Evaluation of the dynamics of national nutrition program implementation in Ethiopia

Masresha TessemaNNP dissemination conference

Adama, Ethiopia, Oct 23-25/2014

Background

• National Nutrition Strategy – 2008

• National Nutrition Program – 2008

• Revised National Nutrition Program – 2013

Objectives

• To assess facilitators and constraints in the implementationof NNP

• To examine cross sector coordination at the federal andregional level in the context of NNP

• To assess the interactions and linkages at federal andregional level

• To assess how programs get translated from the designphase (on paper) to the implementation phase (in practice).

Method

•key informants interview –National/ Federal level – 24 interviewees

– Sub-national/Regional level – 307 interviewees

• 4 Regions

• 11 Zones

• 18 Woredas

Semi-structured tool was used

Analysis

Domains

– Nature of the nutrition problem

– Decision making and ownership

– Program Design and Implementation

– Challenges in implementation

Sectors– Health sectors

– Economic sectors: Agriculture, Trade and Industry, Finance and Economic Development, Small scale enterprise, Cooperative Union, Water and energy

– Social-sectors: Administrative, Education,Women and child affair, civil service and

good governance , early warning and foodsecurity

– Development Partners:

Nature of Nutrition Problem

• Consensus at all levels :

• Food Insecurity

• Undernutrition (particularly stunting)

• Micronutrient deficiency and DD• Low awareness

• Sub-national level:– Economic and Social sectors identified food insecurity as major

problem as compared to health sector

– Most health sector and partners identified undernutrition and micronutrient deficiencies where as they were less likely to be identified by economic and social sectors.

“Our area is one of surplus producing zone in theregion but we give less focus for dietary quality anddiversity rather worried about selling quality tomake more money”, health sector

“Nutritional problem is related with lack of knowledge andfood insecurity. The problem is not only observed in foodinsecure area but also existed in food secured area dueto lack of knowledge and awareness”, Economic sector.

Decision making and ownership of NNP and NNS

• Consultation during development of NNP

–The formulation of NNP 2013 was more inclusive than the NNP 2008

–At federal level most of sectors and partners were involved in the designing of NNP

Decision making and ownership of NNP and NNS

–Majority (more than 70%) of the interviewedat regional, zonal and district level of thehealth sector were consulted on nutritionand it was lower participation for social andeconomic sectors (below 25%).

–Role of global initiatives and movements (Nutrition 1000 days, SUN, REACH) and partners were instrumental.

…..Decision making and ownership

• Attention given on nutrition – All of the interviewees from health sector’s said that

sufficient attention and resources was given for nutrition whereas most from economic and social sectors believe other wise .

• Knowledge on NNS and NNP– At national/federal level all sectors know about the

NNS/NNP where as it as low at sub-national/regional level.

– A wider gap was observed in social and economic sector: • Health sector and partners at the sub-national level are

aware of NNP and NNS as compared to economic and social sector

Knowledge on National Nutrition Strategy

0

10

20

30

40

50

60

70

80

90

100

Health Economic Social Partners

Do you know the NNS?

yes

No

…..Program Design

• Sub-national and sectoral interviewees proposed key issues that will improve NNP implementation

– Focal point for nutrition in all sectors

– Creating more awareness for sub-national

– Nutrition education and advocacy at community level

– Empowering agriculture development agents for nutritionactivities

– Incorporating nutrition in the curriculum

“Unless there is focus at the sub national level on awareness and

capacity development, the nutrition plan will fail” National level government

Challenges

• The challenges were categorized into four

– Leadership.

– Budget.

– Coordination and incentives for collaboration.

– Implementation.

Major challenges during implementation of NNP

0

10

20

30

40

50

60

Budget shortage % Lack of nutritionprofessionals %

less prioprity % Low awareness % Coordination problem%

…..Challenges

• Leadership

– Most reported (national and sub-national level) NNP needhigh level commitment especially in social and economicsector and coordination

“We should make a strong recommendation to GOE that weneed an autonomous body that has accountability andauthority.. May be an office of nutrition in the PM’s Office.”

…..ChallengesBudget

• At the national level, budget is a constraint. Government key informants (64%) from all ministries.

“We can’t do all that is expected in the NNP without more staff and

funds. It’s just not realistic.” Government Representative, Addis Ababa.

• At the sub-national level, budget was identified as a constraint by a quarter of the respondents in Tigray, SNNPR and Amhara, It was not identified as a major issue in Oromia

…..Challenges

• Multi-sectoral coordination– National level coordination is progressing .

– Sub-national coordination was minimal.

– At the national level, 35% indicated there should be incentives for collaboration

– At sub-national level HDA, GTP, sector mandated activities, good M&E plan, work satisfaction and interface were identified as main motivational factors for coordination and collaboration.

Challenges in collaboration and coordination

of nutrition by regions

0 5 10 15 20 25 30

Low awareness in sectors

Less priority

Budget shortage

Poor Community awareness

Lack of nutrition professionals

Absence of structure and ownership

%

%

…..Challenges

• The main operational challenges to implement NNP:

– Lack of capacity on nutrition at sub-national level.

– Poor community awareness and ownership.

Recommendation

• Coordination should be strengthen

• Maintain the high level of enthusiasm

• Awareness creation at all levels

• Capacity building at sub-national level

• Establish monitoring and evaluation system

• Nutrition focal person at all sectors level

• Budget allocation

Acknowledgement

• USAID/ENGINE project.

• Save the Children.

• Regional government sectors offices.

• Interviewees.

• Tufts University.