Food and Nutrition Policy

Food and Nutrition Bulletin

2018, Vol. 39(3) 449-464
ª The Author(s) 2018
Mapping Nutrition Interventions, Article reuse guidelines:
sagepub.com/journals-permissions
a Key Analytical Tool for Informing DOI: 10.1177/0379572118782881
journals.sagepub.com/home/fnb

the Multisectoral Planning Process:

Example From Burkina Faso

Maimouna Halidou Doudou, MD, PEDs, PhD1,

Ousmane Ouedraogo, MIPH, MSc1,
Bertine Ouaro, MIPH2, Nicolas Bidault, PhD3,
and Kristina Reinhardt, MPA3

Abstract
Background: The government of Burkina Faso, along with the United Nations Network for
Nutrition (UNN), activity REACH (Renewed Efforts Against Child Hunger and undernutrition)
partnership, conducted a mapping of nutrition interventions and stakeholders to identify the best
approaches for scaling up priority nutrition interventions and to strengthen a multisectoral response
to fight malnutrition.
Objective: The objectives include describing the process used to map a set of country-prioritized
nutrition interventions and to describe how the results contributed to the multisectoral nutrition
planning process in Burkina Faso.
Methods: The mapping exercise was designed as a cross-sectional study using the Excel-based
Scaling Up Nutrition Planning and Monitoring Tool (SUN PMT) to collect, store, and analyze
data.
Results: The results present different analyses produced by the SUN PMT for 29 prioritized nutrition
interventions. The analyses include the distribution of nutrition stakeholders for each intervention, the
calculation of geographic and population coverage for each intervention, and the utilization of delivery
mechanisms to reach beneficiaries.
Conclusions: The mapping of key nutrition interventions and stakeholders supporting those
interventions in Burkina Faso was an important tool in the multisectoral planning process. The
exercise made it possible to identify gaps and needs; launch a discussion on nutrition planning
and the scaling up of interventions; and mobilize sectors and development partners around
nutrition.

1
REACH, Ouagadougou, Burkina Faso
2
Ministère de la santé, Direction de la nutrition, Ouagadougou, Burkina Faso
3
UN Network for SUN/REACH Secretariat, Rome, Italy

Corresponding Author:
Kristina Reinhardt, Via Cesare Giulio Viola 68, Parco dei Medici, 00148 Rome, Italy.
Email: kristina.reinhardt@outlook.com
450
Keywords
Burkina Faso, planning, scaling up nutrition, coverage, mapping, multisectoral approaches, maternal and
child nutrition, United Nations Network for Nutrition (UNN)
Background
Malnutrition is a global crisis, where 1 in 3 people
is affected by some form of malnutrition in
almost every country in the world.1 It is recog-
nized by actors at the global level that the chal-
lenge of malnutrition is multicausal and requires
a multisectoral approach.2 However, the multi-
sectoral approach has been slow to materialize
on the ground. The multisectoral approach faces
challenges particularly when it comes to financial
allocations, implementation of interventions, and
program evaluation, all of which often tend to
reside within individual sectors.2 The complex
nature of nutrition requires a great deal of deter-
mination to approach planning multisectorally. It
also needs to be supported by the appropriate
tools to enable sectors to better prepare conver-
gent plans and implement nutrition services cohe-
sively. In recent years, there has been growing
momentum around multisectoral approaches to
nutrition, showing that a change of vision and
practice is taking place through the converging
of sectoral policies and plans that engender com-
mon nutrition goals.3 Several key initiatives, such
as the Scaling Up Nutrition (SUN) Movement,4
have helped to strengthen this remarkable prog-
ress at the country level. However, further work
to find the right processes and accompanying
tools is needed to see an impact on the ground.
In Burkina Faso, the government has demon-
strated its commitment to improving the nutri-
tional status of the population through several
measures. First, through creating the Conseil
National de Concertation en Nutrition (CNCN),
a multisectoral, multistakeholder platform for
nutrition coordination chaired by the Ministry of
Health; second, through participating in several
initiatives, such as the SUN Movement in June
2011 and the REACH (Renewed Efforts Against
Child Hunger and undernutrition) Partnership
under the United Nations Network for Nutrition
(UNN) in August 2014; and finally, through inten-
sifying nutrition interventions at the community
Food and Nutrition Bulletin 39(3)
level. However, these commitments have not led
to a significant reduction in the various forms of
malnutrition in Burkina Faso. For example, the
prevalence of stunting has been slow to decline
in recent years, seeing a reduction of only 2 per-
centage points between 2009 and 2012.5 Further-
more, the 2015 Cost of Hunger study in Burkina
Faso estimated that 40.1% of cases of infant mor-
tality were associated with undernutrition, 51.7%
of adults had stunting during childhood, and 5.8%
of children who repeated a year of school was due
to stunting.6 Stunting has a large impact on the
entire country and the Cost of Hunger study also
showed that the annual costs associated with child-
hood malnutrition in Burkina Faso were estimated
to be 409 billion XOF (roughly US$669 million),
corresponding to 7.7% of the GDP.6
Aware of the need to strengthen multisectoral
approaches to nutrition to achieve sustainable
improvements to the nutritional status of the Bur-
kinabe, the government has put in place a process
for joint planning for nutrition. The Nutrition
Directorate of the Ministry of Health convenes
sectors and partners to develop policies and plans
for validation by the CNCN. This process aims to
operationalize the multisectoral strategic plan for
nutrition, Plan Stratégique Multisectoriel en
Nutrition 2016-2020, which, in turn, will inte-
grate into a sectoral reform agenda to expand the
coverage of interventions and improve the quality
of nutrition services. The planning process aligns
with the commitments made by the government
at regional and international levels to combat
malnutrition. These commitments include the
Sustainable Development Goals and targets set
by the World Health Assembly.
To identify the best approaches for scaling up
priority interventions and to strengthen a multi-
sectoral response to fight malnutrition, the gov-
ernment, along with technical and financial
support from REACH, conducted a mapping of
prioritized nutrition interventions and stake-
holders working in nutrition. REACH, a joint
Doudou et al
initiative of 5 United Nations agencies (Food and
Agriculture Organization [FAO], World Food
Programme, World Health Organization, United
Nations Children’s Fund, and International Fund
for Agricultural Development), provides facilita-
tion, coordination, and technical support to gov-
ernments for the strengthening of nutrition
governance and multisectoral approaches to
nutrition interventions.7 The mapping exercise
aimed to collect data on a set of prioritized nutri-
tion interventions taking place in Burkina Faso
and provide evidence on which interventions took
place in each province, how each intervention
was delivered, and how many beneficiaries were
reached. Within the context of this exercise, an
intervention is an activity or a set of activities that
deliver a particular nutrition service to a particu-
lar set of quantifiable beneficiaries. For example,
the treatment of severe acute malnutrition tar-
geted at children younger than 5 years of age who
are identified as acutely malnourished. The
results of the mapping informed discussions
around scaling-up and sustainability of nutrition
interventions in the planning process.
Objective
The objective of this article is twofold. The first
objective is to describe the process used to map a
set of country-prioritized nutrition interventions
taking place across multiple sectors and involving
multiple stakeholders. The second objective is to
describe how the results of the mapping exercise
contributed to the multisectoral nutrition plan-
ning process in Burkina Faso.
Methods
The SUN planning and monitoring tool (SUN
PMT), which was developed by REACH with the
support of the Boston Consulting Group Social
Impact section, was used to collect, store, and
analyze data for the mapping exercise. The SUN
PMT is an Excel-based tool with embedded
macros allowing collected data to be analyzed
using automatic tables that calculate coverage.
The mapping exercise was designed as a cross-
sectional study and was carried out in 4 phases:
preparatory, data collection, data analysis, and
451
interpretation. Data collection took place from
March to June 2015 and collected data on inter-
ventions which took place during 2014. The
National Nutrition Directorate of the Ministry of
Health led each phase of the exercise.
Preparatory Phase
The first task was to inform and involve all
stakeholders from the onset of the process. Both
government and development partners were
included in the preparatory phase. From the
government, several departments across several sec-
tors participated in the introductory meetings. In
addition to government agencies, several other types
of organizations participated, including United
Nations (UN) agencies, Non-Governmental Organi-
zations (NGOs), associations, the private sector, the
academic sector, and donors. From the introductory
meetings, a multisectoral mapping team was estab-
lished. The team was made up of government focal
points from nutrition, agriculture, and statistics
departments as well as REACH facilitators and
UN agency focal points. For 2 weeks, 2 consultants
from the UNN/REACH Secretariat and FAO sup-
ported the team.
The mapping team led the process of identify-
ing the interventions to be included in the map-
ping. The process of identifying key interventions
started with review of the national nutrition Com-
mon Results Framework (CRF), which includes
45 key interventions aimed at reducing stunting
across 7 sectors and were identified at the
National Multisectoral Planning Workshop in
May 2014. Additional criteria were introduced
to refine the list of interventions to be mapped
in a working session held with the sector focal
points. The working session used the list of inter-
ventions defined in the 2008 Lancet series on
maternal and child undernutrition8,9 and addi-
tional considerations, including proven impact
at the individual and household levels, impor-
tance of scaling up each intervention to address
malnutrition, ability to quantify beneficiaries and
target groups for the intervention, and sustainabil-
ity of the intervention. The final list of 29 prior-
itized nutrition interventions to be mapped was
validated at a workshop organized by the Nutri-
tion Directorate (Table 1).
452 Food and Nutrition Bulletin 39(3)

Table 1. Prioritized Nutrition Interventions for Burkina Faso.

Intervention Category Intervention

Infant & young child feeding Promotion of optimal breastfeeding

Promotion of optimal complementary feeding
Micronutrients Vitamin A supplementation
Iron/folic acid supplementation
Acute malnutrition Management of severe acute malnutrition
Management of moderate acute malnutrition
Disease management Treatment of diarrhea with ORS and zinc
Deworming
Insecticide treated bed nets
Intermediate preventative treatment
Maternal health Antenatal care visits
Family planning Family planning services
Nutrition education Promotion of health, hygiene, and nutrition in schools
Food & agriculture Boutiques témoins
Promotion of kitchen gardens
Promotion of small-scale animal rearing
Promotion of nonwood forest products
Fortification of oil with vitamin A
Promotion of complementary foods made with locally produced products
Water & sanitation Promotion of community-led total sanitation
Promotion of handwashing with soap
Infrastructure for improved sanitation
Infrastructure for improved water sources
Treatment of household water supply
Social protection Conditional cash transfers
Nonconditional cash transfers
Exemption of health expenses for children under 5 years
Enrolment and retention of girls in school
School feeding with a nutrition objective
Abbreviations: ORS, oral rehydration salts.

The SUN PMT was then customized to Data Collection Phase

include the 29 prioritized nutrition interventions
The data needed for the mapping was divided into
specific to the country. The next step in custo-
2 parts. The first part was the collection of pop-
mization included assigning specific target
ulation data. The National Institute for Statistics
groups and delivery mechanisms to each inter-
and Demographics (INSD) and statistics officers
vention. The geographical areas (13 regions and
from different sectors provided data on the total
45 provinces) of Burkina Faso were added in
population for each target group (eg, children
order to collect data at the province level. The
younger than 5 years of age or pregnant women).
final aspect of customization was adding nutri-
These data were used as the denominators for the
tion situation indicators (eg, stunting, wasting,
population coverage calculations.
anemia in children and women, and food inse-
The second part comprised data collection on
curity), which were linked to specific interventions
the prioritized nutrition interventions. The data
according to which intervention is expected to
collected used the province as the unit of mea-
have an impact on each situation indicator. The
surement by recording which province(s) an
inclusion of the situation indicators helps to iden-
intervention was implemented in, the number of
tify priority areas and gaps in coverage important
beneficiaries reached in each province, which
for the planning process.
Doudou et al
partner organizations were involved, and which
delivery mechanisms were used to reach benefi-
ciaries. The data for this part were collected from
stakeholders, which provided both qualitative and
quantitative data on the interventions each stake-
holder supported.
Stakeholders who participated in the
mapping were identified through several sources,
including the Ministry of Health’s Nutrition
Directorate, the Office for the Coordination of
Humanitarian Affairs database, implementing
partners of donor and United Nations agencies,
and government registered associations and local
NGOs. Other organizations came forward to par-
ticipate due to word of mouth. All stakeholders
were informed of the objectives of the exercise
and were free to participate. The process of iden-
tifying stakeholders used all available pathways.
The only cases where stakeholders were excluded
from the mapping were if they were not support-
ing one or more the 29 prioritized nutrition inter-
ventions in 2014.
The data were collected from stakeholders
through a 3-step process. First, an Excel-based
questionnaire was shared electronically. Next,
interviews were conducted in-person or over the
phone to assist the stakeholder to complete the
questionnaire. Finally, the questionnaires were
returned to the mapping team. As completed
questionnaires were received, the data from each
stakeholder was entered into the tool. The data
collection process lasted 2 months.
Data Analysis Phase
Over a 1-month period, the data analysis phase
was conducted. The first step of the analysis
phase consisted of a thorough examination of all
the data collected and cleaning of any inconsis-
tencies and duplications within the database.
Errors were identified using the automated tables
within the tool to find interventions that were
reported by 2 or more partners working together.
In the case where coverage calculations were
above 100% at the province level, inspection of
each data point for that intervention was per-
formed. Duplications were identified through
examination of stakeholder partnerships across
entries. Entries where there was repetition of
453
intervention, target group, geographic area, and
stakeholders were considered duplications and
removed from the system after verification with
applicable stakeholders.
Once the database was cleaned, 2 types
of coverage were calculated according to the
following formulas:
Geographic coverage ð%Þ
Number of provinces reached by intervention
¼
Number of total provinces
 100:
Population coverage ð%Þ
Number of individuals in target group
reached by intervention
¼
Total target population for a target group
 100:
The geographic coverage refers to the per-
centage of provinces where the intervention is
implemented out of the total number of prov-
inces within a region or the country. The popu-
lation coverage refers to the percentage of target
population in the province reached by the inter-
vention over the total target population in that
same province, which is calculated based on the
sum of the number of beneficiaries reached by
partners supporting each intervention and is
derived from routine government data and part-
ner program data, discounting for duplicates.
The total target population of a particular target
group is derived from population estimates for
2014 provided by INSD. This coverage refers to
a “delivery” coverage of services delivered to a
target population divided by the total target pop-
ulation. It is different from coverage obtained
from sampled households or individuals through
household surveys.
Interpretation Phase
The automated tables in the tool allowed for
direct generation of the results at the national and
subnational levels, which help to highlight gaps
in coverage of interventions across stakeholders
and among delivery mechanisms. The presenta-
tion of results used maps, tables, and figures to
highlight the key results.
454 Food and Nutrition Bulletin 39(3)

Table 2. Distribution of the Organizations Involved in the Mapping in Burkina Faso, by Stakeholder Type.

Number of Initially Number of Additional Total Number Number of Questionnaires

Stakeholder Type Planned Interviews Interviews Conducted of Interviews Completed and Returned

Government 18 1 19 19
International NGOs 30 11 41 41
National NGOs 11 32 43 34
UN agencies 6 0 6 6
Bi/multilateral 9 23 32 32
organizations and
foundations
Total 74 67 141 132

Abbreviations: NGOs, Non-Governmental Organizations; UN, United Nations.

Intervention coverage was compared to nutri-
tion situation indicators in a matrix to identify
priority geographic areas and target populations
that were underserved and needed to be addressed
during the national planning process. At the Sta-
keholder Validation Workshop, results and key
messages helped fuel discussions on analyzing
current coverage of beneficiaries at the province
level, formulating assumptions for how to
improve coverage for provinces most in need,
evaluating options for improving implementation
of interventions, and the development of the
Multisectoral Strategic Plan for Nutrition (2016-
2020). Furthermore, discussions also included
analyzing programmatic approaches for scaling
up, as well as strategies for reducing costs of
interventions where possible.
Results
The results section presents the different analyses
produced by the SUN PMT, including the presen-
tation of nutrition actors for each intervention, the
calculation of geographic and population cover-
age for each intervention, and the use of delivery
mechanisms.
Completeness of Data
Of the 141 stakeholders contacted, 132 completed
the questionnaire. The response rate was 93.6%.
Table 2 provides a summary of the stakeholders
who participated in the mapping exercise. In all,
52.5% of the stakeholders included were identi-
fied prior to the interviews, while the remaining
were identified during the interview process
through other stakeholders.
Landscape of Nutrition Actors across
Multiple Sectors
The stakeholders included in the mapping fill dif-
ferent roles in the implementation of interven-
tions, which are classified into 4 categories.
(1) The responsible ministry is in charge of the
institutional framework and the overall leadership
of the intervention and plays a leading role in the
planning, implementation, and monitoring and
evaluation (M&E) of the intervention. (2) The
field implementer is responsible for the direct pro-
vision of the intervention to the beneficiaries; this
category often includes government agencies and
may include local NGOs or associations. (3) The
catalyst provides technical support in the form of
guidance and capacity development; this cate-
gory often includes bi/multilateral organizations
and UN agencies as well as international NGOs
supporting the government or subcontracting
with other organizations. (4) The funder provides
financial support and most often include bi/multi-
lateral organizations, foundations, or the govern-
ment. It is important to note that some partners
could play multiple roles simultaneously for the
same intervention.
The distribution by type of intervention
differentiating between nutrition specific and
nutrition sensitive allows examination of nutri-
tion interventions either directly addressing mal-
nutrition or addressing the underlying causes of
malnutrition. Nutrition-specific interventions are
Doudou et al
Figure 1. Who does what? Where? How many provinces reached? A, Management of severe acute malnutrition
(nutrition-specific action). B, Access to portable water (nutrition-sensitive action).
defined as interventions that have a direct impact
on nutrition status,10 while nutrition-sensitive
interventions are defined as interventions that
have an indirect impact on nutrition outcomes
through underlying and basic causes.10 Figure 1
provides an example of the distribution of stake-
holders for a nutrition-specific (Figure 1A) inter-
vention and a nutrition-sensitive (Figure 1B)
intervention; management of severe acute malnu-
trition and improvement of access to safe drink-
ing water. Of the provinces across the 13 regions
in Burkina Faso, the examples in Figure 1 show
that most regions are covered by the presence of
the stakeholders supporting these interventions;
however, most stakeholders are concentrated in
the North, Sahel, Center-North, and East regions.
Mapping the presence of stakeholders at sub-
national level is critical to understanding whether
stakeholders are strategically placed to serve
455
populations most in need. Across all interven-
tions, we find that few stakeholders cover all
provinces, particularly for nutrition-sensitive
interventions (Table 3).
Geographic Coverage
The results of the mapping show that many
nutrition-specific interventions have satisfactory
geographical coverage; 11 nutrition-specific
interventions of 12 are taking place in more than
75% of provinces. Nutrition-specific interven-
tions being implemented in all provinces include
vitamin A supplementation for children, iron–
folic acid supplementation for pregnant women,
deworming for children, and management of
acute malnutrition. However, the geographical
coverage needs to improve for other nutrition-
specific interventions, including promotion of
456 Food and Nutrition Bulletin 39(3)

Table 3. Distribution of Partners according to the Type of Intervention and Geographical Coverage Range.

Number of Stakeholders by Geographic Coverage Range

Stakeholder Type Type of Intervention <25% 25% to <50% 50% to <75% >75%

Government (n ¼ 19) Specific 1 1 1 12

Sensitive 0 7 3 3
International NGOs (n ¼ 41) Specific 40 0 0 4
Sensitive 36 1 0 0
National NGOs (n ¼ 34) Specific 32 3 0 1
Sensitive 29 3 0 0
UN agencies (n ¼ 6) Specific 4 0 1 4
Sensitive 1 2 0 0
Bi/multilateral organizations Specific 31 1 0 3
and foundations (n ¼ 32) Sensitive 28 1 0 0
Abbreviations: NGOs, Non-Governmental Organizations; UN, United Nations.

exclusive breastfeeding (86.6%), promotion of supplementation for pregnant women, deworm-

complementary feeding (80.0%), treatment of
diarrhea with oral rehydration salts (ORS) with
zinc (77.7%), and distribution of insecticide-
treated nets (53.3%). For most nutrition-
sensitive interventions (10 of 17), geographic
coverage is between 25% and 50%. For example,
the provision of materials for household water
treatment reaches 17.8% of provinces. There
were no data available from stakeholders for
some interventions, including promotion of home
gardens, promotion of use of nontimber forest
products, and boutiques témoins (shops providing
access to low-priced cereals). Table 4 shows the
geographic coverage results for a selection of
interventions. Provinces in Sahel, North, and East
regions have low geographic coverage; however,
these regions have the highest burden of
malnutrition.
Population Coverage
The coverage of beneficiaries differs across inter-
ventions, with some interventions having more
than 1 beneficiary group. The results showed that
population coverage is satisfactory for 5 of 12
nutrition-specific interventions, where coverage
of the intended target group is >75%. As with
geographic coverage, nutrition-specific interven-
tions tend to have the highest population cover-
age. These interventions include vitamin A
supplementation for children, iron–folic acid
ing in children, and treatment of children having
diarrhea with ORS with zinc supplementation. In
contrast, most nutrition-sensitive interventions
have low population coverage, except for the
intervention promoting the consumption of
locally produced flour for complementary foods.
In general, it seems that there is more of a priority
placed on nutrition-specific interventions, poten-
tially because they directly address malnutrition
and can produce results in a relatively short
period of time compared to nutrition-sensitive
interventions.
Geographic Coverage and Population
Coverage
When considering geographic and population
coverage simultaneously, the results can be
divided into 3 categories: (1) interventions with
both high geographic and population coverage
(above 75%), including interventions such as
vitamin A supplementation and iron/folic acid
supplementation (Table 4 A); (2) interventions
with high geographical coverage (above 75%) but
low population coverage (less than 50%), includ-
ing interventions such as intermittent preventive
treatment for malaria during pregnancy, family
planning services, and conditional cash transfers
(Table 4B); and (3) interventions with low geo-
graphic and population coverage (<50%), includ-
ing interventions such as promotion of home
 Table 4. Geographical Coverage, Population Coverage, and Delivery Mechanisms.
Number of Coverage
Provinces of Target
Prioritized Nutrition Interventions Covered (%) Target Group Group Delivery Mechanisms

(A) High geographic coverage and high population coverage

Micronutrients Vitamin A Supplementation 45/45 (100) Children 6-59 months CHWs, health centers, mass media, home visits
Iron/folic acid supplementation 45/45 (100) Pregnant women CHWs, health centers, health districts, hospitals, mass media
Management of Acute Management of severe acute malnutrition 45/45 (100) Children 6-59 months CHWs, associations, health centers, health districts, hospitals,
Malnutrition NGOs
Deworming 45/45 (100) Children 12-59 months Centre for health and social advancement, health districts,
schools, handwashing days, mass media, CBOs, home visits

(B) High geographic coverage and low population coverage

Maternal Health Intermediate preventative treatment 45/45 (100) Pregnant women CHWs, health centers, health districts, hospitals, mass media
Family planning 45/45 (100) Women of reproductive CHWs, associations, health centers, health districts, learning
age (15-49 years) and monitoring practices group, hospitals, mass media,
CBOs, NGOs
Social Protection Conditional cash transfers 42/45 (93) Very poor households11 Associations, local authorities, government, town council,
NGOs, public animal husbandry technical services, targeting
Poor households11
survey
School feeding 45/45 (100) Primary school students Management committee, schools, NGOs, public education
technical services, nutrition gardens
(C) Low geographic coverage and low population coverage
Nutrition Education Promotion of health, hygiene and nutrition in 15/45 (33) Primary school students Schools, nutrition gardens, mass media, NGOs, CBOs, public
schools technical services for sanitation and hygiene, local authorities
Food & Agriculture Nonwood forest products 18/45 (40) Women’s groups No data Associations, local authorities, government, NGOs, CBOs,
available village development committees
Households
Fortification of oil with vitamin A 4/45 (9) Poor households Small and medium enterprises, NGOs
WASH Handwashing with soap 26/45 (58) Mothers of children 0-59 CHWs, associations, health centers, local authorities, health
months districts, schools, handwashing days, NGOs, CBOs,
Primary school students billboards, public technical services for sanitation and
hygiene, home visits, mass media
Households
Social Protection Enrolment and retention of girls in school 16/45 (36) Female primary school Associations, government, NGOs, public education technical
students services, schools

Legend: 100%-75% <75%-50% <50%-25% <25%

457
Abbreviations: CBOs, Community Based Organizations; CHW, Community Health Workers; NGOs, Non-Governmental Organizations; WASH, water, sanitation and hygiene.
458
Figure 2. Geographic coverage of nutrition-specific
and sensitive interventions.
Figure 3. Population coverage of nutrition-specific
and sensitive interventions.
gardens; promotion of health, hygiene, and nutri-
tion in schools; fortification of oil with vitamin A;
and distribution of insecticide-treated nets
(Table 4C).
As illustrated in Figures 2 and 3, the results
showed that for nutrition-specific interventions,
the geographic coverage is high (above 75% for
the majority of the interventions), and population
coverage is variable but in general above 50%.
For nutrition-sensitive interventions, the geo-
graphic coverage is lower, between 25% and
75%, and population coverage is low (<25%).
Delivery Mechanisms
Delivery mechanisms are variable across sectors
(see Table 4 and Figure 4). Across both nutrition-
specific and nutrition-sensitive interventions, we
observe the involvement of community-level
actors (ie, community health workers,
community-based organizations, or associations),
mass media, and NGOs. Local authorities and
Food and Nutrition Bulletin 39(3)
technical public services are more often involved
in nutrition-sensitive interventions.
Identified Needs Based on Geographic
and Population Coverage
Most prioritized nutrition interventions mapped
are implemented across most regions in Bur-
kina Faso; however, they only reach a small
proportion of the target population (Figure 5).
A typical child younger than 5 years of age in
Burkina Faso receives 5 of 18 interventions
directed toward children, although the needs
based on the nutritional situation vary depend-
ing on the child. At the decentralized level,
children are much more likely to receive more
of the needed interventions in 3 regions (Sahel,
North, and East), where the highest number of
interventions reach at least 75% coverage of
beneficiaries.
Coverage of interventions to combat malnutri-
tion are not always correlated with the prevalence
of different nutrition indicators at the regional
level, particularly when examining the stunting
situation. Figure 6 shows the regions as a function
of the number of prioritized nutrition interven-
tions with at least 30% of population coverage
and the prevalence of stunting. This figure high-
lights 4 quadrants: (1) areas where the coverage
of interventions need to be maintained and there
is an acceptable nutrition situation; (2) areas
where the coverage of interventions need to be
monitored and have low levels of stunting; (3)
areas where the coverage of interventions need
to be investigated because there are high levels
of stunting; and (4) areas where the coverage of
interventions need to be scaled up because of high
levels of stunting and low population coverage of
many interventions. Many areas in Burkina Faso
should be monitored because they have a noncri-
tical nutritional status, although they have a low
population coverage of many interventions. How-
ever, there are several regions (Southwest, Cas-
cades, Center-East, North, and East), where the
prevalence of stunting is above critical public
health thresholds but the population coverage of
mapped nutrition interventions is low. These
regions need to consider strategies for scaling
up interventions that better address the nutrition
Doudou et al 459

Figure 4. Delivery mechanisms per intervention type.

Figure 5. Coverage of child-centered intervention. A, A typical child in Burkina Faso receives about 5 actions they
may need. B, On average, children in North, Sahel and East regions receive more actions than in other regions.

situation. Moreover, the Sahel region needs fur- Discussion

ther investigation to determine why the coverage
of interventions is not enough to address the
nutrition situation. A better understanding of the
situation, bottlenecks, and the implementation of
interventions, particularly in terms of quality, is
necessary. It was also found that despite the high
coverage of interventions responding to anemia
in children across different regions, prevalence of
anemia remains extremely high.
The 2016 Global Nutrition Report highlights that
some countries, which have fared better than oth-
ers in overcoming the barriers to implementation
of nutrition interventions and achieving high cov-
erage rates in nutrition programs, have also devel-
oped strategic multisectoral nutrition plans.1 The
REACH Partnership under the UNN supports
countries in this regard and provides country part-
ners with effective tools and facilitation support
460
Figure 6. Regional assessment of population coverage and stunting (source: SMART 201411) Prevalence of
stunting (%).
to develop multisectoral plans with the participa-
tion of all stakeholders.7 As in many countries
who are part of the SUN Movement, Burkina
Faso has been using a process for multisectoral
nutrition planning since 2014, supported by sev-
eral analytical exercises, including the mapping
of stakeholders and nutrition interventions. The
SUN PMT, used in the mapping, is dynamic and
adaptable to the context, making it possible to
easily aggregate and calculate coverage for a
variety of intervention types. In the case of Bur-
kina Faso, the mapping provided a first step and
evidence-based approach to understanding the
scale of nutrition interventions. It is expected
that the mapping will be repeated in subsequent
years, since the tool can track across years with
few updates needed. This allows the one-time
mapping of stakeholder and interventions to
transform into a multisectoral and multistake-
holder implementation monitoring system and
further strengthens the routine data landscape.
There were 2 main limitations observed during
the mapping exercise. The first was the risk of
Food and Nutrition Bulletin 39(3)
duplication of the same intervention being
reported multiple times, and the second was the
insufficient quality of the data provided by some
stakeholders. There was an attempt to identify
and eliminate duplication throughout the data col-
lection and cleaning processes in order not to
overestimate population coverage. To improve
data quality and avoid duplication, several steps
were taken. First, before starting the interview
process, the stakeholders were categorized by
type (field implementer, catalyst, funder, and
responsible ministry) and their partners identi-
fied. This helped to make an initial mapping of
how stakeholders may be working together so
that information on a single instance of an action
was not recorded twice. Second, during data
entry, the entries from stakeholders were verified
with reporting stakeholders through additional
interviews when potential duplication of inter-
ventions across partners was noted. Third, during
data cleaning, the automated tables presenting
stakeholders by role and population coverage per
province were used to further identify potential
Doudou et al
instances of duplication. If duplicate interven-
tions were found, one would be removed from
the database insuring that none of the qualitative
data were lost before deleting. An additional part
of data cleaning was to ensure that spelling and
abbreviations are always the same for the names
of stakeholders.
The second limitation of the exercise was the
completeness of the data from all stakeholders.
As the government was leading the mapping
exercise, all partners were urged to share infor-
mation regarding their projects and programs.
Once the data were processed, it was shared with
the partners who reviewed their data for accuracy
and verified with their partners. This approach
strengthened the inclusion of partners in the exer-
cise. The 6.3% of stakeholders not considered
were excluded because another partner had
already reported their activities.
The review of the literature related to stake-
holder and nutrition intervention mapping was
inconclusive, as most of the articles found were
concentrated on individual interventions and used
varying methodologies, many using a more qua-
litative nature.12-17 The tools with methodologies
most similar to the methodology used by the
SUN PMT use Semi-Quantitative Evaluation of
Access and Coverage (SQUEAC) or Simplified
Lot Quality Assurance Sampling Evaluation of
Access and Coverage (SLEAC) methodologies.
These tools are used by NGOs to determine cov-
erage of programs managing treatment of acute
malnutrition in targeted geographic areas through
the use of routine program data and small-scale
surveys.18 The SUN PMT allows for more flexi-
bility by allowing for a variety of interventions to
be mapped, differing from SQUEAC and SLEAC
methodologies, which are focused on a single
intervention. The SUN PMT has been used in
several countries (Ghana, Uganda, Tanzania,
Rwanda, Senegal, Niger, and Mali). Resources
and examples have not been published in scien-
tific journals, but they are available on the
REACH website.19
Our article seems to be the first to attempt to
show how the collection and analysis of coverage
of interventions based on program data from both
the government and the partners has contributed
to the multisectoral nutrition planning process
461
and can be a vital tool in the accountability of
both governments and partners toward achieving
nutrition targets. This exercise was carried out at
a time when the Government of Burkina Faso
initiated the multisectoral nutrition planning pro-
cess, and the results of the exercise could support
data-driven decision-making and planning pro-
cesses. The exercise enabled stakeholders to bet-
ter identify nutrition needs and to provide
background analysis from which to further
explore during the planning process. For exam-
ple, bringing together intervention coverage and
investments with a view to understand whether
low coverage is due to low funding allocation.
Overall mapping results provide useful evidence
to start a meaningful dialogue on interventions
and areas to be prioritized for scaling up that have
the greatest potential to have a sustainable impact
on the nutrition status of key populations.
Planning for nutrition in Burkina Faso began
with the development of the CRF, which serves as
the basis for the development, harmonization, and
approval of a multisectoral strategic plan for
nutrition. The CRF prompts actors to agree on
who is responsible for the implementation of cer-
tain interventions and how to achieve the
expected results.20 The mapping exercise helped
to bridge the gap between the CRF and the multi-
sectoral nutrition plan by providing data on the
current statue of nutrition actions in the country.
The results were used to define common objec-
tives, identify needs, select priority interventions,
and set targets. The results also facilitated discus-
sions for scaling up key interventions and trig-
gered further analysis including on budget and
funding allocation. Through these discussions,
several definitions of “scale up” emerged differ-
ing across sectors and spanning both the capacity
development and means of implementation. Def-
initions of scaling up have also been described by
several authors. 3,20-26 The Global Nutrition
Report 2014 referred to scaling up as a process
to maximize the scope and effectiveness of a
range of relevant nutrition interventions leading
to a sustainable impact on nutrition outcomes.27
The availability of information on the cover-
age of interventions has been crucial in the plan-
ning process in Burkina Faso. According to
Bhutta et al,28 attention must be paid to coverage
462
data as it is an important means of assessing the
presence of interventions on the ground. The
results of the mapping have shown that there are
still issues to address regarding the coverage of
beneficiaries despite having good coverage of
provinces. This divergence of coverage can be
explained by the fact that partners are rarely
implementing nationally and that the heterogene-
ity of partners differs across interventions.
In the analysis of the mapping results, the pop-
ulation coverage of interventions was examined in
comparison to situation indicators at the regional
level in order to better align priorities with
decision-making. For example, coverage of inter-
ventions that address anemia were compared to the
level of anemia in children at the regional level.29
The results help to distinguish that there are
regional discrepancies between the prevalence of
anemia and the interventions being implemented
that have the potential to affect the prevalence of
anemia. Another area where there were regional
discrepancies was between the prevalence of wast-
ing11 and interventions that both treat and prevent
acute malnutrition. Comparisons of this effect
helped to further define the priorities areas within
the CRF. Information from the mapping coupled
with the results of the Cost of Hunger study6 serves
as an advocacy tool for integrating nutrition into
the government’s agenda.
In view of the usefulness of mapping in the
nutrition planning process, the government has
introduced it as a key element of their M&E
system. The mapping will be carried out on a
regular basis of every 2 years. The importance
of mapping on a regular basis makes it possible
to analyze trends in coverage to ensure contin-
uous progress. Coverage data should however
be triangulated with coverage data from house-
hold surveys for better analysis of results and
to guarantee quality and sustainability of inter-
ventions implemented. This will be the subject
of a future article.
Conclusion
The mapping of key nutrition interventions and
stakeholders supporting those interventions in
Burkina Faso was an important tool in the multi-
sectoral planning process. The exercise made it
Food and Nutrition Bulletin 39(3)
possible to identify needs, promote an evidence-
supported planning process in order to scaling up
interventions, and mobilize sectors and develop-
ment partners around nutrition. The Multisectoral
Strategic Plan 2016 to 2020 was developed as a
planning document based on objective informa-
tion, and the implementation of the plan will
undoubtedly improve the nutrition situation in
Burkina Faso. The regular application of the map-
ping exercise will make it possible to continue to
monitor the implementation and coverage of the
prioritized nutrition interventions in the strategic
plan over time and compare with trends in the
nutrition situation in order to make sure there is
continued impact.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest
with respect to the research, authorship, and/or publi-
cation of this article.
Funding
The author(s) disclosed receipt of the following finan-
cial support for the research, authorship, and/or publi-
cation of this article: The mapping exercise was funded
by Global Affairs Canada (GAC).
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