Implementation and scale-up of nutrition-sensitive agriculture in low- and middle-income countries: a systematic review of what works, what doesn't work and why
Sabina Di Prima, Pamela Wright, Indu Sharma, Elena V. Syurina, Jacqueline E. W. Broerse
Abstract
Evidence is rapidly growing on the impact pathways through which nutrition-sensitive agriculture (NSA) contributes to improving nutritional outcomes. However, to harness NSA's full potential, it is equally important to understand why impacts are achieved (or not) and which factors play a role. Evidence on success and failure factors as well as external barriers and facilitators that influence the implementation and scale-up of NSA in low- and middle-income countries (LMICs) is still limited. To address this gap, we reviewed empirical evidence (since 2000) on factors influencing NSA implementation and scale-up. The Consolidated Framework for Implementation Research (CFIR) guided the analysis and synthesis of this systematic review. Eighty-five studies that met the inclusion criteria were extracted and synthesized across the five domains of the CFIR; here we report findings from three of the domains: NSA interventions, inner setting and outer setting. Many factors related to each of the domains were identified: intervention-specific factors (clustered in seven sub-domains and 23 themes), local contextual factors (in six sub-domains and 23 themes), and factors related to the broader enabling environment (in five sub-domains and 12 themes). A strong interplay among factors across the three domains was observed. This review highlights key areas for attention to enhance the success of NSA programs: learning from past successes and failures; appropriateness and acceptability based on context knowledge; project flexibility in addressing design limitations and coping with unforeseen hindrances; strengthening local structures, community empowerment and increasing resilience; supportive policy and governance. Our findings can help decision-makers at multiple levels to strengthen on-going/future NSA programs and anticipate possible pitfalls to maximise NSA's potential to reduce undernutrition in LMICs.