Integration of nutrition assessment counselling and support interventions in health service delivery and respective drivers: A case study of Tororo district, Uganda

Background: Uganda embraced the Nutrition Assessment Counselling and Support (NACS) approach since 2009 as a health system strengthening approach to deliver quality nutrition services for better health and nutrition outcomes of the population. Whilst government and partners provided support for NACS, the extent of its integration in Uganda is unknown. Using Tororo district as a case study, we assessed the extent of NACS assimilation into the health system functions and the respective drivers to inform NACS scale up. Methods: This study used a mixed method design to assess the extent of NACS integration in the health system and the respective drivers. We conducted facilitated panel discussions in 17 health facilities with 4-8 health staff per facility guided by a semi-structured questionnaire. Through consensus, final scores were allotted to each of the health system functions on a five point scoring scale ranging from 1 if not done nor integrated to 5 if NACS was fully integrated. Data were captured and mean scores analysed in excel. Findings were presented in bar and spider charts. Drivers for integration were deductively extracted from the key informant interviews, in-depth interviews and focus group discussions using Atlas.ti 9 and thematic analysis to complement the quantitative data. Results: NACS integration in the health system functions was partial with a mean score of 2.9. The best integrated function was service delivery (3.8) followed by health work force (3.7), health information (3.3), community support system (3.0) and governance and leadership (3.0). Health financing (2.2) and health supplies functions (1.5) were least integrated. Hospitals (3.0) had better integration than HCIV (2.4) and HCIII (2.6). The key drivers for integration were; good leadership, increased funding, competent staff, quality improvement approaches, availability of nutrition logistics and supplies, health and nutrition education talks, and community dialogues. Conclusion: NACS integration in the health system functions was sub-optimal suggestive of a weak nutrition integrated system. Good leadership, capacity building in all health system functions, increased funding, recruitment of nutritionists, nutrition supplies and logistics are important for a fully integrated nutrition service delivery.