Operationalising the Operational Guidance on Infant and Young Child Feeding in Emergencies: A Narrative Review of Implementation Strategies, Barriers, Facilitators, and Health System Integration in Humanitarian Settings.

Background

Humanitarian emergencies disrupt infant and young child feeding (IYCF), weaken health systems, and increase risks of malnutrition, morbidity, and mortality. Although the Operational Guidance on the Infant and Young Child Feeding in Emergencies (OG-IFE) provides a global framework for protecting optimal feeding practices, its translation into practice remains inconsistent. This review examines the operationalisation of OG-IFE within humanitarian health and nutrition systems.

Methods

A structured narrative review synthesised evidence on OG-IFE operationalisation. Seven databases were searched for peer-reviewed and grey literature (2017-2026). PRISMA-informed screening identified 66 eligible sources. Data were systematically extracted and analysed using inductive thematic synthesis, generating ten themes addressing barriers, facilitators, governance, coordination, service delivery, and system-level approaches to implementing OG-IFE across humanitarian settings.

Results

Effective operationalisation depends on integrated systems rather than isolated interventions. Key enablers include institutionalisation within health and emergency systems, multisectoral coordination, trained workforces, community-based delivery platforms, and evidence-informed innovations. Barriers include weak health systems, fragmented coordination, limited financing, sociocultural and gender constraints, inappropriate breastmilk substitute practices, and weak monitoring and accountability systems.

Conclusions

The review found that operationalisation of the OG-IFE is constrained more by health and humanitarian system weaknesses than by technical guidance. Effective operationalisation depends on coherent governance, preparedness, financing, workforce capacity, monitoring, regulation, and community engagement. While breastfeeding support is relatively well operationalised, major gaps remain in support for non-breastfed infants and other system domains, highlighting the need for integrated, systems-based approaches.