Nutrition agenda setting, policy formulation and implementation: lessons from the Mainstreaming Nutrition Initiative

Abstract

Undernutrition is the single largest contributor to the global burden of disease and can be addressed through a number of highly efficacious interventions. Undernutrition generally has not received commensurate attention in policy agendas at global and national levels, however, and implementing these efficacious interventions at a national scale has proven difficult. This paper reports on the findings from studies in Bangladesh, Bolivia, Guatemala, Peru and Vietnam which sought to identify the challenges in the policy process and ways to overcome them, notably with respect to commitment, agenda setting, policy formulation and implementation. Data were collected through participant observation, documents and interviews. Data collection, analysis and synthesis were guided by published conceptual frameworks for understanding malnutrition, commitment, agenda setting and implementation capacities. The experiences in these countries provide several insights for future efforts: (a) high-level political attention to nutrition can be generated in a number of ways, but the generation of political commitment and system commitment requires sustained efforts from policy entrepreneurs and champions; (b) mid-level actors from ministries and external partners had great difficulty translating political windows of opportunity for nutrition into concrete operational plans, due to capacity constraints, differing professional views of undernutrition and disagreements over interventions, ownership, roles and responsibilities; and (c) the pace and quality of implementation was severely constrained in most cases by weaknesses in human and organizational capacities from national to frontline levels. These findings deepen our understanding of the factors that can influence commitment, agenda setting, policy formulation and implementation. They also confirm and extend upon the growing recognition that the heavy investment to identify efficacious nutrition interventions is unlikely to reduce the burden of undernutrition unless or until these systemic capacity constraints are addressed, with an emphasis initially on strategic and management capacities.

The politics of reducing malnutrition: building commitment and accelerating progress

“…In the past decade, several multicountry and single-country studies of such processes have been undertaken, in which conceptual and analytical frameworks have been applied. [15][16][17][18][19][20][21][22][23] These studies sought to uncover key structures, pathways, and dynamics of policy processes for nutrition, with an emphasis on challenges and constraints. In doing so, research from other specialties (eg, political science 24,25 and health systems 26 ) was drawn on to adopt and adapt analytical frameworks and research methods to study nutrition policy.…”

“…10,23,27 Moreover, translation of any such momentum into eff ect on nutrition status is far from automatic and needs the deliberate alignment of several factors and processes. 10,[18][19][20][21][22] Our review also emphasises three linked factors as being crucial for building and sustaining of momentum and for conversion of that momentum into results.…”

“…In Kenya and Bangladesh, this research shows that a handful of catalytic individuals, well-connected and trusted in their formal and informal social networks, 84,85 have played a crucial part in transfer of information, changing of perceptions, and resolving of confl icts; achievements that have proven essential to advance the nutrition agenda in the context of fragmentation and competing interests between and within various groups of stakeholders. 23,82,86,87 Preliminary fi ndings show that these individuals have, in addition to extensive knowledge and experience in nutrition, relatively strongly developed stakeholder awareness and perspective awareness. They show an understanding of the stakeholders relevant to nutrition policy processes and the associations among them, and tend to view the properties of their own and others' perspectives as perspectives with complex contributory causes.…”

Achieving a nutrition revolution for Africa: The road to healthier diets and optimal nutrition

“…A further lesson learned from this case study was that creating political will is fundamental to improving nutrition policy (Catford 2006;Pelletier et al 2012); thus, researchers need to be proactive in translating their research findings (Figure 9.1, step 4) and creating personal contact with policy makers, which is a major facilitator of translating research into policy (Brownson et al 2006). This case study also highlighted how priorities for developing nutrition-related policy will depend on the country's context …”

Using ethnography in implementation research to improve nutrition interventions in populations

“…2011; Pelletier et al . 2012), but we limit the focus on this paper specifically to research designed to improve implementation of nutrition interventions.…”