Barriers and Facilitators to the Implementation of Large-Scale Nutrition Interventions in Africa: A Scoping Review

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Abstract

The effective implementation of large-scale nutrition interventions in Africa is an ongoing challenge. This scoping review identifies and explores the barriers and facilitators to the implementation of large-scale nutrition interventions in the African region. We searched PubMed, EMBASE, Scopus, ERIC, and Web of Science using search terms focused specifically on barriers and facilitators to the implementation of nutrition interventions in Africa. To supplement the database search, reference lists in publications included for full-text review were also examined to identify eligible articles for inclusion. Eligible studies underwent quality assessment, and a directed content analysis approach to data extraction was conducted and aligned to the Consolidated Framework for Implementation Research (CFIR) to facilitate narrative synthesis. The search identified 1452 citations and following removal of duplicates and our inclusion/exclusion criteria, 34 papers were eligible for inclusion. More than half of included studies (n = 19) reflect research conducted in East Africa.

 Overarching thematic areas spanning the barriers and facilitators that were identified included policy and legislation; leadership management; resources mobilization; and cultural context and adaptability. Key activities that facilitate the development of successful implementation include (1) more supportive policy and legislation to improve government competency, (2) effective leadership, strategic partnership, and coordination across multiple sectors, (3) more effective resource mobilization, and (4) adequate adaptation of the intervention so that it is culturally relevant, tailored to local needs and aligned to research data. The barriers and facilitators identified under the CFIR domains can be used to build knowledge on how to adapt large-scale nutrition interventions to national and local settings.