National nutrition planning: lessons of experience

Policy overview of the multisectoral nutrition planning process: The progress, challenges, and lessons learned from Burkina Faso

INTRODUCTION

Malnutrition is a multifactorial problem, and multisectoral planning is an indispensable tool. The objective of this study was (a) to evaluate the extent to which nutrition is integrated into policies and (b) to describe the process used by the government of Burkina Faso to reform its policy frameworks and multisectoral nutrition planning.

METHODS

This was a qualitative study, and data were collected in two key steps: first, through a policy overview conducted in 2015 and, second, in November 2017, through a document review and individual stakeholder interviews with 32 key actors involved in national nutrition planning.

RESULTS

The extent to which nutrition is integrated into development policies varied from one sector to another. Since 2014, Burkina Faso has initiated nutrition planning through a multisectoral approach involving six sectors. This process was implemented in three key stages. Progress includes revision of national nutrition policy towards multisectoral perspective, formulation of a consensual and quality multisectoral nutrition strategic plan, creation of nutrition budget line, and establishment of nutrition technical secretariat.

CONCLUSION

To improve the anchoring of multisectoral coordination bodies at the supra-ministerial level, mobilizing resources and promoting sector accountability are key next steps that would contribute to the success of the implementation.

“Public Nutrition”: The Need for Cross-Disciplinary Breadth in the Education of Applied Nutrition Professionals

A study supported by the Pew Charitable Trusts investigated whether the nutrition situation in Central America and Mexico would be improved by professional training in applied, operationally oriented nutrition. The results reported here are based on interviews conducted with nutrition professionals in the United States and abroad and a survey of graduates of US graduate programmes. The respondents agreed that appropriate training of nutrition professionals could improve the nutrition situation of the region, recognizing that social and economic factors are critical determinants of nutrition. This field was seen as a social science discipline. The name “public nutrition” is proposed for the field. Critical elements of training include reaching a critical mass of persons at multiple levels; obtaining institutional commitment to allow newly trained professionals the resources and responsibility to apply what they have learned in their jobs; building in follow-up through networking, information exchange, and reunions of participants and faculty; and combining the skills and knowledge of public nutrition with a strong disciplinary base in a recognized field. The substance of the training programme would consist of applied research skills; communication and advocacy skills; programme management and administration; nutrition science; nutrition programmes and policies; social science concepts of economic and political economy; and fieldwork, internships, or practical. The usefulness of each of these fields is assessed by employed graduates of US programmes. Effective professionals also need personal qualities of leadership, dedication, motivation, and an entrepreneurial spirit. Immediate returns to short-term training of front-line programme managers should not result in ignoring the long-term benefit of higher-level professional education of senior administrators, policy makers, and researchers needed to advance the field of nutrition.

Bolivia's Multisectoral Zero Malnutrition Program: Insights on Commitment, Collaboration, and Capacities

A number of multilateral and bilateral food security and nutrition initiatives have been launched in the wake of the 2008 food crisis, many with the explicit intention of fostering country ownership, multisectoral action, and harmonization among international partners. These bear some resemblance to the failed multisectoral nutrition planning initiatives that followed the 1974 world food crisis, raising the question of whether the current initiatives are doomed to experience the same fate. This paper explores these questions in one country by focusing on the policy sustainability of Bolivia's Zero Malnutrition Program (ZM), a multisectoral initiative that appeared at its initiation to be buttressed by political support and strengthened by design features that differed in important ways from similar efforts of the 1970s. Retrospective and prospective data collected through an action research and grounded methodology revealed, however, that the real struggle in Bolivia came after ZM was launched. ZM champions made undeniable progress in the first 2 years of the program with health-sector interventions, but they underestimated the challenges of building and sustaining the commitment of high-level political leaders, mid-level bureaucrats, and local-level implementers in the majority of other sectors. These initial experiences from Bolivia hold important lessons for several global initiatives to scale up nutrition actions, which are being launched in great haste and so far have given scant attention to strategies for managing the nutrition policy process and strengthening the capacities for implementation.

The use of national sample surveys for nutritional surveillance: lessons from Malawi's National Sample Survey of Agriculture

National sample surveys, containing measurements of the weights and heights of children along with other socioeconomic modules, represent one of the important sources of information for nutritional surveillance. The potential uses of such information are political sensitization, targeting by geographic area, targeting by socioeconomic group, and identifying the most promising intervention options according to the presumed causes of malnutrition. The latter two applications depend upon the ability to detect stable associations between nutritional status and socioeconomic factors. This paper examines the extent to which these planning applications are affected by variation in the ecology of malnutrition across different segments of society, using Malawi's National Sample Survey of Agriculture (NSSA). The NSSA is nationally representative of Malawi's smallholder sector and contains information on anthropometrics of underfives and various socioeconomic characteristics of their households. This analysis is based upon 3000 households containing at least one underfive, with one child per household being selected for analysis. Height-for-age Z-scores (HAZ) are calculated using WHO standards, and analyzed using analysis of variance (ANOVA). Variation in nutritional ecology is investigated by examining statistical interactions among socioeconomic variables as they relate to HAZ and by comparing ANOVA models constructed within several sample strata. These strata are defined according to geographic region, size of cultivated area, child's sex, child's age and, for a subsample, ethnic/religious identification. The results demonstrate that significant two-way interactions exist between region, cultivated area, household labor availability and age of the child. For the total sample HAZ declines with increasing cultivated area among young children (less than 24 months) but improves with increasing cultivated area among older children (greater than or equal to 24 months). The overall trend for young children is region-specific, however, such that no generalizations can be made concerning the effects of region and cultivated area without taking the other factor and child's age into account. Similarly, cultivated area interacts with household labor availability among young children, such that more labor is associated with lower HAZ on plots less than 0.7 ha, but more labor is associated with higher HAZ on plots above 1.5 ha. The existence of variation in nutritional ecology is further borne out by the observed variation in multivariable ANOVA models constructed within various sample strata. It is concluded that significant variation in nutritional ecology does exist between various segments of society. This limits the usefulness of national sample surveys for selecting intervention options and for targeting interventions according to socioeconomic characteristics.

Making health policy management intersectoral: issues of information analysis and use in less developed countries

There is a growing awareness of the need to approach health problems intersectorally. This has important implications for health policy management, centrally so for the informations systems which should enable 'managers' to monitor performance and also provide feedback to those with broader policy responsibilities. Yet relatively little is being done to adjust the information systems to this new intersectoral awareness: the focus of health information systems remains the collection of health service data. Much of the information collected is not used to provide adequate feedback to planners and managers, and to influence programme implementation. The paper--which focuses on the problems in less developed countries--argues that more attention needs to be paid to analysing the expected links between interventions and outcomes, as well as to cost considerations. Flexible procedures are required to address locally or regionally relevant problems. Thought must be given to making information of interest to health workers by linking it to the outcomes of activities, and by enabling them to discuss the implications of findings. Community members may also be thus involved. Often such processes are wholly neglected. The paper examines institutional and political arrangements that influence the capacity to use information for management and policy making, and which need to be understood if information systems are to be broadened beyond the health sector. The paper ends by discussing the main indicators which have been proposed, and occasionally used, to broaden health monitoring in an intersectoral direction. It argues that much relevant information is being routinely produced by the various departments and discusses briefly how such information can be used to build up gradually an intersectoral information system for health.