Incorporating a gender lens into nutrition and health-related policies in Fiji: analysis of policies and stakeholder perspectives

Background: Gender equality, zero hunger and healthy lives and well-being for all, are three of the Sustainable Development Goals (SDGs) that underpin Fiji’s National Development Plan. Work towards each of these goals contributes to the reduction of non-communicable diseases (NCDs). There are gender differences in NCD burden in Fiji. It is, however, unclear whether a gender lens could be more effectively included in nutrition and health-related policies. Methods: This study consisted of three components: (i) a policy content analysis of gender inclusion in nutrition and health-related policies (n = 11); (ii) policy analysis using the WHO Gender Analysis tool to identify opportunities for strengthening future policy; and (iii) informant interviews (n = 18), to understand perceptions of the prospects for gender considerations in future policies. Results: Gender equality was a goal in seven policies (64%); however, most focused on women of reproductive age. One of the policies was ranked as gender responsive. Main themes from key informant interviews were: 1) a needs-based approach for the focus on specific population groups in policies; 2) gender-related roles and responsibilities around nutrition and health; 3) what is considered “equitable” when it comes to gender, nutrition, and health; 4) current considerations of gender in policies and ideas for further gender inclusion; and 5) barriers and enablers to the inclusion of gender considerations in policies. Informants acknowledged gender differences in the burden of nutrition-related NCDs, yet most did not identify a need for stronger inclusion of gender considerations within policies. Conclusions: There is considerable scope for greater inclusion of gender in nutrition and health-related policies in Fiji. This could be done by: 1) framing gender considerations in ways that are actionable and inclusive of a range of gender identities; 2) undertaking advocacy through actor networks to highlight the need for gender-responsive nutrition and health-related policies for key stakeholder groups; 3) ensuring that data collected to monitor policy implementation is disaggregated by sex and genders; and 4) promoting equitable participation in nutrition related issues in communities and governance processes. Action on these four areas are likely critical enablers to more gender equitable NCD reduction in Fiji

How Can Health, Agriculture and Economic Policy Actors Work Together to Enhance the External Food Environment for Fruit and Vegetables? A Qualitative Policy Analysis in India

The benefits of fruit and vegetables are well established, particularly their role in preventing general micronutrient-deficiencies and chronic diseases. However, global food systems are not delivering diverse and high quality diets: healthy food is unavailable and too expensive for many. Creating food environments that foster consumer access to fruit and vegetables will require coordinated policy action across sectors, mostly outside of the health sector. The aim of this paper is to identify opportunities to strengthen food system policy for nutrition, through an analysis of the policies relevant to the external food environment for fruit and vegetables in India. We conducted interviews based on policy theory with 55 stakeholders from national and state level, from within government, research, private sector and non-government agencies, and from health, agriculture and economic sectors. Specific strategies identified in this study to improve consumers’ external food environment for fruit and vegetables in India were: development of strategic Public-Private Partnerships to increase access to diverse expertise across the supply chain; linking health and economic/agricultural policy agendas; and strengthening surveillance of policy impacts on consumer access to fruit and vegetables. We also found that public health actors can play an important role in advocating for ‘consumer oriented’ fruit and vegetable supply policy. This study demonstrates the usefulness of ‘policy learning’-oriented qualitative policy analysis in identifying ‘points of entry’ for food policy change, and extends understanding of political dynamics in engendering agricultural policy change for nutrition. Improving access to affordable fruit and vegetables is a global priority, and given common global food supply challenges, the findings from this study are also likely to be relevant for other low and middle income countries

Strengthening fruit and vegetable supply-chain policies and programmes in India

India currently has one of the highest numbers of malnourished children in the world – 8% stunted, 43% underweight, and 20% overweight and obese. This distressing public health scenario is further exacerbated by a high prevalence of multiple micronutrient deficiencies among these children – such as iron deficiency anaemia and Vitamin A deficiency. Evidence shows linkages between early life malnourishment (either underweight or overweight-obesity) and predisposition to developing chronic diseases in adult life. Consuming 400g/day of fresh fruits and vegetables can help prevent micronutrient deficiencies while promoting overall growth and development. However, national averages indicate that children do not consume even 40% of the daily recommended amounts. Public Health Foundation of India (PHFI) undertook a study titled ‘Leveraging fruit and vegetable supply policies to tackle the dual burden of malnutrition in India’ supported by the Leveraging Agriculture for Nutrition in South Asia (LANSA) consortium at the M S Swaminathan Research Foundation (MSSRF). The study, discussed in this Brief aimed to analyse the policy environment related with fruit and vegetable (FV) supply in India to identify opportunities for policy to increase access to, and thus intakes of FV, especially among children.Department for International Development (DFID)UKAI

Characterising the evidence base for advanced clinical practice in the UK: a scoping review protocol

Copyright © Author(s) (or their employer(s)) 2020. Introduction A global health workforce crisis, coupled with ageing populations, wars and the rise of non-communicable diseases is prompting all countries to consider the optimal skill mix within their health workforce. The development of advanced clinical practice (ACP) roles for existing non-medical cadres is one potential strategy that is being pursued. In the UK, National Health Service (NHS) workforce transformation programmes are actively promoting the development of ACP roles across a wide range of non-medical professions. These efforts are currently hampered by a high level of variation in ACP role development, deployment, nomenclature, definition, governance and educational preparation across the professions and across different settings. This scoping review aims to support a more consistent approach to workforce development in the UK, by identifying and mapping the current evidence base underpinning multiprofessional advanced level practice in the UK from a workforce, clinical, service and patient perspective. Methods and analysis This scoping review is registered with the Open Science Framework (https://osf.io/tzpe5). The review will follow Joanna Briggs Institute guidance and involves a multidisciplinary and multiprofessional team, including a public representative. A wide range of electronic databases and grey literature sources will be searched from 2005 to the present. The review will include primary data from any relevant research, audit or evaluation studies. All review steps will involve two or more reviewers. Data extraction, charting and summary will be guided by a template derived from an established framework used internationally to evaluate ACP (the Participatory Evidence-Informed Patient-Centred Process-Plus framework). Dissemination The review will produce important new information on existing activity, outcomes, implementation challenges and key areas for future research around ACP in the UK, which, in the context of global workforce transformations, will be of international, as well as local, significance. The findings will be disseminated through professional and NHS bodies, employer organisations, conferences and research papers.Health Education England (DN384826— Evaluation for HEE ACP Programme—Current Evidence Based for Advanced Level Practice within Health and Related Environments)

Characterising the outcomes, impacts and implementation challenges of advanced clinical practice roles in the UK: A scoping review

Copyright © Author(s) (or their employer(s)) 2021. Objectives In response to demographic and health system pressures, the development of non-medical advanced clinical practice (ACP) roles is a key component of National Health Service workforce transformation policy in the UK. This review was undertaken to establish a baseline of evidence on ACP roles and their outcomes, impacts and implementation challenges across the UK. Design A scoping review was undertaken following JBI methodological guidance. Methods 13 online databases (Medline, CINAHL, ASSIA, Embase, HMIC, AMED, Amber, OT seeker, PsycINFO, PEDro, SportDiscus, Osteopathic Research and PenNutrition) and grey literature sources were searched from 2005 to 2020. Data extraction, charting and summary was guided by the PEPPA-Plus framework. The review was undertaken by a multi-professional team that included an expert lay representative. Results 191 papers met the inclusion criteria (any type of UK evidence, any sector/setting and any profession meeting the Health Education England definition of ACP). Most papers were small-scale descriptive studies, service evaluations or audits. The papers reported mainly on clinical aspects of the ACP role. Most papers related to nursing, pharmacy, physiotherapy and radiography roles and these were referred to by a plethora of different titles. ACP roles were reported to be achieving beneficial impacts across a range of clinical and health system outcomes. They were highly acceptable to patients and staff. No significant adverse events were reported. There was a lack of cost-effectiveness evidence. Implementation challenges included a lack of role clarity and an ambivalent role identity, lack of mentorship, lack of continuing professional development and an unclear career pathway. Conclusion This review suggests a need for educational and role standardisation and a supported career pathway for advanced clinical practitioners (ACPs) in the UK. Future research should: (i) adopt more robust study designs, (ii) investigate the full scope of the ACP role and (iii) include a wider range of professions and sectors.Health Education England (DN384826— Evaluation for HEE ACP Programme—Current Evidence Based for Advanced Level Practice within Health and Related Environments)