This document summarizes key points from a paper on creating enabling environments to reduce malnutrition. It discusses three vital factors: 1) Framing, generating, and communicating knowledge and evidence through narratives, advocacy, and research on what works and impact. 2) Political economy of actors, ideas, and interests through multisectoral coordination, accountability, civil society engagement, and private sector contributions. 3) Capacity and financing through leadership, systemic capacity, understanding financing needs, prioritization, and scaling up programs. Case studies highlight the need for evidence, coordination across sectors, capacity building, and leveraging multiple resources to turn commitment into impact on nutrition. Leadership is important at all levels to create momentum and scale up effective actions.
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Stuart Gillespie, Senior Research Staff International Food Policy Research Institute
1. The politics of reducing malnutrition:
building commitment and accelerating impact
Stuart Gillespie
International Food Policy Research Institute
Nairobi, 11 June 2015
2. 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.
5. 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?
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6. 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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7. 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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8. Creating and sustaining
momentum 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
9. 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
10. 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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11. 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
13. Tools for improving commitment, accountability
and responsiveness to undernutrition reduction
14. 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
15. Systemic capacity strengthening
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enable….. require…..
Tools
Skills
Staff and Infrastructure
Structures, Systems and Roles
Brough and Potter (2004)
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17. • 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?
18. 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?
19. Motivators
Personal experience
Exposure
Training
Data
Political &
communication skills
Strategy/vision
Alliance building
Use of evidence
Communication
Boundary crossing
Knowledge
Technical / nutrition
specific
Programming/practice
Decision makers Influencers Clients
Find the framing
Advocacy/campaigns
Electoral pressure
Persuade individuals
around them
Training:
Mobilisation skills
Grassroots
accountability and
advocacy skills
‘Leadership Training’
Workplace
competency, performance &
rewards criteria
Support networks/ alliances
Consensus building
Bring others in
Reward and exemplify
other champions and
cases of success
Bring champions
together
Training and education –
how to recognise nutrition.
Information on rights and
responsibilities and what
are the politicians doing?
Clear narratives
Clear evidence
Brief multisec training
Immersions
Support think tanks, other
knowledge brokers, media
Improve curricula
Clear narratives
Clear evidence
Brief multisec training
Immersions
Make nutrition visible at the
community level – real time
monitoring; community
accountability; support for
community mobilisers
Find the framing
Advocacy/campaigns
Electoral pressure
Persuade 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
20. 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.
24. Table 3: Summary of key issues arising from country case studies
Building commitment Turning commitment into action and impa
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
25. 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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“Enabling environment” = the wider political and policy processes which build and sustain momentum for the effective implementation of actions that reduce undernutrition
