Effective Governance and Policies to Improve

Nutrition Outcomes:

A cross comparison of nine country cases

Andrés Mejía Acosta (IDS)

a.mejia@ids.ac.uk

Jessica Fanzo (Columbia University)

jfanzo@gmail.com

Institute of Development Studies

Brighton, 19 February 2013

The Nutrition Paradoxes Nutrition and GDP growth

economic growth does not lead to

improved nutrition

India vs Brasil vs Peru

Nutrition and food security

policies designed to boost food

production are not sufficient to reduce under

nutrition

The Maradi Paradox

Pakistan, Niger

A political economy approach

Analysing policy change…

Number of stakeholders involved

Ideological differences

Winset = space for policy change

PEA of Nutrition

Why some countries that are strongly committed to reducing

malnutrition can effectively deliver on nutrition outcomes while others

make insufficient or no progress at all?

Why and when do government officials become accountable to the

needs of the most vulnerable?

How are advocacy coalitions formed around a single narrative to

reduce under nutrition?

Stunting levels across nine countries

Source: WHO Global Database on Child Growth and Malnutrition

20

25

30

35

40

45

50

55

60

65

1990-92 93-95 1997-99 00-02 2003-05 2006-08 2009-11

Rate

of

Stu

nti

ng

Bangladesh

Ethiopia

India

Kenya

Niger

Pakistan

Peru

Zambia

Roadmap

Analysing Nutrition Governance

We are not the first ones but…

Building a dashboard of indicators

Intersectoral cooperation

Vertical articulation

Sustainable funding

Looking at and measuring the comparative

evidence

What is perceived as good

Nutrition Governance?

According to the WHO, Strong 'nutrition

governance' countries are those

where governments are committed to having a

national nutrition plan,

which is also part of the national development

strategy,

they have set up inter-sectoral coordinating

committees,

maintain regular surveys and data collections,

and

allocate budget lines for nutrition strategies and

plans, among other criteria

How do we measure governance?

Governance Indicators (World Bank)

Governance scores on the

commitment and willingness (WHO

Landscape)

How do we measure accountability

and incentives?

Performance budgeting

Institutional and capacity building

Translating Governance Analysis

to effective interventions and

Scaling Up

Multisectoral nutrition

planning (1970s)

WHO Landscape Analysis

(2009)

World Bank (2002-2011)

Undernutrition: What Works?

Action Against Hunger (2010)

Mainstreaming Nutrition

Initiative (Pelletier et al 2011)

Scaling Up Nutrition

movement

REACH country process

Analysing Nutrition Governance

–our framework-

The fieldwork

Nine countries, since 2010

A dozen researchers

Nearly 230 interviews

Four languages

Similar questionnaire adjusted to country

specific concerns

Working papers, research reports and policy

briefings posted at

http://www.ids.ac.uk/nutritiongovernance

ANG: Intersectoral cooperation

How (-and why-) do government actors,

donors and other stakeholders cooperate

with one another?

Are there any formal or informal cooperation

instances/coordinating bodies?

Is there direct involvement of the Executive?

Is nutrition part of the national development

and poverty reduction agenda?

In Peru: Initiative Against Child Malnutrition (CNI)

Multisectoral coordination in Ethiopia FMOH

National Nutrition

Coordinating Body

(line ministries chaired by

MoH)

NDPG

Nat. Nutrition

technical

committee

(experts)

Agenda-

setting

Individual

donors

Emergency

nutrition

Nutrition

working group

(DPs and MoH)

Coordination/

implementation

forum

PSNP

Food

Security

Program

Source: Taylor 2012

Min of

Women &

Child Affairs

Min of Local

Government Min of

Educ.

Min of

Ag

Min of

Livestock

Min of Health

and Family

Welfare

Min of

Finance

Min of

Planning

Min of Food

and Disaster

Management

Min of

Sanitation and

Water

National Nutrition

Programme

1) Coordinating cttee (NGO implementers)

2) Monitoring group (NGO mgrs & NNP

monitors)

National Nutrition

Programme

management

committee

IPHN

BNN

C

Food

policy

Community level interventions

ISC in Bangladesh

What makes ISC work?

H1: improved ISC will contribute to (the

formulation of) improved nutrition

governance

H1a: “policy dictators” can make swift policy

changes but are not sustainable over long run

(Niger)

H1b: broad and inclusive “nutrition coalitions”

(…) are likely to make nutrition policies more

sustainable (Brazil)

ANG: Vertical articulation

Why would local elites want to implement

national level policies?

Are there decentralised structures (regional

and local) that facilitate local implementation

and coordination?

Are local elites motivated to comply with and

influence national level policies (upwards)?

Are they accountable to demands of voters

(downwards)?

Vertical Coordination in Brazil

Kebele development

committee Health

ext.

worker

Ag.

Ext.

worker

Woreda development

committee

Regional health bureau Regional agriculture office

Woreda health

officials

Ministry of Agriculture Ministry of Heatlh

Dev.

Army

Dev.

Army

Dev.

Army Dev.

Army

Dev.

Army Dev.

Army

EPRDF (party)

Regional agriculture

officials

6x

Ag

Dev.

Army

Vertical coordination in Ethiopia

What makes vertical articulation

work? H2: effective Vertical coordination is likely

to contribute to improved nutrition

governance (implementation)

H2a: when it builds on existing decentralized

structures

H2b: when it generates greater local

ownership

H2c: when it reproduces intersectoral

cooperation at the national or subnational

level

ANG: Sustainable Funding

How do funding mechanisms facilitate

inter sectoral and vertical cooperation?

Are there centralised (pooled) or coordinated

funding schemes or funding sources are

fragmented?

Are there independent monitoring and

oversight mechanisms that promote efficient

use of revenues?

Are there additional, unexplored sources of

revenue? private sector funding; taxation;

natural resource revenues?

Pooled funding in Niger

Several types of pooled funds:

Bilateral Funds – discretionary

Programmatic – coordinated

Emergency - OCHA

New embedded funding line in the budget

How to make long term use of emergency funds?

Siloed funding in Bangladesh

Fragmented funding encourages isolation

and duplication

Multiple recipients: “Anyone can get funded”

Funding is source of political influence

It can privilege relations with MPs or local goverments

What makes funding work?

H3. Sustainable Funding is likely to

contribute to (financing) improved nutrition

governance

H3a: greater government ownership – greater

government share in nutrition funding - into

state budgets and political process (ie.

Nutrition line?)

H3b: when funding allocations are at least

coordinated to avoid corruption or overlap

H3c: when there are institutional provisions

(earmark, taxes, multiyear budgets) that

ensure long term funding

How does it all add up?

Intersectoral coordination

inclusive, partially inclusive, not inclusive

Vertical Articulation

Effective, partially fragmented, fragmented

Funding

Pooled, coordinated, uncoordinated

Towards a comparative analysis

of nutrition governance Country studies Inter Sectoral

cooperation

Vertical coordination Funding Outcome

(or path

process)

Brazil Inclusive Effective Coordinated O

Peru Inclusive Partly fragmented Coordinated O

Kenya Partially inclusive Partly fragmented Coordinated O

Niger Inclusive fragmented Coordinated and

Pooled

--

Bangladesh Not inclusive Effective Uncoordinated --

Ethiopia Partially inclusive Effective Uncoordinated --

Zambia Inclusive Partly fragmented Uncoordinated --

India Not inclusive Fragmented Uncoordinated X

Pakistan Not inclusive Fragmented Uncoordinated X

Advantages of a process driven

nutrition governance approach

Unpacks the notion of “political will” to look

into specific mechanisms of political

commitment around nutrition

Focuses on the formation and

sustainability of nutrition coalitions

Seeks to measure and extract practical

policy advice for scaling up nutrition efforts