Harmonizing agriculture and health sector actions to improve household nutrition: policy experiences from Afghanistan (2002–2007)

Abstract

Coordination across sectors to address undernutrition with its varied underlying causes remains a challenge in developing countries. In Afghanistan, harmonization of health and agriculture policies and actions to reduce endemic undernutrition occurred during 2002-2007. This qualitative case study explores the forms of harmonization, enabling features and constraints in the policy process. We interviewed 57 stakeholders (39 central level, 18 provincial) involved in public nutrition or food security issues. Forms of harmonization included written policies, reseach, training and advocacy. Important features of the policy process included: policy entrepreneurs with operational and strategic capacity, consensus-building using a shared causal framework, working groups and strategic alliances. This case presents an interesting alternative to a national nutrition coordinating body, an approach that has met with mixed results, often due to the lack of authority, budget, and operational capacity of such a body to oversee ministries and enforce national nutrition objectives. Mid-level professionals mobilized into task forces achieved much with the support of national and international partners. This study highlights the importance of building capacity for sustaining change through local institutions.

Generating political commitment for ending malnutrition in all its forms: A system dynamics approach for strengthening nutrition actor networks

“…Another consistent finding in the literature is that NANs are more likely to be cohesive in the presence of leaders capable of managing complex relationships, conflicts, and competing interests among members, while increased cohesion can in‐turn reinforce the strength of leadership . Nutrition leaders enhance the strategic capacities (ie, “soft‐power” skills) of NANs and are thereby more capable of building internal cohesion and managing external commitment‐building activities across multiple sectors and levels . This resonates with the findings of a recent four‐country Sub‐Saharan Africa study that “boundary‐spanning actors” intentionally engaged in boundary‐spanning actions (eg, brokering, conflict resolution, coordinating, convening, diplomacy, framing, networking, and negotiating) are a feasible and acceptable approach to fostering policy action within complex multisectoral and multiagency nutrition governance contexts .…”

“…Consistent with the framework of Shiffman et al, an expansion in the number and diversity of members may enhance the strategic expertise and organizational capacities and resources available to NANs, although it may also increase the potential for conflict and fragmentation . Greater capacities may in‐turn support the production of robust data and evidence, thereby supporting actions to develop a unifying discourse and hence greater cohesion . The expansion of donor or government nutrition budgetary commitments, adequate funding, and effective financing have enabled many NAN activities .…”

“…This includes the capacity to contextualize and tailor messages to different target audiences, advocate for realistic changes aligned with decision‐maker priorities, utilize high‐level champions, and speak with a consistent and unified voice . Robust data systems (ie, comprehensive food and nutrition monitoring and surveillance systems) and evidence enhance strategic communication capacities by enabling the identification of nutrition problems (ie, to demonstrate severity, trends, and distributions), the identification of causal linkages between nutrition determinants and outcomes, by enabling accountability mechanisms (eg, the watchdog role of civil society), and advocacy for sustained commitment by making it possible to “demonstrate success.” In a five‐country study, for example, data demonstrating a high undernutrition burden and/or limited progress in addressing those burdens were the only consistent factor (out of 12) driving pro‐nutrition policy change within countries …”

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“…Ten years ago, Johnecheck and Holland (2007) envisaged a multisectoral approach to improving malnutrition in Afghanistan, while various other research outcomes have identified gaps between the agricultural and nutrition sectors, and highlighted the significance of food-based approaches to improving nutrition (Levitt, Pelletier and Pell 2009a;Levitt et al 2009b;Levitt et al 2010;Levitt et al 2011). Nevertheless, current policies do not emphasise the role of agriculture and food-based strategies for improving nutrition.…”

Leveraging agriculture for nutrition in South Asia and East Africa: examining the enabling environment through stakeholder perceptions

“…In a comparison of stakeholder priorities and perceptions of malnutrition in Afghanistan, Levitt et al (2009) found that agriculture and health sector stakeholders differed consistently in problem definition. Consensus-building using a shared causal framework, strategic alliances, and policy entrepreneurs with operational and strategic capacity were factors that allowed the policy process to proceed more successfully (Levitt et al 2011). …”