Egypt_policy_Protocol

Tufts University
Analysis of Facilitators, Constraints, and Solutions for
Effective Implementation of Nutrition Policy and Programs at
National Level in Egypt
Prepared by Nutrition Innovation Lab, Africa
Ashish Pokharel, Dr. Patrick Webb, Dr. Shibani Ghosh, Dr.
Jeffrey Griffiths, Elizabeth Marino-Costello, Marwa Moaz, Grace
Namirembe
5/20/2015

Table of Contents
Background ................................................................................................................1
Policy and Program Initiatives in Egypt ..................................................................................... 1
Landscape Analysis..................................................................................................................... 2
Study Aim ..................................................................................................................5
Study Objectives ........................................................................................................5
Methods......................................................................................................................6
Study Design ............................................................................................................................... 6
Study Areas, Interviews and Data Collection ............................................................................. 6
Informed Consent Form .............................................................................................................. 7
Data Safety.................................................................................................................................. 7
Data Analysis .............................................................................................................................. 7
Benefits of the Study..................................................................................................8
References..................................................................................................................9
Annex 1: Informed Consent Form...........................................................................10
Annex 2: Letter of Introduction ...............................................................................11
Annex 3: National level Questionnaire: Government/Academic ............................12

1
Background
Egypt is a middle-income country that has major nutritional problems like high burden of
stunting among children and rates of obesity/overweight among adults and adolescents. About
9.8 percent of children under 5 years are severely stunted and about 21.4 percent of children are
moderately stunted (Egypt DHS 2014). Stunting is higher in Upper Egypt (which has 12% of
children severely stunted and 26.2% moderately stunted) compared to Lower Egypt (which has
8.3% of children severely stunted and 17.9 % of children moderately stunted) (Egypt DHS
2014). In addition, stunting is present among children in all wealth quintiles with minimum
variation across quintiles. The DHS 2014 also shows that among girls aged 5-19 years 26.9 % of
girls are overweight and 9.5% of them are obese. This trend is seen in boys aged 5-19 as 24.5 %
of them are overweight and 10.5% of them are obese.. In addition to stunting among children, the
rates of obesity/overweight in adults in Egypt are another major public health and nutrition
challenge. Among ever-married women aged 15-49, 36.5% of women are overweight and 48.1
% of women are obese. (Egypt DHS 2014) Micronutrient deficiencies are common with 25.2%
of women have anemia in some form or the other. Similarly, Egypt DHS 2014 points out that
two third of ever married women have experienced at least one major barrier to access health
care. The presence of both stunting and obesity within the population and possibly within the
same households highlights the complex manifestation of nutrition problems in Egypt.
Nutritional problems are inevitably linked with other factors like food security, agricultural
production, poor dietary practices, lack of nutritional education and awareness, social protection,
safety nets, and coverage and effectiveness of health services (Egypt Landscape Analysis, 2012).
Policy and Program Initiatives in Egypt
Considering the diverse causes and factors for malnutrition problems, various policies and
programs have been designed in Egypt that aim to harmonize nutrition interventions and
programs across the country. These include comprehensive multisectoral policies and programs.
They have a diverse range of goals ranging from addressing stunting among children to
improving economic standards for farmers. Some of the major programs and policies that
address nutrition outcomes are as follows:
● Food and Nutrition Strategy (2007-2017)
This strategy was developed by various government ministries in Egypt along with
technical support from international donors and organizations like UNICEF, UNFPA,
WHO, WFP. The development of this multisectoral government strategy involved
Ministry of Health and Population, Ministry of Industry and Foreign Trade, Ministry of
Education, National Nutrition Institute, National Council for Motherhood and Childhood
and several other ministries. The major nutrition focus of this strategy is to reduce the
prevalence of lifestyle diseases like obesity, diabetes, cancer, reduce micronutrient
deficiency in high risk groups like mother and children, reduce anemia, vitamin A
deficiency, iodine deficiency, and increase nutrition and health knowledge among the

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people. The strategy also stresses objectives like improving household food security,
promotion of IYCF and breastfeeding practices, capacity building and development at
institutional and community levels, and monitoring the food and nutrition situation.
● National Acceleration Plan for Child and Maternal Health (2013-2015)
This plan aims to reach out to the underprivileged population in 18 governorates with
poor child and maternal health outcomes. It aims for accelerated implementation of
maternal and child health interventions which will result in reduction of maternal and
child deaths. This acceleration plan outlines interventions like improvement of quality of
obstetric and emergency care, increasing access to family planning, increasing skilled
attendants at birth, improving nutritional supplements etc.
● Agricultural Sustainable Development Strategy ( 2011-2030)
The main mission of this agricultural strategy is modernizing the Egyptian agriculture
based on achieving food security and improving the livelihood of the rural inhabitants,
through the efficient use of development resources, utilization of geopolitical and
environmental comparative advantages of the different agro-ecological regions.
Increasing the level of food security of different crops, improving farmer’s income, and
reducing poverty in rural areas are the expected impact of the first phase of the strategy
● UNICEF’s country program ( 2013-2017)
UNICEF is a key nutrition program partner of the government of Egypt as well as other
UN agencies. One of its country program’s objectives is building the institutional and
human capacity of the MOHP to provide high quality nutrition interventions and services
such as growth monitoring, micronutrient supplementation, and promotion of
breastfeeding as well as other recommended child feeding practices. UNICEF also plans
to launch a “Nutritional action plan” on June, 2015 that will include operational
functioning of the nutritional policies. UNICEF expects to reduce the prevalence of
chronic malnutrition among children under 5 years in targeted communities and improve
IYCF practices through community based nutrition program.
● WFP’s country program (2013-2017)
The major nutrition focused objectives of WFP’s country program is to monitor and
respond to food security risks, strengthen national capacity to prevent malnutrition among
vulnerable population, provide evidence-based analysis to guide food security policy,
support the reform of food based safety nets.
Landscape Analysis Study and its Recommendations
The existing scope of policies and programs addressing malnutrition in one form or the other
highlights Egypt’s recognition of the key role of nutrition programs and interventions in public
health and social development. Egypt, like many other countries with high burden of

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malnutrition, aims to implement effective policies and evidence based nutrition interventions and
programs at scale. The Ministry of Health and Population (MOHP) in Egypt is the main
governmental body associated with the enactment of nutrition policies and implementation of
programs to achieve policy objectives. The MOHP considers nutrition as a key priority in
recent years. Along with UNICEF, in 2012, it commissioned a landscape analysis study, which
aimed to get a better understanding of the scope of malnutrition and its possible solutions. This
analysis was designed to ascertain the implementation of the Food and Nutrition Strategy (2007-
2017). It examined the nature and scale of nutrition problems, government’s willingness and
commitment to act, government’s capacity to act at scale, and potential barriers to act at scale. It
examined willingness, commitment and capacity of personnel to act on malnutrition issues at
various levels in the country.
The landscape analysis study engaged stakeholders through interviews and workshops and
gathered evidence of the perceived problems in nutrition governance. Based on the findings of
the analysis, the following recommendations were proposed:
 The Inter-Ministerial Advisory Committee must be revitalized immediately including
incorporation of technical or specialist staff to make sure that the work gets done.
 The Inter-Ministerial Committee on Nutrition needs to be capacitated to improve
coordination and communication amongst nutrition stakeholders in the country and
region.
 The roles of different partners in the National Strategy must not only be defined but
communicated and structures or processes established to make sure that assigned
responsibilities are properly accounted for.
 Training national staff on health systems stewardship and integrated planning. Part of
health systems strengthening requires that the national capacity is enhance to plan,
implement and ensure monitoring and evaluation of programs.
 The MOHP must create an internal platform to ensure that nutrition gets visibility
and that it is integrated into other programs.
 Develop a resource mobilization and funding strategy for the National Food and
Nutrition Policy and Strategy including engaging private business, international donors,
zakat, and other funding agencies in nutrition.
 In the long term, it is recommended that there be one governance platform for Nutrition
and Food Security to allow for greater coordination and management of nutrition
activities.
Egypt’s Commitment to Second International Conference on Nutrition (ICN2)
The Second International Conference on Nutrition (ICN2) was a high-level intergovernmental
meeting in November 2014 that focused global attention on addressing malnutrition in all its
forms. Over 2,200 participants attended the meeting, including representatives from more than
170 governments, 150 representatives from civil society and nearly 100 from the business

4
community. The ICN2 and its preceding meetings provided a forum for participants to delve
deeper into specific nutrition issues.
The two main outcome documents from ICN2 meetings–the Rome Declaration on Nutrition and
the Framework for Action—were endorsed by participating governments at the conference,
committing world leaders to establishing national policies aimed at eradicating malnutrition and
transforming food systems to make nutritious diets available to all. The Framework for Action
provided series of recommendations for achieving significant progress in nutrition.
Egypt was one of the countries that participated in ICN2 meeting, with His Excellency Adel El-
Beltagy, the Minister of Agriculture and Land Reclamation, giving a formal speech. In his
speech, he outlined the goals of the Egyptian government, namely: achieving higher rates of self-
sufficiency in crops, improving consumption pattern, improving quality of food, and improving
social safety nets. He also highlighted the measures taken by the government of Egypt to reduce
nutrition problems and the food prices like renovated bread subsidy system, bread fortification,
vitamin A programs, school nutrition programs etc.
The recommendations, proposed by the Landscape Analysis Study and ICN2 Framework for
Action, require inclusion of many stakeholders and participants. As most of the nutrition policies
and intervention programs cut across many sectors (e.g. public health, agriculture, trade & food
supply, education, women’s empowerment, social protection, and others), challenges in
formulation, design, implementation, and dissemination of policies and programs will exist.
Multidimensional policies and programs leads to challenges in area of responsibilities,
commitment, and coordination among stakeholders. Although donors, INGOs and other
stakeholders try their best to align their policies and programs with the national government’s
Food and Nutrition Strategy (2007-2017), each of the stakeholders have their own objectives,
agenda, and approach towards addressing the nutritional problem. Thus, it is very difficult to
assess these multidimensional and multisectoral policies and programs which targets reduction in
malnutrition.
Questions such as; why and how did the program succeed or did not succeed; which results can
be attributed to which aspects of program; which stakeholders played a key role in achieving the
results, are very difficult to answer. Furthermore, implementation of policies and programs is
difficult as health professionals may lack the knowledge, training and skill. Bhutta et. al. in the
Lancet Series expressed this sentiment in their meta-analysis of efficacy (clinical trial)
interventions. The authors of that series identified a lack of sufficient research and evidence in
the realm of operations research and evaluations focusing on “how interventions work” (Bhutta
et.al. 2008). Similarly, Taylor. L. states that it is equally important to understand if and how
implementation of programs and initiatives meets the identified priorities at country level
(Taylor. L., 2012). Shekar and 17 others in an opinion piece following the release of the Lancet
series strongly encouraged the need to gain knowledge on the effectiveness of large scale

5
programming and the strategic actions needed to build political commitment (Shekar et. al.,
2008).
Nutrition State in Egypt
In order to better understand the current state of nutrition in Egypt, Nutrition Innovation Lab
hired Dr. Habiba Hassan-Waseef as a food and nutrition policy expert. During informal
discussions, the necessity for examining Ministry of Health and Population (MOHP)’s
operational capacity, policy mechanism, and ability to lead multi-sectoral approaches in the
domain of food and nutrition was felt. Dr. Habiba also highlighted the need for MOHP to acquire
capacity and leadership to implement future nutrition agenda. At present, some national scale
nutrition decisions are being made away from the MOHP. With weak multi-sectoral
coordination, the nutrition system is not a sustainable and coherent system; but, a separate
collection of different activities and programs. Furthermore, lack of accountability and weak
commitment to nutrition policies from various nutrition related partners and stakeholders has
contributed to slowing down of progress towards achievement of nutrition goals.
Study Aim
The proposed study focuses on generating empirical evidence to explain the stakeholder’s
perception of how and why multisectoral policies and programs in nutrition achieve their goals
(or not) at national level. The aim of this study is to elicit insights from among key national level
policymakers and stakeholders on 'the process' of implementing nutrition and food security
policies in Egypt. This study will draw from the recommendations of UNICEF’s Landscape
Analysis Report (2012) and ICN2 Framework for Action and it will try to determine the
outcome/follow up of the recommendations made by the Landscape analysis Study and ICN2
Framework For Action.
Study Objectives
This study will focus on understanding the perceived facilitators/barriers/constraints involved in
the conversion of policy initiatives into actions at scale. It will examine cross-sectoral
coordination at the national level within the context of Food and Nutrition strategy, Landscape
Analysis Study, and ICN2 Framework for Action. The study will focus on understanding
horizontal coherence at national level and their perceived effect on formulation of nutrition
policies and nutrition program effectiveness.
The specific objectives of this study are as follows
1. To understand the extent of implementation of the Food and Nutrition Strategy (2007-
2017) and by government coordination bodies and line ministries.
2. To outline facilitators, barriers, collaborations/constraints at the national level in
translating policy to action.

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3. To examine cross –sectoral coordination at national level across government line
ministries, donor communities, and INGOs.
4. To review the follow up on the recommendations made by Landscape Analysis
Report (2012)
5. To review the follow up on the recommendations made by ICN2 Framework for
Action
Methods
Study Design
The study will utilize a structured interview format to interview line ministry, UN and INGO
officials at the national level in Egypt. All efforts will be made to maintain confidentiality of the
interview reports and the respondents. Interviews will be conducted using a structured interview
questionnaire, allowing for easy aggregation of results. The sample size will consist of a
maximum of 40 individuals working at national level nutrition policy and programs realm. These
individuals from different government ministries, INGOs, and donors will be interviewed using a
structured questionnaire. Respondents will be interviewed only upon providing informed
consent. The informed consent form is attached in Annex 1 and the questionnaire for national
level stakeholder interview is attached in Annex 3.
Study Areas, Interviews and Data Collection
The study will be conducted in Cairo, Egypt. National level interviews will be conducted with
senior officials and policy makers from government, donors, and INGOs based in Cairo, Egypt.
There will be approximately 40 interviews at the national level; this is a purposive sample of
individuals involved in different sectors in national policymaking and governance. The sectors
will include, but not be limited to, health, agriculture, education, finance and economic
development, women, children and youth affairs, social protection. In addition, selected officials
from government coordination bodies and line ministries will be interviewed as well as selected
staff from donor agencies, UN agencies and INGOS. Individuals will also include stakeholders
from the academic institutions, UN agencies, bilateral donors (e.g. USAID), and non-
governmental bodies (e.g. Save the Children).
Individuals for interviews will be recruited through their respective offices/departments. For all
interactions, a letter of introduction (via email) will be presented first followed by phone calls as
appropriate. A letter of introduction is attached in Annex 2. In the UN agencies, international
NGOs and academic units, participants will be directly approached. For the government
organizations letter of introduction will be presented to the head of the office/agency as a
formality followed by interaction with the intended participant (if he/she is junior to the head of
office).

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Informed Consent Form
Following the letter of introduction (via email), an appointment will be set up with the intended
participant. At the appointment participants will be provided the details of the interview and
requested for informed consent. If the participant does not give consent, they will be dropped
from the sample. It is anticipated that most intended participants will be interviewed on that visit
itself. However if the participant requires time to consider the request, the team will leave the
consent form with the participant and re contact a week later to determine if the participant is
willing for the interview. If the participant is not willing, he/she will be dropped from the
sample. If the participant requires time to consider doing the visit, the forms will be provided to
the individual during the first visit with a review of the expectations from the interview. Any
further questions will be handled via telephone or email. Individuals will be given one week to
review the form and contacted again for an interview appointment for a later date. This two-step
process will allow those individuals who need adequate time to consider their participation in the
study and minimize the possibility of coercion and undue influence. The informed consent form
to be utilized in the study is attached in Annex 1.
Data Safety
All interviews will be conducted at place of employment and all data will be coded by a
numerical code that will prevent any confidential information being leaked at the place of
employment. This study involves conducting in depth interviews with select officials at national
levels within the government ministries, donors, and INGOs. This study utilizes survey
methodology that has are no risks associated. The survey questions are focused on
understanding perceived willingness, commitment, capacity, barriers and facilitators to nutrition
policy making and program implementation. Some questions will be focused on the workplace;
however, none of the questions included in the survey questionnaires are likely to pose any risk
to the participant within their work place. Furthermore, only the immediate data collection team
will have access to the identities and codes associated with the respondents. All data will be de-
identified and analyses will be presented in aggregate. The researchers by de-identifying the data
will ensure that there is no risk to the participant.
All efforts will be made to maintain confidentiality of the interview reports and the respondents.
Interviews will be conducted anonymously following interview guides, allowing for easy
aggregation of results.
Data Analysis
The primary analysis will be quantitative and qualitative in nature with other related data from
the national levels being utilized to triangulate the findings. Analyses will be presented through
meetings at the national level as well as through published reports and presentations from
Nutrition Innovation Lab at Tufts University.

8
Benefits of the Study
The proposed study focuses on generating rigorous empirical evidence to explain how and why
multi-sector policies and programs in nutrition achieve their goals (or not) at national level in
Egypt. The aim is to elicit insights from among key policymakers and stakeholders on “the
process” of implementing interventions at national level in Egypt. The data collected from the
interviews will be useful to the broader policy environment in Egypt.
This study will analyze how a range of policies and programs get translated from the design
phase (on paper) to the implementation phase (in practice) at a national level. The intent is not
individual program impact evaluations; the focus will be on operations research that achieves
generalizable findings relevant beyond single interventions in Egypt. Building on institutional
readiness for change theory, and assessment of horizontal integration as approaches to enhanced
cross-sector coordination, the research will link metrics of institutional and individual
collaboration at national level.

9
References
Egypt Ministry of Health and Population, (2015). Egypt demographic and health survey 2014
Egypt Ministry of Health and Population, (2012). Egypt nutrition landscape analysis report,
2012
Bhutta, Z.A. et al. 2008 What Works? Interventions for Maternal and Child Undernutrition and
Survival. Lancet 371:417-40.
Taylor L. 2012. From Food crisis to nutrition: challenges and possibilities in Ethiopia’s nutrition
sector. Analyzing Nutrition Governance: Ethiopia country report.
Shekar, M., et al. 2008 Delivery Sciences in Nutrition. Lancet: 371:1751.

10
Annex 1: Informed Consent Form
Hello! My name is………………. I am here from Nutrition Innovation Lab based in Tufts University.
We are collecting data for the study “Analysis of facilitators, constraints, and solutions for effective
implementation for nutrition policy and program effectiveness in Egypt”. The proposed study focuses on
generating empirical evidence to explain the stakeholder’s perception of how and why multisectoral
policies and programs in nutrition achieve their goals (or not) at national level. The aim of this study is to
elicit insights from among key national level policymakers and stakeholders on 'the process' of
implementing nutrition and food security policies in Egypt. This study will draw from the
recommendations of UNICEF’s Landscape Analysis Report (2012) and Second International Conference
on Nutrition (ICN2)’s Framework for Action. The study will try to determine the outcome/follow up of
the recommendations made by the Landscape analysis study and ICN2 Framework for Action.
You are one of several key informants who will be interviewed through this process.
In this study, I will ask you questions related to Egypt’s policy and processes targeting nutrition goals.
We value your opinion and there are no wrong answers to the questions we will be asking in the
interview. We will use approximately 1 hour of your time to collect all the information. There will be no
risk as a result of your participating in the study. Your participation in this research is completely
voluntary. You are free to withdraw your consent and discontinue participation in this study at any time.
The information given by you will be strictly treated as confidential and will only be used for the study.
All your responses are de-identified.
Your participation will be highly appreciated.
Are you willing to participate in the study?
1. Yes 2. No
Name_____________________________ Department: ___________________________
Signature: _________________________ Date: ____/_____/2015
Signature of the witness: ________________________
Contact information: Dr. Habiba Hassan- Wassef, Phone no: +2010 01030507, Email:
bio_egypt@hotmail.com; Ashish Pokharel, Phone no: 01 (339) 545 6542, Email:
ashish_pokharel@hotmail.com; Dr. Patrick Webb, in USA, Phone no: 001(617) 636-3779 Email:
patrick.webb@tufts.edu; Dr. Shibani Ghosh, in USA, Phone no: 001 (617) 636-3771 Email:
shibani.ghosh@tufts.edu

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Annex 2: Letter of Introduction
Hello,
My name is _________________ and I am representing Nutrition Innovation Lab from Tufts University,
Boston, USA. The Nutrition Innovation Lab is conducting a study titled “Analysis of Facilitators,
Constraints, and Solutions for Effective Implementation of Nutrition Policy and Programs at National
Level in Egypt”. The proposed study focuses on generating empirical evidence to explain the
stakeholder’s perception of how and why multisectoral policies and programs in nutrition achieve their
goals (or not) at national level. The aim of this study is to elicit insights from among key national level
policymakers and stakeholders on 'the process' of implementing nutrition and food security policies in
Egypt. This study will draw from the recommendations of UNICEF’s Landscape Analysis Report (2012)
and Second International Conference on Nutrition (ICN2)’s Framework for Action. The study will try to
determine the outcome/follow up of the recommendations made by the Landscape analysis study and
ICN2 Framework for Action.
In this study, I will ask you questions related to Egypt’s policy and processes targeting nutrition goals.
We value your opinion and there are no wrong answers to the questions we will be asking in the
interview. We will use approximately 1 hour of your time to collect all the information. There will be no
risk as a result of your participating in the study. Your participation in this research is completely
voluntary. You are free to withdraw your consent and discontinue participation in this study at any time.
The information given by you will be strictly treated as confidential and will be used only for the study.
All your responses are de-identified.
Your participation will be highly appreciated. Are you willing to participate in the study?
1. Yes 2. No
Name: _________________________ Department: ___________________________________
Signature: ______________________ Date: ____/_____/2015
Contact information: Dr. Habiba Hassan- Wassef, Phone no: +2010 01030507, Email:
bio_egypt@hotmail.com; Ashish Pokharel, Phone no: 01 (339) 545 6542, Email:
ashish_pokharel@hotmail.com; Dr. Patrick Webb, in USA, Phone no: 001(617) 636-3779 Email:
patrick.webb@tufts.edu; Dr. Shibani Ghosh, in USA, Phone no: 001 (617) 636-3771 Email:
shibani.ghosh@tufts.edu

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Annex 3: National level Questionnaire
Nutrition CRSP Africa
ICN2 and Landscape Analysis Recommendation Follow Up study
Introduction
In the recent years, Egypt government has placed an emphasis on improving nutrition status of
the people. Nutrition is a main priority area for the government of Egypt and the government has
developed a 10-year Food and Nutrition Policy and Strategy (2007-2017) to deal with emerging
and existing nutrition challenges. In 2010, UNICEF Egypt Country Office and the Ministry of
Health and Population commissioned a Landscape Analysis study, which complemented the
Food and Nutrition Policy and Strategy and analyzed the challenges in implementation of the
strategy. The Landscape Analysis Study Report (2012) recommended various short-term, mid-
term, long-term actions for improving nutrition policies and programs. Along with the domestic
policies and commitments, Egypt participated in the Second International Conference on
Nutrition (ICN2) and stated its commitments to improve the nutrition status of its people.
A brief description of the National Food and Nutrition Policy and Strategy (2007-2017),
Landscape Analysis Study 2012, and ICN2 are given below:
 National Nutrition Strategy (2007-2017)
The National Nutrition Strategy was developed by the government of Egypt with
discussions and input from various relevant ministries, and technical support from
international organizations and donors like UNICEF, WHO, and WFP. The primary
objectives of this strategy was to promote inter-sectoral collaboration, incorporate
nutrition objectives into other policies and programs, improve household food security,
monitor food situation in the country, improve quality of food, prevent and control diet
related non communicable diseases, promote healthy dietary habits, promote IYCF, and
prevent micronutrient deficiencies. This strategy hoped to achieve a list of expected
outcomes relating to the objectives by the end of the timeframe. In order to complement
this strategy, a Landscape Analysis Study was commissioned to analyze the problems and
the possible solutions in implementation process of National Nutrition Strategy.
 Landscape Analysis Study (2012):
The prevalence of malnutrition is alarming and contrasting. Chronic under nutrition and
overweight/ obesity represents two different facets of malnutrition in Egypt. Recognizing
this challenge, the ministry of Health and Population in Egypt has placed nutrition as one
of its top priorities. In collaboration with other ministries and stakeholders, MOHP
developed a 10-year Food and Nutrition Policy and Strategy (2007-2017). In order to
better understand the problems in implementing the Food and Nutrition Policy and
Strategy (2007-2017) and devise solutions, a Landscape analysis study was undertaken

13
by MOHP with support from UNICEF and other stakeholders. The LA study approached
the malnutrition problem through four different axes; identifying the nature and the scale
of nutrition problems; the government willingness and commitment to act at scale; the
capacity to act at scale; and factors enabling or hindering the commitment and capacity to
act at scale. The LA report came up with recommendations; immediate, medium and long
term. It covered the most critical areas of nutrition in Egypt; coordination, funding,
programs, planning, human resources, services and information systems.
 Second International Conference on Nutrition (ICN2)
The Second International Conference on Nutrition (ICN2) was a high-level
intergovernmental meeting in November 2014 that focused global attention on addressing
malnutrition in all its forms. Over 2,200 participants attended the meeting, including
representatives from more than 170 governments, 150 representatives from civil society
and nearly 100 from the business community. The ICN2 and its preceding meetings
provided a forum for participants to delve deeper into specific nutrition issues. The two
main outcome documents–the Rome Declaration on Nutrition and the Framework for
Action—were endorsed by participating governments at the conference, committing
world leaders to establishing national policies aimed at eradicating malnutrition and
transforming food systems to make nutritious diets available to all.
Egypt was one of the countries that participated in ICN2 meeting, with His Excellency
Adel El-Beltagy, the Minister of Agriculture and Land Reclamation, giving a formal
speech. In his speech, he outlined the goals of the Egyptian government, namely:
achieving higher rates of self-sufficiency in crops, improving consumption pattern,
improving quality of food, and improving social safety nets. He also highlighted the
measures taken by the government of Egypt to reduce nutrition problems and the food
prices like renovated bread subsidy system, bread fortification, vitamin A programs,
school nutrition programs etc.

14
Introduction and Format of the Questionnaire
Nutrition Innovation Lab is trying to understand the extent of implementation of the
recommendations made by the Landscape Analysis Study and the ICN2. Through this
questionnaire, we will analyze your opinions and thoughts on current state of nutrition policies
and activities in Egypt. The questionnaire will cover topics like multi-sector coordination,
resources, training, food systems, social safety nets, education, media, and health and nutrition
services.
After each question, an open-ended discussion will ensue to capture your views and opinion. The
open-ended discussion will help to identify the barriers and facilitators in nutrition policy making
and programming. The discussion will help determine why certain policies and programs work
while others are do not work.
This questionnaire is divided into two sections: background information section and the
discussion questions section.
The background information section is introductory and it will ask you about your position title,
experience, education, and trainings. The discussion questions section asks you for your opinions
and it consists of 37 questions. The response format for most of these questions ranges from
“strongly agree” to “strongly disagree”. There are also a few yes/no questions. An open-ended
discussion will ensue each of these questions.

15
Background Information Section
Interviewer ID ( pre-coded
before the interview)
Interviewer work type 1. Government
2. UN agency
3. Bi-Lateral donors
4. Independent consultants
5. Others (Specify)
______________________________________________
Gender 1. Male
2. Female
3. Other
Current position A. Title:__________
B. Office:___________
C. Duration: _______years ______months
Information on Previous
Position
A. Title:_____________
B. Office:______________
C. Duration: ______years ______months
Highest Level of
education
1. Post doctorate
2. PhD
3. Master’s
4. Bachelors
5. Intermediate
6. Other (specify) ____________
Have you ever had courses
or trainings especially on
nutrition in the past 3
years?
1. Yes
2. No
If no proceed to next question
If yes how many trainings or course and how many days in total (
not to be confused as a part of degree education or schooling)
Type of Training
or courses
Duration
of
Training
or
courses
in days
Usefulness to the training
for the present position
Very
Useful
Slightly
Useful
Not
Useful
1
2
3
4
5

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Have you ever had any
training or courses
specifically about health,
agriculture, or nutrition
in the past 3 years (other
than the ones mentioned
above)?
1. Yes
2. No
If no proceed to next question
If yes what type of training courses, course and how many days in
total ( not to be confused as a part of degree education or schooling)
Type of Training
or courses
Duration
of
Training
or
courses
in days
Usefulness to the training
for the present position
Very
Useful
Slightly
Useful
Not
Useful
1
2
3
4
5

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Discussion Questions
National Nutrition Strategy and Coordination
Questions Respondent comments based on open-
ended discussion
1 In Egypt, is there sufficient political
commitment to improve nutrition at country
level?
1. Strongly Agree
2. Agree
3. Neither agree nor disagree
4. Disagree
5. Strongly disagree
98. Don’t know
2 Are you familiar and/or aware of the National
Nutrition Strategy (2007-2017)?
1. Yes
2. No
3 The Egypt Landscape Analysis Study (2012)
recommends that the National Nutrition
Strategy from 2007-2017 needs to be
reviewed. Do you agree?
1. Strongly Agree
2. Agree
4. Disagree
98. Don’t know
4 Are you aware of any discussions among
stakeholders around an operational plan to
put the National Food and Nutrition Strategy
into practice?
1. Yes
2. No
3. Don’t know
5 Are the roles of various stakeholders having
influence on nutrition in Egypt well defined?
1. Strongly Agree
2. Agree
4. Disagree
98. Don’t know

18
recommends that there needs to be better
coordination between ministries. Do you
agree?
1. Strongly Agree
2. Agree
4. Disagree
98. Don’t know
recommends that the inter-ministerial
committee of nutrition should be revived to
improve coordination and cooperation among
the stakeholders. Do you agree that the
committee should be revived?
1. Yes
2. No
8 Do you agree that the National inter-
ministerial advisory committee on nutrition
has had sufficient capacity over the past 2
years (i.e. allowing experts to function in
tandem with an adequately resourced
secretariat)?
1. Strongly Agree
2. Agree
4. Disagree
98. Don’t know
9 In the past two years, has the MOHP taken
leadership in the implementation of nutrition
strategy (as recommended by the Landscape
analysis)?
1. Strongly Agree
2. Agree
4. Disagree
98. Don’t know

19
10 Do you agree that there is adequate
collaboration between government and other
stakeholders while implementing programs at
national level?
1. Strongly Agree
2. Agree
4. Disagree
98. Don’t know
11 Do you agree that there is a need for
collaboration among colleagues from
different sectors to address nutrition
problems?
1. Strongly Agree
2. Agree
4. Disagree
98. Don’t know
12 Do you agree that you are able to collaborate
adequately with other sectors in addressing
nutrition issues?
1. Strongly Agree
2. Agree
4. Disagree
98. Don’t know
13 Do you agree that you are kept informed
about what nutrition plan and activities that
are going on outside your office/department?
1. Strongly Agree
2. Agree
4. Disagree
98. Don’t know

20
Resources and Training
14 Do you agree that there is sufficient budget
allocation for nutrition by the government of
Egypt?
1. Strongly Agree
2. Agree
4. Disagree
98. Don’t know
15 In the past two years, do you agree that there
has been adequate training on integrated
planning relating to nutrition programs?
1. Strongly Agree
2. Agree
4. Disagree
98. Don’t know
Food Systems and Social Protection
16 Do you agree that current nutrition strategies
and programs are adequately aligned with
food security and agriculture policies and
programs?
1. Strongly Agree
2. Agree
4. Disagree
98. Don’t know
17 Do you agree that current agriculture and
food policies and programmes effectively
support improved nutrition?
1. Strongly Agree
2. Agree
4. Disagree
98. Don’t know

21
18 Do you agree that there is sufficient attention
on women’s empowerment in food
production and processing in current
agriculture and food policies and programs?
1. Strongly Agree
2. Agree
4. Disagree
98. Don’t know
19 Do you agree that there is sufficient attention
towards crop diversification in the current
agriculture and food policy?
1. Strongly Agree
2. Agree
4. Disagree
98. Don’t know
20 Do you think that there is sufficient attention
towards the promotion of production of fruits
and vegetables in the current agriculture and
food policy
1. Strongly Agree
2. Agree
4. Disagree
98. Don’t know
21 Do you think there is sufficient attention to
the production and accessibility of nutrient
dense animal source foods (meat, dairy) in
agriculture and food policy?
1. Strongly Agree
2. Agree
4. Disagree
98. Don’t know

22
22 Do you think that nutrition objectives are
sufficiently incorporated into safety net
policies and programs in Egypt?
1. Strongly Agree
2. Agree
4. Disagree
98. Don’t know
23 Do you agree that foods are adequately
fortified with micronutrients like iron, folic
acid etc.?
1. Strongly Agree
2. Agree
4. Disagree
98. Don’t know
24 Do you agree that the food subsidy programs
are improving the diets of the vulnerable
population?
1. Strongly Agree
2. Agree
4. Disagree
98. Don’t know
25 Do you agree that food subsidy policies
encourage the consumption of a healthy diet
pattern?
1. Strongly Agree
2. Agree
4. Disagree
98. Don’t know
26 Do you agree that cash transfer programs are
better than food subsidies policies at
improving nutrition status of vulnerable
population?
1. Strongly Agree
2. Agree
4. Disagree
98. Don’t know

23
Education and Media
27 Have there been mass media
campaigns/social marketing campaigns
encouraging the consumption of
micronutrient rich foods such as fruits and
vegetables in the past 2 years?
1. Yes
2. No
3. Don’t know
28 Have there been mass media/social
marketing campaigns promoting physical
activity in the past 2 years?
1. Yes
2. No
3. Don’t know
29 Have food safety, labeling and advertising
(marketing of foods and beverages) laws
been reviewed in the past two years?
1. Yes
2. No
3. Don’t Know
30 Do you agree that these laws for marketing
of food and beverages to the children are
strictly enforced?
1. Strongly Agree
2. Agree
4. Disagree
98. Don’t know
31 Do you agree that these food labeling and
advertising laws are strictly enforced?
1. Strongly Agree
2. Agree
4. Disagree
98. Don’t know

24
Health and Nutrition Services
32 Do you think that in the past two years more
efforts are being made in integrating nutrition
services with health care provision?
1. Strongly Agree
2. Agree
4. Disagree
98. Don’t know
33 Do you agree that the current health policy
(strategy) in Egypt emphasizes the need to
improve maternal nutrition and health (e.g.
underweight and overweight in women,
healthy diets and pregnancies)
1. Strongly Agree
2. Agree
4. Disagree
98. Don’t know
improve child nutrition and health (e.g.
underweight and overweight in children,
healthy diets)
1. Strongly Agree
2. Agree
4. Disagree
98. Don’t know
address the increasing prevalence of
overweight and obesity in men and women in
Egypt
1. Strongly Agree
2. Agree
4. Disagree
98. Don’t know

25
address the increasing prevalence of non-
communicable diseases in adults (e.g. heart
disease, cancer, diabetes mellitus)
1. Strongly Agree
2. Agree
4. Disagree
98. Don’t know
37 Do you agree that the current development
policy (strategy) in Egypt emphasizes the
need to improve water, hygiene and
sanitation issues in Egyptian communities
1. Strongly Agree
2. Agree
4. Disagree
98. Don’t know

26
Annex 4: Email Script
Dear (Name of the selected participants),
My name is (Name of the policy expert or in-country coordinator) and I am representing
Nutrition Innovation Lab at Tufts University. The Nutrition Innovation Lab is carrying out a
study titled “Analysis of Facilitators, Constraints, and Solutions for Effective Implementation of
Nutrition Policy and Programs at National Level in Egypt” and you have been chosen as one of
the participants for this study. Your participation will be greatly appreciated and it will help the
Nutrition Innovation lab complete this study and give recommendations to improve nutrition
policy realm in Egypt.
If you are interested in this study, please read and sign the “Letter of Introduction” attached with
this email. Once you have emailed back the signed “Letter of Introduction”, we will proceed to
setup an appointment with you.
We will be waiting for your response. Thank You.
Sincerely,
(Name of the policy analyst or in-country coordinator)

Egypt_policy_Protocol

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