Enhancing Maternal and Child Health: A Cross-National Analysis of Nutrition Service Readiness in Sub-Saharan Africa

Sub-Saharan Africa is off track in achieving the 2025 World Health Assembly nutrition targets. A robust health system is essential to deliver interventions that protect the nutrition of pregnant women and children under 5 years of age. This study aimed to examine health and nutrition service readiness, provision, and training in Côte d'Ivoire, the Democratic Republic of Congo (DRC), Guinea, Kenya, Mali, Niger and Nigeria. Two data sources were used: national-level commodity data and health facility data. Interviews were conducted with Ministry of Health officials to gather information on the procurement of nutrition commodities. Health facility data were collected in a survey using a two-stage random cluster design. This integrated approach assessed the availability of essential nutrition commodities, service provision and training of health personnel. Findings revealed significant variations in health system readiness and service provision. For pregnant women, the availability of iron-folic acid at facilities ranged from 73% in Guinea to 98% in Mali, with similar variability in service provision and health worker training. Multiple micronutrient and calcium supplements showed gaps in availability and provision. For children under five, oral rehydration solution availability ranged from 32% in Côte d'Ivoire to 89% in Niger, with corresponding differences in service provision and training. Newer interventions like micronutrient powders (24% in DRC-49% in Niger) and small-quantity lipid-based nutrient supplements showed low service provision (16% in Guinea-47% in Mali). This study highlights the need for targeted interventions to address supply chain challenges, enhance health worker training and improve service provision.