The document discusses changes and challenges in Zambia's nutrition policy environment since 1990 based on a mixed methods study. Key findings include: - Stunting in children under 5 has declined significantly from 1992 to 2014 but remains high at 40%. - Future studies on nutrition drivers should combine health and agricultural data and collect dietary data from different populations. - Zambia now has coherent nutrition policies across sectors but needs monitoring to ensure new policies still prioritize nutrition. - Strengthening the capacity of "boundary spanner" organizations and the three key nutrition institutions could help drive further progress. - More work is needed to strengthen intersectoral coordination at both national and local levels.

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. 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. 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. 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. 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. 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. 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. 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. 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. 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
Thank you

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. 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. 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. Intersectoral coordination
2011 2015
15

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