Implementation of multisectoral interventions to improve nutrition in Uganda: stakeholder perceptions and experiences

Abstract

Malnutrition in sub-Saharan Africa remains a persistent public health challenge driven by food insecurity, inadequate health services, suboptimal caregiving practices, and weak livelihoods. Addressing these complex determinants requires multisectoral interventions that integrate nutrition, health, agriculture, and community development. The Uganda Community Connector (UCC) programme was designed to address these challenges through integrated, community-based approaches. This study explored stakeholder perceptions of UCC implementation strategies using the RE-AIM framework. A cross-sectional qualitative study grounded in Participatory Action Research was conducted in six UCC implementation districts in Uganda. Data were collected through key informant interviews with policymakers, health workers, and implementers, and focus group discussions with community members, including lactating mothers, youth, and community leaders. Thematic content analysis was conducted using a combined deductive approach based on the RE-AIM framework and inductive coding for emerging themes. The UCC programme achieved broad reach among vulnerable populations, particularly women of reproductive age, children under five years, and youth, through community mobilisation and use of local leadership and existing local systems. Study participants reported high adoption of integrated nutrition, health, WASH, agriculture, and livelihood practices among participating households, supported by participatory training and group-based platforms such as Village Savings and Loan Associations. Stakeholders reported perceived improvements in dietary practices, hygiene behaviours, health-seeking practices, women’s empowerment, and household livelihoods, alongside strengthened linkages between communities and health services. However, implementation and adoption were constrained by environmental shocks, weak infrastructure, limited resources, gender norms, and inconsistent incentives for community volunteers. Sustainability of gains was strongest where community ownership, institutional capacity, and integration into district systems were present. The UCC programme demonstrates that integrated, community-led, and multisectoral approaches can improve nutrition and health-related behaviours in rural settings. However, sustaining and scaling such gains requires stronger institutional integration, continued capacity strengthening, adaptive implementation strategies, and inclusive engagement of marginalized groups, particularly men and vulnerable households.