The

base on nutrition
Weresearch
need to understand
the barriers to
governance,
actors
working at the interface of agriculture
is
to a handful of studies
andlimited
nutrition:
[and]
systematic
evidence
about processes
Using a variety
of methods,
we need to
related
find out
tothe
intersectoral
and these
multisectoral
following from
actors:
integration
of How
actions
is urgently
much
do they needed.
know about
nutrition?
Gillespie et al. (2013) Lancet paper 4
What do they think could be done?

PoSHAN policy process study

questions
(repeat panels, office holders, 20132017)
in context of national Multi-Sector
Nutrition Plan
1. What metrics effectively measure nutrition
governance?
2. Is stronger nutrition governance associated
with better
nutrition outcomes over time?
3

PoSHAN research field sites (21)

Sunaula Hazar
Multi-Sector Nutrition Plan

Level

Institution/Individual

National

Policy makers, donors, international nongovernmental organizations (NGOs),

academics

Regional

District

Regional Administrator, Ministries of Health,

Agriculture, Livestock, Education, Local
Development, Water Supply,
Departments of Health, Agriculture,
Livestock, Education, Local Development,
Social Development, implementing NGOs

N=
780
26
99
278

79

Ilaka

Offices of Health, Agriculture, Livestock,

Education, Local Development

Village
Developme
nt
Committee

VDC Secretaries of Health, Agriculture,

Livestock, Education, implementing NGOs

Ward

FCHV, Representative Ward Citizen Forum,

Representative MG, Representative
5 2013
Source: PoSHAN survey data
Cooperative/Groups

97
199

What is measured?
Commitment (willingness to act)
Understand and accept responsibility in multisector policy, senior management support, desire
to work across line ministries, incentives, etc.
Capacity (capacity to act)
Posts filled, adequate skills, purposive training,
frustrations, resources available, disincentives,
bureaucracy, etc.
Coherence (horizontal and vertical
collaboration)
Degrees of agreement on nutrition problems,
priority actions needed, joint ownership of

everyone see nutrition problems the same way

Food
Productio
n
Disease
Illiteracy
Poor
Breastfee
ding
Cultural
taboos

Min Min
Min. Min
Min
Wome
Agri Healt Wat Educati Local n in
c.
h
er
on
Dev. Dev.
44%
42
31
52
39
47

40
98
0

55
97
18

46
84
15

48
98
6

39
92
8

15
85
19

22

22

15

15

15

20
7

everyone see nutrition problems the same way

Food
Production
Disease
Illiteracy
Breastfeed
ing

High
levels
govern.
% (N
456)
48

Lower OR 95%CI
level
gov.
% (N
296)
44 1.22
0.907,
1.633
43
43 0.99
0.736,
1.329
80
66 2.11
1.509,
2.938
5
12 0.38
0.222,
0.661

Pvalue

0.1896
0.9438
<.000
1
0.000
48

ency of views on:

to promote cross-sector collaboration for nutri

Strong
management
support
Joint
responsibility
Mandatory
mechanism
Capacity

Highe
r
level
gov.
%
9

Lowe OR
95%CI
P-value
r
level
gov.
%
7 1.23
0.717,
0.4510
2.111

30

18

1.93

30

4.32

13

11

1.22

1.346,
2.760
2.775,
6.735
0.767,

0.0003
<.0001
9

0.3982

ency of views on:

to promote cross-sector collaboration for nutri

Strong
management
support
Joint
responsibility
Mandatory
working
mechanism

Health
sector
%
(n=12
3)
8

NonOR 95%CI
P-value
health
sector
% (n532)
9 0.87
0.429,
0.6935
1.754

23

26 0.85

15

23 0.58

0.544,
1.326
0.347,
0.964

0.4732
0.0340
10

ional multi-sector nutrition plan roll-out districts

11

sistency of views on:

challenges in multi-sector policy roll-out

Sufficiently
consulted on
nutrition issues
Freq. discuss
nutrition with
colleagues
Institutional
hurdles affect
collaboration
Colleagues in

MSNP All
OR
95% CI
P value
sites other
%
sites %
(n=65 (n=643
)
)
41
25 2.11
1.2800,
0.002
3.4631
40

24

2.1

49

28

2.47

58

41

1.95

1.2746,
3.4711

0.003

1.5145, 0.0002
4.0215
1.1989,

12

0.006

Consistency of views on:

challenges to effective multi-sector work
on
nutrition MSNP All

OR 95% CI
P
sites %

Lack financial
resources
Political
interference
Lack
coordination
Rely on
external aid,
donor driven

other
sites
%
37
49 0.62

5
14
10

15 0.33
9

1.7

12 0.82

valu
e
0.3771, 0.0
1.0218
4
0.1184, 0.0
3
0.9292
0.8277, 0.0
4
3.4894
0.3621, 0.0
1.8444
3
13

Districts with
best and least
changes in
stunting 20062011

14

istency of views on:

allenges across best vs worst performing districts

Feel unable to
respond
effectively
Discussed
stunting in past
month
Trained in ag/
lstock in past 3y
Trained in
nutrition

Most
improv
ed sites
%
34

OR 95% CI
P value
Least
improv
ed
sites %
58 0.3
0.210, 0.0004
7
0.640

25

11 2.6
7

1.248, 0.0095
5.688

15

8 2.0
4
19 0.4
1

0.838, 0.1109
3.023
0.182, 0.0311
0.939
15

Preliminary conclusions
1. Governance elements (commitment, capacity,
coherence) vary across sectors, levels of
government, and location. Must tailor incentives,
information, training.
2. Few (even MoA) claim that more food is the
solution to
nutrition problems. But little agreement on key
actions.
3. Expression of willingness to collaborate across
sectors; but
uncertainty on how to do that.

Ways forward?
1. Study of nutrition governance still in its
infancy. Methods and methodological
challenges must be widely shared.
2. Encouraging findings:
Its possible to measure policy processes
(motivation, commitment to collaboration
across sectors, willingness to act, capacity to
act).
Real action is at sub-national level.
Quality of nutrition governance linked
(measurably) to impact. Worth exploring
17
more.

Many collaborators