Intended for healthcare professionals

Analysis Leaving No One Behind

How can we realise the full potential of health systems for nutrition?

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.l6911 (Published 27 January 2020) Cite this as: BMJ 2020;368:l6911

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  1. Rebecca A Heidkamp, professor1,
  2. Emily Wilson, researcher1,
  3. Purnima Menon, researcher2,
  4. Helen Kuo, researcher1,
  5. Shelley Walton, researcher1,
  6. Giovanna Gatica-Domínguez, researcher3,
  7. Inacio Crochemore da Silva, researcher3,
  8. Tricia Aung, researcher1,
  9. Nemat Hajeebhoy, donor4,
  10. Ellen Piwoz, donor4
  1. 1Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
  3. 3International Center for Equity in Health, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
  4. 4Nutrition Division, Global Development Program, Bill and Melinda Gates Foundation, Seattle, Washington, USA
  5. Correspondence to: Rebecca Heidkamp rheidka1@jhu.edu

Poor nutrition contributes substantially to global disease, diminishing the wellbeing of women and children in low and middle income countries, and better nutrition must be part of the universal health coverage agenda, say Rebecca Heidkamp and colleagues

Key messages

  • Most essential nutrition interventions are delivered through health systems

  • Global movements to scale up effective nutrition interventions and achieve universal health coverage have not been connected to help each realise their full potential

  • Scaling up nutrition interventions among those who are already reached by health services is an important first step for accelerating progress

  • Other countries can learn from the experience of those that seem to be on track to achieving universal health coverage for specific health services and nutrition interventions

  • We need to deal with the widespread gaps in data on the coverage of nutrition interventions if we want to monitor progress and achieve universal coverage

Over the past decade, global efforts to raise awareness of malnutrition have been accompanied by national movements to gain high level political commitment and accelerate actions, proved to work, to improve nutrition.1 Despite this momentum, by 2018 just under half of countries are on track to meet at least one of nine nutrition related targets set by the World Health Assembly for 2025 (table 1).4 Many countries are not achieving the goals because coverage of effective interventions remains low. Health systems are the primary vehicle for nutrition interventions in many low and middle income countries. Ideally, health systems reach women and children through frequent antenatal care, normal and emergency delivery services, early postnatal care, and preventive and curative care throughout early childhood. Nutrition interventions commonly include counselling about diets and infant and young child feeding during antenatal care, postnatal care, and for the first two years of life. Additionally, weight gain is monitored …

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