Integrating Infant and Young Child Feeding Counseling and Iron-folic Acid Distribution into Routine Immunization Services in Ethiopia

Together with MOH counterparts, JSI authors have published “Lessons Learned From Integrating Infant and Young Child Feeding Counseling and Iron-Folic Acid Distribution Into Routine Immunization Services,” in the journal Global Health: Science and Practice. The Universal Immunization through Improving Family Health Services (UI-FHS) project used innovative approaches from 2011 to 2021 to expand equitable routine immunization services to reach zero-dose and under-immunized children and strengthen the health system.

In 2019, UI-FHS conducted a pilot study with Ethiopia’s regional health bureaus, woreda (district) health offices, and nutrition partners to explore integrating selected nutrition services with routine immunization services. They chose to integrate IYCF counseling and IFA supplement distribution into immunization because of the similarities in target populations, the degree to which the services complement each other, and the overlap in the life stage when the interventions are delivered.

The article describes pilot study learning from planning and delivering integrated services, including factors that hindered or enabled implementation, and makes recommendations for integrating immunization and nutrition services in other settings. Findings yielded insights into the perspectives of program managers, health workers, and community members that other countries should consider as they integrate different health services over the life course.

The full article is available, and the abstract is below.

A full list of UI-FHS peer-reviewed articles and other reports and publications is available under the “Resources” tab.

Article link: https://doi.org/10.9745/GHSP-D-22-00166

Abstract

Immunization programs reach more children and communities than any other health intervention, thus making immunization a promising platform for integrating other essential health services. There is a dearth of literature on integrating nutrition interventions, such as infant and young child feeding (IYCF) counseling and iron-folic acid (IFA) supplementation, into routine immunization services.

To address this evidence gap, a 15-month pilot study (August 2019 to November 2020) tested the feasibility of integrating IYCF counseling and IFA supplement distribution into immunization service delivery in Ethiopia. The interventions focused on joint microplanning for integrated services (including estimating target populations for all services), revising client flows for service delivery, and providing on-the-job support to HWs for implementing and monitoring integrated service delivery.

Findings suggest that planning for and delivering IYCF counseling and IFA supplementation with immunization services is feasible. Integrating these services provided opportunities for collaborative planning and enabled health workers (HWs) to offer multiple services to clients through 1 interaction. However, HWs felt that additional human resources were needed to manage integrated services, especially during integrated outreach and mobile service delivery. HWs also reported that communities appreciated accessing 2 services in 1 visit but expressed reservations about the longer wait times.

Countries may consider expanding fixed and outreach immunization services to provide integrated service delivery provided that it is feasible, sustainable, of high quality, and incorporates the careful planning, follow-up, and increased human and financial resources needed to reinforce new practices and expand access to a broader array of health services.

Photo by: Adriana Almiñana, JSI