South Africa has marked social differences and substantial inequalities in health. Finding itself in the midst of a nutrition transition, it is a prime example of the double burden of disease , with both large numbers of undernourished and rising numbers of overweight and obesity. In order to combat the malnourishment, the Department of Health launched the Integrated Nutrition Programme (INP) in 1994. This was a comprehensive nutrition strategy focusing on vulnerable groups such as children under 5 years, at-risk pregnant and lactating women and those affected by communicable and non-communicable diseases. However, despite increased focus on nutrition and primary health care programs, child health and nutritional status have virtually not improved.
This project was aimed at evaluating two parts of the Integrated Nutrition Program, namely the vitamin A supplementation program and the nutrition supplementation program (NSP). Focus was on the staff in the primary health clinics that administer these programs. The overall aim was to detect pitfalls and weaknesses in the implementation which hopefully can lead to improvements for future recipients. The study was cross-sectional and based on interviews of staff members working in ten urban clinics and ten rural clinics in the Western Cape Province.
The most important finding was that the staff felt they handled both supplementation programs well and problems with the implementation were for the most part attributed to the clients. Apart from a different distribution of roles in the programs there were few significant differences between urban and rural clinics. Finally, some confusion was found when addressing responsibilities for and sufficiency of the NSP budget.
This study shows that future studies aimed at improving the vitamin A- and nutrition supplementation programs in the Western Cape will need to focus on causes of poor compliance among the clients rather than the performance of PHC staff.