Integration can be immensely powerful – but more must be done to realise its full potential
Sunit Bagree is Senior Policy Advocacy Officer at Results UK. This blog post is jointly published by Action for Global Health and the International Parliamentary Network for Education.
There is no escaping the fact that the Sustainable Development Goals are way off-track. Yet this does not mean that progress is not occurring anywhere at all. The skies may be dark but some stars are still shining.
A new Results UK briefing shows what can happen when different sectors like health, education and agriculture collaborate rather than work in silos. Collaboration allows for a range of interventions that address multiple needs to be strategically delivered in a participatory manner. This powerful approach is known as integration.
Good practice in integration
Examples of good practice in integration exist at both preschool and school levels. Indeed, programmes operating at different stages of a child’s life can be mutually reinforcing.
At the preschool level, immunisation-nutrition integration (INI) programmes deliver both nutrition interventions and vaccinations to children. In Uganda’s capital, Kampala, INI involves: vitamin A supplementation (VAS); nutrition assessments and referrals if necessary; and bacillus Calmette-Guérin, diphtheria-tetanus-pertussis, measles and polio vaccinations.
The availability of multiple health services in the form of a ‘one-stop shop’ is clearly attractive to members of the public. Significant progress was seen just a year after INI implementation. For example, data from community outreach demonstrated an increase in VAS of 52% for the first dose and 44% for the second dose. Similarly, data from public health facilities showed an increase of 116% in full immunisation by one year of age.
At the school level, integrated health and nutrition programmes can provide a wide range of developmental benefits to schoolchildren. When food is procured from local smallholder farmers, known as home-grown school feeding (HGSF), the benefits of such programmes can extend to marginalised farmers. In Nigeria, the national government seeks to integrate HGSF with school-based deworming (providing anti-parasitic drugs to children to rid them of intestinal worms) and water, sanitation and hygiene interventions.
The success of the integrated HGSF programme in Nigeria is remarkable. In 2019, the national government announced that the programme had helped to increase enrolment in primary schools by over 20% in just four years. The programme also has significant health benefits for schoolchildren, in terms of better nutrition and lower prevalence of worms. Furthermore, the households of smallholder farmers benefiting from the programme are twice as likely to be food-secure compared with the households of smallholder farmers who do not benefit from it.
Challenges to overcome
Despite the indisputable power of integration, challenges exist. Three in particular cut across both examples outlined above.
First, it ought to be recognised that integration requires more planning time and greater coordination at different levels, including in relation to monitoring, evaluation, accountability and learning. Greater alignment of systems and processes, along with clarity regarding the division of responsibilities, can maximise efficiency.
Second, there is a need for more capacity building and advice. For example, in Uganda, more effective training and support for clinical health workers is necessary. Similarly, in Nigeria, caterers require more training on meal preparation, handling and distribution, and smallholder farmers require greater assistance to supply food during off-seasons.
Third, there is a need for greater community sensitisation and mobilisation. In Uganda, for instance, some people leave after the child in their care has been immunised, as some of the nutrition interventions that are available take more time to administer. In Nigeria, school-based management committees and parent-teacher associations need to be better leveraged so that they can fully contribute to decision-making in relation to the integrated HGSF programme.
Realising the potential of integration
What can the UK Government do to help to realise the full potential of integration?
That integration boosts efficiency is not at all a reason to reduce funding. The UK should immediately reverse its recently announced cuts to overseas development assistance (ODA), and publish a clear timetable for returning to spending 0.7% of gross national income on ODA.
As a member of the International Coalition for Advocacy on Nutrition UK and Action for Global Health, and the host organisation for the International Parliamentary Network for Education, Results UK believes that nutrition, health and education must all receive their fair share of good quality ODA. The UK’s ODA cuts have put civil society organisations under pressure to make the case for their specific cause. In this challenging situation, it is important to be advocating for our respective causes through the lens of integration.
By producing ‘win-wins’, integration is an important way of making ODA more strategic. Thus the UK should fully exploit and promote useful tools for promoting integration; in the nutrition sector, for example, such tools include the Organisation for Economic Co-operation and Development’s nutrition policy marker and Global Compact on Nutrition Integration.
Two further measures are required. At the preschool level, the UK should promote multi-stakeholder partnerships for research into INI, and ensure that research findings are utilised by UK-funded programmes and widely shared. At the school level, the UK should become a member of the School Meals Coalition, and recognise the importance and potential of integrated school health and nutrition programmes for development.
By taking these steps, the UK would certainly help to make stars of hope shine brighter and pierce the current gloom.