Fighting maternal and child malnutrition: analysing the political and institutional determinants of delivering a national multi-sectoral response in six countries: a synthesis paper

Fighting maternal and child malnutrition: analysing the political and institutional determinants of delivering a national multi-sectoral response in six countries: a synthesis paper

Governance is a critical yet understudied component in the nutrition agenda, according to this paper’s authors. The paper uses a political economy approach to examine questions around the progress or lack thereof toward nutrition goals in six countries: Bangladesh, Brazil, Ethiopia, India, Peru and Zambia. All have medium to strong nutrition governance indicators, but only some are on track to meet the Millennium Development Goal and others have made no progress at all.

The study proposes a four pillar nutrition governance framework: intersectoral cooperation across stakeholders, vertical coordination within the government and the financing mechanisms for nutrition policymaking and implementation. The fourth element is the extent to which countries are committed to developing accurate indicators of nutrition and required budgets, validated by a wide array of stakeholders and the extent to which the data is effectively used to monitor progress.

The study reports ten key findings from the six country studies:

  • the direct involvement of the Executive Branch (at Presidential or Prime Ministerial level) is critical for success of nutrition efforts
  • bodies set up to coordinate nutrition actions can play a critical role or act as fig leaves
  • framing nutrition as part of the national development agenda
  • developing a single narrative about the severity of undernutrition can help set clear policy goals 
  • delivering nutrition services to the local level tends to work better in countries that have adequate decentralised structures
  • encourage local ownership of nutrition programmes and their outcomes
  • support civil society groups to develop social accountability mechanisms
  • collect nutrition outcome data at regular intervals
  • use Centralised funding mechanisms to generate greater incentives to cooperate in the design, implementation and monitoring of nutrition interventions
  • governments should create financial mechanisms to protect and earmark nutrition funding and use it in a transparent way.

The authors conclude that the challenge is ensuring these interventions are delivered through cost-effective and sustainable governance systems.

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