Multisector Nutrition Program Governance and Implementation in Ethiopia

Abstract

Governments globally are stressing both direct nutrition interventions combined with nutrition sensitive policies and programs to combat malnutrition. Governance at all levels has been identified as a critical element in ensuring success of national nutrition plans. For example, the most recent National Nutrition Program (NNP) in Ethiopia discusses the essentiality of governance and coordination at all levels. The research uses a qualitative study based on semi-structured interviews with key informant. The research discussed in this article focuses on governance structures from national to regional to district level in Ethiopia with an emphasis on translation of a strategy and implementation of the NNP. This article concentrates primarily on results from the national and regional levels. Data at both the national and regional levels indicate that there is general agreement on the nature of the nutrition problems in Ethiopia. At all levels of government, under nutrition, food insecurity, and micronutrient deficiencies were listed as the main nutrition problems. The challenges in governance and implementation identified at both the national and regional levels, however, varied. The implementation of the 2013 NNP was in its early stages at the time of this research. While there was palpable energy around the launch of the NNP, respondents indicated issues related to leadership, coordination, collaboration, advocacy, and budget would be challenges in sustaining momentum.

Linkages between health and agriculture sectors in Ethiopia: a formative research study exploring barriers, facilitators and opportunities for local level coordination to deliver nutritional programmes and services

“…However, consistent with our findings, a study on nutrition governance in Ethiopia that explored the views of actors at central and regional levels also found limited knowledge of the National Nutrition Programme, with large differences reported between sectors in their level of awareness [15]. Of those who were aware of the programme, representatives of non-health sectors were more likely to report the view that their own sectors were not required to contribute to improved nutrition outcomes.…”

“…Of those who were aware of the programme, representatives of non-health sectors were more likely to report the view that their own sectors were not required to contribute to improved nutrition outcomes. For example, representatives from the Federal Ministry of Agriculture perceived the National Nutrition Programme to be a health sector initiative and did not identify a clearly defined role for agriculture [15].…”

“…Provision of information and tools alone is unlikely to be sufficient and advocacy may be needed to sustain commitment and to improve cohesion and coordination [19]. Identifying "champions" who are empowered to advocate for the nutrition agenda may be essential [15], especially to support changes in the views of staff from sectors that have not traditionally prioritised nutrition-sensitive objectives or interventions. It has also been recommended that systems of incentives and accountability are adopted to mainstream nutrition-sensitive approaches within sectors [20]; successful multi-sectoral coordination structures will also depend on such features [21].…”

Changes in the policy environment for infant and young child feeding in Vietnam, Bangladesh, and Ethiopia, and the role of targeted advocacy

“…The content of the revised NNP is considered technically sound, and the document incorporated many evidence-based recommendations from international actors, especially an emphasis on prevention of chronic malnutrition alongside measures to treat severe acute malnutrition. The execution of the strategy outlined in the NNP at local levels, where implementation takes place, is considered to face multiple challenges [25]. Similarly for IYCF, while there is a high-level strategy in place, it lacks completeness (for instance ratification of the Code), and a challenge has been a lack of updated IYCF guidelines for use by frontline practitioners.…”

Nutrition Security and Sustainable Development Goals in Africa

“…Emerging evidence shows strong association between poor WASH standards and stunting 20,27 , and likewise a number of ongoing studies show links between agriculture, nutrition and health 26,28,29 . In many settings, however, nutrition-sensitive strategies implemented as part of development programs have largely remained vertically implemented 30,31 .…”