Structural readiness of health facilities for implementing maternal and child nutrition services in Mozambique Réka Maulide Cane1,4*, Ashely Sheffel5, Cristolde Salomão1, Júlia Sambo1,4, Elias Matusse1, Edmilson Ismail2, Ananias António2, Érica Manuel3, Talata Sawadogo-Lewis5, Timothy Roberton5 1Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique; 2Department of Nutrition, Ministry of Health, Maputo, Mozambique; 3Superior Institute of Health Sciences, Maputo, Mozambique; 4Institute of Hygiene and Topical Medicine, Nova University Lisbon, Lisbon, Portugal; 5Institute for International Programs at Johns Hopkins University, Bloomberg School of Public Health, Baltimore, USA. Background: Health systems play a crucial role in the delivery of nutrition-specific interventions for children and mothers, still, the quality and more specifically readiness of health services have not been widely tracked. We explored the access and readiness of health facilities to deliver nutrition services for pregnant women and children. Objective: To assess the readiness of health facilities to provide maternal and child nutrition services in Mozambique. Methods: We defined indicators of readiness for 7 maternal and child nutrition interventions: anemia testing with iron supplementation, folic acid supplementation, breastfeeding promotion, pregnancy growth monitoring, vitamin A supplementation, preventive zinc supplementation, and child growth monitoring. We used data from the 2018 Mozambique SARA health facility survey to calculate readiness scores for each facility in the country. A facility was considered “ready” if it both stated that it offered the intervention and if it had the physical inputs required for service delivery. After calculating readiness scores, we used geospatial data from the WorldPop initiative to estimate the proportion of people in Mozambique within 10 kilometers of a ready facility. For each square kilometer in the country, we identified all the facilities in range. If at least one facility within 10 kilometers was "ready", we considered all the people in the square kilometer to have access to a ready facility. In this way, for each province and for the country as a whole, we calculated the proportion of people with access to a ready facility, for each of the 7 nutrition interventions. Results: At the national level, 29.1% and 37.3% of the population within 10 kilometers of a facility that is ready to deliver all maternal nutrition services and all child nutrition services, respectively. The north region has the lowest rates for both maternal (19.4%) and child nutrition (26.9%) compared to south and center regions. Nampula (14.9%) and Zambézia (17.9%) are the least ready provinces to deliver maternal services. Nampula (20.4%) and Cabo Delgado (21.2%) are the least ready to deliver child nutrition services. Among interventions, anemia testing with iron supplementation for pregnant women (45.1%) and preventive zinc supplementation for children (50.3%) showed the least structural readiness across Mozambique. Conclusions: Improving nutrition in Mozambique will require multisectoral effects both within and outside of the health system. Although facility-based interventions are not sufficient by themselves, they are a necessary piece of an overall strategy to ensure that all mothers and children in Mozambique achieve full health. Currently, only a minority of people in Mozambique have access to a health facility that is ready to deliver all maternal and child nutrition interventions. If we are to improve nutrition in Mozambique, we must invest in robust supply chains, particularly in the north of the country, to ensure that every health facility has the needed supplies and equipment to deliver nutrition interventions. Funding source: European Union; Acknowledgments: Technical Working Women, Child Health and Nutrition Platform of the National Observatory of Health and Fundação Calouste Gulbenkian.
Instituto Nacional de Saude (National Institute of Health), MoH, Mozambique
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