The politics of reducing malnutrition: building commitment and accelerating

impact

Stuart GillespieInternational Food Policy Research Institute

Nairobi, 11 June 2015

Lancet Nutrition Series (2013) Paper 4:

Gillespie, Stuart; Haddad, Lawrence; Mannar, Venkatesh; Menon, Purnima; and Nisbett, Nicholas (2013) The politics of reducing malnutrition: Building commitment and accelerating progress. The Lancet 382 (9891): 552-569.

The Lancet framework

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Shifts in the nutrition landscape

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Rationale for Lancet paper

• Political discourse ramped up since 2008• Greater consensus on:– nature of problem of undernutrition and its causes– package of key nutrition-specific interventions– need for complementary nutrition-sensitive actions

• A third level of action – relating to the political, institutional and policy environment -- is key, but it has been neglected.

• Nutrition continues to lag behind economic growth

• How can enabling environments and processes be cultivated, sustained and ultimately translated into impact on the ground? 5

Reviews and analyses

• Policy process literature review– led to structure of paper

• SUN 6-country e-consultation• SUN country tabulation• Three country case studies

– Maharashtra, Peru, Malawi

• Nutrition Commitment Index• Nutrition leadership assessment

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What does an enabling environment look like?

What does an enabling environment look like?

Three vital factors for creating momentum and converting it to impact:

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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 financing• 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

1. Knowledge and evidence

• Undernutrition is multisectoral and open to multiple interpretations; each context requires its own enabling narrative or framing

• Multisectorality challenges nutrition programme implementation and evaluation

• Irreversibility early in life: high return to timely and reliable information on nutrition status and its determinants

• Societal benefits will not be captured within short term political cycles. Rigorous research needed on the longer term benefits of undernutrition prevention, so that politicians can be more confident of the value of the returns that will be realized long after they are out of power

Nutrition Narratives

• Nutrition for Growth

• Supercharging the Demographic Dividend

• Nourishing Minds

• Child Survival

• Hidden Hunger

• Zero Hunger

• Preventing NCDs in later life

Narratives need to be backed up with credible evidence

Narratives need to be backed up with credible evidence

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2. Politics and governance

• Many actors and agencies, each with different and frequently competing agendas (esp. in decentralized systems of governance), need to work together to reduce undernutrition

• All but the most extreme manifestations of undernutrition are invisible, and thus open to neglect, so even well-meaning governments may underinvest in nutrition

• Nutrition trend and program impact data often out of date or virtually absent, allowing unsubstantiated political narratives to be sustained in an evidence vacuum

Policy coherence

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Tools for improving commitment, accountability and responsiveness to

undernutrition reduction

Capacity and Resources

• Human and organizational capacity is more than nutrition know-how; soft-power skills needed to operate across boundaries and disciplines (e.g. leadership for alliance building and networking, communicating the case for collaboration, leveraging resources and being able to speak truth to those in power)

• Strategic and operation capacities of different actors at several levels are key

• Additional financial resources and much better budget data are required if undernutrition efforts are to be scaled up, with innovation required from governments and donors to maximize investment

Systemic capacity strengthening

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enable….. require…..

ToolsSkills

Staff and InfrastructureStructures, Systems and Roles

Brough and Potter (2004)

e (2001)

e (2001)

e (2001)

• 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?

Nutrition leadership: why and how?

TN’s leadership assessment: 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?

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

Can we recognise, incentivize and support nutrition champions?

Resources for Nutrition: Look everywhere but be guided by a plan, with checks

and balances

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Table 3: Summary of key issues arising from country case studies

Building commitment Turning commitment into action and impact Evidence, data, perceptions

Clarify agriculture-nutrition links (that go beyond food pathways) Stakeholder consultations, cross-sectoral dialogue Learn a new language (incentives)/nutrition literacy Highlight mutual gain (“win-wins”) Support civil society advocacy Engage the media Raise awareness about nutrition at all levels

Ensure policy is implementable Generate and use actionable evidence Operational research and evaluations Highlight what works in programmes Embed relevant indicators in wider M&E systems NGO role in piloting and innovation Learn about scale up and integration

Policy, politics, governance

Horizontal (cross-sectoral) coherence Priority-setting and policy formulation processes Address production bias Identify mechanisms for communication and coordination Decision-making incentives (for change) Leadership/champions Pro-nutrition legislation Global and regional conferences and movements

Vertical coherence (national to community) Ensure incentives for implementation Clarify and ensure accountability at all levels Decide whether to integration or co-locate programmes and interventions Empower women through agriculture Engage private sector and other development partners, based on comparative advantage. Forums for sharing lessons on what works

Capacity and finance

Lateral leadership (across sectors) Policymaker rotation problematic Coordination capacity (e.g. multistakeholder platforms) Capacity to demand and use research evidence

Operational capacity / implementation coordination Pre and in-service training Under-used research capacity Leveraging private sector capacity Funding not necessarily the major problem North-South and South-South knowledge exchange

Enabling environments are needed to harmonize stakeholders and unleash the potential of both nutrition-specific and nutrition-sensitive actions.

Key features of enabling environments for nutrition:• Systems for generating and using evidence and data, collective

approach, political approach, strengthened accountability, strengthened capacity at all levels, more creativity around resource mobilisation with stronger checks and balances

Leadership at all levels is fundamentally important – for creating and sustaining momentum and for converting it to impact

Operational research on how to scale up (with quality and intensity) and a shift in emphasis to the “why?” and “how?” as well as the “what” of effectiveness

Political will and momentum can be created.

Undernutrition reduction can be accelerated through deliberate action

Key messages

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Thank you