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

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