The nutrition assessment, counseling, and support (NACS) approach aims to improve the nutritional status of individuals and populations by integrating nutrition into policies, programs, and the health service delivery infrastructure.  Improvement methods can help to strengthen the linkage between communities and points of care for nutritional services to improve the coverage, compliance, referral, and follow-up of people of all ages with special nutritional needs, including pregnant and lactating women, young children, and persons living with HIV or tuberculosis.

Nutrition MUAC

Integrating nutrition support into existing health services can be challenging. Health care providers may lack the technical knowledge and skills to deliver the correct care; high staff turnover make one-off training in nutrition assessment and follow-up unsustainable; low staff numbers make it hard for clinics to handle the increased workload required to integrate a new service into their already busy clinics; and supply chain issues mean that supplies of specialized food products are not always available at clinics. These challenges can be addressed by improvement interventions to build technical skills, improve the efficiency and effectiveness of service delivery, and strengthen data systems at all levels.

Malawi NCST QI Training Materials

ASSIST developed the quality improvement component of the Malawi Nutrition, Care, Support and Treatment (NCST) training package in June 2014. The materials include a facilitator’s guide, participant’s guide, and a participant’s workbook. These will be part of the Malawi NCST training package for national use. The materials were field tested during the NCST training in Balaka District. Comments were consolidated and the training materials were updated based on the comments and observations.

The quality improvement component is part of the Nutrition Assessment, Counseling, and Support (NACS): A User's Guide developed by FANTA III. It is currently comprised of three modules:

Module 1. What Is NACS?

Module 2. Nutrition Assessment and Classification

Module 3. Nutrition Counseling

USAID ASSIST Project Annual Performance Monitoring Report FY14

This annual report for the USAID ASSIST Project summarizes the project's accomplishments and results in FY14 supporting the application of modern improvement methods by host country providers and managers in USAID-assisted countries.

During FY14, USAID ASSIST provided assistance in 24 countries through field and core funding; activities in 21 of these countries were funded through field support.  Funds from the USAID Office of HIV/AIDS supported activities in community health and health workforce development in Uganda and Tanzania; HIV and AIDS activities in Uganda, Tanzania, and Swaziland; nutrition assessment, counselling, and support in Malawi; and technical leadership activities for the Partnership for HIV-Free Survival, which ASSIST is supporting in Tanzania, Uganda, Kenya, Lesotho, and Mozambique. 

USAID Office of Health Systems cross-bureau funds supported family planning activities in Niger; pilot maternal and child health activities in Mali and Senegal; maternal, neonatal, and child health activities in Uganda; regional initiatives in the Latin American and East/Central/Southern Africa regions; the development of a framework for systems strengthening through mHealth; and non-communicable disease (NCD) prevention and treatment activities.  The project also provided technical assistance to the Regional Center for Quality in Health Care with field support from the East Africa Region and assistance in Ukraine with Europe and Eurasia Bureau funding.

As discussed in this report, ASSIST-supported programs demonstrated improved care and outcomes for a range of services, including antenatal and postnatal care, essential obstetric and newborn care, PMTCT, HIV care and treatment, TB-HIV case management, and non-communicable disease services. 

The work also contributed to the publication of four peer-reviewed articles; 12 case studies; 11 technical reports; 21 flyers and short reports; and 8 guides for country institutions. The report also discusses the project's research and evaluation studies to help show country programs how and why investment in improvement adds value to health care delivery and to contribute to the body of evidence on improvement methods.

Improving Health Care: The Results and Legacy of the USAID Health Care Improvement Project

This final report of the USAID Health Care Improvement Project (HCI) summarizes the key accomplishments and learning of this seven-year global technical assistance project of the USAID Office of Health Systems.  Implemented from 2007-2014, HCI provided technical assistance in health care and social service improvement in 38 countries. In addition to building assisted country capacity to make measurable improvements in quality of health care and services for vulnerable children and families affected by HIV, the project sought to expand the evidence base for the application of modern improvement methods to health and social service delivery as well as to human resources planning and management. 

The report summarizes the magnitude of improvement achieved on targeted indicators from 23 countries for HIV and AIDS, maternal, newborn and child health, family planning, health workforce development, orphans and vulnerable children, community health, non-communicable disease, nutrition, and tuberculosis improvement interventions.  The report also provides highlights from HCI's extensive research and evaluation component, which encompassed 92 studies on institutionalization of improvement methods, design of collaborative improvement, spread, and cost-effectiveness of improvement interventions. Also listed in the report are the 26 peer-reviewed articles, 75 technical reports, and 66 research and evaluation reports developed from HCI's work.

HCI was managed by University Research Co., LLC (URC) with key contributions from EnCompass LLC, FHI 360, HEALTHQUAL International, Initiatives Inc., Institute for Healthcare Improvement, Johns Hopkins University Center for Communication Programs, and WI-HER LLC.

Cover Improving Health Care

Everyday KM

Lani Marquez

Knowledge Management Director, USAID ASSIST Project/URC

How can knowledge management (KM) improve food and nutrition programming?  Alyssa Lowe of CARE and I posed that question last week at the Food Security and Nutrition (FSN) Network  “Knowledge Sharing” Meeting held July 10-11 in Washington, DC, sponsored by the USAID Food for Peace Office’s  Technical and Operational Performance Support (TOPS) Project.

What Is Knowledge Management and How Can It Improve Your Food Security Program?

Washington, DC

Learning from experience is essential to improve our work and the programs we support or implement.  This session at the Food Security and Nutrition Network/TOPS Project Knowledge Sharing Conference in Washington, DC explored  key concepts in knowledge management that have proven relevant for development sectors. 

Strengthening Systems to Improve Nutrition Care, Support and Treatment in Malawi: Results from Balaka and Karonga Districts

In Malawi, USAID ASSIST has worked with the Government of Malawi and the FANTA and LIFT projects since February 2013 to support the MOH Nutrition Department and the Office of the President to improve nutrition care for people living with HIV and tuberculosis in Karonga and Balaka districts and to use the lessons from these districts to help the Ministry strengthen the national Nutrition Care, Support and Treatment

(NCST) program. The work has focused initially on two aims:

  1. To integrate nutrition assessment, care and support into general HIV care.
  2. To provide data on the number of malnourished clients to the district 

and national level and to identify sources of funding to provide ready-to-eat therapeutic food and other support for the NCST program.

This technical report describes how improvement teams in eight facilities in the two districts analyzed how nutrition assessments were being done to identify changes that could be made to increase the number of clients assessed. Teams testing a number of changes, including: Shifting the point of assessment in the facility, using different types of staff to conduct assessments, developing a schedule for facility staff to assign responsibility each day for conducting assessments, and expanding the number of days nutrition services were available.  The efforts of these teams led to improvements in both the identification and management of malnourished clients and the successful integration of nutrition assessment, care, and support into general HIV care.

Using team work to improve nutrition services

Linley Elsie Hauya

Nutrition Advisor, USAID ASSIST Project/URC

Most health facilities in Malawi are always crowded with patients to receive medical treatment and the health service providers are overloaded with work.  The Nutrition Assessment, Counseling and Support (NACS) program never received any attention in recent years because there were no resources to run the program and no therapeutic supplies to treat the malnourished HIV positive patients. Quality improvement work is the flag ship that has brought NACS to stakeholder’s attention at national level such that it has begun to receive support.

Integrating nutrition services in HIV and TB care in Karonga and Balaka Districts of Malawi

With support from the United States Agency for International Development (USAID), health workers in Karonga and Balaka districts are reaching people with HIV and TB with a critical new service—nutrition assessment, counseling and support. By introducing three simple changes – 1) conducting nutrition assessment during registration before the client sees a health worker, 2) teaching clerks, assistants and other staff to help take arm circumference measurement, and 3) creating new data forms to track nutritional assessment – Karonga Hospital increased nutritional assessment from only 4% of clients visiting the HIV clinic to 98% in nine months.

Improving household food security in Mwanganya area through community involvement in Karonga District, Malawi

With support from the United States Agency for International Development (USAID), a group of community members agreed to improve their household food security situation during the hunger months with support from a multi-sectoral team of stakeholders. The community members from Mwanganya village in Group Village Mwandambo in Karonga District were assisted by communitybased government extension workers and community members to try some actions recommended in the national OVC standards to enhance their household food security and nutrition. Using the quality improvement methods, communities in Mwanganya village mobilised themselves to establish grain banks to improve food availability at the household level during the hunger months.

National Quality Service Guidelines for Improving Vulnerable Children Programs in Haiti

Before the Haiti drafted the National Service Guidelines, children’s service providers were working with some protocols, though they were oftentimes just doing what they thought they should do, without specific national guidance. The draft service guidelines have clarified what outcomes service providers should be achieving, indicators to see if programs are making a measurable difference in the lives of vulnerable children, and evidence-based interventions that should be put into practice to achieve those desired outcomes. This flyer describes experiences of the improvement teams piloting the draft service guidelines and using improvement methods to improve the services they offer to vulnerable children. 
The flyer is also available in French, which can also be found below.