From biological to program efficacy: promoting dialogue among the research, policy, and program communities.

The biological efficacy of nutritional supplements to complement usual diets in poor populations is well established. This knowledge rests on decades of methodologic research development and, more recently, on codification of methods to compile and interpret results across studies. The challenge now is to develop implementation (delivery) science knowledge and achieve a similar consensus on efficacy criteria for the delivery of these nutrients by public health and other organizations. This requires analysis of the major policy instruments for delivery and well-designed program delivery studies that examine the flow of a nutrient through a program impact pathway. This article discusses the differences between biological and program efficacy, and why elucidating the fidelity of delivery along the program impact pathways is essential for implementing a program efficacy trial and for assessing its internal and external validity. Research on program efficacy is expanding, but there is a lack of adequate frameworks to facilitate the process of harmonizing concepts and vocabulary, which is essential for communication among scientists, policy planners, and program implementers. There is an urgent need to elaborate these frameworks at national and program levels not only for program efficacy studies but also for the broader research agenda to support and improve the science of delivering adequate nutrition to those who need it most.