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. 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. 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 knowledge rests on decades of methodologic research development and, more recently, on codification of methods to compile and interpret results across studies. ![]() ![]() The biological efficacy of nutritional supplements to complement usual diets in poor populations is well established.
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