Drivers of change in nutrition in Senegal: the critical role of political institutions by Halie Kampman, Amanda Zongrone, Rahul Rawat, and Elodie Becquey

1. Drivers of change in nutrition in Senegal:
the critical role of political institutions
Halie Kampman, Amanda Zongrone, Rahul Rawat, and Elodie Becquey
International Food Policy Research Institute (IFPRI)
October 23, 2016

2. Methods
Decomposition Analysis; Policy Reviews; Stakeholder Interviews
POLICIES
• Letter of Nutrition Policy (2001) / National Nutrition Policy (2015)
• National Plan for Local Development (2006)
• Strategic Document for the Reduction of Poverty II (2006-2010)
• National Policy for Integrated Early Childhood Development (2007)
• National Plan for Child Survival (2007-2015)
• National Health Development Plan (2009-2018)
• National Agricultural Investment Program (2011-2015)
• The National Strategy for Economic Development (2013-2017)
• Plan for an Emergent Senegal (2014-2035)
• Policy Document of Health/Nutrition/Environment in the
Education System (2015)
STAKEHOLDER INTERVIEWS
National Stakeholder Interviews with 4 different sectors
(Government, CSOs, UN, Academia)
• Ministry of Education
• Ministry of Health
• Ministry of Agriculture
• Ministry of Women, Family and Childhood: National Agency for
Early Childhood
• National Program of Local Development
• Ministry of Finance: Planning
Community Interviews (FLWs, mothers)

3. Analysis (3C Framework)
COMMITMENT COHERENCE COMMUNITY
1. How has understanding about the
nature of nutrition issues changed?
2. What have been the major changes
in the political context around
nutrition?
3. Across sectors what kinds of changes
can we see in policies related to
nutrition?
1. How is institutional coherence
established, and how has it
changed?
2. What changes can we see regarding
horizontal coherence (between and
across sectors)?
3. What changes can we see regarding
vertical coherence (from policy to
community level implementation)?
1. What changes can we see in
nutrition service delivery at the
community level?
2. What are the changes regarding
human resources, and how do these
changes affect service delivery?
3. What motivates FLWs, and how have
changes in these motivating factors
affected service delivery?
4. How do FLWs contribute to changes
in knowledge and awareness of
nutrition, and how does this affect
service delivery?

4. RESULTS: Decomposition Analysis
• Change in stunting
prevalence from 33% (1993)
to 19% (2014)
• The model explains
approximately half of the
actual change in HAZs
observed over this period.
• Among the sources of
predicted change, wealth
accumulation is the
dominant factor, followed by
healthcare and parental
education.
Mother's education (6%) Husband's
education (1%)
Asset index (24%)
4 or more
antenatal visits
(8%)
Born in a medical
facility (6%)Birth interval (2%)
Unexplained
(53%)
Data source: DHS data 1993-2014

5. RESULTS: Commitment
• End of the PNC (1994-2001); recognizing that nutrition
needs “a home”
• Creation of the CLM in 2001 housed in the PMO
• Moving from PNC to the PRN (2002-2016)
Political
Context
• Nutrition Policy
• Letter of Nutrition Policy (2001-2014) to the National
Nutrition Development Policy (2015-2025)
• Increased presence of nutrition in policy documents
(Health, Education, and Agriculture)
Policy Changes

6. RESULTS: Coherence
• Stakeholders from multiple sectors agreed that the CLM
introduces a platform for institutional coordination at a new
level: one which is about relationship building
Institutional
• Increased awareness across the sectors for the need for
horizontal coordination
• CLM focal points from each sector
Horizontal
(between sectors)
• Increased engagement and flow of information between
policymakers and technical agencies, and communities
Vertical
(policy to community)

7. RESULTS: Community, FLW perceptions
Human resources: The PRN has substantially increased the network of
volunteer health and development agents (relays) at the community level
through its broad network of implementers
Motivation: Many relays are strongly motivated by their ability to play a new
role as community health agents. Financial considerations are the biggest
hurdle to FLW motivation and is cited cited as the biggest risk regarding long
term sustainability.
Knowledge and awareness: Increased community awareness of nutrition
services and knowledge were attributed to the PRN

8. CHALLENGES
1. Fragility of leadership and sustaining nutrition champions
2. CLM’s authority to enforce coordination
3. Multi-sectoral coordination
• Budget line items for nutrition
• Lack of clear nutrition objectives
• Lack of specificity around indicators and measurement.
4. PRN sustainability at community level through dependency on a broad
network of community implementers.
5. Lack of costing to scale up nutrition specific interventions

9. KEY MESSAGES
Government ownership of nutrition is evident, with
strong political commitment
This commitment has translated into inclusion of
nutrition in policies across several sectors
The CLM plays a critical role as the anchor for nutrition
and facilitator pf community reach for nutrition through
the PRN—there are sustainability questions at
community level
To realize further impact, Senegal needs to cost out the
scale up of nutrition specific interventions
1
2
3
4

12. Conclusion
Commitment
Understanding: Stakeholders feel that there is more awareness about the way that nutrition
touches upon multiple sectors. However, nutrition remains “homeless” and difficult to take
ownership of.
Political context: The founding of the CLM allowed for a new platform for commitment, and the
change from the PNC to PRN invited new multi-sectoral engagement. This multi-sectoral team
can be difficult to responsible-ize, and is dependent on the maintenance of a certain level of
leadership and trust
Policies: We see renewed engagement of health, education, sectors, and to some extent
agriculture. However, across the board there are often a lack of indicators and budget for
nutrition, and often a conflict of interest with other priorities.

13. Conclusion
Coherence
Institutional coherence: strengthened through the CLM, which brings coordination to a new
level building collaborative relationships between actors. CLM does not have the authority to
enforce cooperation: the future of this institutional coherence rests to a certain extent upon the
willingness of actors.
Horizontal coherence: has the potential to become stronger, as the different sectors are aware
of the need. However many sectors are held back because a lack of internal initiative, connected
to the absence of a real nutrition budget.
Vertical coherence: increased flow of information both “up” and “down” between
experts/policy makers actors and the community. However, many local governments still don’t
have a clear vision of the problematic of nutrition, and some claim there is a disconnect
between experts and the communities they serve.

15. Commitment
Changes in political context
CHANGES
•The end of the PNC, and the recognition that nutrition
needs “a home”
•Creation of the CLM in 2001 housed in the prime
ministers office: high level of political priority, new
opportunity for the nutrition community to grow
•Moving from PNC (1995-2001) to PRN (2002-2016)
opened a window for a change in both leadership and
policy
• PRN had a “home” within an institution, the CLM (unlike
PNC)
• The PRN anchored the community approach
• Coordinating body, platform, team of leaders with a
common vision, multi-sectoral team
CHALLENGES
•Some stakeholders felt there was an initial
fragility of new structure and and dependency on
the right mix of leadership and trust
•Multi sectoral team can be difficult to
responsible-ize
“Change is about people. It’s about men, and not
men as a gender but change is about how we
relate to each other…If there is not that trust then
change cannot happen. What happened to
nutrition here, has been big changes, so what you
can be sure of is that there has been trust at lots
of different levels ” (Respondent from an IO)
Data source: national stakeholder interviews

16. Commitment
Policy changes
CHANGES
•Nutrition Policy
• Letter of Nutrition Policy to the National Nutrition Policy
• A greater emphasis on multi-sectoral collaboration
• A participatory process
•Increased presence of nutrition in policy documents (Health,
Education, and Agriculture)
• Increased mention of nutrition
• Involvement of CLM
CHALLENGES
•Lack of standardized indicators
•Lack of specified budget for
nutrition
•Competing priorities
Data source: national stakeholder interviews,
policy review

17. RESULTS: Coherence
• Stakeholders from multiple sectors agreed that the CLM
introduces a platform for institutional coordination at a new
level: one which is about relationship building
Institutional
• Increased awareness across the sectors for the need for
horizontal coordination
• CLM focal points from each sector
Horizontal
(between sectors)
• increased engagement and flow of information between
policymakers and experts, and communities
Vertical
(policy to community)

18. Coherence
Institutional
CHANGE
•Stakeholders from multiple sectors agreed that the CLM
introduces a platform for institutional coordination at a
new level: one which is about relationship building
“It’s the conductor of the orchestra who we need to identify,
give him appropriate ‘arms’, instruments, so that he can
organize this whole symphony in a manner that there is not
any dissonance .” (Respondent from an IO, speaking about
the CLM)
“...there can be links, but really we are not working on the
links. Its the glue, the cement, that we need to put between
the bricks. It’s that we are looking for at the
CLM .” (Respondent from the government)
CHALLENGES
•The CLM as a coordinating body
does not have the authority to
enforce coordination
Data source: national stakeholder interviews

19. Coherence
Horizontal (between sectors)
CHANGE
• Increased awareness across the sectors for the
need for horizontal coordination
•CLM focal points from each sector
•“I think that sectors are more aware of the fact
that there are transformations happening…two
years ago I sat with a multi-sectoral group and I
said to agriculture, you must include nutrition
indicators. They said no that’s not our affair. But
now when you talk to agriculture, they say, can
you help us to integrate nutrition in our affairs.”
(Respondent from the government, agriculture
sector)
CHALLENGES
•Some sectors show lack of initiative, often
based on the lack of budget to integrate
nutrition
“We cannot impose plans of action without the
financial means to follow...People tell us we
need a plan of action… unfortunately there are
no means ”
(Respondent from government, agriculture
sector)
Data source: national stakeholder interviews

20. Coherence
Vertical (policy to community implementation)
CHANGE
•There is increased engagement and flow of
information between policymakers and
experts, and communities
• Bottom up: Since 1994 decentralization,
increased power in hands of community defining
their own needs, increased influence from
bottom up
• Top down: Growth of nutrition community, and
highly specialized nutritionists
CHALLENGES
•Despite flows of information, actors felt that
many local governments don’t have a clear vision
nutrition, so they don’t take ownership
•Some actors feel there can be a disconnect
between “esoteric” experts and policy makers
and communities they serve
“...local governments...they don’t have a clear
vision of the problematic of nutrition, they don’t
have just one priority.” (Respondent from an NGO,
representing civil society)
“...from my point of view, nutritionists, not to
throw a stone, they consider nutrition as an
esoteric science.”(Respondent from the
government, agriculture sector)
Data source: national stakeholder interviews