Integrating and scaling-up SQ-LNS within coordinated strategies to prevent child malnutrition, improve child survival, and promote healthy development
Bill & Melinda Gates Foundation Office, Washington DC
May 25-26, 2022
The objective of this convening was to focus on the operational aspects of scaling-up small-quantity lipid-based nutrient supplements (SQ-LNS), with the goal of creating a road map to prioritize next steps for the next 1-2 years. The evidence base, cost- and cost-effectiveness of SQ-LNS were covered in two pre-convening webinars. Participants agreed that positioning and integrating SQ-LNS within overall country strategies is critical. Because SQ-LNS provides multiple benefits (e.g., reduces child mortality, prevents wasting, stunting and anemia and improves diets and child development outcomes), it can be positioned within multiple relevant frameworks (e.g., Child Survival Call to Action, Global Action Plan on Child Wasting, Human Capital Index, etc.) and can be integrated within different distribution channels (social protection programs, resilience packages, shock responses, community health care systems). The vision of scale should include clear definitions of target populations, delivery platforms, operational issues in various contexts (e.g., fragile health systems, large-scale emergencies), long-term plans for capacities and resources, opportunities for built-in learning and course corrections, and clear indicators of program monitoring and impact. Several key lessons have been learned from programs that have utilized SQ-LNS: a) Get out of the nutrition “bubble” to build strong political will and buy-in, and use existing data and modeling to provide context-specific, local information to understand the potential impact of SQ-LNS; b) Consider how SQ-LNS can be integrated into different platforms/existing systems, and the potential of SQ-LNS to incentivize participation or increase efficiencies in existing programs and confer broader benefits beyond nutrition-specific outcomes (e.g., increasing uptake of vaccinations, attendance at SBCC sessions, and contact with health care workers); c) Recognize the heterogeneity of contexts and tailor implementation to the food security context - in highly food insecure contexts, household food rations or cash transfers may need to be provided alongside SQ-LNS for the target child; d) Design communication and terminology to avoid product confusion and mis-use of SQ-LNS; e) Select targeting strategies based on the selected platform and the rationale for targeting – in general, targeting at the community/regional level is likely to be more efficient than targeting at the household or individual level; g) Take into account the capacity of the program/platform to deliver the intervention from the outset (e.g., personnel skills, capacity, workload and supervision, financial incentives, supply chain including production, storage, distribution, etc.); h) Consider conducting demonstration projects at early stages of the scaling process, prior to moving to larger-scale programs; and i) Establish mid- to long-term predictable financing to cover programmatic costs and service delivery, with embedded investments in monitoring and evaluation. Participants discussed sites in which near-term implementation and scale-up might be feasible, and the need for future meetings with a broader set of participants and consideration of issues regarding SQ-LNS production/supply and the role of the private sector. They also agreed to prepare a joint statement regarding the rationale for inclusion of SQ-LNS in various initiatives, and to create several working groups to address key topics regarding scaling-up of SQ-LNS. Working groups will contribute to further development of operational guidance; identification of an operational research agenda; preparation of a policy brief on cost and cost-effectiveness; development of a strategy for advocacy, branding, terminology, and integration/bundling of SQ-LNS; and consideration of regulatory issues, including potential listing on the WHO Model Essential Medicines List.