From Policy to Practice: What Do We Know about Policy’s Influence on Planning and Financing for Nutrition?
Multisectoral national nutrition action plans (NNAPs) are an important step in advocating for increased nutrition activities across sectors, but they can lose momentum in the day-to-day realities of governing. Nonetheless, multisectoral NNAPs provide a critical platform to bring the disparate parts of government together for nutrition; according to the 2013 WHO Nutrition Policy Review, the majority of current NNAPs include at least health, education, and agriculture/food security sectors.
But we must understand how these plans can succeed in improving nutrition for them to be truly useful. What influence can these NNAPs really have on decision-making processes, funding, and nutrition outcomes? To avoid losing momentum toward multisector action for nutrition, we need to show that these plans are more than just lip service. We need answers to the following questions:
- How do countries create buy-in and understanding of a multi-sector NNAP across stakeholder groups/sectors and at every level of government?
- What is needed to translate NNAP commitments into activities, especially in sectors not traditionally fluent in nutrition-sensitive activities?
- What enabling factors help make this conversion from commitment to action?
- Through which mechanisms can multi-sectoral NNAPs increase funding for nutrition activities?
- How can governments and researchers track the amount of funding going toward nutrition-sensitive NNAP activities?
USAID’s multi-sectoral nutrition project, Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING), completed two prospective Pathways to Better Nutrition (PBN) studies in Nepal and Uganda that shed light on these questions.
Pathways to Better Nutrition Studies
SPRING carried out this research in partnership with the nutrition secretariats in Nepal and Uganda—two countries that could be considered high achievers and therefore could potentially show successful implementation of a multi-sectoral NNAP. Both Nepal and Uganda have developed truly multisectoral plans that are being implemented today, and both countries were interested in having timely, relevant, and accurate information to better understand and support their NNAPs.
SPRING conducted this research from 2013-2016, collecting detailed qualitative and financial data for a wide array of national and selected district stakeholders (see the December 2016 Food and Nutrition Bulletin for study methods and results in Nepal and Uganda). Because of this longitudinal, 360-degree approach, the Pathways to Better Nutrition studies provide a rare time-series view of the influence of multi-sector NNAPs on priority-setting and financing. While many useful country-specific insights came out of each study, we found a number of common lessons.
What We Learned
In both countries, we saw increased understanding and use of the NNAP by nearly all national nutrition stakeholders, across sectors, by government and non-government stakeholders. In Nepal, this was also true of the districts. We found that training on NNAPs increased knowledge of nutrition as a multi-sectoral issue, at least down to the district level. This increased understanding appeared to be facilitated in both countries by local and regional trainings coordinated by nutrition secretariats. However below districts (we visited two sub-counties in Uganda and three village development committees in Nepal), the impact of the NNAPs had not yet penetrated—an important “failure point.” In our reports for Nepal, and Uganda we discuss why this may have occurred and how to overcome it.
We also found common factors that helped or hindered turning NNAP commitments into nutrition actions: multi-sectoral coordination, human resources, advocacy, and the building or strengthening of sustainable structures (see box). We tracked changes in these themes over the course of the study to understand how they influenced prioritizing and financing of nutrition activities in the yearly work-planning cycle. In both countries, stakeholders most often cited improved coordination or successful advocacy efforts as the reason for newly added activities or funding, while human resource constraints were a universal reason for why activities or funding were not added. Ugandan stakeholders identified lack of sustainable structures for planning, financing, and M&E as constraints to new activities or funding, while Nepali stakeholders cited weak M&E structures as a hindrance.
Multi-sectoral coordination of nutrition planning, funding, and implementation occurs horizontally (across sectors, stakeholders) and vertically (levels of governance).
Human resources for nutrition includes all people involved in nutrition, including clinical and community providers, and clinical, policy management, and support staff at every level in every stakeholder group.
Advocacy for nutrition is an effort to convince people of the importance of nutrition (general or specific), and can be done both within and outside the government by any stakeholder group.
Sustainable Structures refer to the maintenance and strengthening of structures within the government to plan, fund, implement, and monitor and evaluate (M&E) nutrition activities.
Finally, we developed estimates of the nutrition funding available in each country to identify any changes in funding over time (this effort resulted in a budget analysis tool that other countries can use). Where we found increased nutrition funding, the reason often related to newly added activities or to development of longer-term financing structures (like a designated budget line, a tracking code, or multi-year donor commitments). However, as is always true, even when allocations increased, it did not always result in more available funding because actual spending on nutrition did not always increase.
By combining this evidence, we identified where further work is needed to make sure multisectoral nutrition policies are more than just words—that is, to ensure key nutrition activities are planned, funding is allocated, and those funds are spent. There is much to learn from Nepal and Uganda about building a successful national multisectoral, multi-stakeholder nutrition effort. This collaborative research should help to support more effective advocacy efforts, more funding transparency, and clearer negotiation for funding within various ministries, donor and UN agencies, and the private sector.