Processes and challenges of integrating nutrition assessment, counselling, and support into health systems in Uganda: A case study of Tororo district

Background Nutrition assessment, counselling and support is a holistic strategy designed to combat malnutrition and enhance health outcomes. Uganda has been implementing this strategy for a decade; however, a comprehensive documentation of the processes and experiences of integrating nutrition assessment, counselling and support in health systems remains scarce. This study aimed at describing the processes and experiences associated with integrating nutrition assessment counselling, and support into the health system. Methods A cross-sectional study design employing qualitative techniques was used to document the process and experiences of health workers in integrating nutrition assessment, counselling and support into the health system. The study utilised four focus group discussions, 24 key informant interviews and 22 in-depth interviews to gather insights. The interviews were recorded, transcribed verbatim and analysed thematically using ATLAS. ti version 22. Results Four themes emerged from the study: service delivery and quality for nutrition assessment, counselling and support; challenges and barriers associated with integrating nutrition assessment, counselling and support; community involvement and client empowerment; and capacity building and sustainability. From these themes, the processes and experiences included structured mentorship, performance reviews, supervision, capacity building of health workers, male involvement and community sensitisation on the utilisation of locally available foods. The challenges included staff shortages, inadequate continuous training, a lack of essential equipment, difficulties in managing nutritional assessment data and heavy reliance on donor support. Conclusion The effective integration of nutrition assessment, counselling, and support programs into the health system requires a structured and well-supported approach at all levels of service delivery. By addressing these challenges and leveraging the lessons learned, a more robust and effective nutrition service delivery system can be achieved.