment critical for delivery of outcomes in integrated programs. Considering the scale and uniqueness of such programs as investments in multi-sectoral nutrition-sensitive and -specific interventions, adopting an effectiveness model that links strategy with activity level measures will allow for an unprecedented understanding of key factors for success. FUNDING SOURCES: Funded by the USAID Advancing Nutrition |
