This presentation was made possible by the American people through the U.S. Agency for
International Development (USAID) u...
Outline
Context
Rationale: Why integration?
Definitions: What do we mean by integration?
Previous work: What do we know?
S...
SteeringCommittee
BENEFICIARY MOTHERS
MODEL FARMERS
HEALTH VOLUNTEERS
(committees /
grandmothers)
INTERNAL RELATION (HKI)
...
Malnutrition
Institutions
Political and ideological framework
Economic structure
Resources
Environment, technology, people...
INTEGRATION
Bringing together of structures and functions (resources, personnel,
strategy and planning) with a merging of ...
Case studies of intersectoral action
6
The study in Burkina Faso
ASSUMPTION: provision of interventions to improve
agricultural production, health behavior, and
...
How and why did different sectors integrate
at different programmatic levels within
HKI’s E-HFP program in Burkina Faso?
1...
External
context
Internal
context
Institutiona
l links
• Development priorities
• Urgency
• Environmental context (economi...
Program Design
Level Agriculture Health
HKI- Regional Agriculture advisors Health advisors
HKI- National Project manager; ...
Enabling environment
Malnutrition seen as a development issue locally
Not mentioned spontaneously
Issues mentioned were de...
Perceptions of integration
High level of understanding of multisectoral causes of
malnutrition
Understanding and agreement...
Implementation of integration
Mode of integration assumed to be harmonization of
messages at beneficiary level
Other manag...
Best practices / challenges
Broadly positive about E-HFP integrated approach
Many positive impacts reported
Workers wanted...
Monitoring of integration
No formal monitoring of modes of integrated working
Unclear if and how the Steering Committee ai...
Modes of integration
1
• Harmonized messaging: Messages are harmonized at
managerial level; little interaction across sect...
Conclusions
Understanding, confidence, and motivation for cross-
sectoral work was high
Staff turnover, dual workload, and...
Lessons going forward
Pay explicit attention to different modes of integration in
program design (strategies /day-to-day p...
Thank you!
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Integrating Agriculture and Nutrition_Jody Harris and Aaron Buchsbaum_5.7.14

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  • Given current interest in nutrition-sensitive agriculture, we need to better understand how the agriculture sector might coordinate with others involved in the delivery of nutrition-related services for greater impact. This presentation will describe the history and experiences of intersectoral coordination for nutrition and learning form other sectors, with reference to Zambia.
  • HKI programBackgroundStudyFindings
  • Helen Keller International: Improve nutritional status of young children in Eastern Burkina Faso Increase year-round availability of nutrient-rich foods Increase knowledge & promote optimal nutrition practices Target, engage and empower women Income generation through sale of surplus productionThe project is most clearly understood from the perspective of the community actors, where health-side and ag-side volunteers are delivering messages and trainings to the same group of target mothers.Above them are a number of NGO and government partners who interact in various ways and help build and coordinate the cascade trainings, monitoring and evaluation efforts, and other decisions related to the project. I’ll just note quickly that APRG is a health-focused Burkina Faso NGO which was located in the project region, and that likewise HKI worked with health, ag, and vet agents within the respective government ministries. For our purposes, it is helpful to think of E-HFP can in terms of (1) Managers, (2) Frontline workers, and (3) Community members, especially as this study was able to explore perspectives around integration from these different ‘levels’. Finally, there is an overarching steering committee which draws from each of these groups and would meet periodically to address observations among each of the different groups. Very briefly in terms of scope:30 villages 1109 households; women family gardeners (POINT TO BENEFICIARIES)120 female village farmer leaders (POINT TO MODEL FARMERS)180 health facilitators (POINT TO HEALTH VOLUNTEERS)
  • RATIONALEbuild this from the top down…Malnutrition is the outcome (could be various types of malnutrition, refer to previous slide)Nutrient intake and health status are the immediate causes of malnutrition; essentially biological, at the individual levelThe underlying causes of malnutrition, at the household and societal level, are food, health, and careThe basic causes underpin these at a political and organizational levelThe point I want to make is:UNICEF framework shows multiple determinants of malnutrition (UNICEF 1990)The public goods and services relating to nutrition will necessarily be available from a range of sectors, and I and others have argued that these need to be provided in a coordinated fashion for maximum effect(Garrett, 2008)Show different sectors
  • What do we mean when we talk about coordination? A review of literature reveals lots of different definitions of coordination : Not conclusive, as people use language differently, but it is almost always described as a continuum from more to less coordination. Where do we want to be? This depends on the goals of a particular project and its context.
  • WHAT DO WE KNOW: HOW TO DO ITThere have been several case-studies of intersectoral action for nutrition in different contexts, and these have provided some initial lessons on what works in intersectoral coordination- though it should be noted that some elements are quite context-specific.Mozambique, Nigeria, Uganda, and Ghana (TANA 2007-11)Pakistan, Vietnam, Bangladesh, Bolivia, Peru, Uganda, and Ethiopia (MNI 2006-9)Senegal and Colombia (WB/IFPRI, 2012)Peru, Brazil and Bangladesh (MDG-F, 2013)India (POSHAN, 2014)Zambia (coming soon!)WHAT WE STILL NEED TO KNOW:It has been concluded that there has been little research on how inter-sectoral solutions are best implemented or institutionalized within different political and institutional contexts, and I would add, particularly at local level, where implementation actually occurs. In nutrition, we know a lot of the technical fixes now, but while many countries now have good nutrition policies and plans at national level, these very often get stuck at implementation- one reason for this is identified as difficulties coordinating across sectors, so we need a better understanding of intersectoral processes, in the specific context of nutrition policies and programs.
  • Research questions
  • Using an existing conceptual framework to guide interviews and analysis, the views and experiences of those working in and receiving the E-HFP program at different levels were sought through a series of structured interviews, and framework analysis was used to draw out patterns in findings and lessons going forward
  • - The project was not designed to be integrated at all levels, but to have intersectoral oversight at managerial level within each NGO, and separate technical sectors training and implementing in the field. The major conceptual basis for integration appears to have been through harmonized messaging, and therefore was at the level of the beneficiary mother, where all messages come together, and where improved nutrition is created through the improved practices, and consumption of the nutrient-rich foods produced by them.
  • When asked directly, all respondents agreed that malnutrition is an important development problem for their communities; however, very few mentioned malnutrition among the top development issues and priorities facing the community upfront, before the term ‘malnutrition’ was mentioned by the interviewers. What respondents identified when asked about development priorities were the determinants of malnutrition – e.g. lack of access to water, farming inputs, health centers, and money – while malnutrition was further down the list, possibly because it is seen as an outcome of these broader and more tangible issues.
  • There was a high level of understanding among respondents at all levels about multisectoral causes of malnutrition, and therefore why it is important to integrate different program components in some way in order to tackle the complex issue of malnutrition. When asked about their understanding of the roles of direct counterparts in the E-HFP project, those closer to the community generally had a better understanding of the work of those in other sectors; as training gets more specific and work more specialized further up the hierarchy, the detailed understanding of daily tasks in other sectors diminishes. Technical capacity and knowledge among frontline workers was reported to be adequate, with respondents reporting confidence in undertaking their specific roles. Motivation for working in general, and with those from other sectors in particular, was generally high; respondents valued the knowledge they could gain from other sectors, and were motivated by the sense of value placed on the project by the community.
  • There appears to have been little attention to modes of integrated working in the design of the program, so management systems and field activities emerged throughout the lifetime of the project. Fieldworkers took individual initiative as they saw fit-- with some supervisors mandating intersectoral meetings, and some community workers choosing to meet and plan together even in the absence of this mandate-- leading to large differences in levels of integrated working across project areas. Some community-level workers ended up with two roles- model farmer and health volunteer- receiving the training and providing significant time for both jobs, but this way of working was not consistent across the project area. It was at the community level that integration between sectors became a more common way of working, with sectors more commonly separated on technical grounds further up the programmatic levels.
  • All respondents were broadly positive about the intersectoral approach that HKI is taking in order to implement the project, and reported many different positive impacts. In general, workers wanted more knowledge both within their own technical area and in complementary areas, even if undertaking dual teaching roles in both agriculture and nutrition was seen as onerous. Frequent staff turnover particularly at government level, and therefore loss of understanding of the need for intersectoral action and need for constant re-iteration and training, was cited as a challenge. The issue of resources, and particularly the unequal distribution of inputs across sectors at community level, was mentioned by several respondents as a point of friction in the program. Workload and time was an issue for some, and particularly those with dual roles
  • It was discovered early on in the research process that there was no formal monitoring of integrated modes of working in the project; intersectoral actions were not tracked. The steering committee was reported to aid accountability across sectors, but it was not clear from these interviews what the accountability mechanisms were, or how decisions and learning were fed back to the project as a whole and field workers in particular.
  • Three distinct modes of integration emerged from the interviews- harmonized messaging to beneficiaries, joint training and planning among frontline workers in different sectors, and holistic training of individuals to preform dual roles- and each of these modes of intersectoral working is being used in parts of the E-HFP program. The method used appears to be ad-hoc however, leading to large differences in integration in different areas. One mode of integration not reported was holistic training of individuals without expecting them to perform dual roles, providing cross-sectoral information purely for clearer understanding of intersectoral action. There are pros and cons to each mode of integration, and these would need to be thought through for each particular project context.
  • This was a single case study of a single program, and therefore is not intended to generate generalizable models or look for differential effect on impact of different modes of integrated working. The responses of those interviewed have however shed some light on how those involved in implementing and receiving the E-HFP program experience intersectoral working, and suggest some lessons going forward. While the overall intersectoral goal of delivering harmonized messages to beneficiaries remained throughout the design and implementation of the E-HFP project, and project staff at all levels were generally motivated to work with those from other sectors, intended modes of intersectoral working were not clear in the project design. This is to be expected with a novel project where ways of working across sectors are being learned at an organizational level, and tallies with findings from other assessments of intersectoral working. But without explicit attention to these intersectoral modes from the start, processes become ad-hoc, depending on the level of initiative taken by supervisors and individuals, and integration becomes uneven throughout the project areas, left to chance as to who integrated and how. While this ad-hoc style might have been sufficient in this particular program with these particular managers, clearer structures and processes may have led to improved harmonization, and would be needed if the program were to scale up coherently beyond the current technical staff. Trialing different modes of integration to see what works on the ground is a valid method, and should be taken forward in future research, assigning different modes of integration to different groups and assessing outcomes. Given that there was no explicit monitoring of or accountability for intersectoral working at any programmatic level in this particular case, it would have been difficult to extract any systematic learning of what was working better among the different modes discussed above, to take forward.The findings from this case study indicate the beginnings of a typology of modes of integration, which can help project designers to be more explicit about expected ways of intersectoral working, and help researchers to test these different modes.
  • In future projects involving the integration of different sectors, program designers and managers should pay explicit attention to modes of integration at the design stage, thinking explicitly about strategies as well as day-to-day processes for collaborative working, how to track and monitor whether these are happening during implementation, and how to assess whether the processes are useful. This learning can start to improve ways of working in complex intersectoral programs such as those required for tackling malnutrition.
  • Integrating Agriculture and Nutrition_Jody Harris and Aaron Buchsbaum_5.7.14

    1. 1. This presentation was made possible by the American people through the U.S. Agency for International Development (USAID) under Cooperative Agreement No. AID-OAA-A-11-00031, the Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project. Experiences of Intersectoral Integration in an NGO nutrition program A study of HKI’s Enhanced-Homestead Food Production model in Burkina Faso Jody Harris, IFPRI, LCIRAH Aaron Buchsbaum, SPRING Growing Together?
    2. 2. Outline Context Rationale: Why integration? Definitions: What do we mean by integration? Previous work: What do we know? Study aims, research questions, and methods Findings: Program design, implementation, and monitoring Conclusions Lessons 2
    3. 3. SteeringCommittee BENEFICIARY MOTHERS MODEL FARMERS HEALTH VOLUNTEERS (committees / grandmothers) INTERNAL RELATION (HKI) PARTNER RELATION HKI PROJECT COORDINATOR TRAINING AND COMMUNICATONS COORDINATOR PRODUCTION COORDINATOR M&E COORDINATOR APRG FACILITATORS 5 Nutrition 4 Production GOVERNMENT AGENTS 17 Health, 4 Agriculture, 4 Vet ANIMATEURS HKI 3 Production APRG GOVERNMENT TECHNICAL MINISTRIES Enhanced Homestead Food Production 180 120 30 villages; 1109 HH
    4. 4. Malnutrition Institutions Political and ideological framework Economic structure Resources Environment, technology, people Health services and WASH Care resources and practices Food security and quality Nutrient intake Health status Adapted from UNICEF 1990 Immediate determinants Underlying determinants Basic determinant s Agriculture Health 4
    5. 5. INTEGRATION Bringing together of structures and functions (resources, personnel, strategy and planning) with a merging of sectoral remits COLLABORATION / PARTNERSHIP Sharing of some resources or personnel to facilitate strategic joint planning and action on certain issues, while maintaining sectoral remits COORDINATION / LINKAGE / COOPERATION Maintaining sectoral remits while working together on certain issues; interactions often unstructured or based on a loose goal- oriented agreement LINE FUNCTIONNING Continuing to work in separate sectors with little communication or strategic planning on issues Harris and Drimie 2012 5
    6. 6. Case studies of intersectoral action 6
    7. 7. The study in Burkina Faso ASSUMPTION: provision of interventions to improve agricultural production, health behavior, and empowerment will create synergies that help to improve nutrition outcomes PROBLEM: how these synergies are expected to occur; it is likely that the form of integrated action chosen, and the assumptions underlying these choices, would affect programs AIM: to explore experiences of intersectoral integration in HKI’s E-HFP program in Burkina Faso, to provide insight into intersectoral working arrangements from the viewpoint of those working in (or targeted by) this integrated program 7
    8. 8. How and why did different sectors integrate at different programmatic levels within HKI’s E-HFP program in Burkina Faso? 1. Integration in design 2. Environment for integration 3. Perceptions of integration 4. Implementation of integration 5. Best practices/common challenges 6. Monitoring of integration 7. Modes of integration for service delivery Q 8
    9. 9. External context Internal context Institutiona l links • Development priorities • Urgency • Environmental context (economic, social, cultural, political, legal) • Leaders/Champions • Vision • Capacity • Incentives • Organizational structures, values, cultures, experiences • Shared understanding • Roles and accountability • Participation and partner Relations • Partnership types Adapted from Garrett and Natalicchio 2012 Framework for intersectoral coordination 9
    10. 10. Program Design Level Agriculture Health HKI- Regional Agriculture advisors Health advisors HKI- National Project manager; Communications officer; M&E officer HKI- Local Production officer Production facilitators Steeringcommittee Government- Local Agriculture/ livestock agents Health agents APRG APRG HFP focal point Production facilitators Nutrition facilitators Community Model farmers Health volunteers Mothers 1 10
    11. 11. Enabling environment Malnutrition seen as a development issue locally Not mentioned spontaneously Issues mentioned were determinants of malnutrition: lack of access to water, farming inputs, health centers, poverty 2 11
    12. 12. Perceptions of integration High level of understanding of multisectoral causes of malnutrition Understanding and agreement on need for integration Those closer to the community had a deeper understanding of the roles of counterparts Technical capacity and knowledge adequate within sector Confidence reported due to training Motivation mixed for intersectoral working Knowledge gained in other sectors Sense of value placed on the project ‘Just doing my job’ “I didn’t need to work with agents in different sectors to complete my activities.” - NGO agriculture facilitator “Working together brings with it certain advantages, such as complementarity and effectiveness.” - NGO agriculture facilitator 3 12
    13. 13. Implementation of integration Mode of integration assumed to be harmonization of messages at beneficiary level Other management systems and field activities emerged ad-hoc if staff saw linkages to be made Some fieldworkers took initiative (supervisors and staff)  differences in levels of integrated working across project Some community-level workers ended up with dual roles  different across project areas More integration closer to community level “No, we never initiated a joint activity together. The Relais did their work, we did ours. There was no confusion between tasks.“ - Model farmer “Although it wasn’t planned that we worked together, he came with me on certain trips because of the long distances.” - NGO health facilitator “Playing both roles was difficult because I had a lot of responsibilities, and I didn’t have the means for moving around and making house visits—even though the houses were very far from each other.” - Community health and agriculture worker 4 13
    14. 14. Best practices / challenges Broadly positive about E-HFP integrated approach Many positive impacts reported Workers wanted more knowledge from other sectors BUT Workload: particularly challenging for dual roles Staff turnover: loss of understanding of the need for integration Resources: unequal distribution across sectors at community level was a point of friction “We would have liked training on ENA much like the nutrition facilitators received. That would have allowed for a certain complementarity on the ground, a certain junction of our activities.” - NGO agriculture facilitator 5 14
    15. 15. Monitoring of integration No formal monitoring of modes of integrated working Unclear if and how the Steering Committee aided intersectoral accountability 6 15
    16. 16. Modes of integration 1 • Harmonized messaging: Messages are harmonized at managerial level; little interaction across sectors at field level; messages come together at beneficiary level 2 • Joint education and planning: Field workers with separate sectoral training come together to plan and/or implement joint education sessions / home visits for beneficiaries 3 • Cross-training: Field workers receive cross-sectoral training; messages are delivered by sectoral experts 4 • Holistic training: Field workers receive cross-training and are expected to deliver messages from more than one sector 7 16
    17. 17. Conclusions Understanding, confidence, and motivation for cross- sectoral work was high Staff turnover, dual workload, and unbalanced resources across sectors were challenges The goal of harmonized messaging remained from design through into implementation Alternative modes of integration were not elaborated or monitored, leading to varied delivery Several modes of integration were identified  Typology 17
    18. 18. Lessons going forward Pay explicit attention to different modes of integration in program design (strategies /day-to-day processes) Use the emerging typology to start to think through appropriate modes in different contexts Monitor whether and how these are implemented Future research: Build in learning as to which is more useful 18
    19. 19. Thank you!

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