Global Implementation of the Nutrition-Friendly School Initiative (NFSI): A Scoping Review of Strategies, Challenges, Barriers, and Facilitators.

BACKGROUND

The Nutrition-Friendly School Initiative (NFSI) is a whole-school approach designed to address the triple burden of malnutrition among school-aged children. However, evidence on its implementation across diverse settings remains fragmented.

METHODS

This scoping review followed Arksey and O'Malley's framework and searched PubMed, Web of Science, Embase, Scopus, and gray literature sources for studies explicitly implementing the NFSI framework.

FINDINGS: Sixteen records were included. Evidence suggests that NFSI implementation improves nutrition knowledge, dietary behaviors, and selected health outcomes, including BMI, stunting, and micronutrient status. Major facilitators included institutional commitment, multisectoral collaboration, and stakeholder engagement. Common barriers were limited resources, insufficient training, weak policy enforcement, and sociocultural resistance.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Integrating NFSI principles into education and public health systems may strengthen school nutrition policies and reduce health inequities. Sustainable implementation requires cross-sector collaboration, equitable resource allocation, supportive school food environments, and stronger monitoring systems, particularly in resource-constrained settings.

CONCLUSION

The NFSI is a promising framework for promoting child nutrition and health, but stronger long-term evaluations and more comprehensive implementation strategies are needed.