What drives and constrains effective leadership in tackling child undernutrition? Findings from Bangladesh, Ethiopia, India and Kenya. Nicholas Nisbett 1 Institute of Development Studies, UK [email protected]Based on collaborative research reported in : Nisbett, N., Wach, E., Haddad, L., & El Arifeen, S. (2015). What drives and constrains effective leadership in tackling child undernutrition? Findings from Bangladesh, Ethiopia, India and Kenya. Food Policy , 53 , 33-45 .
Transcript
What drives and constrains effective leadership in tackling child
undernutrition? Findings from Bangladesh, Ethiopia, India and Kenya.
Based on collaborative research reported in : Nisbett, N., Wach, E., Haddad, L., & El Arifeen, S. (2015). What drives and constrains effective leadership in tackling child undernutrition? Findings from
Bangladesh, Ethiopia, India and Kenya. Food Policy, 53, 33-45.
•What are the features of an enabling environment; key preconditions, drivers? •How to assess, monitor and strengthen leadership and capacity?•How to assess, monitor and strengthen accountability and responsiveness?
“How can an enabling environment be promoted so as to use existing political and economic resources more effectively, and so to generate new resources to improve nutrition?”
Creating and sustainingmomentum for undernutrition
reduction
Converting momentum to impact on nutrition status
Framing, generating and communicating knowledge and evidence• Framing and narratives • What works?• How well do nutrition interventions work relative to
other interventions?• Evidence/data on outcomes and benefits• Advocacy to increase priority (civil society)• Evidence on coverage and scale
• Implementation research (what works, why and how)
• Monitoring coverage• Programme evaluation (impact pathways)• Generating demand for evidence of impact• Learning during crisis
Political economy of actors, ideas and interests• Incentivising and delivering horizontal coherence
(multisectoral coordination)• Building up accountability to citizens• Civil society: galvanizing commitment• Enabling and incentivizing positive contributions from
the private sector
• Delivering horizontal and vertical coherence• The role of civil society in delivery & impact• The role of private sector
Capacity (individual, organizational, systemic) and financial resources• Leadership/championing• Systemic capacity to sustain commitment• Understanding financing and making the case for
additional resource mobilisation
• Prioritisation and sequencing of nutrition action• Capacity for Implementation and scaling up• New forms of resource mobilisation
Gillespie S, Haddad L, Mannar V, Menon P, Nisbett N (2013) and the Maternal and Child Nutrition Study Group. The
politics of reducing malnutrition: building commitment and accelerating progress. Lancet 2013
• Why some countries address nutrition better than others is still an enigma
• Evidence on ‘what to do’ is relatively clear. What’s not clear is why it’s not done.
• Individuals have been recognised as essential in championing the policy changes necessary to address undernutrition
• But…how much do we know about the people who are, or could be, leaders in the field of nutrition?
Why nutrition leadership and champions?
“capacities that are needed urgently include the knowledge, skills, leadership, and human resources for envisioning, shaping, and guiding the national and subnational nutrition agendas”
(Bryce et al 2008 in Lancet Nutrition Series)
–WPHNA – Competencies for Global Public Health Nutrition Workforce. (Hughes et al 2011)–Leadership as central in tackling other complex public health agendas (Horton 2011; Day et al 2014 –The Lancet)
Existing literature
Existing literature
– Leadership as critical factor in country case studies (e.g. Mainstreaming Nutrition Initiative - Pelletier et al 2012; IDS’ Analysing Nutrition Governance work – Mejia Acosta & Fanzo 2012).
– Leadership as part of political commitment to nutrition – Heaver 2005• Decision makers Champions• Influencers Policy Entrepreneurs• Clients Supporters
Existing literature
– Development Leadership Programme – existing development scholarship on leadership draws on e.g. US business/management literature – individual traits… lacks attention to wider political processes:• “Leadership is a political process involving the skills of
mobilising people and resources in pursuit of a set of shared and negotiated goals” (Leftwich and Wheeler 2011, p.5)
– Systemic and adult development studies literature – adaptive leadership; leadership is what people do not how they are labelled
Key questions
• What is motivating people to become leaders in nutrition, is there anything common in their background which may have led to them to champion nutrition?
• What enables leaders to operate effectively in the nutrition policy sphere; In particular, what are their analytical and political capabilities?
• What are the external challenges and barriers to their effective operation?
• What do leaders assess as knowledge gaps that are important to fill; how do they employ their existing knowledge?
• How can the international policy community better support and nurture emerging leaders?
Identifying organisations, people, power
Net-map sessions in Kenya, India,
Bangladesh, Ethiopia
Understanding issues and context
Nutrition context analysis +other desk
research Draft list of influential individuals in nutrition; verify with
local partners(60-70 per country)
Stakeholder Interviews
With some of these people
(n=89; 15-27 per country;
Sampling : purposive/snowba
lling
Further analysis of capacities; politics and knowledge
Further analysis of capacities; politics and knowledge
Nutrition Leadership
Thematic coding (NVIVO) (both emergent and pre-selected
analytical themes)
Thematic coding (NVIVO) (both emergent and pre-selected
analytical themes)
Confirmation of influential individuals
Confirmation of influential individuals
Who is involved?
How are they connected?
How influential are they?
* from Gillespie et al. 2013
Capacities
Knowledge, evidence and
narratives
Political economy of actors and
ideas
Section 6 – understanding
individual motivations,
knowledge and capacities
Section 8 – knowledge
environment
Section 7 – political
environment
What is motivating people to become leaders in nutrition, is there
anything common in their background which may have led
them to champion nutrition?
What do leaders assess as the knowledge gaps, how do they
employ their existing knowledge?
What are the external challenges and barriers to their effective
operation?
What enables people to become effective in the nutrition policy
sphere? In particular, what are their political and analytical capabilities?
How can the
international
community better support
and nurture
emerging leaders?
Interview analysis
Conceptual framework*
Research Questions
Figure 1 – conceptual framework mapped to research questions and paper structure
Section 9 – summary of findings and implications
Individual attributes and capacities
• Wide range of actors: clinical research / practice ; nutrition qualifications vs career CS, donors, NGOs
• Several influenced by earlier experience of humanitarian/natural disaster – e.g. famine, drought; cyclones;
• Many drawn increasingly into nutrition – wanting to understand the ‘roots’ of undernutrition and its consequences
• National political landscape (e.g. G’ment power/donor power) contributed to who and why powerful
• Actors demonstrated ability to locate themselves within complex systems of policy, knowledge and power...
• Those seen as effective were often those able to transcend particular disciplinary boundaries/framings; learn new disciplinary boundaries in order to work with others
“We are brought up in silos so we don’t know the world. What you need to do is listen for days and then start talking”
“multisectorality is not about making everyone an expert across all sectors, but is about how everyone can measure their outcomes in terms of the collective impact on a single person”
Political Economy of Actors and Ideas
• Policy challenges described echoed a range of existing literature - e.g. evidence/politics/resources (Gillespie & Haddad et al 2013) or on horizontal & vertical co-ordination: (Mejia Acosta et al 2012);
• Decisions and actions have been stymied by – fragmented co-ordination (e.g. between donors or civil society),
unclear internal or external framing of issues (Shiffman 1997), competing interests, varying donor interests and narratives;
– Lack of institutional home and lack of high level / executive champions
– Vertical co-ordination; bureaucratic/programmatic capacity and a lack of ground level ‘champions’
‘Nutrition is the problem one. Nutrition is no one’s baby. Presently it is under the Ministry of Health, but there’s more focus on health than nutrition then…we haven’t got enough emphasis to nutrition and there’s a lack of coordination. There’s too much focus on the health side, but we need the other sides, such as women…awareness raising, etc.’
“USAID is having program with govt that is more focused on boosting agricultural production agricultural diversity plus behavioural change then comes DFID that believes strongly in micro nutrients supply and behavioural change communication, [...then] FAO has it this is not the way to go and I think we confuse govt more than we assist them”
Knowledge, evidence and narratives
• Competing ‘framings’ and different knowledge claims – leads to fractured nutrition community; limits political effectiveness
• Frustration with lack of data and evidence – stress on locally collected and commissioned research, knowledge and data
• importance of local brokers of research• (although external actors can add to ‘kudos’ to
‘Are nutritionists all talking about the same thing? One group says only breast feeding; another says breastfeeding plus complementary feeding; another says micronutrients, another says RUTF...At senior levels in government, do they really understand what is meant by nutrition?’
“We organise meetings and these are sometimes informal, these are sometimes formal. Informal meetings are very helpful. Just go to some place with a cup of tea...But the guy whom we are talking to he must be influential. So it’s quality that matters.”
Research Question
Findings
Implications
What is motivating people to become leaders in nutrition, is there anything common in their background which may have led to them to champion nutrition?
o No common origin/catalyst drivers
o But several common pathways including exposure in situations of high malnutrition prevalence or wanted to understand the root of health problems
o Nutrition is ‘sticky’ for some – expose as many potential leaders as possible to the realities of undernutrition
What enables leaders to operate effectively in the nutrition policy sphere; In particular, what are their analytical and political capabilities?
o Most effective leaders able to deal with complexity; systemic thinkers; post-conventional levels of adult development
o Roles depend on networks: in fragmented networks, they may be boundary spanners; in less fragmented but not cohesive networks they may be co-creators; Individuals may change roles depending on need and capacities
o Find ways to support these capabilities & build them in others
o Encourage development of networks
What are the external challenges and barriers to their effective operation?
o Donor / CS politicso Fragmentation / lack of coherent
frameso Lack of executive level political
commitment (rhetoric not backed by reality)
o Knowledge and data gaps (below)
o Consensus buildingo Accountability mechanisms
for top-level commitmento Consult identified leaders on
political constraints
What do leaders assess as the knowledge gaps; how do they employ their existing knowledge?
o Gaps– effective multisectorality, timely data, operational research
o Effective use – locally sourced and or translated for policy audiences
o Consult identified leaders on knowledge/data gaps
o Support local research supply & demand & local knowledge brokers
MotivatorsPersonal experience
ExposureTraining
Data
Political & communication skills
Strategy/visionAlliance buildingUse of evidenceCommunication
Boundary crossing
KnowledgeTechnical / nutrition
specificProgramming/practice
Decision makers Influencers Clients
Find the framingAdvocacy/campaigns
Electoral pressurePersuade individuals
around them
Training:Mobilisation skills
Grassroots accountability and
advocacy skills
‘Leadership Training’
Workplace competency, performance &
rewards criteria Support networks/ alliances
Consensus buildingBring others in
Reward and exemplify other champions and
cases of successBring champions
together
Training and education – how to recognise
nutrition. Information on rights and responsibilities
and what are the politicians doing?
Clear narrativesClear evidence
Brief multisec trainingImmersions
Support think tanks, other knowledge brokers, media
Improve curricula
Clear narrativesClear evidence
Brief multisec trainingImmersions
Make nutrition visible at the community level – real time monitoring;
community accountability; support
for community mobilisers
Find the framingAdvocacy/campaigns
Electoral pressurePersuade individuals
around them
Nutrition Champions Nutrition Policy Entrepreneurs Nutrition Supporters
Nisbett, N., Wach, E., Haddad, L., El-Arifeen, S., Wach (2014) What are the factors enabling and constraining effective leaders in Nutrition? A four country Study. IDS Working Paper 447 IDS: Brighton
Can we build leadership competencies?
Hughes R, Shrimpton R, Recine E, Margetts B. A competency framework for global public health nutrition workforce development : A background paper.2011. World Public Health Nutrition Association.
Transforming Nutrition: Ideas, Policy and Outcomes
