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Changes and challenges in Zambia's nutrition policy environment

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Jody Harris (IFPRI) presents From coherence towards commitment: changes and challenges in Zambia's nutrition policy environment at the 'Stories of Change in nutrition symposium' at the Micronutrient Forum, Cancun October 2016

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Changes and challenges in Zambia's nutrition policy environment

  1. 1. FROM COHERENCE TOWARDS COMMITMENT : CHANGES AND CHALLENGES IN ZAMBIA'S NUTRITION POLICY ENVIRONMENT Jody Harris, Scott Drimie, Terry Roopnaraine, Namukolo Covic Micronutrient Forum 2016
  2. 2. Research design. Objective:Tounderstandwhathasdrivenchangein nutritionsince1990 Quantitative: Drivers of stunting change • Data: • DHS datasets 2002, 2007, 2014 • Analysis: • Descriptive statistics • Linear regression Qualitative: Policy process • Data: • 67 in-depth interviews • 14 focus groups • Social network mapping • Document and budget review • Analysis: • Coding (open and to frameworks) • Framework analysis for key themes • Triangulation among sources 2
  3. 3. Changes in nutrition outcomes 3 0 10 20 30 40 50 60 Underweight Stunting Wasting Chld overweight Female undeweight Female overweight and obesity % 1992 1996 2002 2007 2014
  4. 4. Context 4 To fully assess nutrition change drivers, future data collection should combine health and agricultural factors, and collect dietary data from different sections of the population. (Gillespie et al 2012 “data disconnect”)
  5. 5. Linking the under- and over-nutrition agendas might be a useful way to gain traction that is lacking on undernutrition, while heading off an impending overnutrition crisis. (Popkin 2004 “Nutrition transition”) 5 Agenda setting
  6. 6. Policy coherence 6 Millennium Development Goals, 2000 Zambia Vision 2030, GRZ 2006 Zambia Poverty Reduction Strategy Paper, IMF 2007 Zambia Sixth National Development Plan, GRZ 2011 Nutrition Agriculture Health Education Social protection Water and sanitation SUN Framework for Action 2010 CAADP agreement World Health Assembly agreement National Food and Nutrition Policy 2006 National Agriculture Policy 2004-15 National Health Policy 1992 National School Health and Nutrition Policy 2006 National Food and Nutrition Strategic Plan 2011-15 MAL Strategic Plan 2013- 16 (“Budget Strategy”) National Health Strategic Plan 2011-16 Social Protection Framework 2013 WASH Framework 2006 1000 Most Critical Days Program 2013-15 Agriculture Sector Implementation Plan Micronutrient Policy 2005-2011 School Health and Nutrition Program Guidelines 2008 National Rural / Urban Water & Sanitation Supply Programmes National Agriculture Investment Plan 2014 Multisectoral District Plan (Mumbwa) Agriculture Ministry Workplan (Mumbwa) MCDMCH-DOH Workplan (Mumbwa) Education Ministry Workplan (Mumbwa) MCDMCH-DCW/DSP Workplan (Mumbwa) Local Gov Ministry Workplan (Mumbwa) 100% policy agreement is neither feasible nor in fact desirable (Duraiappah and Bhardwaj 2007). Zambia has good coherence- now needs monitoring of sectoral policy to ensure that new policies do not lose their nutrition thread, and do not adversely affect nutrition outcomes.
  7. 7. Leadership Social, political, institutional, economic Political: Permanent secretaries nutrition group, parliamentary nutrition caucus Donors: SUN Fund, DFID, Irish Aid, SIDA, USAID, EU Academic: UNZA, IAPRI, NRDC Media: Post, Daily MailSource: Adapted from UNICEF 1990 Immediate causes Underlying causes Basic causes Food security MAL, MCDMCH, WFP, FAO, PAM, Java foods Care environment UNICEF, MOG, CWZ Health and WASH services MOH, MLGH, WHO, UTH Health status MOH, UNICEF Diet MCDMCH, Java foods, WFP Nutrition NFNC, NAZ, CSOSUN, CARE, CWZ, PATH, REACH If the three key nutrition institutions – NFNC, NAZ, and CSOSUN – can strengthen their capacity and deliberately align their respective roles, then together they will be a clear force for nutrition. (Sabatier and Jenkins Smith 1993 “Advocacy coalitions”) (Pelletier 2011 “Strategic capacity”) 7
  8. 8. 0 5 10 15 20 25 30 35 40 0 20 40 60 80 100 120 140 160 180 200 2012 2013 2014 HRC score NC score HANCI score HRC rank NC rank HANCI rank Commitment SUN may have bypassed the need for political attention, moving the nutrition agenda forward quickly, but also limiting broader government attention to nutrition and therefore limiting system-wide commitment. (Heaver 2005 “attention vs. commitment”) 8
  9. 9. Accountability 9 Strengthening the capacity, influence and ability of “boundary spanning” organisations to leverage their roles can move nutrition policy and practice forward. (Leifer and Delbecq 1978 “Boundary spanners”) Strengthening citizens’ understanding of their rights would strengthen their voice, to improve demand for better nutrition, and to demand accountability from relevant officials. (Jonsson 2009 “Right to nutrition”)
  10. 10. Conclusions  Written policy complete and coherent x Boundary spanners pulled in multiple directions x International momentum has bypassed the need for national commitment  Strengthen the capacity of boundary spanners to coordinate delivery  Strengthen the capacity of the population to hold government accountable for their nutrition rights 10
  11. 11. 11 Thank you
  12. 12. Summary of key issues for Zambia 12 Issue Cases Population Source Maternal mortality 440 per 100,000 National WHO 2014 Under-5 mortality 75 per 1,000 National DHS 2014 Malaria cases 4.89 million National WHO 2014 Child stunting 40% National DHS 2014 Child wasting 6% National DHS 2014 Female anaemia 42% 3 provinces NFNC 2013 Female overweight / obesity 23% National DHS 2014 Adult hypertension 49% Urban Lusaka WHO 2008 Adult glucose intolerance (diabetes) 9% Urban Lusaka WHO 2008 Adult HIV 13% National DHS 2014 Population undernourishment (hunger) 48% National FAO 2015 Population poverty 78% Rural World Bank 2014
  13. 13. Accountability to Community 13 Nangoma mothers’ FGD Shimbizhi mothers’ FGD Nangoma men’s FGD “We can tell them through our councilors and Members of Parliament who represent us” / “In a situation where we are not happy we are able to channel our complaints through them” / “We cant tell the government directly but [we can communicate] through our representatives that we elected.” “The government has poor services, just to deliver farming inputs takes them years” / “We don’t know where to go and complain…those in the offices [in Mumbwa] are not helpful in any way”. Nangoma mothers’ FGD “For the NGOs, so far we can’t complain because they have shown seriousness in the execution of duties. Our lives would be improved or developed by the NGOs [because of] the way they have started their programing. The government departments, the services are not good because of the time they [take to]deliver the needed services”. “During campaigns they promise us a lot things which they don’t deliver, and once they are elected they go for good”
  14. 14. Community coordination 14 Nangoma mothers’ FGD Nangoma men’s FGD Nangoma mother’s FGD “The sector has people on the ground who are working as community health volunteers (CHVs), who are teaching women on good feeding practice and breastfeeding to the women groups which are doing farming”. “Yes, they teach us about nutrition and health, at times you will find that at one meeting you have different ministries…each one with a different story or message” “They [Ministries of Agriculture and Health] work separately” / “When people from the Ministry of Agriculture are holding field days, we don’t see people from [the Ministry of] Health”.
  15. 15. Intersectoral coordination 2011 2015 15
  16. 16. Recommendations 1. Datasets do not exist to fully assess drivers of nutrition change. Important in future data collection will be combining health and agricultural factors in datasets, and collecting dietary data from different sections of the population. 2. Working with organizations identified as boundary spanners to increase their capacity, their influence, and their ability to leverage their complex roles is clearly one important intervention for moving nutrition policy and practice forward. 3. If the three key nutrition institutions – NFNC, NAZ, and CSOSUN – can strengthen their capacity to undertake and deliberately align their respective roles – strategy, professional support, and advocacy – then together they will be a clear force for nutrition going forward. 4. It will be important to explore the opportune placement of NAZ, including membership from across sectors and stakeholders, to foster inter- sectoral alignment. 5. An important tension is between a reticence to single out individuals publicly for either praise or blame, and recent public calls for nutrition champions to be identified. This tendency may be an important barrier to recognition and cultivation of strong leadership, and will be an important point for the Zambian nutrition community to bring to the fore of future discussions 6. There are many unfulfilled expectations in the Zambian nutrition community, tensions between expectations and capacity. These tensions need to be acknowledged and discussed if they are to be resolved. 7. It is important to distinguish between different parts of government when talking about commitment. Technical parts of government are working on a range of different initiatives to improve nutrition, but the financial and executive arms must be encouraged in supporting these efforts with political attentions and funds. 8. Many of the big successes underpinning nutrition changes have been externally funded. The international community should see the focus on nutrition as a long-term commitment to building systems and engagement- but in creating sustainability must be flexible in its approach to defining objectives and disbursing funds. 9. The financial arms of government can contribute by exploring mechanisms that would promote targeted resource mobilization for nutrition, as part of commitments to nutrition made during election time 10. Government can help in other ways as well, in particular by making sure that the policy environment affecting nutrition is coherent and up to date, and that basic services are functioning 11. Strengthening communities’ understanding of their rights and of commitments made would make their voice more powerful, leading to awareness creation at community level to improve demand for better nutrition, but also to demand accountability from the relevant officials. Clarity is needed on which advocacy roles fall to which organizations if advocacy is to be coherent. Smaller civil society organizations closer to communities should be supported to make clear advocacy plans if grassroots demand for nutrition is to be generated 16

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