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

Document Type : Original Article

Authors

1 Public Administration and Policy Group, Wageningen University & Research, Wageningen, The Netherlands

2 Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands

3 Institute of Development Studies, University of Sussex, Brighton, UK

Abstract

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.

Keywords


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Articles in Press, Corrected Proof
Available Online from 03 April 2022
  • Receive Date: 15 January 2021
  • Revise Date: 06 March 2022
  • Accept Date: 30 March 2022
  • First Publish Date: 03 April 2022