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PPWNov13- Day 1 Keynote-  D.Pelletier- Cornell
 

PPWNov13- Day 1 Keynote- D.Pelletier- Cornell

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Day 1 keynote address: David Pelletier, Cornell University: “Nutrition Policy Processes” ...

Day 1 keynote address: David Pelletier, Cornell University: “Nutrition Policy Processes”

Workshop on Approaches and Methods for Policy Process Research, co-sponsored by the CGIAR Research Programs on Policies, Institutions and Markets (PIM) and Agriculture for Nutrition and Health (A4NH) at IFPRI-Washington DC, November 18-20, 2013.

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  • In many cases the distinctions shown in these tables are a matter of degree or emphasis rather than discrete categories, and exceptions can be found in the literature. The table is intended to convey a sense of where the frontiers are moving or can move in the future. The categories listed under What we Study and Who we Study are intentionally broad and non-specific. They embrace a wide range of potential objects of study at the level ‘above the consumer.’ We will not pretend or aim to cover or give examples of all of these. The more important and main contribution of the symposium is to expose participants to new types of questions, new research approaches and a wider range of research methods, with the recognition that they will need to customize the methods for their own particular research questions.
  • Intentional capacity building at national and sub-national levelsSupport development of strategic allies/ increase their capacities to seize opportunities, develop vision of how to solve nutrition in the country, take or mobilize action, mobilize funds, etc. Develop capacities in district level managers to develop the intelligence and skills to identify and fix implementation bottlenecks in timely fashion, vs. waiting for formal evaluation periods when it is too late for adjustments. important aspect that applies to #1 and #2, is real time collective learning through a set of tools enabling reflective practice and for engaging actors and documentation of the emergent knowledge.

PPWNov13- Day 1 Keynote-  D.Pelletier- Cornell PPWNov13- Day 1 Keynote- D.Pelletier- Cornell Presentation Transcript

  • The Nutrition Policy Process: A Role for Mode 2 Research David Pelletier Division of Nutritional Sciences Cornell University IFPRI Workshop on Approaches and Methods for Policy Process Research. Nov 18-20, 2013
  • Outline 1. 2. 3. 4. 5. 6. Trends in society The nature of problems Trends in science Population nutrition research Illustrations Summary
  • Collaborators Past Present (Cornell) • • • • • • • • • • • • • • • • • • Tahmeed Ahmed, ICDDR,B Shamshir Ahmed, ICDDR,B Allison Corsi, Cornell Silvana Faillace, AED, HKI Ed Frongillo, USC, Cornell Suzanne Gervais, Cornell Renee Hill, U Idaho, Cornell Lesli Hoey, U Mich, Cornell Robin Houston, Consultant Purnima Menon, IFPRI, Cornell Rebecca Stoltzfus, Cornell Suzanne Gervais Isabelle Michaud-Letourneau Barnabas Natamba Edna Possolo Hajra Hafeez-ur-Rehman Dia Sanou Jackson Tumwine Financial Supporters: AED/USAID, Centers for Disease Control, GAIN, Micronutrient Initiative, UNICEF, World Bank
  • Trends in Society • Nutrition has ascended on public and private agendas • An extensive web of interconnected issues now is recognized • Demand for results and accountability in public programs and publicly funded research • Demand for research on effectiveness of interventions at scale (translational and implementation science) • Nutrition research must respond to these trends in order to remain relevant
  • Trends in Society
  • Trends in Society
  • Trends in Society
  • Trends in Society
  • Trends in Society
  • Trends in Society Results and Accountability: GPRA’s 20th Birthday!! (1993-2013) (97:3)
  • Proven Solutions are At-Hand “The Challenge Now is to Scale Them Up”
  • The Nature of Problems
  • What Kind of Problems Are We Dealing With? Simple Complex The Nature of Problems Complicated Socially Complex / Wicked Adapted from: Getting to Maybe: How the World is Changed. Westley, Zimmerman, Patton, 2006
  • Illustrations Social Complexity in Nutrition Policy “[] the donors and NGOs basically could not get their act together because they were all arguing for their own special interest or their own view of how things ought to be handled for nutrition.” (International researcher and consultant to countries) World Bank 2006
  • Batie, 2008. Amer. J. Agr. Econ. 90 (Number 5, 2008): 1176–1191. (Author holds endowed Chair in Food and Agricultural Economics Policy, Dept of Agricultural, Food, and Resource Economics at Michigan State University)
  • The Nature of Problems Implications of Wicked Problems for the Research Approach “Because wicked problems are in essence “expressions of diverse and conflicting values and interests” (Norton, 2012, p. 450), the process of working with them is fundamentally social, and should not be scientized in the conventional sense (Conklin & Weil, 2007). “Instead of the partial and linear strategy of divide and conquer that aims at searching for definitive solutions, it requires a holistic and process oriented approach that is by nature adaptive, participatory, and transdisciplinary (APT for short). “By examining a wicked problem as a whole through a panoramic social lens rather than a scientific microscope, and working with it through an open and heuristic process of collective learning, exploration, and experimentation, the APT approach promises to be efficacious in fostering collaborative behavior, reducing conflicts, building trust among all stakeholders and communities involved, and ultimately producing better and more satisfying results. “With more empirical research and applications, a more developed APT approach, along with innovative methods and skill sets, will be a competent alternative to the traditional solution-seeking approaches.” Xiang (Editorial) Landscape and Urban Planning 110:1– 4, 2013
  • Trends in science The Multisectoral Nutrition Policy Process: Complex Adaptive Systems (and Subsystems) Donors NGO/CSO Ministries Donors NGO/CSO Ministries
  • The NPP Complexity Context Informal Governance Structures: Stakeholder Network Map for Ethiopia Source: www.transformnutrition.org/ Illustrations
  • Fd Sec & Nutr Unit in PMs The Nutrition Policy Process: Fd Sec Unit Office The Composite Case of in PMs NGO MOH Esperanza Office Comm- CommFish Farms Supplem. Feeding Based Based in clinics, schools, Nutr Ed Nutr Ed High Lysine NGO programs Maize BF Promotion Nutr Rehab Units Home gardening & poultry Clinic GMP Clinic nutrition education 1970 1980 The Nature of Problems VitA campaigns Host internatl conference First Lady/Nutrition IFA in clinics MOH Nutr Educ & Nutr Rehab Units Uncoordinated and competitive NGO Comm-based programs 1990 Unified Natl Nutr Strategy: - Core objectives - Diverse implem 2000 2010 Donor Micronutrient Agenda Economic WHO, NGO, FSNU, NPP: dynamic, contingent, emergent, non-linear, UNICEF MOH, donor Cap Stunting 45% Crisis Bldg Advocacy rapport Donor Wasting 6% multi-scale, chaordic, open conflicts systemsShared Better Urban food 70% rural U5MR 180 MatMR 2000 Anemia VAD Seasonal and chronic food insecurity price spike Weak Commitment in MOH, MOA, MOE Weak networking Skills in FSNU USAID BF Program Nutrition lost in health sector reform 40% Absorptive Capacity in MOH Weak/no evaluations credit Strategic Alliance for Nutr NGO networking, sharing, voluntary coordination, trust building, advocacy evals Staff Turnover& Donor Conflicts resume
  • The Nature of Problems The Nature of Problems: Bottom Line Message “We can't solve problems by using the same kind of thinking we used when we created them.” Einstein
  • Trends in Science
  • Trends in Science Complexity and Systems Thinking “I think the next century will be the century of complexity” S. Hawking “Every PhD student in everything should get to grips with the ‘chaos/complexity’ programme, not for reasons of fashion or even legitimate career building, but because this is the way the world works and we need to understand that” D. Byrne In: Complexity and the Social Sciences
  • Trends in science Complexity and its Properties “It is difficult, nowadays, to open a popular science magazine, or a leading science journal, without reading about complexity, the approach to science that is expected to ‘define the scientific agenda for the 21st century’.1 Complexity theory is influencing fields as diverse as physics,2 cosmology,3 chemistry,4 geography,5 climate research,6 zoology,7 biology,8 evolutionary biology,9 cell biology,10 neuroscience,11 clinical medicine,12 management,13 and economics.14 However, it has to date had relatively little influence on the theory and practice of epidemiology.15 In this paper we review the basic concepts of complexity theory and discuss their relevance to epidemiology.”
  • Systems in Public Health Trends in science
  • Trends in science Two “Approaches” to Research on Complex Systems 1. Modeling 2. Engaging
  • 1. Modeling the Obesity System Trends in science
  • The UK Foresight Project: : http://www.bis.gov.uk/foresight http://www.shiftn.com/obesity/zoom-map.html
  • Trends in science 2. Engaging with Complex Systems “If you want to truly understand something, try to change it.” -Kurt Lewin
  • 2. Engaging with Complex Systems Trends in science Research Question: Can intentional complexity-aware actions by some actors alter the behavior of the system? Properties of Complex Adaptive Systems (a) nonlinear interdependencies (b) self-organization (c) emergence (d) co-evolution w/ environment (e) Interaction, learning and adaptation among many actors
  • Mode 2 Knowledge Production Trends in science The central elements of sustainability science: • inter- and intra-disciplinary research • co-production of knowledge • co-evolution of a complex system and its environment • learning through doing and doing through learning • system innovation instead of system optimization Martens, P. 2006. Sustainability: Science, Practice and Policy 2(1):36-41.
  • Trends in science Research on Wicked Problems and Complex Adaptive Systems “Much of the research and scholarship, as substantive as it may seem, remains largely a repetitive description of the social reality of wickedness, rather than well-grounded theoretical explorations or empirical investigations. “Aside from substance, the peer reviewed scholarly publications on wicked problems remain modest in quantity—our recent survey found a total of 332 cited papers on the Scopus database in the Elsevier Editorial System, and 162 on Web of Science. They are also geographically scattered, presenting a huge disparity across the world.” Xiang (Editorial) 2013
  • Clarifying (and Qualifying) the Complexity Space and the Management Approach Source: Barden, 2012. Complexity, Adaptation, and Results, Center for Global Development http://www.cgdev.org/blog/complexity-adaptation-and-results
  • Population Nutrition Research
  • Population Nutrition Research Complexity, Systems Thinking and Mode 2 Research in Nutrition Adv Nutr 4:92-114, 2013
  • Population Nutrition Research Frontier Dimensions • • • • • • Why we study What we study Who we study How we study: Methods How we study: Approaches Disciplines
  • Dimension Current Tendencies Frontiers Why Generalizable/ fundamental Actionable knowledge for stakeholders, orgs, knowledge re. scientific communities or publics at various scales; questions generalizable knowledge re. problem-solving What nutrients, nutritional status, laws, regulations, norms, programs, organizations, food and nutrient intake, systems, change processes in communities, food insecurity, behavior programs, policies, etc. Who women, infants, children, elderly, consumers policy makers, managers, implementers, leaders, networks, coalitions, private sector actors, citizens, universities How (methods) limited range of quant and qual methods: Interviews, focus groups, regression, trials… social network analysis, discourse analysis, Q methodology, document analysis, media analysis, process tracing, stakeholder analysis, influence mapping, program impact pathways, etc How (approach) detached, objectivist, positivist, reductionist, behaviorist, hypothesis testing… engaged, participatory, action research, CBPR, participant-observer, reflection in action, embedded, emergent, systems- and complexityoriented, reflexive, etc Disciplines Nutrition, epi/biostatistics, biomedicine, psychology, social psychology… economics, sociology, anthropology, policy analysis, law, urban planning, political science, organizational behavior, management sciences.. and TRANSDISCIPLINARY
  • “It is difficult, nowadays, to open a popular science magazine, or a Population Nutrition Research leading science journal, without reading about complexity, the approach to science that is expected to ‘define the scientific agenda for the 21st century’.1 Complexity theory is influencing fields as diverse as physics,2 cosmology,3 chemistry,4 geography,5 climate research,6 zoology,7 biology,8 evolutionary biology,9 cell biology,10 neuroscience,11 clinical medicine,12 management,13 and economics.14 However, it has to date had relatively little influence on the theory and practice of epidemiology.15 In this paper we review the basic concepts of complexity theory and discussTotal their relevance to epidemiology.” Journal Name Nutrition Journals Ecology of Food and Nutrition Journal of Nutrition Education and Behavior Maternal and Child Nutrition Journal of Nutrition Public Health Nutrition International Journal of Behavioral Nutrition and Physical Activity Subtotal nutrition papers in 2012 19 90 47 308 252 No. of papers with ≥1 Mode 2 characteristic1 4 13 5 7 22 (21%) (14%) (11%) (2%) (9%) 46 1 (2%) 762 52 (7%) Pham and Pelletier, in prep
  • Trends in science Nutrition journals: Mode 2 "Methods" • • • • • • • • • • • • • • Ethnographic narrative Immersion-observation Thematic analysis Policy review Onsite receipt collection Iterative action research via workshops Health-economic analysis Stakeholder analysis Consultative workshops Systematic internet review Emerging policy options with stakeholder input Implementation pathways Simulation of food intake patterns Impact pathways Pham and Pelletier, in prep
  • The Landscape for Population Nutrition Research
  • Illustrations • Mainstreaming Nutrition Initiative • Program Implementation (PAG) • African Nutrition Security Partnership
  • Illustrations Our Complexity Context in All Cases NPP: dynamic, contingent, emergent, non-linear, multi-scale, chaordic, open systems World Bank 2006
  • The NPP Complexity Context Illustrations Informal Governance Structures: Stakeholder Network Map for Ethiopia NPP: dynamic, contingent, emergent, non-linear, multi-scale, chaordic, open systems Source: www.transformnutrition.org/
  • Mainstreaming Nutrition Initiative (MNI) (Scope: Bolivia, Guatemala, Peru, Vietnam, Bangladesh plus 14 country narratives) Feature Description Comment Research Question What factors influence movement of nutrition within national policy agendas? Initially broad and open, with specific foci emerging during engagement, and guided by broad frameworks or elements of frameworks Frameworks, Elements & Principles Policy sciences, Shiffman, Heaver, Kingdon, Potter and Brough, Grounded theory Used flexibly and as heuristics to guide our attention to certain elements or dynamics and to help interpret what we are seeing Research Methods Participant-obs, Field notes, Interviews, Documents, Member checks, Peer debriefing Emergent and eclectic; driven by need, opportunity, feasibility and acceptability Orientation Transdisciplinary, contextual, problem-oriented, socially-engaged, methodologically eclectic and reflexive Key findings Routes to agenda-setting; conflict in policy formulation; political attention vs political commitment vs system commitment; strategic capacity
  • The Focus and Orientation of Mainstreaming Nutrition
  • African Nutrition Security Partnership (ANSP) (Scope: Burkina Faso, Mali, Ethiopia, Uganda) Feature Deacription Comment Research Question What factors influence movement of nutrition within national policy agendas? Initially broad and open, with specific foci emerging during engagement, and guided by broad frameworks or elements of frameworks Frameworks, Elements & Principles Complex Adaptive Systems, Developmental Evaluation Policy sciences, Action Research, Change mgt, Adaptive management Used flexibly and as heuristics to guide our attention to certain elements or dynamics and to help interpret what we are seeing Research Methods Participant-obs, Field notes Practitioner profiles, NetMap Q methodology, Workshop docs, Interviews, Others tbd Emergent and eclectic; chosen for their reflective potential (participatory learning); and chosen to be as non-intrusive and nonextractive as possible Orientation Transdisciplinary, contextual, problem-oriented, socially-engaged, methodologically eclectic and reflexive Key findings In process
  • The Focus and Orientation of ANSP
  • Program Assessment Guide (PAG) (Scope: 3 countries with full workshops: Kyrgyz, Bolivia, Haiti 2 countries with partial workshops : Nepal, Tanzania) Feature Description Comment Research Question Can the PAG improve the design and delivery of nutrition interventions? What factors influence its performance? PAG was designed as an intervention in a moderately complex systems. The research question is more focused than MNI and ANSP Frameworks, Elements & Principles Results orientation Program theory Management, Change mgt, Adaptive management Principles from multiple frameworks were used in designing the PAG; Multiple frameworks will be used in evaluating experience with PAG Research Methods Partic-obs, Interviews Pre/post workshop eval Workshop documents Long-term follow-up Methods for evaluating the PAG have been challenged by the dynamic nature of workshops, the need for longer-term followup and lack of an explicit counterfactual Orientation Contextual, problem-oriented and socially engaged; transdisciplinary, but emphasizing mgt and action research Key findings Feasibility of PAG assessment; overlooked and contextualized bottlenecks; motivating influence of implementers’ participation; weak follow-up
  • The Focus and Orientation of PAG etc
  • A Few More Details
  • Mainstreaming Nutrition Mainstreaming Nutrition Initiative • • • Funded by World Bank nutrition section ICDDR,B, Cornell: 2006-8 Objective: develop approaches and experience in moving nutrition from the status of a marginal issue with time-limited funding to a permanent feature on policy agendas and in MCN programs and policies Methods: • 1. – – 2. – – 3. – – Cross-country study (interviews, written case studies, observations) 30 respondents (nationals, researchers, NGOs, donors) 18 country experiences Focal countries (participant-observer and interviews): Bolivia, Guatemala, Peru Vietnam, Bangladesh Conflict and consensus sub-studies (interviews) Bolivia Guatemala
  • Mainstreaming Nutrition Mainstreaming Nutrition Initiative Policy Process Study What factors influence the development of the national nutrition agenda? What are some promising avenues for future efforts? Country Experiences
  • Mainstreaming Nutrition 1.Societal Conditions 2.Catalytic Events 3.Structural Factors & Behaviors 4.Points of Contention 5.Strategies & Tactics Thematic coding Interviews, Written Accounts, Observations Grounded Theory, Kingdon, Policy Sciences Respondents: 12 nationals, 12 donor/NGO, 6 nationals in donor/NGO Benin, Burkina, Ethiopia, Kenya, Madagascar, Malawi, Mali, Mauritania, Senegal, Tanzania, Uganda, The Philippines, Thailand, Bangladesh, Bolivia, Chile, Guatemala, Haiti, Peru Source: Food and Nutrition Bulletin 32(2): S59-S69, 2011
  • Points of Contention Mainstreaming Nutrition “[] the donors and NGOs basically could not get their act together because they were all arguing for their own special interest or their own view of how things ought to be handled for nutrition.” (International researcher and consultant to countries)
  • Mainstreaming Nutrition Strategies and Tactics “[] they had a lot of disagreements but they always went ahead with one voice. They sat behind closed doors and didn’t get out, but then they put on a good face when they came out and had one recommendation. (Donor agency)
  • Mainstreaming Nutrition Societal Conditions Catalytic Events Structural Factors & Behaviors Points of Contention ”Strategic Capacity” Diminished commitment, coherence, coo rdination and support for the national nutrition agenda Enhanced commitment, coherence, coo rdination and support for the national nutrition agenda
  • Mainstreaming Nutrition Strategic Capacity The human and institutional capacity to: • build commitment, vision and consensus towards a long-term national nutrition agenda, aka- the ability to • broker agreements, work within • resolve conflicts, a Complex • respond to recurring challenges and Adaptive System!!! opportunities, • build relationships, • undertake strategic communications, • strengthen operational capacities and implementation as part of the national nutrition agenda
  • Program Implementation (PAG)
  • Program Implementation The Challenge ? Pelletier AED PAG Training Jan 5-7, 2011
  • Program Implementation Pelletier AED PAG Training Jan 5-7, 2011
  • Program Implementation Program Assessment Guide (PAG) Processes Outputs Participatory Procedures To Strengthen: 1. Action Plan to Address Barriers & Enablers • The Systematic Integration Of Evidence, Contextual Knowledge & Experience 2. Operations Research Agenda • Shared understanding, commitment, ownership, motivation & capacity to advance the micronutrient agenda 3. Issues for Inclusion in M&E •Links with the broader nutrition and health agendas in the country 4. Strategic Plan to Build Support, Capacity & Sustainability Pelletier AED PAG Training Jan 5-7, 2011
  • Program Implementation Applications of the PAG 1. 2. 3. 4. 5. 6. 7. Kyrgyzstan (micronutrient powders) Bolivia (micronutrient powders) Nepal (iron-folate supplements) Tanzania (iron-folate supplements) Haiti (mobile clinic w/ IFA) Haiti (community-based programs w/ multiple interventions) Haiti (Child Health Weeks w/ vit A)
  • Lessons Learned 1. Sponsorship, Responsibility, Commitment, Follow-up 2. Timing 3. Preparation 4. Participants 5. Contextuality (selection and sequencing) 6. Time constraints 7. Facilitation Pelletier AED PAG Training Jan 5-7, 2011 Program Implementation Before the workshop During the workshop
  • ANSP (African Nutrition Security Partnership)
  • ANSP (African Nutrition Security Partnership) • UNICEF/EU, 3 year project • Build on MNI and PAG • Focus on: – Strategic capacities – Adaptive Management – Developmental Evaluation ANSP
  • ANSP Africa Nutrition Security Partnership (ANSP) 2011-2015 UNICEF implements EU funds EU Objective Reduce stunting by: promoting, developin g and adopting a multisectoral approach 1. 2. 3. 4. 4 Pillars Up-stream policy development and nutrition security awareness Institutional development & capacity building Develop useful information systems and data analysis Scale-up interventions
  • ANSP, Cornell contribution 2013-2015 “Strategic capacity and adaptive management of multisectoral nutrition policies and programs” 1. strengthen strategic capacity within the national nutrition netywork 2. strengthen the capacity (and a model) for adaptive management of community-based, multisectoral nutrition strategies in selected districts 3. support real-time collective learning, sharing and documentation of project experiences.
  • ANSP ANSP Guiding Frameworks: Complexity, Developmental Evaluation, Policy Sciences And Change Management
  • In Closing
  • The Nature of Frontiers • Detailed maps do no exist – they are vague, sketchy and made during exploration and settlement • Explorers must be willing to embrace uncertainty, danger, hardship and hunger, so the tangible rewards (and/or the quest for discovery) must be substantial • New tools, skills and relationships will be needed to survive and thrive in the new lands • Native inhabitants, fellow travelers and explorers from other lands possess valuable knowledge to aid the process • Frontiers move in many directions and over varied terrains, so diversity in focus and approach is warranted
  • Summary • • • Nutrition has “arrived” “Nutrition” is no longer just “nutrition” How can we deliver results at-scale? “We can't solve problems by using the same kind of thinking we used when we created them.” Einstein “I think the next century will be the century of complexity” S. Hawking “If you want to truly understand something, try to change it.” Kurt Lewin “Every PhD student in everything should get to grips with the ‘chaos/complexity’ programme, not for reasons of fashion or even legitimate career building, but because this is the way the world works and we need to understand that” D. Byrne “Much of the research and scholarship, as substantive as it may seem, remains largely a repetitive description of the social reality of wickedness, rather than well-grounded theoretical explorations or empirical investigations. Xiang
  • Acknowledgments to everyone in our Complex Adaptive (Learning) System