Presentation from Institute of Development Studies Nutrition Group and Transform Nutrition seminar on 19 February - 'Effective Governance and Policies to Improve Nutrition Outcomes: A Cross Comparison of Nine Country Cases'
Effective Governance and Policies to Improve Nutrition Outcomes
Effective Governance and Policies to Improve Nutrition Outcomes: A cross comparison of nine country cases Andrés Mejía Acosta (IDS) firstname.lastname@example.org Jessica Fanzo (Columbia University) email@example.com Institute of Development Studies Brighton, 19 February 2013
The Nutrition Paradoxes Nutrition and GDP growth economic growth does not lead to improved nutrition India vs Brasil vs Peru Nutrition and food security policies designed to boost food production are not sufficient to reduce under nutrition The Maradi Paradox Pakistan, Niger
A political economy approach Analysing policy change… Number of stakeholders involved Ideological differences Winset = space for policy change PEA of Nutrition Why some countries that are strongly committed to reducing malnutrition can effectively deliver on nutrition outcomes while others make insufficient or no progress at all? Why and when do government officials become accountable to the needs of the most vulnerable? How are advocacy coalitions formed around a single narrative to reduce under nutrition?
Stunting levels across nine countries 65 Bangladesh 60 Ethiopia 55 India 50 Kenya Niger Rate of Stunting 45 Pakistan 40 Peru 35 Zambia 30 25 20 1990-92 93-95 1997-99 00-02 2003-05 2006-08 2009-11Source: WHO Global Database on Child Growth and Malnutrition
Roadmap Analysing Nutrition Governance We are not the first ones but… Building a dashboard of indicators Intersectoral cooperation Vertical articulation Sustainable funding Looking at and measuring the comparative evidence
What is perceived as good Nutrition Governance? According to the WHO, Strong nutrition governance countries are those where governments are committed to having a national nutrition plan, which is also part of the national development strategy, they have set up inter-sectoral coordinating committees, maintain regular surveys and data collections, and allocate budget lines for nutrition strategies and plans, among other criteria
How do we measure governance? Governance Indicators (World Bank) Governance scores on the commitment and willingness (WHO Landscape) How do we measure accountability and incentives? Performance budgeting Institutional and capacity building
Translating Governance Analysis to effective interventions and Scaling Up Multisectoral nutrition planning (1970s) WHO Landscape Analysis (2009) World Bank (2002-2011) Scaling Up Nutrition movement Undernutrition: What Works? Action Against Hunger (2010) REACH country process Mainstreaming Nutrition Initiative (Pelletier et al 2011)
The fieldwork Nine countries, since 2010 A dozen researchers Nearly 230 interviews Four languages Similar questionnaire adjusted to country specific concerns Working papers, research reports and policy briefings posted at http://www.ids.ac.uk/nutritiongovernance
ANG: Intersectoral cooperation How (-and why-) do government actors, donors and other stakeholders cooperate with one another? Are there any formal or informal cooperation instances/coordinating bodies? Is there direct involvement of the Executive? Is nutrition part of the national development and poverty reduction agenda?
In Peru: Initiative Against Child Malnutrition (CNI)
Multisectoral coordination in Ethiopia FMOH Nat. Nutrition technical committee Agenda- (experts) setting National Nutrition Individual Coordinating Body donors Coordination/ (line ministries chaired by implementation MoH) NDPG forum Nutrition working group Food (DPs and MoH) Security Program PSNP Emergency nutritionSource: Taylor 2012
Min of FoodISC in Bangladesh Min of and Disaster Min of Min of Finance Management Min of Local Livestock Government Educ. Min of Min of Health Min of Women & Min of Min of Child Affairs Ag and Family Sanitation and Planning Welfare Water Food National Nutrition policy Programme management committee IPHN National Nutrition Programme BNN 1) Coordinating cttee C (NGO implementers) 2) Monitoring group (NGO mgrs & NNP monitors) Community level interventions
What makes ISC work? H1: improved ISC will contribute to (the formulation of) improved nutrition governance H1a: “policy dictators” can make swift policy changes but are not sustainable over long run (Niger) H1b: broad and inclusive “nutrition coalitions” (…) are likely to make nutrition policies more sustainable (Brazil)
ANG: Vertical articulation Why would local elites want to implement national level policies? Are there decentralised structures (regional and local) that facilitate local implementation and coordination? Are local elites motivated to comply with and influence national level policies (upwards)? Are they accountable to demands of voters (downwards)?
Vertical coordination in Ethiopia Ministry of Heatlh EPRDF (party) Ministry of Agriculture Regional health bureau Regional agriculture office Woreda developmentWoreda health committee Regional agriculture officials officials Kebele development Ag. Health committee Ext. ext. worker worker 6x Ag Dev. Dev. Dev. Dev. Army Dev. Dev. Dev. Army Army Army Army Army Army
What makes vertical articulation work? H2: effective Vertical coordination is likely to contribute to improved nutrition governance (implementation) H2a: when it builds on existing decentralized structures H2b: when it generates greater local ownership H2c: when it reproduces intersectoral cooperation at the national or subnational level
ANG: Sustainable Funding How do funding mechanisms facilitate inter sectoral and vertical cooperation? Are there centralised (pooled) or coordinated funding schemes or funding sources are fragmented? Are there independent monitoring and oversight mechanisms that promote efficient use of revenues? Are there additional, unexplored sources of revenue? private sector funding; taxation; natural resource revenues?
Pooled funding in Niger Several types of pooled funds: Bilateral Funds – discretionary Programmatic – coordinated Emergency - OCHA New embedded funding line in the budget How to make long term use of emergency funds?
Siloed funding in Bangladesh Fragmented funding encourages isolation and duplication Multiple recipients: “Anyone can get funded” Funding is source of political influence It can privilege relations with MPs or local goverments
What makes funding work? H3. Sustainable Funding is likely to contribute to (financing) improved nutrition governance H3a: greater government ownership – greater government share in nutrition funding - into state budgets and political process (ie. Nutrition line?) H3b: when funding allocations are at least coordinated to avoid corruption or overlap H3c: when there are institutional provisions (earmark, taxes, multiyear budgets) that ensure long term funding
How does it all add up? Intersectoral coordination inclusive, partially inclusive, not inclusive Vertical Articulation Effective, partially fragmented, fragmented Funding Pooled, coordinated, uncoordinated
Towards a comparative analysis of nutrition governanceCountry studies Inter Sectoral Vertical coordination Funding Outcome cooperation (or path process)Brazil Inclusive Effective Coordinated OPeru Inclusive Partly fragmented Coordinated OKenya Partially inclusive Partly fragmented Coordinated ONiger Inclusive fragmented Coordinated and -- PooledBangladesh Not inclusive Effective Uncoordinated --Ethiopia Partially inclusive Effective Uncoordinated --Zambia Inclusive Partly fragmented Uncoordinated --India Not inclusive Fragmented Uncoordinated XPakistan Not inclusive Fragmented Uncoordinated X
Advantages of a process driven nutrition governance approach Unpacks the notion of “political will” to look into specific mechanisms of political commitment around nutrition Focuses on the formation and sustainability of nutrition coalitions Seeks to measure and extract practical policy advice for scaling up nutrition efforts