The objective of the Towards Zero Stunting in Djibouti Project is to reduce stunting among children under five in Djibouti. There are four components to the project, the first component being high-impact health and nutrition services to reduce stunting. This component focuses on the delivery of services and interventions that address stunting at both the facility and community levels. This component includes two subcomponents: strengthening of health and nutrition services at the facility level; prevention and management of stunting and wasting at the community level. The second component is the strengthening multi-sectoral interventions for stunting reduction. This component will focus on creating an enabling environment for strengthening multi-sectoral interventions that are critical for reduction of stunting. This component includes three subcomponents: using multi-sectoral platforms for the prevention and management of stunting; addressing stunting in relevant policies and strategies; and multi-sectoral capacity building. The third component is the strengthening coordination, project management and monitoring and evaluation. This component includes two subcomponents: institutional strengthening for coordination, project management and M&E, and strengthening the use of information systems for enhanced M&E capacity. Finally, the fourth component is the contingent emergency response component. (Djibouti)
Uganda needs to allocate more resources to the social sectors (education, health and social protection) and to productivity-enhancing policies in the agriculture sector. Higher levels of investment in education, social protection, health (complemented by investments to increase access to water and sanitation services), and agriculture, are required for Uganda to attain two of its medium-term policy objectives: reducing poverty and inequality, and promoting economic growth in Uganda. While education has been a major factor in reducing poverty and inequality in the past, current levels of funding are inadequate. Education also helps households to smooth adverse shocks, making them less vulnerable to factors outside the control of households and individuals. Additional investment is needed to address the recent decline in primary enrollment rates and increase the quality of education at this level. Also, improving the availability and affordability of secondary education, especially in rural areas, is essential the raise the stubbornly low secondary enrollment rates. Addressing the high levels of under-five mortality, child stunting and teenage pregnancy requires the GoU to improve the provision of health care services to women and children. This in turn requires devoting more resources to the delivery of these services. Given the multi-faceted nature of these issues, complementary efforts in other sectors are also required, particularly through education programs and investments in sanitation and hygiene facilities. Programs aimed at increasing the agricultural productivity of smallholder farmers should have sufficient funding in the budget. The GoU should promote programs that improve the quality of inputs in local markets through certification programs and should increase the availability of extension services and credit to smallholder farmers. (Uganda)
The development objective of Social and Economic Inclusion Project for Kenya is to enhance access of poor and vulnerable to integrated social and economic inclusion as well as shock-responsive social protection. some of the negative impacts include: (i) fragile and hazardous location; (ii) lack of access to resources and services; (iii) disintegration of social patterns; (iv) disinheritance of land and other livelihood related resources; (v) exclusion from the political and socioeconomic activities of the country; (vi) lack of access to information and knowledge; (vii) lack of public awareness; and (viii) limited access to political power and representation. Some of the mitigation measures include: (i) limited access to political power and representation; (ii) training and civic education of the recruited VMG groups should be undertaken to enhance understanding of their rights and entitlements; (iii) women and youth groups recruited and trained for economic inclusion activities should be disclosed and displayed at the Assistant Chief’s office; and (iv) ensure that barriers to inclusion are addressed for eligible population, including minority groups. (Kenya)
The development objective of Social and Economic Inclusion Project for Kenya is to enhance access of poor and vulnerable to integrated social and economic inclusion as well as shock-responsive social protection. Some of the negative impacts include: i) increased tension between beneficiaries and non-beneficiaries; ii) over-reliance on cash transfers and failure to engage in livelihood activities that build resilience to climate change; iii) absence of broad community support; iv) inadequate engagement in decision-making processes; v) poor targeting of beneficiaries and exclusion; vi) broken promises and unmet expectations of benefits; vii) disruption to amenities and lifestyle; viii) loss of livelihood; ix) violation of human rights; x) social dislocation; Some of the mitigation measures include: (i) increased access to self-employment opportunities through investments; (ii) development of entrepreneurial skills for setting up businesses but also to access devolved funds (UWEZO, Youth and Women Funds); (iii) skills development in leadership, managing groups and civic education, and (iv) training on personal and community development; (v) Government has committed to universal NHIF coverage, but KSEIP would only target existing National Safety Net Program (NSNP) beneficiaries; (vi) ensure proper targeting so that multiple HHs are not considered as one; (vii) Economic inclusion interventions would also include some non-NSNP beneficiaries; (viii) nutrition counseling to include guidance on nutritional food and importance of parents providing their children with nutritional food; (ix) economic inclusion interventions would also include some non-NSNP beneficiaries; (x) beneficiary outreach strategy, enhancing the understanding of communities on the need for inclusion of all VMGs; (xi) create better awareness among beneficiaries that the CT programs are resilience building and should not be seen as humanitarian assistance; (xii) Involve both majority and minority groups in project design, planning and implementation; (Kenya)
The development objective of Protection of Essential Health Services Project is to increase the utilization and quality of an essential package of health services in South Sudan, with a particular focus on the former states of Upper Nile and Jonglei. Some of the negative impacts include: (i) inequitable availability and access to service delivery in areas that are not highly vulnerable; (ii) poor hygiene, water and sanitation in health facilities negatively impacts safe delivery of health care services; (iii) Implementing partners (IPs) are not prepared nor equipped to respond to emergencies, including disease outbreaks; (iv) ghost workers and ghost health facilities included in the project fraudulently consuming budgetary resources through inflated staffing and facility costs; (v) expired and damaged drugs negatively affecting communities in the areas where the project is implemented; (vi) inequitable availability and access to service delivery in areas that are not highly vulnerable; and (vii) shortage of suitably qualified staff or presence of lowly skilled medical staff. Some of the mitigation measures include: (i) mapping of functional health facilities and selection of those to be supported, considering, local administrative boundaries, government and non-government (IO) controlled areas, population size, cultural characteristics of the population, and conflict dynamics; (ii) develop waste management plans for each health facility; (iii) train IPs in emergency preparedness and response, including infectious disease surveillance and response (IDSR); (iv) physical verification and mapping of health facilities by community mobilizers as well as an auditing firm; (v) conduct a diagnostic assessment to assess how the supply chain can be improved to ensure adequate delivery to health facilities located in Sudanese People’s Liberation Army in Opposition (SPLA-IO) areas as well as other hard-to-reach areas; (vi) strengthen community engagement and dialogue to reduce targeting of health institutions when conflict occurs; and (vii) United Nations Children’s Fund (UNICEF) will continue to work closely with United Nations Mission in South Sudan (UNMISS) and Office for the Coordination of Humanitarian Affairs (OCHA) to utilize their channels for lobbying for access in conflict areas to allow programmatic assessments and interventions, monitoring and vital distribution of life saving drugs by UNICEF and its partner’ access. (South Sudan)
Background : Globally, one in five infants under 6 months is at risk of death, illness and poor development. They may be identified as being malnourished, growing poorly, or underweight and may have been born too early or too small. The MAMI Care Pathway Package is an integrated care pathway approach, with a package of adaptable resources to guide inter-disciplinary continuity of care for these at-risk infants under 6 months and their mothers within health systems. This approach supports implementation of WHO health and nutrition guidelines that recommend outpatient care. However, the MAMI Care Pathway approach has not been robustly tested within national health systems that has impeded national policy transtion from inpatient-only care for this age-group. To address this evidence gap, the MAMI RISE (Research, Innovate, Scale, Establish) Research Project was developed to test the MAMI Care Pathway in a randomised controlled trial (RCT) in outpatient clinics in Ethiopia. This five-year project (2019-2025) was delivered in a co-creative partnership between LSHTM, Emergency Nutrition Network, Jimma University and GOAL Ethiopia funded by the Eleanor Crook Foundation. Within this research project, I investigated what factors influence implementation of an integrated care pathway in outpatient clinics in Ethiopia through three studies. Methods: I undertook a scoping review of global policies to appraise global policy guidance relevant to the care of at-risk infants under 6 months and their mothers in Ethiopia (Study 1); a pre-trial feasibility study to identify factors that may influence implementation of the MAMI Care Pathway in outpatient health facilities (Study 2); and a realist-informed process evaluation to evaluate how the MAMI Care Pathway worked, for whom and under what circumstances during the RCT (Study 3). The scoping review of global policies involved a literature search of publicly available data according to PRISMA-ScR guidance. The feasibility study involved interviews with health workers and senior policymakers in Ethiopia to explore both health service and policy fit. The process evaluation involved interviews with mothers, fathers, health and research staff in intervention and control sites, and secondary RCT data from research team meetings and incident logs. Results: The scoping review of global policies found rich but fragmented policy guidance that mask interdiscipline policy synergies and important guidance gaps. Evidenced growth markers of infant mortality risk are largely absent from WHO health-oriented guidance. Continuity of care for mothers and infants lacked depth and detail. Using the MAMI Care Pathway to support WHO recommendation uptake is constrained by institutional procedures that limit consideration of nonUN guidance. Transitioning to a living guideline system is necessary and urgent. Applying the WHOINTEGRATE framework to handle complexity within guidance could improve policy fit for implementation of integrated care. The feasibility study found the intervention was perceived by staff as feasible to implement in outpatient services with additional structural support and likely acceptable to mothers. High staff acceptability was influenced by perceived demand, need, implementation realities and integration potential with Integrated Management of Childhood Illness (IMCI) protocols. Identified service constraints included low availability of maternal nutrition and health services and limited breastfeeding and mental health counselling competencies. Policymakers identified good coherence of the MAMI Care Pathway with national policy provisions and intent but emphasised their need for implementation evidence to appraise policy implications of RCT findings. Overall, the process evaluation found the MAMI Care Pathway approach was acceptable, feasible, valued and impactful during a pragmatic, responsive RCT in outpatient services. Positive and varied RCT outcomes were explainable, given case complexities, setting differences, and implementation conditions. Synergism between intervention components, people and health-research systems maximised what was possible. Shared vision gave purpose and drove impact. Adaptive changes meant implementation varied between clinics, settings and over time. Both mothers and health workers had improved access to resources and experienced motivational outcomes that empowered them to cooperatively act. The study also identified that routine service gaps have negative consequences for infants, mothers and families. It is likely that greater scope and intensity of intervention is needed for some cases. Embedded staff generated rich transferable knowledge that strengthens integration potential. Evidencing approaches should transition to locally led implementation research embedded in health services. In summary, the scoping review of global policies identified strong potential but important limitations with global policy content and processes that risk limiting implementation of integrated care. The feasibility study confirmed consistency of the MAMI Care Pathway approach with national policy guidance and IMCI based outpatient protocols. The process evaluation confirmed intervention fit with outpatient services in Ethiopia and strong integration potential. Implications: This body of research provides contextualised evidence for the interpretation of an RCT of the MAMI Care Pathway approach in Ethiopia. Findings have informed national policy development on malnutrition management in Ethiopia. This research provides transferable learning on evidencing and implementing integrated, equitable and just systems of health for localised, scalable, and sustainable care. Co-creative research partnerships that plan for scale maximise national policy fit and system readiness. Implementation research should accompany trials of complex health interventions. The generative knowledge of local stakeholders is essential to evidencing how to deliver effective sustainable care. Programming approaches for at risk infants and mothers must extend beyond nutrition interventions, health interventions must embed action on infant growth and maternal wellbeing. Integrated care is feasible with structural and professional support for staff. Multi-level research, programming and policy action and interaction is necessary for synergistic effects. Inter-disciplinary and inter-system brokerage and stronger global accountability mechanisms to secure better international policy order are needed to achieve this. My findings demonstrate how implementation of integrated care requires policies and programmes that empower local stakeholders to develop, adapt and deliver interventions for at risk infants under 6 months and their mothers. This approach will require a re-focus of international support on catalytic long-term investments in systems of person-centred care, and the pursuit of sustainable scale through contextually grounded, locally led implementation research and learning exchange.
Somalia's escalating humanitarian financing crisis is exposing a neglected dimension of health-system vulnerability: aid volatility can itself become a determinant of primary health-care (PHC) failure. Recent funding contractions have disrupted hospitals, primary facilities, mobile teams, and nutrition services while drought, displacement, infectious-disease outbreaks, and undernutrition continue to intensify health needs. In a system heavily reliant on external financing, abrupt donor withdrawal can destabilise frontline staffing, essential medicines, referral pathways, surveillance, and continuity of care. These disruptions disproportionately threaten populations already experiencing structural disadvantage, particularly children, displaced communities, and households exposed to recurrent climate shocks. We argue that humanitarian financing should, therefore, be understood not only as emergency assistance but also as a critical determinant of health-system resilience and equity. Protecting essential PHC functions, strengthening government stewardship, establishing predictable transition financing, and investing in climate-resilient community health systems are essential to prevent financing shocks from becoming enduring public-health crises.
Fardowso Mohamed Harbi, Ilyas Abdullahi Khalif, Samar Yusuf Omar et al.
Somalia's National Transformation Plan (NTP) 2025–2029 presents an ambitious health-reform agenda centred on maternal and child health, workforce development, health-system strengthening, regulation, financing, digitalisation, and emergency preparedness. The policy challenge is whether the institutional conditions required for implementation can be assembled in a fragile, federal, highly aid-dependent and predominantly mixed-provider health system. This Policy and Practice Review critically examines the implementation readiness of the NTP health chapter and proposes a sequenced framework for converting national commitments into measurable results. A structured narrative review was undertaken from June to July 2026 using peer-reviewed literature, national policy documents, and reports from governmental and international institutions. Evidence was interpreted through the health-policy triangle, the updated Consolidated Framework for Implementation Research (CFIR), applied prospectively to anticipated determinants, and a health-system resilience lens. The synthesis generated six interdependent proposed readiness foundations: a negotiated federal-state governance compact; a technically validated, costed and sequenced operational plan; sustainable financing and strategic purchasing; workforce and regulatory capacity; integrated information, monitoring and public accountability systems; and shock-responsive adaptive management. Important policy strengths include explicit targets for service coverage, workforce expansion, hospital rehabilitation, regulation and digital health. Key risks include inconsistent or under-specified targets and baselines, uncertain fiscal pathways, weak federal-state role specification, and dependence on external resources and non-state providers. Comparative evidence suggests that contracting and pooled financing can expand services when stewardship, fiduciary safeguards, workforce integration, community accountability and learning systems develop concurrently. We propose a phased 2026–2029 pathway prioritising technical validation, essential-service continuity, subnational compacts, workforce payroll transition, interoperable data systems and annual public performance reviews. The proposed framework is prospective and has not yet been empirically validated; consultation with federal and subnational authorities, providers, partners, civil society and communities is required before formal adoption.
Nor Haji Osman, Dahir Osman Mohamed, Hamdi Mohamud Osman et al.
Uganda ranks third with the highest malaria cases globally, highlighting limitations in existing prevention efforts. Malaria vaccination is a key promising strategy to reduce both morbidity and severity among children under 5 (U5) years. In April 2025, Uganda introduced a four-dose R21 malaria vaccine for U5s. We assessed willingness to vaccinate with the malaria vaccine and associated factors among caregivers of U5s to support vaccine rollout in the targeted population. In March 2025, we conducted a cross-sectional study at the Maternal and Child Health unit of Masaka Regional Referral Hospital among 292 caretakers. We generated caretaker attendance lists daily to serve as sampling frames and developed a sampling interval. We used systematic sampling to obtain the total sample size. We administered a questionnaire assessing caregivers’ willingness to vaccinate, and identified associated factors using modified Poisson regression. We interviewed 292 caretakers, 250(86%) were female and 249(85%) indicated willingness to vaccinate their children. Prior experience with adverse events following immunization (AEFIs) (adjusted prevalence ratio [aPR]=0.2,95%Confidence Interval [CI]0.05-0.5), having other relatives than biological parents as main decision makers (aPR 0.2, 95%CI0.04-0.9) and having tertiary education (aPR 0.14, 95%CI0.04-0.6) were associated with reduced willingness to vaccinate, while receipt of malaria Intermittent Preventive Treatment in pregnancy (IPTp) (aPR 6.2, 95%CI1.6-23) and trust in vaccine safety (aPR 13, 95%CI4.0-43) were associated with increased willingness to vaccinate. Majority of the caretakers were not aware of the malaria vaccine butwere willing to vaccinate their children when oriented. AEFI history, household decision-making roles, and education level were associated with reduced willingness, while having received malaria IPTp and trust in vaccine safety were associated with increased willingness to vaccinate. We recommended providing malaria vaccine information through antenatal care, preparing health workers to address the AEFI history and vaccine-safety concerns and prioritizing safety-focused messaging over general awareness messaging.
Annet Mary Namusisi, Richard Migisha, Dominic Kizza et al.
ABSTRACT Protein-Energy Malnutrition among young children under five years old remains a critical public health concern in many developing countries, particularly in Burundi partly due to the overreliance of high energy but deficient in vitamin A, and essential amino acids such as lysine and tryptophan. Food fortification using animal protein is a potentially sustainable approach to increasing protein quality in young children’s diets. This study aimed to develop and evaluate the nutritional, functional, sensory properties, and stability of the ready-to-use porridge flours formulated using maize-orange-fleshed sweet potato (OFSP) blends fortified with silver cyprinid powder. Six formulations were prepared by the extrusion technique by substituting the blends of maize and OFSP with 5, 10, 15, 20 and 25% of silver cyprinid powder. Proximate, mineral, and beta-carotene compositions, invitro protein digestibility, reactive lysine, water absorption capacity, oil absorption capacity, bulk density, swelling index and consumer acceptability were determined. Additionally, storage stability of the flours was assessed over a period of 12 weeks. Substituting maize-OFSP blends with silver cyprinid powder significantly increased the protein, ash, fat, and mineral contents, the protein digestibility and reactive lysine. Water absorption capacity, bulk density and swelling index significantly decreased while oil absorption capacity increased. The formulated ready-to-use porridge was acceptable and the formulated flours were stable throughout the storage period. The formulated ready-to-use porridge flours fortified with silver cyprinid powder have the potential to serve as complementary foods for alleviating Protein-Energy Malnutrition in infants and young children under 5 years old.
