Building Multi-Sectoral Nutrition Systems

1. Building Multisectoral Nutrition Systems:
Challenges, Strategies, Capacities, Tools and Lessons from
the African Nutrition Security Partnership (ANSP)
The ANSP Cornell Team
David Pelletier, Director
Suzanne Gervais, Project Coordinator
Dia Sanou, Coordinator for Burkina Faso and Mali
Jackson Tumwine, Coordinator for Uganda
Hajra Hafeez-ur-Rehman, Coordinator for Ethiopia
Functional Capacity Workshop
Nairobi, June 11-12, 2015

2. Acknowledgments:
Our Co-Learners and Co-llaborators
Ethiopia, Uganda, Burkina Faso and Mali:
• Nutrition focal points, advisors and staff in government
• UNICEF Country Offices
• Collaborating partners in-country
UNICEF Regional Offices:
• Eastern/Southern Africa
• Western/Central Africa
European Union Funding

3. Objectives
1. Brief overview and rationale for the
Africa Nutrition Security Partnership (ANSP)
2. Multisectoral Nutrition as a System
3. Tools, Strategies and Capacities for Building the System
4. Emerging Lessons

4. Multisectoral Nutrition:
The Basic Storyline
1. Government decides nutrition
is important, a multisectoral
approach is appropriate and
drafts a national plan
2. A multisectoral coordinating structure
is created at national level and sub-nat’l
levels, with focal points from all relevant
sectors
3. Focal points and their sectors,
identify nutrition-specific and
nutrition-sensitive interventions
4. The interventions are costed
and resources are mobilized
from govt and partners
5.Interventions are implemented
by each sector and coordinated
by coordinating/governance
structures at sub-national levels
6.The national and sub-national
governance structures exercise overall
monitoring and oversight, while sectors
apply M&E to their own interventions
7. IMPACT ON NUTRITION

5. Governance of Multisectoral Nutrition: Three Perspectives
World Bank Transform Nutrition
MSN is a dynamic,
emergent, non-
linear, multi-scale,
chaordic, open
system

6. African Nutrition Security Partnership

7. African Nutrition Security Partnership
• UNICEF/EU, 4 year project
• Objective: Reduce stunting by:
promoting, developing and
adopting a multisectoral
approach through:
1. Up-stream policy
development and nutrition
security awareness
2. Institutional development &
capacity building
3. Develop useful information
systems and data analysis
4. Scale-up multisectoral
interventions
ANSP

8. Multisectoral
Nutrition Plan,
Program or
Policy
Multisectoral
Nutrition
Structures
Functional
Multisectoral
Nutrition
Structures
• Operationalizing the Plan
by Building “the System”
The Overall
Challenge:
ANSP

9. “this is all new and we are learning as we go”
ANSP

10. Cornell Roles Within ANSP
1. Build on experiences from other countries (strategic capacity and
adaptive management)
2. Facilitate co-learning and co-building of the multisectoral nutrition
systems with partners:
– Bring an “insider/outsider” perspective
– Bring a ‘systems lens’ to multisectoral nutrition
– Play multiple roles as boundary-crossing agent, knowledge broker,
alliance broker, learning/reflection facilitator, etc.
3. Document lessons and experiences for external audiences:
– Country efforts to operationalize multisectoral nutrition
– Experience working in/with complexity adaptive systems
ANSP

11. Some Key Methods
• Tools: devices that help stakeholders solve a problem or
perform a task
• Sensitizing Concept: an idea presented in a way that is
simple, resonates with experience, memorable and stimulates
thinking and action in a productive direction
• Knowledge brokering: facilitating the exchange of knowledge
(global, cross-national and contextual) among stakeholders in
the system

12. Tools, Sensitizing Concepts and Knowledge Brokering
Within and Across Countries
Illustrations
ANSP
Input Type
1. Multisectoral Nutrition System Model A sensitizing concept and a tool
2. Working model at district-community level Knowledge brokering
3. Voltage drop A sensitizing concept
4. Implementation teams Knowledge brokering
5. Decision matrix A tool
6. Practitioner profiles Strategic capacity building
7. Horizontal sharing Knowledge brokering

13. Fragmented Views of Multisectoral Nutrition
A Common Understanding
Is Required!!
ANSP

14. Land Cruiser as a Sensitizing Concept for
a Functional and Effective System
1. Clear Purpose
2. Components
3. Connections & Alignment
4. Fuel
5. Designers and Engineers
6. Servicing and Repairs
7. Resources
ANSP

15. 1. The Purpose of Multisectoral Nutrition
What is needed?
Nutrition-specific actions
Nutrition-sensitive actions
Consequences:
1. Child survival
2. Child health
3. Adult health
4. Cognitive development
5. School performance
6. Adult income
7. Economic growth
8. Equity
9. Human Rights
ANSP

16. 2. The Components of a Multisectoral
Nutrition System
Multi-sectoral: Health, Agriculture, Education, Gender, Water, Trade, Industry…
Multi-level: National, regional, district, sub-district, community, household
Multi-stakeholder: government, bilaterals, UN, NGOs, CSOs, academia
ANSP

17. Health Agric Educ WCY etc
National
Regional
Zonal
(in some
Regions)
Woreda
Kebele
(frontline
workers)
NNCB
NNTC
RNCB
RNTC
ZNTC
WNTC
Figure 2: Structures in the Working Model for the NNP
3. Connections and Alignment
ANSP

18. 4. Fuel for the Multisectoral Nutrition System
Leadership
Commitment
Motivation
Expectations
Accountability
Incentives Solidarity
ANSP

19. 5. Designers and Engineers for the
Multisectoral Nutrition System
Development
of Common
Understanding
Vision &
Purpose
Design
Team
Common
Work Spaces &
Opportunities
Communication
and Alignment
With Other
Stakeholders
Engineering
Team
ANSP

20. 6. Resources for the Multisectoral
Nutrition System
• People
• Knowledge
• Experience
• Skills
• Facilities
• Tools
• Equipment
• Finances
• Partners
ANSP
• Operations Manuals
• Guidelines
• ToRs
• etc.

21. 7. Servicing and Repairs for the
Multisectoral Nutrition System
ANSP

22. “The System”

23. 2.Common
understanding
3.Common
communications
4.Consensus
on actions
6.Commitment
& Leadership
8.Consistent
Incentives &
Accountability
1.Strategic Capacities and Adaptive Management
at National & Sub-National Levels
1. Requirements for an Effective Multisectoral Nutrition System
7.Clear Roles &
Responsibilities(ToRs)
5.Common Results
Framework
10.Community, NGO,
Partner & Private
Sector Alignment
12.Consistent
Financing
11.Capacities,
Facilities, Tools,
Equipment…
ALIGNMENT COMPONENTS AND CONNECTIONS FUEL
RESOURCES 9.Coordinated M&E,
Learning Platforms,
Operations Research,
Adaptive Management
SERVICING and REPAIRS
DESIGN, ENGINEERING AND MAINTENANCE

24. Tools, Sensitizing Concepts and Knowledge Brokering
Within and Across Countries
Illustrations
ANSP
Input Type
1. Multisectoral Nutrition System Model A sensitizing concept and a tool
2. Working model at district-community level Knowledge brokering
3. Voltage drop A sensitizing concept
4. Implementation teams Knowledge brokering
5. Decision matrix A tool
6. Practitioner profiles Strategic capacity building
7. Horizontal sharing Knowledge brokering

25. 2. Clarify “The Working Model”
Mali
Burkina Faso Uganda
Ethiopia
“I understand the
Importance of nutrition.”
“Now what exactly do
you want me to do?”

26. Tools, Sensitizing Concepts and Knowledge Brokering
Within and Across Countries
Illustrations
ANSP
Input Type
1. Multisectoral Nutrition System Model A sensitizing concept and a tool
2. Working model at district-community level Knowledge brokering
3. Voltage drop A sensitizing concept
4. Implementation teams Knowledge brokering
5. Decision matrix A tool
6. Practitioner profiles Strategic capacity building
7. Horizontal sharing Knowledge brokering

27. National
Regional
Zonal
Woreda
Household/Mother/Child
Zone of
Desired Impact
Implementation
Quality
3. Voltage Drop
Kebele
High
Low
?
ANSP

28. Federal
Regional
Zonal
Woreda
Household/Mother/Child
Zone of
National
Control
Zone of
Desired Impact
Control/Quality
Some Ways to Prevent “Voltage Drop”
Kebele
High
Low
Business as usual
Strong, clear ToRs
Strong training.
guides, tools, etc
Strong monitoring
& support
Strong local
capacity
Strong local
AAA
etc
ANSP

29. Tools, Sensitizing Concepts and Knowledge Brokering
Within and Across Countries
Illustrations
ANSP
Input Type
1. Multisectoral Nutrition System Model A sensitizing concept and a tool
2. Working model at district-community level Knowledge brokering
3. Voltage drop A sensitizing concept
4. Implementation teams Knowledge brokering
5. Decision matrix A tool
6. Practitioner profiles Strategic capacity building
7. Horizontal sharing Knowledge brokering

30. A Day in the Life of the
Government Multisectoral Nutrition Leader
ANSP

31. A Day in the Life of the
UNICEF Multisectoral Nutrition Leader
ANSP

32. 4. Implementation Teams
• Tacit assumption: sectoral focal points are the team
• The reality: nutrition is an ‘added responsibility’ for them
• Transitional team: MOH/nutrition + partners
• Longer-term arrangement: full-time sectoral focal points

33. Tools, Sensitizing Concepts and Knowledge Brokering
Within and Across Countries
Illustrations
ANSP
Input Type
1. Multisectoral Nutrition System Model A sensitizing concept and a tool
2. Working model at district-community level Knowledge brokering
3. Voltage drop A sensitizing concept
4. Implementation teams Knowledge brokering
5. Decision matrix A tool
6. Practitioner profiles Strategic capacity building
7. Horizontal sharing Knowledge brokering

34. 5. Decision Matrix: A Tool for Facilitating Agreements on
Governance Arrangements (and many other matters)
Criteria
Governance Arrangements (Options)
MOH MOA OPM etc.
1. Has convening power
2. Has Enforceable authority
3. Consistent with statutory mandate
4. Will give proper attention to nutrition
5. Will foster shared ownership
6. Has access to necessary technical knowledge
7. Likelihood of consensus among govt
stakeholders
8. Likelihood of broad and sustained partner
support
9 . etc
ANSP

35. Tools, Sensitizing Concepts and Knowledge Brokering
Within and Across Countries
Illustrations
ANSP
Input Type
1. Multisectoral Nutrition System Model A sensitizing concept and a tool
2. Working model at district-community level Knowledge brokering
3. Voltage drop A sensitizing concept
4. Implementation teams Knowledge brokering
5. Decision matrix A tool
6. Practitioner profiles Strategic capacity building
7. Horizontal sharing Knowledge brokering

36. Strategic Capacity
The human and institutional capacity to:
• build commitment, vision and consensus
towards a long-term national nutrition
agenda,
• broker agreements,
• resolve conflicts,
• respond to recurring challenges and
opportunities,
• build relationships,
• etc.
In other words:
The ability to work within
a Complex Adaptive System

37. 6. Practitioner Profiles:
Discovering Strategic Capacity from Within
Example from Uganda
ANSP

38. Tools, Sensitizing Concepts and Knowledge Brokering
Within and Across Countries
Illustrations
ANSP
Input Type
1. Multisectoral Nutrition System Model A sensitizing concept and a tool
2. Working model at district-community level Knowledge brokering
3. Voltage drop A sensitizing concept
4. Implementation teams Knowledge brokering
5. Decision matrix A tool
6. Practitioner profiles Strategic capacity building
7. Horizontal sharing Knowledge brokering

39. 7. “Horizontal” Sharing

40. Emergent Lessons
1. Most nutrition programming in the past has involved implementing
interventions within existing delivery systems
2. MSN includes this but also requires new structures, functions,
interventions and capacities at the organizational and whole system level
3. Building, facilitating and sustaining these requires strategic (or
functional) capacity - a set of actors at national level with an eye on the
big picture and able to work strategically and effectively across sectors,
administrative levels and stakeholder groups
4. Cascading these new structures, functions, interventions and capacities
to lower levels (with high quality) requires an implementation team (full-
time staff) - to develop guidelines, ToRs, reporting templates, etc. and to
orient, train, support and track the work at lower levels
5. Learning Platforms at each level are important for systematizing and
institutionalizing the “learning and adjusting as we go”