Multisectoral Approaches for
Improving Nutrition: Lessons from
Global Experiences
James Garrett, IFPRI/IFAD
Consultation: Working Multisectorally to
Improve Maternal and Child Nutrition in India
Funding support: Bill & Melinda Gates Foundation

Outline
• nutrition: a multisectoral outcome
• synergies among food, health, and care
• overview of an approach to working
multisectorally
• global experiences and practical principles

Nutrition: A multisectoral outcome
Causes of Malnutrition, by causal level
E co n o m i c
stru ctu re
Po l i ti ca l a n d i d e o lo g i ca l
su p e rstru ctu re
F o rm a l a n d n o n -fo rm a l
i n sti tu ti o n s
In a d e q u a te
e d u ca ti o n
In a d e q u a te d i e tary i n ta k e Di se a se
In a d e q u a te
ca re fo r
m o th e rs a n d
ch ild re n
In a d e q u a te
a cce ss to fo o d
In su ffi ci e n t
h e a l th se rvi ce s
a n d u n h e a l th y
e n viro n m e n t
Ma l n u tri ti o n
a n d d e a th
Po l i ti ca l
re so u rce s
O utcomes
Immediate
causes
Underlying
causes
Basic causes

Collaboration Continuum….

Synergies of Food, Health, and Care

Approaches to Working
Multisectorally
ALL key actors agree on problem,
causes, and solutions
• reducing malnutrition given top priority
by top authorities
• create political space
• create common language and understanding
• share in identification of solutions, including convergence
• institutionalize coordination

Approaches to Working
Multisectorally
ALL key actors agree on what to do and
everyone’s roles and responsibilities
and work to implement solutions
• benefits of participating > costs
• participating helps partners achieve their goals
• credit is shared
• capacity exists or can be built
• partners are held accountable for actions by highest
authority
– assumption: highest authority maintains interest

Principles of Transformation and Change:
The U Process
“
Co-Seeing
Co-Understanding
Co-Acting
Phase 0: Convening
Clarify purpose and players
Phase 1: Co-Seeing
Learn to see
Put evidence on the table: Talk
Meetings and Workshops
Phase 2: Co-Understanding
Develop shared understanding
Retreats and Reflection
Phase 3: Co-Acting
Bring new reality into existence
Pilot Projects

“Attention: Nutrition is NOW a
priority!”
• creation of political space
• get it on the agenda and stay there
• continuous education of d’makers and
s’holders
• show effects of work
– need visible results, impact studies
• involve authorities and s’holders and get their
support
– (see below on incentives….)

“Attention: Nutrition is NOW a
priority!"
PERU: candidate commitments, 5-in-5, NGO advocacy
COLOMBIA: Gaviria’s commitment, charged technicians
with solution, built understanding, commitment, broad
support; “partners are my babies”
SENEGAL: used PROFILES to show benefits; continuous
meetings….
BOLIVIA: president prioritized…then distracted

“Yeah, we all get it. Really we do.”
• create common language and understanding
• share in identification of solutions, including
convergence
• processes / tools exist to guide this

“Yeah, we all get it. We really do.”
UGANDA: NAS initiative to discuss (nutrition) in a neutral platform,18 gvt sectors
+ donors; monthly meetings to produce a document for workshop (end result
was Ntl Nutr Plan) -- but most impt was people working together, to learn about
one another, each others’ language and perspective: key leaders / catalyst from
NAS, author of Ntl Development Plan, former min of ag
SENEGAL: Agreed with ms, but contentious issue was how to operationalize it?! /
Series of workshops from all relevant ministries, MoF, donors, NGOs; small group
discussed then communicated back / convinced broader home org; President and
WB holding them accountable…
COLOMBIA: small meetings of 4 core high-level technicians (ed, ag, health), lots
of coffee and arguments; with draft built out with an information campaign,
including stats on mn to convince physicians; Matus’ Situational Strategic
Planning
SOUTH AFRICA: Food Lab for fns followed the U process, with consultations,
discussions, learning journeys….

“I’m in it for me”
• benefits of participating > costs
• participating helps partners achieve their
goals
COLOMBIA: Director offered implementation services to other
ministries for their own programs, which were part of the
collaboration: for lower costs, they got same or better program,
and were given full credit; lots of PR for everyone; personal and
financial interests met

“We can do it! Or figure out how…”
• lead agencies need solid capacity, esp good
(appropriate) leadership and management
• not all need to be strong: capacity can be built
• strength can be a disadvantage
– prefer isolation

“We can do it! Or figure out how…”
BOLIVIA: limited capacity at local level frustrated implementation
COLOMBIA: …..equally so, but had strong lead unit (Health), strong
implementing partners (universities, regional development
corporations, consulting firms) held to task through performance
contracts, had ms / m-institutional teams who visited municipalities
frequently and resolved problems, had separate firm specifically to
build municipality cap to plan / implement
SOUTH AFRICA / SENEGAL: ntl ministries self-sufficient and don’t see
benefits of “subjecting themselves” to ms coordination – so don’t
participate strongly

Champions and Leaders
• Champions and leaders needed at all levels / phases
– initiators [policymakers]
– creators [high level technicians/ civil servants]
– managers
– sustainer [policymakers + managers /directors]
• Lateral leadership
– results without authority
• but by persuasion, connection with self-interests
• “soft” over “hard” skills
– by definition cannot be top down (no hierarchical stucture)
– key leadership post for implementation bc top authority is not
operational….

Management and Other
Organizational Factors
• Good management
• Organizational values (all partners)
– promote collaboration, including inclusiveness,
transparency respect for routines, missions of
others, openness to learning and new ways of
doing, orientation toward results
– institutional flexibility

Additional Insights
• Accountability mechanisms
– higher authority maintains interest
– reporting mechanisms to s’holders, other
authorities
• e.g., communities [scorecards, reflection sessions],
legislature / parliament, donors
• History of working together..or not

Additional Insights
• Working MS requires constant education and communication
– advocacy, evidence
– investment in personal relationships as well as technical expertise
• Should inoculate against political change
– move from policy of Government to policy of the State
• Successfully working multisectorally at scale is possible
• Structures are populated by people. They must be led and
managed effectively

Component 1 : Nutrition/C-IMCI.,
-GMP/C-IMCI
-Micronutrients
-Community Initiatives
Component 3 : Support to the policy and
monitoring and evaluation
-Support to steering structures
-Monitoring and evaluation
-Capacity building of actors
Component 2 : Multisectorial
interventions related to nutrition
-Health Sector
-Education Sector
-Other Sectors
Component 4 : Program
management

Thank you!