Day 1 keynote address: David Pelletier, Cornell University: “Nutrition Policy Processes” Workshop on Approaches and Methods for Policy Process Research, co-sponsored by the CGIAR Research Programs on Policies, Institutions and Markets (PIM) and Agriculture for Nutrition and Health (A4NH) at IFPRI-Washington DC, November 18-20, 2013.

1. The Nutrition Policy Process:
A Role for Mode 2 Research
David Pelletier
Division of Nutritional Sciences
Cornell University
IFPRI Workshop on Approaches and Methods for Policy Process Research. Nov 18-20, 2013

2. Outline
1.
2.
3.
4.
5.
6.
Trends in society
The nature of problems
Trends in science
Population nutrition research
Illustrations
Summary

3. Collaborators
Past
Present (Cornell)
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Tahmeed Ahmed, ICDDR,B
Shamshir Ahmed, ICDDR,B
Allison Corsi, Cornell
Silvana Faillace, AED, HKI
Ed Frongillo, USC, Cornell
Suzanne Gervais, Cornell
Renee Hill, U Idaho, Cornell
Lesli Hoey, U Mich, Cornell
Robin Houston, Consultant
Purnima Menon, IFPRI, Cornell
Rebecca Stoltzfus, Cornell
Suzanne Gervais
Isabelle Michaud-Letourneau
Barnabas Natamba
Edna Possolo
Hajra Hafeez-ur-Rehman
Dia Sanou
Jackson Tumwine
Financial Supporters: AED/USAID, Centers for Disease Control, GAIN,
Micronutrient Initiative, UNICEF, World Bank

4. Trends in Society
• Nutrition has ascended on public and private agendas
• An extensive web of interconnected issues now is recognized
• Demand for results and accountability in public programs and
publicly funded research
• Demand for research on effectiveness of interventions at
scale (translational and implementation science)
• Nutrition research must respond to these trends in order to
remain relevant

5. Trends in Society

6. Trends in Society

7. Trends in Society

8. Trends in Society

9. Trends in Society

10. Trends in Society
Results and Accountability: GPRA’s 20th Birthday!!
(1993-2013)
(97:3)

11. Proven Solutions are At-Hand
“The Challenge Now is to Scale Them Up”

12. The Nature of Problems

13. What Kind of Problems Are We Dealing With?
Simple
Complex
The Nature of Problems
Complicated
Socially Complex / Wicked
Adapted from: Getting to Maybe: How the World is Changed. Westley, Zimmerman, Patton, 2006

14. Illustrations
Social Complexity in Nutrition Policy
“[] the donors and NGOs basically could not get their act together because
they were all arguing for their own special interest or their own view of
how things ought to be handled for nutrition.”
(International researcher and consultant to countries)
World Bank 2006

15. Batie, 2008. Amer. J. Agr. Econ. 90 (Number 5, 2008): 1176–1191. (Author holds endowed Chair in Food and
Agricultural Economics Policy, Dept of Agricultural, Food, and Resource Economics at Michigan State University)

16. The Nature of Problems
Implications of Wicked Problems for the Research Approach
“Because wicked problems are in essence “expressions of diverse and conflicting
values and interests” (Norton, 2012, p. 450), the process of working with
them is fundamentally social, and should not be scientized in the conventional
sense (Conklin & Weil, 2007).
“Instead of the partial and linear strategy of divide and conquer that aims at
searching for definitive solutions, it requires a holistic and process oriented
approach that is by nature adaptive, participatory, and transdisciplinary (APT
for short).
“By examining a wicked problem as a whole through a panoramic social lens
rather than a scientific microscope, and working with it through an open and
heuristic process of collective learning, exploration, and experimentation, the
APT approach promises to be efficacious in fostering collaborative behavior,
reducing conflicts, building trust among all stakeholders and communities
involved, and ultimately producing better and more satisfying results.
“With more empirical research and applications, a more developed APT
approach, along with innovative methods and skill sets, will be a competent
alternative to the traditional solution-seeking approaches.”
Xiang (Editorial) Landscape and Urban Planning 110:1– 4, 2013

17. Trends in science
The Multisectoral Nutrition Policy Process:
Complex Adaptive Systems (and Subsystems)
Donors NGO/CSO Ministries
Donors NGO/CSO Ministries

18. The NPP Complexity Context
Informal Governance Structures:
Stakeholder Network Map for Ethiopia
Source: www.transformnutrition.org/
Illustrations

19. Fd Sec & Nutr
Unit in PMs
The Nutrition Policy Process:
Fd Sec Unit Office
The Composite Case of
in PMs
NGO
MOH
Esperanza
Office
Comm- CommFish Farms
Supplem. Feeding Based Based
in clinics, schools, Nutr Ed Nutr Ed
High Lysine
NGO programs
Maize
BF Promotion
Nutr
Rehab
Units
Home gardening &
poultry
Clinic
GMP
Clinic nutrition education
1970
1980
The Nature of Problems
VitA campaigns
Host internatl conference
First Lady/Nutrition
IFA in
clinics
MOH Nutr Educ &
Nutr Rehab Units
Uncoordinated and competitive
NGO Comm-based programs
1990
Unified Natl
Nutr Strategy:
- Core objectives
- Diverse implem
2000
2010
Donor
Micronutrient
Agenda
Economic WHO,
NGO, FSNU,
NPP: dynamic, contingent, emergent, non-linear,
UNICEF
MOH, donor Cap
Stunting 45%
Crisis
Bldg
Advocacy
rapport
Donor
Wasting 6%
multi-scale, chaordic, open conflicts
systemsShared Better
Urban food
70% rural
U5MR 180
MatMR 2000
Anemia
VAD
Seasonal and chronic food insecurity
price spike
Weak
Commitment in
MOH, MOA, MOE
Weak networking
Skills in FSNU
USAID BF Program
Nutrition lost in
health sector reform
40% Absorptive
Capacity in MOH
Weak/no
evaluations
credit
Strategic
Alliance
for Nutr
NGO
networking, sharing,
voluntary coordination,
trust building, advocacy
evals
Staff
Turnover&
Donor
Conflicts
resume

20. The Nature of Problems
The Nature of Problems:
Bottom Line Message
“We can't solve problems by using the same kind
of thinking we used when we created them.”
Einstein

21. Trends in Science

22. Trends in Science
Complexity and Systems Thinking
“I think the next century will be the century of complexity”
S. Hawking
“Every PhD student in everything should get to grips with the
‘chaos/complexity’ programme, not for reasons of fashion or
even legitimate career building, but because this is the way the
world works and we need to understand that”
D. Byrne
In: Complexity and the Social Sciences

23. Trends in science
Complexity and its Properties
“It is difficult, nowadays, to open a popular science
magazine, or a leading science journal, without reading
about complexity, the approach to science that is expected
to ‘define the scientific agenda for the 21st century’.1
Complexity theory is influencing fields as diverse as physics,2
cosmology,3 chemistry,4 geography,5 climate research,6
zoology,7 biology,8 evolutionary biology,9 cell biology,10
neuroscience,11 clinical medicine,12 management,13 and
economics.14 However, it has to date had relatively little
influence on the theory and practice of epidemiology.15 In
this paper we review the basic concepts of complexity
theory and discuss their relevance to epidemiology.”

24. Systems in Public Health
Trends in science

25. Trends in science
Two “Approaches” to
Research on Complex Systems
1. Modeling
2. Engaging

26. 1. Modeling the Obesity System
Trends in science

27. The UK Foresight Project: :
http://www.bis.gov.uk/foresight
http://www.shiftn.com/obesity/zoom-map.html

28. Trends in science
2. Engaging with Complex Systems
“If you want to truly understand something, try to change it.”
-Kurt Lewin

29. 2. Engaging with Complex Systems
Trends in science
Research Question:
Can intentional complexity-aware actions
by some actors alter the behavior of the
system?
Properties of Complex Adaptive Systems
(a) nonlinear interdependencies
(b) self-organization
(c) emergence
(d) co-evolution w/
environment
(e) Interaction, learning and adaptation
among many actors

30. Mode 2 Knowledge Production
Trends in science
The central elements of sustainability science:
• inter- and intra-disciplinary research
• co-production of knowledge
• co-evolution of a complex system and its environment
• learning through doing and doing through learning
• system innovation instead of system optimization
Martens, P. 2006. Sustainability: Science, Practice and Policy 2(1):36-41.

31. Trends in science
Research on Wicked Problems and Complex Adaptive Systems
“Much of the research and scholarship, as substantive as it may seem, remains largely a
repetitive description of the social reality of wickedness, rather than well-grounded
theoretical explorations or empirical investigations.
“Aside from substance, the peer reviewed scholarly publications on wicked problems
remain modest in quantity—our recent survey found a total of 332 cited papers on
the Scopus database in the Elsevier Editorial System, and 162 on Web of Science.
They are also geographically scattered, presenting a huge disparity across the
world.”
Xiang (Editorial) 2013

32. Clarifying (and Qualifying) the Complexity Space
and the Management Approach
Source: Barden, 2012. Complexity, Adaptation, and Results, Center for Global Development
http://www.cgdev.org/blog/complexity-adaptation-and-results

33. Population Nutrition Research

34. Population Nutrition Research
Complexity, Systems Thinking and Mode 2 Research in Nutrition
Adv Nutr 4:92-114, 2013

35. Population Nutrition Research
Frontier Dimensions
•
•
•
•
•
•
Why we study
What we study
Who we study
How we study: Methods
How we study: Approaches
Disciplines

36. Dimension
Current Tendencies
Frontiers
Why
Generalizable/ fundamental Actionable knowledge for stakeholders, orgs,
knowledge re. scientific
communities or publics at various scales;
questions
generalizable knowledge re. problem-solving
What
nutrients, nutritional status, laws, regulations, norms, programs, organizations,
food and nutrient intake,
systems, change processes in communities,
food insecurity, behavior
programs, policies, etc.
Who
women, infants, children,
elderly, consumers
policy makers, managers, implementers, leaders,
networks, coalitions, private sector actors,
citizens, universities
How
(methods)
limited range of quant and
qual methods: Interviews,
focus groups, regression,
trials…
social network analysis, discourse analysis, Q
methodology, document analysis, media analysis,
process tracing, stakeholder analysis, influence
mapping, program impact pathways, etc
How
(approach)
detached, objectivist,
positivist, reductionist,
behaviorist, hypothesis
testing…
engaged, participatory, action research, CBPR,
participant-observer, reflection in action,
embedded, emergent, systems- and complexityoriented, reflexive, etc
Disciplines
Nutrition, epi/biostatistics,
biomedicine, psychology,
social psychology…
economics, sociology, anthropology, policy
analysis, law, urban planning, political science,
organizational behavior, management sciences..
and TRANSDISCIPLINARY

37. “It is difficult, nowadays, to open a popular science magazine, or a
Population Nutrition Research
leading science journal, without reading about complexity, the
approach to science that is expected to ‘define the scientific agenda
for the 21st century’.1 Complexity theory is influencing fields as
diverse as physics,2 cosmology,3 chemistry,4 geography,5 climate
research,6 zoology,7 biology,8 evolutionary biology,9 cell biology,10
neuroscience,11 clinical medicine,12 management,13 and
economics.14 However, it has to date had relatively little influence
on the theory and practice of epidemiology.15 In this paper we
review the basic concepts of complexity theory and discussTotal
their
relevance to epidemiology.”
Journal Name
Nutrition Journals
Ecology of Food and Nutrition
Journal of Nutrition Education and Behavior
Maternal and Child Nutrition
Journal of Nutrition
Public Health Nutrition
International Journal of Behavioral Nutrition
and Physical Activity
Subtotal
nutrition
papers in
2012
19
90
47
308
252
No. of papers with
≥1 Mode 2
characteristic1
4
13
5
7
22
(21%)
(14%)
(11%)
(2%)
(9%)
46
1 (2%)
762
52 (7%)
Pham and Pelletier, in prep

38. Trends in science
Nutrition journals: Mode 2 "Methods"
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Ethnographic narrative
Immersion-observation
Thematic analysis
Policy review
Onsite receipt collection
Iterative action research via workshops
Health-economic analysis
Stakeholder analysis
Consultative workshops
Systematic internet review
Emerging policy options with stakeholder input
Implementation pathways
Simulation of food intake patterns
Impact pathways
Pham and Pelletier, in prep

39. The Landscape for Population Nutrition
Research

40. Illustrations
• Mainstreaming Nutrition Initiative
• Program Implementation (PAG)
• African Nutrition Security Partnership

41. Illustrations
Our Complexity Context in All Cases
NPP: dynamic, contingent, emergent, non-linear,
multi-scale, chaordic, open systems
World Bank 2006

42. The NPP Complexity Context
Illustrations
Informal Governance Structures:
Stakeholder Network Map for Ethiopia
NPP: dynamic, contingent, emergent, non-linear,
multi-scale, chaordic, open systems
Source: www.transformnutrition.org/

43. Mainstreaming Nutrition Initiative (MNI)
(Scope: Bolivia, Guatemala, Peru, Vietnam, Bangladesh
plus 14 country narratives)
Feature
Description
Comment
Research
Question
What factors influence
movement of nutrition
within national policy
agendas?
Initially broad and open, with specific foci
emerging during engagement, and guided by
broad frameworks or elements of frameworks
Frameworks,
Elements
& Principles
Policy sciences, Shiffman,
Heaver, Kingdon, Potter and
Brough, Grounded theory
Used flexibly and as heuristics to guide our
attention to certain elements or dynamics and
to help interpret what we are seeing
Research
Methods
Participant-obs, Field notes,
Interviews, Documents,
Member checks, Peer debriefing
Emergent and eclectic; driven by need,
opportunity, feasibility and acceptability
Orientation
Transdisciplinary, contextual, problem-oriented, socially-engaged,
methodologically eclectic and reflexive
Key findings
Routes to agenda-setting; conflict in policy formulation; political attention vs
political commitment vs system commitment; strategic capacity

44. The Focus and Orientation of
Mainstreaming Nutrition

45. African Nutrition Security Partnership (ANSP)
(Scope: Burkina Faso, Mali, Ethiopia, Uganda)
Feature
Deacription
Comment
Research
Question
What factors influence
movement of nutrition
within national policy
agendas?
Initially broad and open, with specific foci
emerging during engagement, and guided by
broad frameworks or elements of frameworks
Frameworks,
Elements
& Principles
Complex Adaptive Systems,
Developmental Evaluation
Policy sciences, Action
Research, Change mgt,
Adaptive management
Used flexibly and as heuristics to guide our
attention to certain elements or dynamics and
to help interpret what we are seeing
Research
Methods
Participant-obs, Field notes
Practitioner profiles, NetMap
Q methodology, Workshop
docs, Interviews, Others tbd
Emergent and eclectic; chosen for their
reflective potential (participatory learning);
and chosen to be as non-intrusive and nonextractive as possible
Orientation
Transdisciplinary, contextual, problem-oriented, socially-engaged,
methodologically eclectic and reflexive
Key findings
In process

46. The Focus and Orientation of ANSP

47. Program Assessment Guide (PAG)
(Scope: 3 countries with full workshops: Kyrgyz, Bolivia, Haiti
2 countries with partial workshops : Nepal, Tanzania)
Feature
Description
Comment
Research
Question
Can the PAG improve the
design and delivery of
nutrition interventions?
What factors influence its
performance?
PAG was designed as an intervention in a
moderately complex systems. The research
question is more focused than MNI and ANSP
Frameworks,
Elements
& Principles
Results orientation
Program theory
Management, Change mgt,
Adaptive management
Principles from multiple frameworks were
used in designing the PAG;
Multiple frameworks will be used in
evaluating experience with PAG
Research
Methods
Partic-obs, Interviews
Pre/post workshop eval
Workshop documents
Long-term follow-up
Methods for evaluating the PAG have been
challenged by the dynamic nature of
workshops, the need for longer-term followup and lack of an explicit counterfactual
Orientation
Contextual, problem-oriented and socially engaged; transdisciplinary, but
emphasizing mgt and action research
Key findings
Feasibility of PAG assessment; overlooked and contextualized bottlenecks;
motivating influence of implementers’ participation; weak follow-up

48. The Focus and Orientation of PAG
etc

49. A Few More Details

50. Mainstreaming Nutrition
Mainstreaming Nutrition Initiative
•
•
•
Funded by World Bank nutrition section
ICDDR,B, Cornell: 2006-8
Objective: develop approaches and experience in moving nutrition
from the status of a marginal issue with time-limited funding to a
permanent feature on policy agendas and in MCN programs and policies
Methods:
•
1.
–
–
2.
–
–
3.
–
–
Cross-country study (interviews, written case studies, observations)
30 respondents (nationals, researchers, NGOs, donors)
18 country experiences
Focal countries (participant-observer and interviews):
Bolivia, Guatemala, Peru
Vietnam, Bangladesh
Conflict and consensus sub-studies (interviews)
Bolivia
Guatemala

51. Mainstreaming Nutrition
Mainstreaming Nutrition Initiative
Policy Process Study
What factors
influence the
development of
the national
nutrition agenda?
What are some
promising
avenues for future
efforts?
Country Experiences

52. Mainstreaming Nutrition
1.Societal
Conditions
2.Catalytic
Events
3.Structural
Factors &
Behaviors
4.Points of
Contention
5.Strategies
& Tactics
Thematic coding
Interviews, Written Accounts,
Observations
Grounded Theory, Kingdon,
Policy Sciences
Respondents: 12 nationals, 12 donor/NGO, 6 nationals in donor/NGO
Benin, Burkina, Ethiopia, Kenya, Madagascar,
Malawi, Mali, Mauritania, Senegal, Tanzania,
Uganda, The Philippines, Thailand, Bangladesh,
Bolivia, Chile, Guatemala, Haiti, Peru
Source: Food and Nutrition Bulletin 32(2): S59-S69, 2011

53. Points of Contention
Mainstreaming Nutrition
“[] the donors and NGOs basically could not get their act together because
they were all arguing for their own special interest or their own view of
how things ought to be handled for nutrition.” (International researcher
and consultant to countries)

54. Mainstreaming Nutrition
Strategies and Tactics
“[] they had a lot of disagreements
but they always went ahead with
one voice. They sat behind closed
doors and didn’t get out, but then
they put on a good face when they
came out and had one
recommendation. (Donor agency)

55. Mainstreaming Nutrition
Societal
Conditions
Catalytic
Events
Structural
Factors &
Behaviors
Points of
Contention
”Strategic Capacity”
Diminished
commitment, coherence, coo
rdination and
support for the national
nutrition agenda
Enhanced
commitment, coherence, coo
rdination and
support for the national
nutrition agenda

56. Mainstreaming Nutrition
Strategic Capacity
The human and institutional capacity to:
• build commitment, vision and consensus
towards a long-term national nutrition
agenda,
aka- the ability to
• broker agreements,
work within
• resolve conflicts,
a Complex
• respond to recurring challenges and
Adaptive System!!!
opportunities,
• build relationships,
• undertake strategic communications,
• strengthen operational capacities and
implementation as part of the national
nutrition agenda

57. Program Implementation (PAG)

58. Program Implementation
The Challenge
?
Pelletier AED PAG Training Jan 5-7, 2011

59. Program Implementation
Pelletier AED PAG Training Jan 5-7, 2011

60. Program Implementation
Program Assessment Guide (PAG)
Processes
Outputs
Participatory Procedures To
Strengthen:
1. Action Plan to
Address Barriers
& Enablers
• The Systematic Integration Of
Evidence, Contextual Knowledge &
Experience
2. Operations
Research
Agenda
• Shared understanding, commitment,
ownership, motivation & capacity to
advance the micronutrient agenda
3. Issues for
Inclusion in
M&E
•Links with the broader nutrition and
health agendas in the country
4. Strategic Plan to
Build Support,
Capacity &
Sustainability
Pelletier AED PAG Training Jan 5-7, 2011

61. Program Implementation
Applications of the PAG
1.
2.
3.
4.
5.
6.
7.
Kyrgyzstan (micronutrient powders)
Bolivia (micronutrient powders)
Nepal (iron-folate supplements)
Tanzania (iron-folate supplements)
Haiti (mobile clinic w/ IFA)
Haiti (community-based programs
w/ multiple interventions)
Haiti (Child Health Weeks w/ vit A)

62. Lessons Learned
1. Sponsorship, Responsibility,
Commitment, Follow-up
2. Timing
3. Preparation
4. Participants
5. Contextuality (selection and sequencing)
6. Time constraints
7. Facilitation
Pelletier AED PAG Training Jan 5-7, 2011
Program Implementation
Before the workshop
During the workshop

63. ANSP
(African Nutrition Security Partnership)

64. ANSP
(African Nutrition Security Partnership)
• UNICEF/EU, 3 year project
• Build on MNI and PAG
• Focus on:
– Strategic capacities
– Adaptive Management
– Developmental Evaluation
ANSP

65. ANSP
Africa Nutrition Security Partnership (ANSP) 2011-2015
UNICEF implements
EU funds
EU
Objective
Reduce stunting by:
promoting, developin
g and adopting a
multisectoral
approach
1.
2.
3.
4.
4 Pillars
Up-stream policy
development and nutrition
security awareness
Institutional development
& capacity building
Develop useful information
systems and data analysis
Scale-up interventions

66. ANSP, Cornell contribution 2013-2015
“Strategic capacity and adaptive management of multisectoral nutrition policies and programs”
1. strengthen strategic capacity within the national
nutrition netywork
2. strengthen the capacity (and a model) for adaptive
management of community-based, multisectoral
nutrition strategies in selected districts
3. support real-time collective learning, sharing and
documentation of project experiences.

68. ANSP
ANSP Guiding Frameworks:
Complexity, Developmental Evaluation, Policy Sciences
And Change Management

69. In Closing

70. The Nature of Frontiers
• Detailed maps do no exist – they are vague, sketchy and made
during exploration and settlement
• Explorers must be willing to embrace
uncertainty, danger, hardship and hunger, so the tangible
rewards (and/or the quest for discovery) must be substantial
• New tools, skills and relationships will be needed to survive
and thrive in the new lands
• Native inhabitants, fellow travelers and explorers from other
lands possess valuable knowledge to aid the process
• Frontiers move in many directions and over varied terrains, so
diversity in focus and approach is warranted

71. Summary
•
•
•
Nutrition has “arrived”
“Nutrition” is no longer just “nutrition”
How can we deliver results at-scale?
“We can't solve problems by using the same
kind of thinking we used when we created
them.”
Einstein
“I think the next century will be the century of
complexity”
S. Hawking
“If you want to truly understand
something, try to change it.”
Kurt Lewin
“Every PhD student in everything should get to grips with the ‘chaos/complexity’
programme, not for reasons of fashion or even legitimate career building, but because this
is the way the world works and we need to understand that”
D. Byrne
“Much of the research and scholarship, as substantive as it may seem, remains largely a
repetitive description of the social reality of wickedness, rather than well-grounded
theoretical explorations or empirical investigations.
Xiang

72. Acknowledgments
to everyone in our Complex Adaptive (Learning) System