Integration of parenting and nutrition interventions in a community health program in Pakistan: an implementation evaluation

Policy and program implementers require evidence on whether integrated psychosocial stimulation and nutrition interventions can be effectively delivered at-scale, how, and at what cost? To address some of these issues, a comprehensive evaluation of implementation was designed for a trial in Pakistan that integrated psychosocial stimulation and nutrition interventions in a community health service. The first objective was to describe, analyze, and assess the quality and accuracy of the implementation of the interventions. The second objective was to identify barriers and facilitators for uptake of interventions. A mixed-methods evaluation of implementation processes was conducted. Interventions were accepted by the community and health providers and there was evidence for behavior change uptake of the care for early childhood care recommendations. The new interventions did not dilute delivery of routine services. However, fidelity and quality required supportive supervision and active use of monitoring data, which would require attention in scale-up.