Date post: | 07-Sep-2015 |
Category: |
Documents |
Upload: | nutrition-innovation-lab |
View: | 9 times |
Download: | 1 times |
2
The research base on nutrition governance, is limited to a handful of studies[and] systematic evidence about processes related to intersectoral and multisectoral integration of actions is urgently needed.
Gillespie et al. (2013) Lancet paper 4
We need to understand the barriers to actors working at the interface of agriculture and nutrition: Using a variety of methods, we need to find out the following from these actors: How much do they know about nutrition? What do they think could be done? What do they see as trade-offs?
Meeker and Haddad (2013)
3
PoSHAN policy process study questions (repeat panels, office holders, 2013-2017) in context of national Multi-Sector Nutrition Plan 1. What metrics effectively measure nutrition governance?
2. Is stronger nutrition governance associated with better nutrition outcomes over time? 3. What aspects of nutrition governance should be prioritized
for capacity enhancement by governments and donors?
4
Sunaula Hazar
PoSHAN research field sites (21)
Multi-Sector Nutrition Plan
5 Source: PoSHAN survey data 2013
Level Institution/Individual
National Policy makers, donors, international non-governmental organizations (NGOs), academics
Regional Regional Administrator, Ministries of Health, Agriculture, Livestock, Education, Local Development, Water Supply,
District Departments of Health, Agriculture, Livestock, Education, Local Development, Social Development, implementing NGOs
Ilaka Offices of Health, Agriculture, Livestock, Education, Local Development
Village Development Committee
VDC Secretaries of Health, Agriculture, Livestock, Education, implementing NGOs
Ward FCHV, Representative Ward Citizen Forum, Representative MG, Representative Cooperative/Groups
N = 780
26
99
278
79
97
199
6
What is measured? Commitment (willingness to act)
Understand and accept responsibility in multi-sector policy, senior management support, desire to work across line ministries, incentives, etc.
Capacity (capacity to act)
Posts filled, adequate skills, purposive training, frustrations, resources available, disincentives, bureaucracy, etc.
Coherence (horizontal and vertical collaboration)
Degrees of agreement on nutrition problems, priority actions needed, joint ownership of outcomes, common language, etc.
7
Does everyone see nutrition problems the same way?
Min Agric.
Min Health
Min. Water
Min Education
Min Local Dev.
Women in Dev.
Food Production
44% 42 31 52 39 47
Disease 40 55 46 48 39 15
Illiteracy 98 97 84 98 92 85
Poor Breastfeeding
0 18 15 6 8 19
Cultural taboos
22 22 15 15 15 20
8
Does everyone see nutrition problems the same way?
High levels govern. % (N 456)
Lower level gov. % (N 296)
OR 95%CI P-value
Food Production
48 44 1.22 0.907, 1.633 0.1896
Disease 43 43 0.99 0.736, 1.329 0.9438 Illiteracy 80 66 2.11 1.509, 2.938
9
Consistency of views on: how to promote cross-sector collaboration for nutrition?
Higher level gov. %
Lower level gov. %
OR 95%CI P-value
Strong management support
9 7 1.23 0.717, 2.111 0.4510
Joint responsibility 30 18 1.93 1.346, 2.760 0.0003 Mandatory mechanism
30 9 4.32 2.775, 6.735
10
Consistency of views on: how to promote cross-sector collaboration for nutrition?
Health sector % (n=123)
Non- health sector % (n-532)
OR 95%CI P-value
Strong management support
8 9 0.87 0.429, 1.754 0.6935
Joint responsibility 23 26 0.85 0.544, 1.326 0.4732 Mandatory working mechanism
15 23 0.58 0.347, 0.964 0.0340
Capacity building 14 11 1.33 0.769, 2.294 0.3069 Allowances 22 22 0.99 0.629, 1.558 0.9664 None 5 1 2.88 1.027, 8.059 0.0358
11
National multi-sector nutrition plan roll-out districts
12
Consistency of views on: challenges in multi-sector policy roll-out
MSNP sites % (n=65)
All other sites % (n=643)
OR 95% CI P value
Sufficiently consulted on nutrition issues
41 25 2.11 1.2800, 3.4631 0.002
Freq. discuss nutrition with colleagues
40 24 2.1 1.2746, 3.4711 0.003
Institutional hurdles affect collaboration
49 28 2.47 1.5145, 4.0215 0.0002
Colleagues in own sector trained role
58 41 1.95 1.1989, 3.1857 0.006
Colleagues in other sectors not trained
44 35 1.44 0.8817, 2.3417 0.14
Had nutrition training 23 18 1.37 0.7708, 2.4431 0.28
13
Consistency of views on: challenges to effective multi-sector work on nutrition
MSNP sites %
All other sites %
OR 95% CI P value
Lack financial resources
37 49 0.62 0.3771, 1.0218 0.04
Political interference 5 15 0.33 0.1184, 0.9292 0.03
Lack coordination 14 9 1.7 0.8277, 3.4894 0.04
Rely on external aid, donor driven
10 12 0.82 0.3621, 1.8444 0.03
Logistics 14 21 0.6 0.3004, 11996 0.03
14
Districts with best and least changes in stunting 2006-2011
15
Most improved sites %
Least improved sites %
OR 95% CI P value
Feel unable to respond effectively
34 58 0.37 0.210, 0.640 0.0004
Discussed stunting in past month
25 11 2.67 1.248, 5.688 0.0095
Trained in ag/ lstock in past 3y
15 8 2.04 0.838, 3.023 0.1109
Trained in nutrition in past 3y
9 19 0.41 0.182, 0.939 0.0311
Can collaborate better?
83 72 1.92 0.995, 3.716 0.0494
Consistency of views on: Challenges across best vs worst performing districts
Preliminary conclusions 1. Governance elements (commitment, capacity, coherence) vary
across sectors, levels of government, and location. Must tailor incentives, information, training.
2. Few (even MoA) claim that more food is the solution to nutrition problems. But little agreement on key actions. 3. Expression of willingness to collaborate across sectors; but uncertainty on how to do that. 4. Need incentives for working differently, identify weak links in
horizontal and vertical chains of authority.
17
Ways forward? 1. Study of nutrition governance still in its infancy. Methods
and methodological challenges must be widely shared.
2. Encouraging findings: Its possible to measure policy processes (motivation,
commitment to collaboration across sectors, willingness to act, capacity to act).
Real action is at sub-national level. Quality of nutrition governance linked (measurably) to
impact. Worth exploring more.
Many collaborators
Slide Number 1Slide Number 2Slide Number 3Slide Number 4Slide Number 5Slide Number 6Slide Number 7Slide Number 8Slide Number 9Slide Number 10Slide Number 11Slide Number 12Slide Number 13Slide Number 14Slide Number 15Slide Number 16Slide Number 17Slide Number 18