Policy content and stakeholder network analysis for infant and young child feeding in Nepal

Abstract

BackgroundDespite concerted effort from government and partners, Nepal continues to have a high burden of under nutrition among children. Identifying opportunities to strengthen policy support for infant and young child feeding (IYCF) is a key component to improve child survival, growth and development. This study aims to explore policy support for IYCF and to identify the influential stakeholders for IYCF for effective future policy development and programmatic action.MethodsPolicies relevant to IYCF were identified through web searches and direct approaches to relevant government ministries. Policy content was analysed based on four key domains focussed on mothers, using a qualitative synthesis approach. Three group interviews were conducted using the participatory tool “Net-Map”, to identify the influential stakeholders in IYCF policy and programming processes.ResultsTwenty-six relevant policy documents were analysed for content relating to IYCF. General support for IYCF was found in most of the development plans and high-level health sector policies. Most implementation level documents included support for provision of correct information to mothers. Capacity building of frontline workers for IYCN and system strengthening were well supported through sectoral plans and policies. However, gaps were identified regarding maternity protection, support for monitoring and evaluation, and translation of high-level policy directives into implementation level guidelines, resulting in a lack of clarity over roles and responsibilities.Both government and non-governmental stakeholders, particularly donors, emerged as influential drivers of IYCF policy decisions in Nepal, through technical assistance and funding. The Nutrition Technical Committee under the Ministry of Health, UNICEF, Suaahara, USAID and WHO were identified as key actors providing technical assistance. Key funding agencies were identified as UNICEF and USAID.ConclusionsThis study reveals strong policy support for key dimensions of IYCF, supported by a highly networked stakeholder environment. Opportunities to further strengthen IYCF policy in Nepal include: further support for training of frontline workers and complementary feeding interventions; extending maternity leave provisions; and clarifying roles and responsibilities of actors, particularly non-governmental actors. Engaging technical and funding agencies and developing partnerships with other relevant actors will be crucial for ensuring effective policy translates into effective practice.

An analysis of stakeholder networks to support the breastfeeding scale-up environment in Mexico

“…Net-Map is a participatory interview technique combining stakeholder mapping, social network analysis and power mapping activities. This technique was developed by the International Food and Policy Research Institute (IFPRI) and has been successfully used in the maternal-child nutrition field (14)(15)(16)(17)(18)(19)23,24) .…”

“…UNICEF, WHO/Pan-American Health Organization (PAHO), the World Bank, donor agencies, academics, nongovernment organisations (NGO), civil society organisations and consultants) rated breastfeeding as a high-political priority (13) . Stakeholder network analysis has been successfully used to inform explicit strategies to engage diverse stakeholders in the formation and implementation of infant and young child feeding policies in Southeast Asia (14)(15)(16)(17)(18)(19) . However, there is little information on how to garner political commitment towards implementing appropriate large-scale breastfeeding policies and programmes by systematically targeting key stakeholders and decision makers.…”

Analysis of stakeholder networks for breastfeeding policies and programs in Ghana

“…GHS and MOH), as indicated above, most of the networks included a diverse spread of actor groups. This diversity of actors has been previously demonstrated by social network mapping of actors working in infant and young child feeding elsewhere [16,22,23]. In India, network analysis at both national and subnational levels reported diverse actors across both government and non-government agencies, and also spanned multiple sectors including, social protection, health and nutrition, research, health, planning, population sciences, media and trade unions [22].…”

“…The current study mapped individual experiences of actor involvement in breastfeeding in Ghana. Although Net-Map interviews of individuals have been previously reported [15] and are considered valid [14], unlike a group Net-Map approach [16,23], it may limit the precision and validity of recall of the role of actors by the respondents. In group Net-Map exercises, participants have an opportunity to calibrate their opinions and experiences with each other and to arrive at consensus on actor roles, linkages, and influence.…”

“…Stakeholder analysis, power mapping, and social network analysis are tools that have been used previously to identify stakeholders and their influence on policies across diverse fields [ 14 – 16 ]. The International Food Policy Research Institute developed the Net-Map methodology which combines these three analytical methods [ 14 ].…”