Overcoming the Limits of Evidence on Effective Multisectoral Nutrition Policy

Abstract

The multisectoral approach has evolved as a popular instrument to attain nutrition goals and targets. But as policy makers, we need timely, relevant, and accurate information in order to effectively support these plans. This commentary comes from the members of the nutrition secretariats at the National Planning Commission in Nepal and the Office of the Prime Minister in Uganda on availability and use of evidence and the nutrition policy cycle. As has been highlighted in this supplement, some of the challenges we have faced include tracking nutrition spending and limited human resource capacity. It will be important for countries, including our own, to take steps to ensure that all sectors with responsibility for nutrition issues adequately prioritize nutrition—as evidenced by budgets and targets—and coordinate efforts for the most efficient use of funds. Countries will also need to consider the importance of transparency and accountability at all levels, as well as planning and reporting systems to ensure better cooperation and stronger partnerships. Going forward, we call on all those working in the field of nutrition to focus on developing evidence that is useful for decision-making and that can facilitate monitoring of practical measures of governance and financing by national- and district-level stakeholders.

Commentary

The multisectoral approach has evolved as a popular instrument to attain nutrition goals and targets. Implementation of the multisectoral nutrition policy and plans is complex, but until recently, most evidence on this subject has been at the global level, limiting its usefulness to country-level decision makers. Other issues with evidence have been the lack of timeliness for policy decisions, relevance to country policy, data accuracy, critical nutrition stakeholder input, and implementation research on nutrition-sensitive and nutrition-specific interventions. As policy makers, we need timely, relevant, and accurate information about nutrition policy processes like governance and financing in order to effectively support nutrition action. We also need to know what interventions are most effective, in order to include them in the activities supported by those multisectoral policies and plans.

In Nepal, the National Planning Commission (NPC) has been working to implement the Multi-Sectoral Nutrition Plan (MSNP) since 2013. The MSNP has helped us engage with key government agencies, such as the Ministry of Finance, and present data to prove that nutrition is not a charitable action but rather an investment. With the MSNP, we have shown the return on investment from nutrition spending and the importance of all sectors working to address malnutrition. Research findings produced by the Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project have helped pinpoint and address several challenges that come with MSNP implementation such as coordination at national and local levels, use of nutrition-specific and nutrition-sensitive services for enhanced maternal and child nutritional status, and the importance of capacity at all levels of government. Evidence such as that from the SPRING Pathways to Better Nutrition case study and the Nutrition Innovation Lab (NIL)’s Policy and Science for Health, Agriculture and Nutrition study in Nepal has been particularly helpful to the NPC.

Nepal has set national goals to meet the World Health Assembly’s Global Targets 2025, as well as the United Nations Sustainable Development Goals 2030. Encouraged by expanded activities coverage, as well as lessons learned, we are also preparing a second MSNP for 2018 to 2022. With the second MSNP, we hope to have a separate nutrition budget coding system to better and more accurately track budgets on nutrition. We are also planning to make our coordination mechanisms more inclusive and active and aim to attain value for every dollar spent on nutrition. Cooperation and coordination with development partners supporting us in the field of nutrition is critically important, as is additional data on the effectiveness of the implementation, good practices, lessons learned, and the gaps in the implementation of nutrition intervention through various sectors. We are committed to avoiding duplication, overlapping, and fragmentation while implementing nutrition funds and programs.

In Uganda, the Office of the Prime Minister has made progress in implementing the Uganda Nutrition Action Plan (UNAP) launched by His Excellency Yoweri Kaguta Museveni, the president of Uganda, in 2011. Progress increased further following the completion of these studies. Key nutrition achievements in Uganda include the establishment of a legal and planning framework for nutrition through the development of a nutrition policy and the UNAPs, as well as the establishment of robust coordination frameworks at central and local government levels. Uganda has implemented key nutrition service delivery interventions through the District Nutrition Coordination Committees established in all 112 districts of the country. A national advocacy and communications strategy, to provide increased nutrition awareness throughout the population, has been developed and launched. The Cost of Hunger Study provided important evidence for the first UNAP. The work of SPRING and NIL has provided additional data, particularly about nutrition governance and budgeting processes in the multisectoral nutrition policy. The policy focuses on building alliances with the private sector, civil society organizations, and development partners; operationalizing and rolling out the national advocacy and communications strategy; strengthening nutrition monitoring and evaluation; producing and disseminating regular nutrition assessment reports at national and district levels; and promoting indigenous nutritious diets using existing structures.

We suggest that other countries considering how to improve nutrition policy could learn from our experiences in Nepal and Uganda, particularly regarding nutrition governance and financing. As has been highlighted in this supplement, some of the challenges we have faced include tracking nutrition spending and limited human resource capacity. It will be important for countries, including our own, to take steps to ensure that all sectors with responsibility for nutrition issues adequately prioritize nutrition—as evidenced by budgets and targets—and coordinate efforts for the most efficient use of funds. Countries will also need to consider the importance of transparency and accountability at all levels, as well as planning and reporting systems to ensure better cooperation and stronger partnerships.

Going forward, we call on all those working in the field of nutrition to focus on developing evidence that is useful for decision-making and that can facilitate monitoring of practical measures of governance and financing by national- and district-level stakeholders.