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Aivalli P, Gilmore B, Srinivas PN, De Brún A. Navigating intersectoral collaboration in nutrition programming: implementors' perspectives from Assam, India. Arch Public Health 2024; 82:82. [PMID: 38849925 PMCID: PMC11157891 DOI: 10.1186/s13690-024-01312-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/29/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND There is a growing interest in the use of intersectoral collaborative (ISC) approaches to address complex health-related issues. However, relatively little empirical research exists on the challenges of implementing, fostering and sustaining these approaches. Our study explores the perceptions and experiences of programme implementers regarding the implementation of an ISC approach, focusing on a case study of nutrition programming in Assam, India. METHODS We conducted qualitative semi-structured face-to-face in-depth interviews with eleven programme implementers from two selected districts of Assam, India. These participants were purposefully sampled to provide a comprehensive understanding of the experiences of implementing intersectoral collaboration. Following the interviews, an inductive thematic analysis was performed on the collected data. RESULTS The study identified three main themes: operationalisation of ISC in daily practice, facilitators of ISC, and barriers to effective ISC. These were further broken down into six subthemes: defined sectoral mandates, leadership dynamics, interpersonal relationships and engagement, collective vision and oversight, resource allocation, and power dynamics. These findings highlight the complexity of ISC, focusing on the important structural and relational aspects at the macro, meso, and micro levels. Interpersonal relationships and power dynamics among stakeholders substantially influenced ISC formation in both the districts. CONCLUSION Despite challenges, there is ongoing interest in establishing ISC in nutrition programming, supported by political development agendas. Success relies on clarifying sectoral roles, addressing power dynamics, and engaging stakeholders systematically. Actionable plans with measurable targets are crucial for promoting and sustaining ISC, ensuring positive programme outcomes. The insights from our study provide valuable guidance for global health practitioners and policymakers dealing with similar challenges, emphasising the urgent need for comprehensive research given the lack of universally recognised policies in the realm of ISC in global health practice.
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Affiliation(s)
- Praveenkumar Aivalli
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
- School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
- , Guwahati, India.
| | - Brynne Gilmore
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
- School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | | | - Aoife De Brún
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
- School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Resnick D, Anigo KM, Anjorin O, Deshpande S. Voice, access, and ownership: enabling environments for nutrition advocacy in India and Nigeria. Food Secur 2024; 16:637-658. [PMID: 38770157 PMCID: PMC11102356 DOI: 10.1007/s12571-024-01451-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 04/05/2024] [Indexed: 05/22/2024]
Abstract
What constitutes an enabling environment for nutrition advocacy in low- and middle-income countries? While a sizeable body of scholarship considers the enabling environment for nutrition policy, we focus specifically on the necessary conditions for advocacy. We argue that three factors-voice, access, and ownership-provide a useful lens into the advocacy enabling environment. These are operationalized, respectively, as the space to articulate and frame policy positions, entry points to interact with policy decision makers, and the existence of committed decision makers rather than those responding to pressures from external actors. These three factors are explored vis-à-vis a comparative analysis of two federal democracies-India and Nigeria-that each have vibrant advocacy communities confronting persistent malnutrition. Drawing on more than 100 structured interviews with nutrition advocates, government actors, donors, and researchers in the two countries, we highlight the ways in which voice, access, and ownership interactively shape advocacy efforts. In doing so, we find that Nigeria has a less ideological approach to certain nutrition issues than in India but also perceived to be more beholden to external actors in defining its nutrition actions. Recent restrictions on freedom of speech and association shrunk the civic space in India but these were less problematic in Nigeria. In both countries, the multi-tiered, multi-party system offers many different points of access into the policy arena, with sometimes negative implications for coordination. Overall, the paper contributes more broadly to the literature on enabling environments by highlighting potential indicators to guide nutrition advocates in other settings.
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Affiliation(s)
- Danielle Resnick
- International Food Policy Research Institute, Washington, DC USA
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Reeve E, Bell C, Sacks G, Mounsey S, Waqa G, Peeters A, Thow AM. Lessons for strengthening policymaking for obesity and diet-related noncommunicable disease prevention: A narrative synthesis of policy literature from the Western Pacific Region. Obes Rev 2024; 25:e13651. [PMID: 37905309 DOI: 10.1111/obr.13651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/28/2023] [Accepted: 09/09/2023] [Indexed: 11/02/2023]
Abstract
Obesity and diet-related noncommunicable diseases (NCDs) have a profound impact on individuals, households, health care systems, and economies in low- and middle- income countries (LMICs), with the Western Pacific Region experiencing some of the highest impacts. Governments have committed to improving population diets; however, implementation challenges limit effective policy action. We undertook meta-narrative synthesis of the academic literature and used theories of policymaking and implementation to synthesize current knowledge of issues affecting the adoption and implementation of policies to prevent obesity and diet-related NCDs in LMICs in the Western Pacific Region. We found that political leadership and management of food and nutrition policies often diluted following policy adoption, and that nutrition and health advocates find it difficult to enforce policy compliance from actors outside their sectors. Opportunities for strengthening implementation of food and nutrition policies in the Western Pacific include (1) improved and earlier engagement between health policymakers and implementing agencies; (2) focusing on the need for increased accountability from governments, including through effective engagement and organization of actor networks, knowledge sharing, and in highlighting where stronger action is required; and (3) identifying and building the strategic capacities of policy actors in framing, advocacy, coalition-building, knowledge translation, and leadership.
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Affiliation(s)
- Erica Reeve
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Colin Bell
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Gary Sacks
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Sarah Mounsey
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Gade Waqa
- Pacific Research Centre for Prevention of Obesity and Non-Communicable Disease (C-POND), Fiji National University, Suva, Fiji
| | - Anna Peeters
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Anne Marie Thow
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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Madurawala S, Kiringoda K, Thow AM, Arunatilake N. Fiscal policies and regulations for healthy diets in Sri Lanka: an analysis of the political economy of taxation and traffic light labelling for sugar-sweetened beverages. Glob Health Action 2023; 16:2280339. [PMID: 38018465 PMCID: PMC10795608 DOI: 10.1080/16549716.2023.2280339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/02/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Unhealthy dietary patterns significantly contribute to rising non-communicable diseases (NCDs) in Sri Lanka. The government has implemented policy measures to promote healthy dietary patterns, including the traffic light labelling (TLL) system for sugar-sweetened beverages (SSBs) in 2016 and taxation on SSBs in 2017. OBJECTIVES To analyse how ideas, institutions, and power dynamics influence the formulation and implementation of these two interventions, and to identify strategies for public health actors to advocate for more effective food environment policies in Sri Lanka. METHODS This study drew on Kingdon's theory of agenda-setting and Campbell's institutionalist approach to develop the theoretical framework. We examined the political economy at the policy development and implementation stages, adopting a deductive framework approach for data collection and analysis. Data were collected from documents and key informants. RESULTS NCDs and nutrition are recognised and framed as important policy issues in health-sector policy documents, and the SSB tax and TLL system are seen as means of improving diets and health. Sri Lanka's commitment to addressing NCDs and nutrition-related issues is evident through these policies. The Ministry of Health led policy development, and key stakeholders were involved. However, there are opportunities to learn and strengthen policy in Sri Lanka and elsewhere. Limited involvement and commitment of some stakeholders in developing national policies, industry interferences, and other gaps resulted in weaker policy design. Gender considerations were also given minimal attention in policy formulation and implementation. CONCLUSIONS To enhance the effectiveness of the policies and regulations to promote healthy diets in Sri Lanka, comprehensive policy coverage, multistakeholder involvement and commitment to national policies, balanced power dynamics, technical feasibility, government commitment backed with high-level political support, awareness, and knowledge creation, managing industry interferences, integrating gender considerations are crucial factors.
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Affiliation(s)
- Sunimalee Madurawala
- Health, Education & Labour Department, Institute of Policy Studies of Sri Lanka, Colombo, Sri Lanka
| | - Kimuthu Kiringoda
- Health, Education & Labour Department, Institute of Policy Studies of Sri Lanka, Colombo, Sri Lanka
| | - Anne Marie Thow
- Menzies Centre for Health Policy and Economics, The University of Sydney, Sydney, Australia
| | - Nisha Arunatilake
- Health, Education & Labour Department, Institute of Policy Studies of Sri Lanka, Colombo, Sri Lanka
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Hasan AMR, Selim MA, Anne FI, Escobar-DeMarco J, Ireen S, Kappos K, Ash D, Rasheed S. Opportunities and challenges in delivering maternal and child nutrition services through public primary health care facilities in urban Bangladesh: a qualitative inquiry. BMC Health Serv Res 2023; 23:1172. [PMID: 37891649 PMCID: PMC10612189 DOI: 10.1186/s12913-023-10094-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 09/30/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Public primary health facilities are an important source of nutrition services for the urban areas in Bangladesh. We aimed to understand the challenges and facilitators of delivering maternal and child nutrition services through public sector from the perspectives of the users and service providers. METHOD The study was conducted in selected public primary health care facilities and their catchment area in Dhaka city from April-July 2019. We carried out 15 free listing exercises and 43 semi-structured interviews (SSI) with pregnant women and mothers of 0-24 months old children; 6 key informant interviews (KII) with facility managers and healthcare providers; and observed service delivery in 8 health facilities. RESULTS Findings reveal that public primary health facilities address some economic and cultural barriers to access such as cost and provision of female service providers for maternal and child health services but challenges such as distance, waiting time, and cleanliness remained. In terms of service provision, there were gaps in provision of anthropometric measurement and counseling, and healthcare providers had inadequate training and therefore, knowledge of nutrition. The low priority given to nutrition services during program design hampered the delivery of nutrition services provided through urban public sector health facilities. CONCLUSIONS There were important gaps in terms of service provision and capacity of healthcare providers, and therefore, the quality of nutrition service provided through public primary health care facilities. To maximize the coverage of quality nutrition services in the urban areas, it is important to think through the design of nutrition service delivery and allocate adequate resources to fill the material and capacity gaps.
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Affiliation(s)
- A M Rumayan Hasan
- Health Systems and Population Studies Division (HSPSD), International Centre for Diarrhoeal Disease Research, 68 Shaheed Tajuddin Ahmed Sarani, 1212, Mohakhali, Dhaka, Bangladesh
| | - Mohammad Abdus Selim
- Health Systems and Population Studies Division (HSPSD), International Centre for Diarrhoeal Disease Research, 68 Shaheed Tajuddin Ahmed Sarani, 1212, Mohakhali, Dhaka, Bangladesh
| | - Faugia Islam Anne
- Health Systems and Population Studies Division (HSPSD), International Centre for Diarrhoeal Disease Research, 68 Shaheed Tajuddin Ahmed Sarani, 1212, Mohakhali, Dhaka, Bangladesh
| | - Jessica Escobar-DeMarco
- Department of Public Health Sciences, The University of North Carolina Charlotte, Charlotte, NC, USA
| | - Santhia Ireen
- FHI Solutions / Family Health International 360, Washington, DC, USA
| | - Kristen Kappos
- FHI Solutions / Family Health International 360, Washington, DC, USA
| | - Deborah Ash
- FHI Solutions / Family Health International 360, Washington, DC, USA
| | - Sabrina Rasheed
- Health Systems and Population Studies Division (HSPSD), International Centre for Diarrhoeal Disease Research, 68 Shaheed Tajuddin Ahmed Sarani, 1212, Mohakhali, Dhaka, Bangladesh.
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Ezekannagha O, Adeyemi O, Ajieroh V, Onabolu A. Advancing a Multisectoral Platform for Nutrition-Sensitive Agriculture in Nigeria: Reflections on Effectiveness and Lessons Learned. Food Nutr Bull 2023; 44:S52-S60. [PMID: 37317523 DOI: 10.1177/03795721231179786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Inadequate coordination mechanisms and capacity to coordinate are limiting factors for maximizing the ability of agriculture to improve nutrition in Sub-Saharan Africa. Effective coordination requires the availability of a platform for stakeholder convening, planning, operationalization of ideas, communication, and accountability. Nigeria's Federal Ministry of Agriculture and Rural Development established one such platform to support the institutionalization of nutrition-sensitive agriculture. Platform members include several departments within the Ministry, other ministries, and development partners. While the platform achieved key milestones and fostered collaboration, some gaps remained. OBJECTIVE This study reports an assessment to understand the perspectives of members of the coordination platform and identify ways of increasing effectiveness. METHODS Desk reviews of relevant documents and 18 key informant interviews were conducted. Documents and interview notes were coded and analysed to identify recurring themes. Themes were appraised using a nutrition coordination framework. RESULTS Sufficiently understanding the nutrition role of representatives' own organization/department and the purpose of the coordination platform and its activities was important for success. The profile and seniority of representing officers also mattered. While the leadership of the Ministry was committed to advancing nutrition through agriculture, the coordination platform could improve its functionality through consistent leadership, increased seniority of member representatives, and appropriate communication. CONCLUSIONS Multisectoral coordination platforms are necessary but do not alone achieve nutrition coordination. Effective leadership and investments in time, strategic orientation, and training are critical to achieving a shared purpose, individual sector fulfilment of nutrition roles, and additional coordination success factors.
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Affiliation(s)
| | - Olutayo Adeyemi
- Department of Human Nutrition and Dietetics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | | | - Adeyinka Onabolu
- Global Alliance for Improved Nutrition, Abuja, Nigeria
- Federal Ministry of Agriculture and Rural Development, Abuja, Nigeria
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Diasso D, Halidou Doudou M, Cruz S, Tonnoir F, Compaoré-Sérémé D, Zongo U, Savadogo A. Capacity needs assessment and challenges for multisectoral implementation of nutrition in Burkina Faso: A guide for the formulation of a capacity development plan. Int J Health Plann Manage 2023; 38:1520-1538. [PMID: 37464724 DOI: 10.1002/hpm.3685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/24/2022] [Accepted: 07/07/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION Achieving nutritional goals depends on individual, organisational and environmental capacities. The aim of this study was to analyse and identify capacity gaps among the coordination platforms and networks, and the key technical institutions related to nutrition in Burkina Faso for a capacity development plan formulation. METHODS Using the new Nutrition Capacity Framework developed by the United Nations Network, information were collected using the Nutrition Stakeholder Mapping and Analysis tool, and the Checklist for Capacity Areas. Capacity needs were analysed in terms of Human resource and infrastructure, functional, organisational, coordination and partnership, and financial and resource mobilisation. RESULTS Limited human resource capacity in nutrition was highlighted in most cases by the structures, and the nutrition coordination structure and more than 4/5 of the technical structures are faced with the unavailability of working materials, tools and basic Internet connection. Only 10 among the 30 structures have a unit or service for exchange on nutrition, and only three of them have integrated nutrition actions. Shortfalls were noted in terms of functional, facilitation, communication and advocacy skills, as well as a weak diversification of resource mobilisation strategies. CONCLUSION The use of the analytical framework helped to identify the gaps and to propose paths for capacity development. Efforts need to be strengthened, intensified, coordinated, monitored, evaluated and funded.
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Affiliation(s)
- Dieudonné Diasso
- Laboratory of Applied Biochemistry and Immunology, Center for Research in Biological Sciences of Food and Nutrition, Department of Biochemistry and Microbiology, Joseph KI-ZERBO University, Ouagadougou, Burkina Faso
| | - Maimouna Halidou Doudou
- Epidemiology, Bio-Statistics and Clinical Research Center, School of Public Health, Brussels, Belgium
| | - Sarah Cruz
- UN Network for SUN/REACH Secretariat, World Food Programme (WFP), Rome, Italy
| | - Florence Tonnoir
- UN Network for SUN/REACH Secretariat, World Food Programme (WFP), Rome, Italy
| | - Diarra Compaoré-Sérémé
- Department of Food Technology, Institute for Sciences and Technologies Applied Research, National Center for Scientific and Technological Research, Ouagadougou, Burkina Faso
| | - Urbain Zongo
- Laboratory of Applied Biochemistry and Immunology, Center for Research in Biological Sciences of Food and Nutrition, Department of Biochemistry and Microbiology, Joseph KI-ZERBO University, Ouagadougou, Burkina Faso
| | - Aly Savadogo
- Laboratory of Applied Biochemistry and Immunology, Center for Research in Biological Sciences of Food and Nutrition, Department of Biochemistry and Microbiology, Joseph KI-ZERBO University, Ouagadougou, Burkina Faso
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Neill R, Shawar YR, Ashraf L, Das P, Champagne SN, Kautsar H, Zia N, Michlig GJ, Bachani AM. Prioritizing rehabilitation in low- and middle-income country national health systems: a qualitative thematic synthesis and development of a policy framework. Int J Equity Health 2023; 22:91. [PMID: 37198596 PMCID: PMC10189207 DOI: 10.1186/s12939-023-01896-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND There is a large and growing unmet need for rehabilitation - a diverse category of services that aim to improve functioning across the life course - particularly in low- and middle-income countries. Yet despite urgent calls to increase political commitment, many low- and middle-income country governments have dedicated little attention to expanding rehabilitation services. Existing policy scholarship explains how and why health issues reach the policy agenda and offers applicable evidence to advance access to physical, medical, psychosocial, and other types of rehabilitation services. Drawing from this scholarship and empirical data on rehabilitation, this paper proposes a policy framework to understand national-level prioritization of rehabilitation in low- and middle-income countries. METHODS We conducted key informant interviews with rehabilitation stakeholders in 47 countries, complemented by a purposeful review of peer-reviewed and gray literature to achieve thematic saturation. We analyzed the data abductively using a thematic synthesis methodology. Rehabilitation-specific findings were triangulated with policy theory and empirical case studies on the prioritization of other health issues to develop the framework. RESULTS The novel policy framework includes three components which shape the prioritization of rehabilitation on low- and middle-income countries' national government's health agendas. First, rehabilitation lacks a consistent problem definition, undermining the development of consensus-driven solutions which could advance the issue on policy agendas. Second, governance arrangements are fragmented within and across government ministries, between the government and its citizens, and across national and transnational actors engaged in rehabilitation service provision. Third, national legacies - particularly from civil conflict - and weaknesses in the existing health system influences both rehabilitation needs and implementation feasibility. CONCLUSIONS This framework can support stakeholders in identifying the key components impeding prioritization for rehabilitation across different national contexts. This is a crucial step for ultimately better advancing the issue on national policy agendas and improving equity in access to rehabilitation services.
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Affiliation(s)
- Rachel Neill
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD 21205 USA
| | - Yusra Ribhi Shawar
- Department of International Health, Johns Hopkins University Blomberg School of Public Health, Baltimore, MD USA
- Paul H. Nitze School of Advanced International Studies, Johns Hopkins University, Washington, DC USA
| | - Lamisa Ashraf
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD 21205 USA
| | - Priyanka Das
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD 21205 USA
| | - Sarah N. Champagne
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD 21205 USA
| | - Hunied Kautsar
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD 21205 USA
| | - Nukhba Zia
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD 21205 USA
| | - Georgia J. Michlig
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD 21205 USA
| | - Abdulgafoor M. Bachani
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD 21205 USA
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Etiaba E, Eboreime EA, Dalglish SL, Lehmann U. Aspirations and realities of intergovernmental collaboration in national- level interventions: insights from maternal, neonatal and child health policy processes in Nigeria, 2009-2019. BMJ Glob Health 2023; 8:bmjgh-2022-010186. [PMID: 36810159 PMCID: PMC9945032 DOI: 10.1136/bmjgh-2022-010186] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 02/05/2023] [Indexed: 02/23/2023] Open
Abstract
In Nigeria's federal government system, national policies assign concurrent healthcare responsibilities across constitutionally arranged government levels. Hence, national policies, formulated for adoption by states for implementation, require collaboration. This study examines collaboration across government levels, tracing implementation of three maternal, neonatal and child health (MNCH) programmes, developed from a parent integrated MNCH strategy, with intergovernmental collaborative designs, to identify transferable principles to other multilevel governance contexts, especially low-income countries.National-level setting was Abuja, where policymaking is domiciled, while two subnational implementation settings (Anambra and Ebonyi states) were selected based on their MNCH contexts. A qualitative case study triangulated information from 69 documents and 44 in-depth interviews with national and subnational policymakers, technocrats, academics and implementers. Emerson's integrated collaborative governance framework was applied thematically to examine how governance arrangements across the national and subnational levels impacted policy processes.The results showed that misaligned governance structures constrained implementation. Specific governance characteristics (subnational executive powers, fiscal centralisation, nationally designed policies, among others) did not adequately generate collaboration dynamics for collaborative actions. Collaborative signing of memoranda of understanding happened passively, but the contents were not implemented. Neither state adhered to programme goals, despite contextual variations, because of an underlying disconnect in the national governance structure.Collaboration across government levels could be better facilitated via full devolution of responsibilities by national authorities to subnational governments, with the national level providing independent evaluation and guidance only. Given the existing fiscal structure, innovative reforms which hold government levels accountable should be linked to fiscal transfers. Sustained advocacy and context-specific models of achieving distributed leadership across government levels are required across similar resource-limited countries. Stakeholders should be aware of what drivers are available to them for collaboration and what needs to be built within the system context.
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Affiliation(s)
- Enyi Etiaba
- SOPH, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa .,Health Administration and Management, Faculty of Health Sciences and Technology, University of Nigeria, Enugu, Nigeria
| | | | - Sarah L Dalglish
- Department of International Health, University College London, London, UK,Department of International Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Uta Lehmann
- SOPH, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa,South African Medical Research Council, Tygerberg, South Africa
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Bhandari S, Frongillo EA, Suwal R, Schreinemachers P, Gupta AS, Blake CE, Tiwari NP, Cunningham K. Sustaining Agriculture and Nutrition Interventions: Continued Engagement of Village Model Farmers in Nepal. Food Nutr Bull 2022; 43:412-428. [PMID: 35726207 DOI: 10.1177/03795721221106588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND In homestead food production (HFP) programs, village model farmers (VMFs), after training, implement agriculture and nutrition activities to improve household knowledge and practices. Little evidence exists on what enables VMFs to remain actively engaged and for impacts to be sustained. OBJECTIVE To examine variables explaining active engagement of VMFs, at least 4 years post-training, in an HFP program in Nepal. METHODS We used cross-sectional data, collected from 2018 to 2019, among 4750 VMFs of Suaahara, a multisectoral nutrition program. We assessed whether respondents registered their HFP group with the local government, conducted regular group meetings, discussed vegetable growing and chicken rearing practices with group members, or engaged in saving and credit activities in their HFP group. Outcome variable was a count of these 4 activities in which the VMF engaged. Socioeconomic, demographic, and programmatic explanatory variables were identified a priori and by bivariate analysis and were adjusted in ordinal regression models accounting for clusters. RESULTS On average, VMFs engaged in 1.4 activities. Having attended primary or secondary school (adjusted odds ratios [AOR] = 1.39), being a female community health volunteer (AOR = 1.27), being from an advantaged caste/ethnic group (AOR = 1.34), receiving additional trainings (AOR = 1.56) and inputs (AOR = 1.31) were associated with more active engagement of VMFs. CONCLUSION Village model farmers receiving more training and inputs were more likely to remain actively engaged. Female community health workers, people from higher caste/ethnic groups, and those with primary or secondary education were more likely to remain active VMFs and could be targeted for this role in HFP programs leading to sustained impact.
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Affiliation(s)
- Shiva Bhandari
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | | | | | | | - Christine E Blake
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | | | - Kenda Cunningham
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Herawati DMD, Sunjaya DK. Implementation Outcomes of National Convergence Action Policy to Accelerate Stunting Prevention and Reduction at the Local Level in Indonesia: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13591. [PMID: 36294173 PMCID: PMC9602846 DOI: 10.3390/ijerph192013591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/11/2022] [Accepted: 10/15/2022] [Indexed: 06/16/2023]
Abstract
The study aims to explore the implementation outcome variables of Indonesia's national policy convergence action in the stunting reduction intervention at district, sub-district, and village levels. The study design was qualitative with an implementation research approach at District Cirebon, Indonesia. Data were collected through in-depth interviews, focus group discussions, study documents, and 6 months of participant observation. We recruited 172 respondents. The assessment instrument used was formed on was implementation outcomes variables. Data were analyzed through coding, categorizing and thematic content analysis based on a predetermined theme. Comparative cross district activity-site analysis was applied between sub-districts and villages. The implementation outcome variables for the convergence action policy were performed well at the district level, in line with the central government's adequate regulation, control, and budget. Meanwhile, the sub-district and village levels only performed aspects of acceptability, appropriateness, and coverage for specific interventions. The acceptability level in the village was only partially running. The barriers at the sub-district and village levels were issues of commitment, staff capacity, and poor coordination. Superficial understanding and capacity weaknesses drove the convergence of the stunting reduction responsibility back into the burden of the health sector at the forefront. Local politics also colored the implementation in the village.
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Resnick D, Anigo K, Anjorin OM. Advocacy Organizations and Nutrition Policy in Nigeria: Identifying Metrics for Enhanced Efficacy. Health Policy Plan 2022; 37:963-978. [PMID: 35482483 PMCID: PMC9469884 DOI: 10.1093/heapol/czac037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 04/05/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
Advocacy organizations have played a significant role in the field of nutrition in recent years. However, why are some advocates viewed as more effective than others? This paper derives metrics for assessing advocacy efficacy by first drawing on key insights from the nutrition and public policy scholarship. A set of metrics is proposed to capture the constitutive elements of three concepts that often emerge as critical from that literature: organizational capacity, strong networks, and external outreach. Based on a survey of 66 nutrition stakeholders in Nigeria, including at the federal level and within the states of Kaduna and Kano, the metrics are then applied to a set of advocacy organizations within the country. We show that the metrics can provide insights into why some advocacy organizations are perceived as more effective than others by policymakers. Specifically, we find that geographical reach, share of budget allocated to advocacy, action plans with clear objectives, large networks that include government and non-governmental policy champions, multiple media and dissemination outputs, and numerous training events collectively increase nutrition advocates' visibility to, and influence on, policymakers. Although the metrics are subject to further testing in other country settings and need to be interpreted based on a country's underlying policy system, they offer a useful starting point for more systematic, comparative advocacy analysis and learning within the nutrition field and beyond.
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Affiliation(s)
- Danielle Resnick
- Brookings Institution, 1775 Massachusetts Avenue NW, Washington, DC 20036, USA
| | - Kola Anigo
- Ahmadu Bellow University, Zaria, Nigeria
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13
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Knight F, Bourassa MW, Ferguson E, Walls H, de Pee S, Vosti S, Martinez H, Levin C, Woldt M, Sethurman K, Bergeron G. Nutrition modeling tools: a qualitative study of influence on policy decision making and determining factors. Ann N Y Acad Sci 2022; 1513:170-191. [PMID: 35443074 PMCID: PMC9546113 DOI: 10.1111/nyas.14778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Nutrition modeling tools (NMTs) generate evidence to inform policy and program decision making; however, the literature is generally limited to modeling methods and results, rather than use cases and their impacts. We aimed to document the policy influences of 12 NMTs and identify factors influencing them. We conducted semistructured interviews with 109 informants from 30 low‐ and middle‐income country case studies and used thematic analysis to understand the data. NMTs were mostly applied by international organizations to inform national government decision making. NMT applications contributed to enabling environments for nutrition and influenced program design and policy in most cases; however, this influence could be strengthened. Influence was shaped by processes for applying the NMTs; ownership of the analysis and data inputs, and capacity building in NMT methods, encouraged uptake. Targeting evidence generation at specific policy cycle stages promoted uptake; however, where advocacy capacity allowed, modeling was embedded ad hoc into emerging policy discussions and had broader influence. Meanwhile, external factors, such as political change and resource constraints of local partner organizations, challenged NMT implementation. Importantly, policy uptake was never the result of NMTs exclusively, indicating they should be nested persistently and strategically within the wider evidence and advocacy continuum, rather than being stand‐alone activities.
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Affiliation(s)
- Frances Knight
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Nutrition Division, United Nations World Food Programme, Rome, Italy
| | | | - Elaine Ferguson
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helen Walls
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Saskia de Pee
- Nutrition Division, United Nations World Food Programme, Rome, Italy.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.,Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - Stephen Vosti
- Department of Agricultural and Resource Economics, University of California, Davis, Davis, California
| | | | - Carol Levin
- Department of Global Health, University of Washington, Seattle, Washington
| | - Monica Woldt
- Helen Keller International, Washington, District of Columbia.,USAID Advancing Nutrition, Arlington, Virginia.,Formerly with Food and Nutrition Technical Assistance Project (FANTA), Washington, District of Columbia
| | - Kavita Sethurman
- Formerly with Food and Nutrition Technical Assistance Project (FANTA), Washington, District of Columbia
| | - Gilles Bergeron
- New York Academy of Sciences, New York, New York.,Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia
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14
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Iruhiriye E, Olney DK, Frongillo EA, Niyongira E, Nanama S, Rwibasira E, Mbonyi P, Blake CE. Translation of policy for reducing undernutrition from national to sub-national levels in Rwanda. Food Secur 2022. [DOI: 10.1007/s12571-022-01271-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AbstractUnderstanding how countries improve children’s nutrition can inform policies and contribute to further improvements. We examined the relationship between improvements in nutrition in Rwanda (1992–2017) and political commitment to- and policy coherence in- nutrition. We reviewed nutrition-relevant Rwandan policies and programs (2000–2018) and conducted 90 semi-structured interviews with national (n = 32), mid-level (n = 38), and community (n = 20) nutrition stakeholders and 40 community-level focus group discussions (FGDs). FGDs and sub-national interviews were conducted in ten purposefully selected districts, five each in which stunting decreased (reduced) and increased or stagnated (non-reduced) between the 2010 and 2014/15 Rwanda Demographic and Health Surveys. Analysis consisted of thematic analysis and the assessment of events, policy developments, and strategies that influenced nutrition in Rwanda, including operationalization of political commitment and policy coherence for nutrition. Political and institutional commitment to nutrition increased in Rwanda as evidenced by the adoption of a multisectoral nutrition policy that was reinforced with national and subnational horizontal coordination platforms. These platforms strengthened multisectoral strategies to address nutrition and supported operational and institutional commitment. The role of mid-level actors in nutrition governance increased as responsibilities for planning, implementing, and monitoring nutrition programs were increasingly delegated to sub-national administrative levels. Variations in policy implementation existed between reduced and non-reduced districts. Despite improvements, challenges remained in coordination, financial commitment, and capacity to address, monitor, and evaluate nutrition. Political commitment to- and policy coherence in- nutrition at the national level are important for improving nutrition, and when reinforced institutionally, can be translated to sub-national levels where implementation occurs.
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15
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Phulkerd S, Ngqangashe Y, Collin J, Thow AM, Schram A, Schneider CH, Friel S. Moving from silos to synergies: strengthening governance of food marketing policy in Thailand. Global Health 2022; 18:29. [PMID: 35264200 PMCID: PMC8905862 DOI: 10.1186/s12992-022-00825-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/17/2022] [Indexed: 11/25/2022] Open
Abstract
Background Governance processes play an important role in shaping the formulation and implementation of policy measures such as restrictions on marketing of ultra-processed foods. However, there is limited analysis of the factors that affect governance for nutrition, especially in low- and middle-income countries such as Thailand and the Southeast Asia region. This study aimed to examine governance factors that create opportunities and challenges for the introduction of policy to restrict food marketing in Thailand, in line with the WHO recommendations to restrict food marketing to children. Methods A qualitative study design was used. Interviews were conducted with 20 actors with experience and in depth knowledge of food marketing in Thailand, including government, civil society, industry and international organisations. Open questions were asked about experiences and perceptions of the governance processes related to policies for restricting food marketing in Thailand. Themes were derived from the 3-i Framework which relates to interests, ideas and institutions influencing the introduction of food marketing policy were identified and analysed using abductive methods. Results Actors viewed institutional challenges as a significant barrier to advancing effective regulation of food marketing. Three major clusters emerged from the data: interests (priorities, relationships), institutions (formal structures, informal structures, broader institutional strategies), and ideas (norms). The study has three major findings in relation to these factors, highlighting the influence of formal structures, institutional interests in food marketing issues, and ideas in promoting multisectoralism. The siloed nature of policymaking was reflected in the government failing to stimulate engagement among key actors, posing challenges for implementation of effective policy change. Contested interests led to disagreements between actors over food marketing agenda and thus competing policy priorities. Consistent with these findings, the lack of effective mechanisms to promote multisectoral coordination across diverse actors reinforced barriers to policy change. Conclusion The findings highlight ongoing challenges to the government’s aim to strengthen policy to restrict food marketing which, without greater coordination in governance mechanisms, will hinder effective regulation and the achievement of public health goals. This analysis suggests that the Government should prioritise the development of a holistic, multisectoral approach to improve governance for better nutrition outcomes by overcoming policy silos.
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Affiliation(s)
- Sirinya Phulkerd
- Institute for Population and Social Research, Mahidol University, 999 Phutthamonthon 4 Road, Phutthamonthon, Nakhon Pathom, 73170, Thailand.
| | - Yandisa Ngqangashe
- School of Regulation and Global Governance, Australian National University, Canberra, Australia
| | - Jeff Collin
- Global Health Policy Unit, School of Social & Political Science, University of Edinburgh, Edinburgh, UK
| | - Anne-Marie Thow
- Menzies Centre for Health Policy and Economics, School of Public Health, University of Sydney, Sydney, Australia
| | - Ashley Schram
- School of Regulation and Global Governance, Australian National University, Canberra, Australia
| | - Carmen Huckel Schneider
- Menzies Centre for Health Policy and Economics, School of Public Health, University of Sydney, Sydney, Australia
| | - Sharon Friel
- School of Regulation and Global Governance, Australian National University, Canberra, Australia
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16
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Escobar-Alegria JL, Frongillo EA, Blake CE. How country policy actors understand sustainability of food and nutrition security policy. GLOBAL FOOD SECURITY 2022. [DOI: 10.1016/j.gfs.2021.100603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Nisbett N, Harris J, Backholer K, Baker P, Jernigan VBB, Friel S. Holding no-one back: The Nutrition Equity Framework in theory and practice. GLOBAL FOOD SECURITY 2022; 32:100605. [PMID: 36873709 PMCID: PMC9983632 DOI: 10.1016/j.gfs.2021.100605] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Equity remains poorly conceptualised in current nutrition frameworks and policy approaches. We draw on existing literatures to present a novel Nutrition Equity Framework (NEF) that can be used to identify priorities for nutrition research and action. The framework illustrates how social and political processes structure the food, health and care environments most important to nutrition. Central to the framework are processes of unfairness, injustice and exclusion as the engine of nutrition inequity across place, time and generations, ultimately influencing both nutritional status and people's space to act. The NEF illustrates conceptually how action on the socio-political determinants of nutrition is the most fundamental and sustainable way of improving nutrition equity for everyone everywhere, through 'equity-sensitive nutrition'. Efforts must ensure, in the words of the Sustainable Development Goals, that not only is "no one left behind" but also that the inequities and injustices we describe do not hold anyone back from realising their right to healthy diets and good nutrition.
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Affiliation(s)
- Nicholas Nisbett
- Institute of Development Studies at the University of Sussex, UK
| | - Jody Harris
- Institute of Development Studies at the University of Sussex, UK.,World Vegetable Centre, Thailand
| | - Kathryn Backholer
- Deakin University, Geelong, Institute for Health Transformation, Victoria, Australia
| | - Philip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | | | - Sharon Friel
- School of Regulation and Global Governance, Australian National University, Australia
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18
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Reeve E, Thow AM, Huse O, Bell C, Peeters A, Sacks G. Policy-makers' perspectives on implementation of cross-sectoral nutrition policies, Western Pacific Region. Bull World Health Organ 2021; 99:865-873. [PMID: 34866682 PMCID: PMC8640684 DOI: 10.2471/blt.20.283366] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 02/07/2023] Open
Abstract
Implementation of effective cross-sectoral nutrition policies remains a challenge worldwide. By reviewing reports from World Health Organization meetings and consultations - convened for policy-makers representing Member States of the Western Pacific Region - we provide an insight into how national policy-makers and external actors can support different dimensions of nutrition policy implementation. Key insights of policy-makers attending food and nutrition-centred meetings include that country-level implementation of nutrition policy relies on strong policy design, organizational planning and governance mechanisms that promote collective responsibility across multiple sectors. Policy-makers responsible for implementing nutrition policies face major challenges resulting from limited capacity, both within and external to government, particularly in relation to monitoring and enforcement activities. Successful implementation of nutrition policy measures will require greater political will to provide the requisite resources and institutional structures to ensure sustained policy effectiveness. Nongovernmental partners, including international agencies and researchers, have an opportunity to support policy implementation by providing technical support to Member States to frame action on nutrition in a more compelling way. They can also help policy-makers to build the organizational and structural capacity to coordinate cross-sectoral policy. Improved policy design, planning and governance and strategic capacity-building, supported by external partners, can strengthen the sustained implementation of cross-sectoral nutrition policy and improve nutrition outcomes.
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Affiliation(s)
- Erica Reeve
- Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Anne-Marie Thow
- Menzies Centre for Health Policy, University of Sydney, Sydney, Australia
| | - Oliver Huse
- Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Colin Bell
- Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Anna Peeters
- Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Gary Sacks
- Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
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19
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Billings L, Pradeilles R, Gillespie S, Vanderkooy A, Diatta D, Toure M, Diatta AD, Verstraeten R. Coherence for nutrition: insights from nutrition-relevant policies and programmes in Burkina Faso and Nigeria. Health Policy Plan 2021; 36:1574-1592. [PMID: 34450629 PMCID: PMC8597973 DOI: 10.1093/heapol/czab108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 08/06/2021] [Accepted: 08/27/2021] [Indexed: 11/13/2022] Open
Abstract
There is consensus that policy coherence is necessary for implementing effective and sustainable approaches to tackle malnutrition. We look at whether policies and programmes provide a coherent pathway to address nutrition priorities and if programmes are designed to deliver interventions aligned to the nutrition policy agenda in Nigeria and Burkina Faso. A systematic desk review was performed on nutrition-relevant policy and programme documents, obtained through grey literature searches and expert recommendations. We developed a framework with an impact pathway structure that includes five process steps, which was used to guide coding, data reduction and synthesis and structure the analysis. We assessed internal coherence along process steps within a given document and external coherence across process steps for explicitly linked policy/programme pairs. The majority of policies and programmes had partial internal coherence for both countries. The identification of relevant nutrition interventions to address challenges and reach objectives was the strongest connection within policies (16 out of 45 had complete coherence), while among programmes, the strongest connection was coverage indicators that measure interventions (9 out of 21 had complete coherence). Eight programmes explicitly referenced at least one nutrition-relevant policy, with a total of 16 linked policy/programme pairs (13 pairs for Burkina Faso and 3 for Nigeria) across health, nutrition, agriculture and social focus areas. However, none of the linked pairs were assessed to have complete external coherence, suggesting that priorities at the policy level are not fully realized nor translated at the programme level. This study offers a new approach for the assessment of policy and programme coherence and specifically examines policy and programme linkages. We conclude that improved leadership on country priority setting and better alignment for nutrition within and across sectors is needed to enhance the effectiveness of nutrition investments.
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Affiliation(s)
- Lucy Billings
- Poverty Health and Nutrition Division, International Food Policy Research Institute, 1201 Eye Street, NW, Washington, DC 20005USA
| | - Rebecca Pradeilles
- School of Sport, Exercise and Health Sciences, Loughborough University, Clyde Williams Building, Epinal Way, Loughborough LE11 3TUUK
| | - Stuart Gillespie
- Poverty Health and Nutrition Division, International Food Policy Research Institute, 1201 Eye Street, NW, Washington, DC 20005USA
| | | | - Dieynab Diatta
- Poverty Health and Nutrition Division, International Food Policy Research Institute, 1201 Eye Street, NW, Washington, DC 20005USA
| | - Mariama Toure
- Poverty Health and Nutrition Division, International Food Policy Research Institute, 1201 Eye Street, NW, Washington, DC 20005USA
| | - Ampa Dogui Diatta
- Poverty Health and Nutrition Division, International Food Policy Research Institute, 1201 Eye Street, NW, Washington, DC 20005USA
| | - Roos Verstraeten
- Poverty Health and Nutrition Division, International Food Policy Research Institute, 1201 Eye Street, NW, Washington, DC 20005USA
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20
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Kodish SR, Farhikhtah A, Mlambo T, Hambayi MN, Jones V, Aburto NJ. Leveraging the Scaling Up Nutrition Movement to Operationalize Stunting Prevention Activities: Implementation Lessons From Rural Malawi. Food Nutr Bull 2021; 43:104-120. [PMID: 34747237 DOI: 10.1177/03795721211046140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The rural district of Ntchisi is in the central region of Malawi. Among children aged 6 to 23 months, the stunting prevalence is 40% to 50%. To address this high prevalence, the World Food Programme, with cooperating partners, supported the Government of Malawi to implement an integrated stunting prevention program entitled The Right Foods at the Right Time from 2013 to 2018. OBJECTIVE To provide implementation lessons learned from systematic documentation of how the Scaling Up Nutrition (SUN) movement, combined with other international and national initiatives and policies, was translated into tailored programming. METHODS During program conception, early design, and implementation, this descriptive study systematically documented the process of translating SUN principles and government policies into an operational stunting prevention program in rural Malawi. RESULTS We identified 8 factors that contributed to successful translation of policy into program activities: (1) well-structured National SUN framework, (2) reliable coordination platforms and district ownership, (3) systematic and evidence-informed program design, (4) multiple forms of data used to inform program planning, (5) multisectoral implementation approaches to stunting prevention, (6) innovation in technology to improve overall program efficiency, (7) systematic collaboration among diverse stakeholders, and (8) strong public health nutrition capacity of program team members. CONCLUSIONS Lessons from this nutrition program in Ntchisi, Malawi, provide one case illustrating how the SUN movement, government policies, and global evidence base can be operationalized into tailored programming for improving nutrition.
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Affiliation(s)
- Stephen R Kodish
- United Nations World Food Programme Headquarters, Rome, Italy.,The Pennsylvania State University, University Park, PA, USA
| | - Arghanoon Farhikhtah
- United Nations World Food Programme Headquarters, Rome, Italy.,Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Trust Mlambo
- United Nations World Food Programme, Lilongwe, Malawi
| | | | - Vanessa Jones
- United Nations World Food Programme Headquarters, Rome, Italy
| | - Nancy J Aburto
- United Nations World Food Programme Headquarters, Rome, Italy.,Food and Agriculture Organization of the United Nations, Rome, Italy
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21
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Hoey L, Khoury CK, Osiemo J, Shires A, Binge B, Duong TT, Jalango D, Trinh HT, Huynh TTT, Judelsohn A, Haan SD, Heller MC, Chege CK, Jones AD. Challenges to Operationalizing Sustainable Diets: Perspectives From Kenya and Vietnam. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2021. [DOI: 10.3389/fsufs.2021.690028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Despite the urgent need for comprehensive food systems strategies, the challenge lies in defining feasible, evidence-based intervention points. Too little is known about issues food systems decision-makers and other change agents are running up against, particularly in low- and middle-income countries where food systems are the most vulnerable to a growing number of intertwined crises. We look at this question through the lens of sustainable diets, a growing area of research and a concept that is the basis of over 30 sets of national guidelines that aim to simultaneously address health, economic and environmental dimensions of food systems. Based on 114 interviews carried out in Kenya and Vietnam, we examine the extent to which food systems researchers, business and project managers and policy actors are attempting to intervene in food systems in ways that mirror the concept of sustainable diets. We also consider how they are managing two key ingredients that are critical to systems-change—interdisciplinary data and cross-sector collaboration. Most stakeholders we interviewed were carrying out systems-based projects, oriented—even if not explicitly—around many of the sustainable diets domains: agriculture, livelihoods, food security/access/nutrition and/or environment. The majority faced formidable challenges with both data and collaborations, however, showing why it can be so difficult to move from normative ideals like “sustainable diets” to practical realities, regardless of the context. To support more comprehensive food systems policies and interventions, our findings suggest the need for strategies that can improve the collection and accessibility of actionable, cross-sector data, and mechanisms to overcome institutional barriers that limit collaboration.
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22
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Coile A, Wun J, Kothari MT, Hemminger C, Fracassi P, Di Dio D. Scaling up nutrition through multisectoral planning: An exploratory review of 26 national nutrition plans. MATERNAL & CHILD NUTRITION 2021; 17:e13225. [PMID: 34101997 PMCID: PMC8518575 DOI: 10.1111/mcn.13225] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 11/27/2022]
Abstract
With a growing consensus on the need to address malnutrition in a comprehensive and multisectoral way, there has been increased attention on the processes and factors for multisectoral nutrition planning to be successful. To guide countries, the Scaling Up Nutrition (SUN) Movement developed a checklist that defined characteristics of good national nutrition plans. This exploratory review used the framework of the Checklist to assess 26 national multisectoral nutrition plans (MSNPs) developed between 2014 and 2020. The MSNPs were assessed against a subset of 31 Checklist characteristics defined as basic plan components. Although the level of detail varied across the reviewed plans, the majority included core components that are important to facilitate effective planning and implementation, such as an assessment of the nutritional status and determinants of malnutrition for children under 5 years of age, a commitment to global recommendations related to reducing malnutrition, actions consistent with global evidence and responding to identified issues/gaps, governance arrangements to facilitate coordination, and identification of capacity-building needs/actions to support effective implementation. Common gaps across plans included risk analysis and mitigation, defined responsible agencies for each action, an assessment of the financial gap and defined mechanisms for financial tracking and resource allocation, and mechanisms to coordinate operational research. These findings provide a high-level, multi-country review of multisectoral nutrition planning that can support future policymakers, technical assistance providers and regional and global stakeholders to consider the foundational elements of and further validate and address common shortcomings in developing such a plan.
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Affiliation(s)
- Amanda Coile
- PATHWashingtonDistrict of ColumbiaUSA
- JSI Research and Training Institute Inc.ArlingtonVirginiaUSA
| | | | | | | | - Patrizia Fracassi
- Scaling Up Nutrition Movement SecretariatGenevaSwitzerland
- Food and Agriculture Organization of the United NationsRomeItaly
| | - Debora Di Dio
- Scaling Up Nutrition Movement SecretariatGenevaSwitzerland
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23
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Kim J, Liu Y, Wang W, Blossom JC, Dwivedi LK, James KS, Sarwal R, Kim R, Subramanian S. Estimating the Burden of Child Undernutrition for Smaller Electoral Units in India. JAMA Netw Open 2021; 4:e2129416. [PMID: 34714345 PMCID: PMC8556624 DOI: 10.1001/jamanetworkopen.2021.29416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Geographic targeting of public health interventions is needed in resource-constrained developing countries. OBJECTIVE To develop methods for estimating health and development indicators across micropolicy units, using assembly constituencies (ACs) in India as an example. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included children younger than 5 years who participated in the fourth National Family and Health Survey (NFHS-4), conducted between January 2015 and December 2016. Participants lived in 36 states and union territories and 640 districts in India. Children who had valid weight and height measures were selected for stunting, underweight, and wasting analysis, and children between age 6 and 59 months with valid blood hemoglobin concentration levels were included in the anemia analysis sample. The analysis was performed between February 1 and August 15, 2020. EXPOSURES A total of 3940 ACs were identified from the geographic location of primary sampling units in which the children's households were surveyed in NFHS-4. MAIN OUTCOMES AND MEASURES Stunting, underweight, and wasting were defined according to the World Health Organization Child Growth Standards. Anemia was defined as blood hemoglobin concentration less than 11.0 g/dL. RESULTS The main analytic sample included 222 172 children (mean [SD] age, 30.03 [17.01] months; 114 902 [51.72%] boys) from 3940 ACs in the stunting, underweight, and wasting analysis and 215 593 children (mean [SD] age, 32.63 [15.47] months; 112 259 [52.07%] boys) from 3941 ACs in the anemia analysis. The burden of child undernutrition varied substantially across ACs: from 18.02% to 60.94% for stunting, with a median (IQR) of 35.56% (29.82%-42.42%); from 10.40% to 63.24% for underweight, with a median (IQR) of 32.82% (25.50%-40.96%); from 5.56% to 39.91% for wasting, with a median (IQR) of 19.91% (15.70%-24.27%); and from 18.63% to 83.05% for anemia, with a median (IQR) of 55.74% (48.41%-63.01%). The degree of inequality within states varied across states; those with high stunting, underweight, and wasting prevalence tended to have high levels of inequality. For example, Uttar Pradesh, Jharkhand, and Karnataka had high mean AC-level prevalence of child stunting (Uttar Pradesh, 45.29%; Jharkhand, 43.76%; Karnataka, 39.77%) and also large SDs (Uttar Pradesh, 6.90; Jharkhand, 6.02; Karnataka, 6.72). The Moran I indices ranged from 0.25 to 0.80, indicating varying levels of spatial autocorrelation in child undernutrition across the states in India. No substantial difference in AC-level child undernutrition prevalence was found after adjusting for possible random displacement of geographic location data. CONCLUSIONS AND RELEVANCE In this cross-sectional study, substantial inequality in child undernutrition was found across ACs in India, suggesting the importance of considering local electoral units in designing targeted interventions. The methods presented in this paper can be further applied to measuring health and development indicators in small electoral units for enhanced geographic precision of public health data in developing countries.
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Affiliation(s)
- Julie Kim
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts
| | - Yuning Liu
- JP Morgan Chase Institute, Washington, DC
| | - Weiyu Wang
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts
| | - Jeffrey C. Blossom
- Center for Geographic Analysis, Harvard University, Cambridge, Massachusetts
| | - Laxmi Kant Dwivedi
- International Institute for Population Sciences, Deonar, Mumbai, Maharashtra, India
| | - K. S. James
- International Institute for Population Sciences, Deonar, Mumbai, Maharashtra, India
| | - Rakesh Sarwal
- National Institution for Transforming India Aayog. Government of India, New Delhi, India
| | - Rockli Kim
- Division of Health Policy and Management, College of Health Science, Korea University, Seoul, South Korea
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
| | - S.V. Subramanian
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts
- National Institution for Transforming India Aayog. Government of India, New Delhi, India
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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24
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Okeyo I, Lehmann U, Schneider H. Policy Adoption and the Implementation Woes of the Intersectoral First 1000 Days of Childhood Initiative, In the Western Cape Province of South Africa. Int J Health Policy Manag 2021; 10:364-375. [PMID: 32979893 PMCID: PMC9056136 DOI: 10.34172/ijhpm.2020.173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 09/01/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND There is a growing interest in implementing intersectoral approaches to address social determinants especially within the Sustainable Development Goals (SDGs) era. However, there is limited research that uses policy analysis approaches to understand the barriers to adoption and implementation of intersectoral approaches. In this paper we apply a policy analysis lens in examining implementation of the first thousand days (FTD) of childhood initiative in the Western Cape province of South Africa. This initiative aims to improve child outcomes through a holistic intersectoral approach, referred to as nurturing care. METHODS The case of the FTD initiative was constructed through a triangulated analysis of document reviews (34), in depth interviews (22) and observations. The analysis drew on Hall's 'ideas, interests and institutions' framework to understand the shift from political agendas to the implementation of the FTD. RESULTS In the Western Cape province, the FTD agenda setting process was catalysed by the increasing global evidence on the life-long impacts of brain development during the early childhood years. This created a window of opportunity for active lobbying by policy entrepreneurs and a favourable provincial context for a holistic focus on children. However, during implementation, the intersectoral goal of the FTD got lost, with limited bureaucratic support from service-delivery actors and minimal cross-sector involvement. Challenges facing the health sector, such as overburdened facilities, competing policies and the limited consideration of implementation realities (such as health providers' capacity), were perceived by implementing actors as the key constraints to intersectoral action. As a result, FTD actors, whose decision-making power largely resided in health services, reformulated FTD as a traditional maternal-child health mandate. Ambiguity and contestation between key actors regarding FTD interventions contributed to this narrowing of focus. CONCLUSION This study highlights conditions that should be considered for the effective implementation of intersectoral action - including engaging cross-sector players in agenda setting processes and creating spaces that allow the consideration of actors' interests especially those at service-delivery level. Networks that prioritise relationship building and trust can be valuable in allowing the emergence of common goals that further embrace collective interests.
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Affiliation(s)
- Ida Okeyo
- Department of Community and Health Sciences, School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Uta Lehmann
- Department of Community and Health Sciences, School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Helen Schneider
- UWC/SAMRC Health Services to Systems Research Unit, School of Public Health, University of the Western Cape, Cape Town, South Africa
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Warren AM, Constantinides SV, Blake CE, Frongillo EA. Advancing knowledge about stakeholder engagement in multisectoral nutrition research. GLOBAL FOOD SECURITY 2021. [DOI: 10.1016/j.gfs.2021.100521] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Frongillo EA. Designing and implementing at-scale programs to improve complementary feeding. Nutr Rev 2021; 78:62-70. [PMID: 33196087 DOI: 10.1093/nutrit/nuz043] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Advancing knowledge about how to improve complementary feeding at large scale is a high priority. This article identifies strategies for designing and implementing programs to improve complementary feeding at large scale, drawing on lessons learned from three initiatives: Alive & Thrive, which implemented large-scale programs in 3 countries; a low-burden intervention in Mexico that used scripted messages; and Estrategia Integral de Atención a la Nutrición, which is introducing large-scale programs tied to Mexico's conditional cash transfer program. These initiatives illustrate different ways of designing and implementing large-scale programs, with lessons about the importance of having partnerships and alliances; well-grounded understanding from research; a public health strategy; scalable program modes and elements; using existing systems where possible; monitoring, learning, and evaluating; and adopting a model aimed at successfully implementing programs at scale. Improving complementary feeding globally is challenging because of the complex behaviors involved, and the development of specific programs geared to complementary feeding is necessary. Designing and implementing such specific programs at large scale is achievable with the intention, commitment, appropriate strategies, and financial support to do so from the outset.
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Affiliation(s)
- Edward A Frongillo
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Reeve E, Thow AM, Bell C, Soti-Ulberg C, Sacks G. Identifying opportunities to strengthen school food environments in the Pacific: a case study in Samoa. BMC Public Health 2021; 21:246. [PMID: 33514338 PMCID: PMC7844953 DOI: 10.1186/s12889-021-10203-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 01/10/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Despite global recommendations to prioritise policies that create healthy food environments within education institutions, the implementation of effective healthy school food policies has proved challenging for many countries. This study examined the experience of Samoa subsequent to the 2012 introduction of a stronger policy to improve the healthiness of school food environments. Our aim was to identify opportunities to strengthen healthy school food policy implementation in Samoa and other comparable contexts. METHODS We used a qualitative case study approach, underpinned by policy science theory. In 2018, we conducted in-depth semi-structured interviews with 30 informants, coupled with analysis of relevant documents, to generate a detailed understanding of the relevant policy implementation processes in Samoa, and the perspectives and capacities of key implementation actors. Data collection and analysis were guided by the Health Policy Analysis Triangle, supplemented by other policy theories relevant to policy process. RESULTS Samoa's school food policy operationalizes international 'best practice' recommendations. We found health policymakers and leaders in Samoa to be strongly committed to improving school food environments. Despite this, there continued to be challenges in ensuring compliance with the school nutrition standards. Key issues that negatively impacted the policy's effectiveness were the lack of priority given to school food by stakeholders outside of health, the high prevalence of unhealthy food in the areas immediately surrounding schools, vendor knowledge and capacity, and the high degree of agency exercised by actors in and around the school. We noted several opportunities for policies to be effectively implemented and sustained. Respondents identified community-level leaders as potentially pivotal stakeholders, particularly where school governance arrangements draw heavily on community representation. CONCLUSIONS Sustained and effective implementation of healthy school food policies requires continued engagement from political and community leaders, beyond initial commitment. There is potential to capitalize on political will for diet-related NCD prevention by more clearly demonstrating the institutional and operational requirements for effective and sustained implementation. Strong incentives for compliance and effective enforcement mechanisms are also likely to be crucial to success.
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Affiliation(s)
- Erica Reeve
- Deakin University, Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, 1 Gheringhap Street, Locked Bag 20001, Geelong, Victoria 3220 Australia
| | - Anne-Marie Thow
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Level 2, Charles Perkins Centre, University of Sydney, Sydney, NSW 2006 Australia
| | - Colin Bell
- Deakin University, School of Medicine, 1 Gheringhap Street, Geelong, Victoria 3220 Australia
| | | | - Gary Sacks
- Deakin University, Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, 1 Gheringhap Street, Locked Bag 20001, Geelong, Victoria 3220 Australia
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Juarez M, Dionicio C, Sacuj N, Lopez W, Miller AC, Rohloff P. Community-Based Interventions to Reduce Child Stunting in Rural Guatemala: A Quality Improvement Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020773. [PMID: 33477580 PMCID: PMC7831302 DOI: 10.3390/ijerph18020773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/07/2021] [Accepted: 01/14/2021] [Indexed: 12/30/2022]
Abstract
Rural Guatemala has one of the highest rates of chronic child malnutrition (stunting) in the world, with little progress despite considerable efforts to scale up evidence-based nutrition interventions. Recent literature suggests that one factor limiting impact is inadequate supervisory support for frontline workers. Here we describe a community-based quality improvement intervention in a region with a high rate of stunting. The intervention provided audit and feedback support to frontline nutrition workers through electronic worklists, performance dashboards, and one-on-one feedback sessions. We visualized performance indicators and child nutrition outcomes during the improvement intervention using run charts and control charts. In this small community-based sample (125 households at program initiation), over the two-year improvement period, there were marked improvements in the delivery of program components, such as growth monitoring services and micronutrient supplements. The prevalence of child stunting fell from 42.4 to 30.6%, meeting criteria for special cause variation. The mean length/height-for-age Z-score rose from −1.77 to −1.47, also meeting criteria for special cause variation. In conclusion, the addition of structured performance visualization and audit and feedback components to an existing community-based nutrition program improved child health indicators significantly through improving the fidelity of an existing evidence-based nutrition package.
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Affiliation(s)
- Michel Juarez
- Center for Research in Indigenous Health, Wuqu’ Kawoq|Maya Health Alliance 2a Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango 04006, Guatemala; (M.J.); (C.D.); (N.S.); (W.L.)
| | - Carlos Dionicio
- Center for Research in Indigenous Health, Wuqu’ Kawoq|Maya Health Alliance 2a Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango 04006, Guatemala; (M.J.); (C.D.); (N.S.); (W.L.)
| | - Neftali Sacuj
- Center for Research in Indigenous Health, Wuqu’ Kawoq|Maya Health Alliance 2a Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango 04006, Guatemala; (M.J.); (C.D.); (N.S.); (W.L.)
| | - Waleska Lopez
- Center for Research in Indigenous Health, Wuqu’ Kawoq|Maya Health Alliance 2a Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango 04006, Guatemala; (M.J.); (C.D.); (N.S.); (W.L.)
| | - Ann C. Miller
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115, USA;
| | - Peter Rohloff
- Center for Research in Indigenous Health, Wuqu’ Kawoq|Maya Health Alliance 2a Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango 04006, Guatemala; (M.J.); (C.D.); (N.S.); (W.L.)
- Division of Global Health Equity, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA
- Correspondence:
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Erzse A, Abdool Karim S, Thow AM, Ahaibwe G, Amukugo HJ, Asiki G, Gaogane L, Mukanu MM, Ngoma T, Ruhara CM, Wanjohi MN, Hofman K. The data availability landscape in seven sub-Saharan African countries and its role in strengthening sugar-sweetened beverage taxation. Glob Health Action 2021; 14:1871189. [PMID: 33876702 PMCID: PMC8079050 DOI: 10.1080/16549716.2020.1871189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/29/2020] [Indexed: 12/05/2022] Open
Abstract
Background: Credible data and indicators are necessary for country-specific evidence to support the design, implementation, monitoring and evaluation of sugar-sweetened beverage (SSB) taxation.Objective: A cross-country analysis was undertaken in seven Sub-Saharan African countries to describe the potential role of available data in strengthening SSB taxation. The objectives were to: document currently available data sources; report on public access; discuss strengths and limitations for use in monitoring SSB taxation; describe policy maker's data needs, and propose improvements in data collection.Methods: The study used a mixed-methods approach involving a secondary data analysis of publicly available documents, and a qualitative exploration of the data needs of policy makers' using primary data. Findings were synthesised and assessed for data strengths and weaknesses, including usability and availability. SSB taxation-related data availability was critically assessed with respect to adequacy in strengthening taxation policy on SSBs.Results: Findings showed a paucity of SSB taxation-related data in all seven countries. National survey data are inadequate regarding the intake of SSBs and household expenditure on SSBs. Fiscal data from SSB tax revenue, value added tax from SSB sales, corporate income tax from SSB companies and SSB custom duty revenues, are lacking. Accurate information on the soft drink industry is not easily accessed.Conclusion: Timely, easily understood, concise, and locally relevant evidence is needed in order to inform policy development on SSBs. The relevant data are drawn from multiple sectors. Cross- sector collaboration is therefore needed. Indicators for SSBs should be developed and included in current data collection tools to ensure monitoring and evaluation for SSB taxation.
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Affiliation(s)
- Agnes Erzse
- Faculty of Health Sciences, SAMRC/Centre for Health Economics and Decision Science, PRICELESS, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Safura Abdool Karim
- Faculty of Health Sciences, SAMRC/Centre for Health Economics and Decision Science, PRICELESS, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Anne Marie Thow
- Menzies Centre for Health Policy, School of Public Health, The University of Sydney, Sydney, Australia
| | - Gemma Ahaibwe
- Economic Policy Research Centre (EPRC), Makerere University, Makerere, Uganda
| | | | - Gershim Asiki
- African Population and Health Research Center, Health and Systems for Health Unit, Kenya
| | - Lebogang Gaogane
- Boitekanelo College, Department of Health Promotion & Education, University of Botswana, Gaborone, Botswana
| | - Mulenga M. Mukanu
- Health Policy and Management Unit, University of Zambia School of Public Health, Lusaka, Zambia
| | - Twalib Ngoma
- Economic and Social Research Foundation, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | | | - Milkah N Wanjohi
- African Population and Health Research Center, Health and Systems for Health Unit, Kenya
| | - Karen Hofman
- Faculty of Health Sciences, SAMRC/Centre for Health Economics and Decision Science, PRICELESS, University of Witwatersrand School of Public Health, Johannesburg, South Africa
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Bhattacharyya S, Issac A, Girase B, Guha M, Schellenberg J, Iqbal Avan B. "There Is No Link Between Resource Allocation and Use of Local Data": A Qualitative Study of District-Based Health Decision-Making in West Bengal, India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218283. [PMID: 33182464 PMCID: PMC7665146 DOI: 10.3390/ijerph17218283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/28/2020] [Accepted: 10/28/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Effective coordination among multiple departments, including data-sharing, is needed for sound decision-making for health services. India has a district planning process involving departments for local resource-allocation based on shared data. This study assesses the decision-making process at the district level, with a focus on the extent of local data-use for resource allocation for maternal and child health. METHODS Direct observations of key decision-making meetings and qualitative interviews with key informants were conducted in two districts in the State of West Bengal, India. Content analysis of the data maintained within the district health system was done to understand the types of data available and sharing mechanisms. This information was triangulated thematically based on WHO health system blocks. RESULTS There was no structured decision-making process and only limited inter-departmental data-sharing. Data on all 21 issues discussed in the district decision-making meetings observed were available within the information systems. Yet indicators for only nine issues-such as institutional delivery and immunisation services were discussed. Discussions about infrastructure and supplies were not supported by data, and planning targets were not linked to health outcomes. CONCLUSION Existing local data is highly under-used for decision-making at the district level. There is strong potential for better interaction between departments and better use of data for priority-setting, planning and follow-up.
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Affiliation(s)
- Sanghita Bhattacharyya
- Public Health Foundation of India, Gurgaon, Haryana 122002, India; (S.B.); (A.I.); (B.G.); (M.G.)
| | - Anns Issac
- Public Health Foundation of India, Gurgaon, Haryana 122002, India; (S.B.); (A.I.); (B.G.); (M.G.)
| | - Bhushan Girase
- Public Health Foundation of India, Gurgaon, Haryana 122002, India; (S.B.); (A.I.); (B.G.); (M.G.)
| | - Mayukhmala Guha
- Public Health Foundation of India, Gurgaon, Haryana 122002, India; (S.B.); (A.I.); (B.G.); (M.G.)
| | - Joanna Schellenberg
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK;
| | - Bilal Iqbal Avan
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK;
- Correspondence:
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Savary S, Akter S, Almekinders C, Harris J, Korsten L, Rötter R, Waddington S, Watson D. Mapping disruption and resilience mechanisms in food systems. Food Secur 2020; 12:695-717. [PMID: 32837660 PMCID: PMC7399354 DOI: 10.1007/s12571-020-01093-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This opinion article results from a collective analysis by the Editorial Board of Food Security. It is motivated by the ongoing covid-19 global epidemic, but expands to a broader view on the crises that disrupt food systems and threaten food security, locally to globally. Beyond the public health crisis it is causing, the current global pandemic is impacting food systems, locally and globally. Crises such as the present one can, and do, affect the stability of food production. One of the worst fears is the impacts that crises could have on the potential to produce food, that is, on the primary production of food itself, for example, if material and non-material infrastructure on which agriculture depends were to be damaged, weakened, or fall in disarray. Looking beyond the present, and not minimising its importance, the covid-19 crisis may turn out to be the trigger for overdue fundamental transformations of agriculture and the global food system. This is because the global food system does not work well today: the number of hungry people in the world has increased substantially, with the World Food Programme warning of the possibility of a "hunger pandemic". Food also must be nutritious, yet unhealthy diets are a leading cause of death. Deepening crises impoverish the poorest, disrupt food systems, and expand "food deserts". A focus on healthy diets for all is all the more relevant when everyone's immune system must react to infection during a global pandemic. There is also accumulating and compelling evidence that the global food system is pushing the Earth system beyond the boundaries of sustainability. In the past twenty years, the growing demand for food has increasingly been met through the destruction of Earth's natural environment, and much less through progress in agricultural productivity generated by scientific research, as was the case during the two previous decades. There is an urgent need to reduce the environmental footprint of the global food system: if its performances are not improved rapidly, the food system could itself be one main cause for food crises in the near future. The article concludes with a series of recommendations intended for policy makers and science leaders to improve the resilience of the food system, global to local, and in the short, medium and long term.
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Affiliation(s)
- Serge Savary
- UMR AGIR (AGroécologie, Innovations et teRritoires), INRAE, Institut National Polytechnique de Toulouse, INP-EI Purpan, Université de Toulouse, Castanet Tolosan, France
| | - Sonia Akter
- Lee Kuan Yew School of Public Policy, The National University of Singapore, Singapore, Singapore
| | - Conny Almekinders
- Knowledge, Technology and Innovation, Social Sciences, Wageningen University, Hollandseweg 1, 6706 KN Wageningen, The Netherlands
| | | | - Lise Korsten
- Department of Plant and Soil Sciences, Centre of Excellence Food Security, University of Pretoria, Pretoria, 0002 South Africa
| | - Reimund Rötter
- TROPAGS, Department of Crop Sciences, University of Göttingen, Grisebachstr. 6, 37077 Göttingen, Germany
| | | | - Derrill Watson
- Department of Accounting, Finance, and Economics, Tarleton State University, Stephenville, TX 76401 USA
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Syuryadi N, Martianto D, Sukandar D. Pengembangan Metode Evaluasi Komitmen Ketahanan Pangan Dan Gizi Pemerintah Daerah Provinsi Di Indonesia. AMERTA NUTRITION 2020. [DOI: 10.20473/amnt.v4i2.2020.140-146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Methods of evaluation of the regional government’s commitment in the development of food and nutrition security are not yet available. The index that measures the government’s commitment to national food and nutrition security is HANCI. Therefore, this study aimed to develop a method of evaluating the commitment of the regional government in the development of food and nutrition security.Objectives: This study aimed to develop a method of evaluating the commitment of regional government in the development of food and nutrition security. Methods: The design of this study was a cross-sectional study using secondary data that refers to HANCI measurements. This research stage consisted of identification of potential indicators, qualitative selection of candidate indicator, assessment of indicator used the scoring method, and applied the method to provinces in Indonesia. Results: The result showed shortlist of 42 commitment indicators of food and nutrition security and aggregate score of provinces. Only 2.9% of provinces had high commitment and 17.6% of provinces with low commitment level. Highest rank was achieved by East Java Province and the lowest rank was East Nusa Tenggara Province. Low political commitment could lead to low priority of food and nutrition interventions. The government was in need to make regulations/policies and prepare adequate budgets for specific and sensitive food and nutrition programs.Conclusions: Development of this evaluation method is relevant to show the commitment of the regional government. The government needs to improve efforts to address problems of food and nutrition.ABSTRAK Latar Belakang: Metode evaluasi komitmen pemerintah daerah provinsi dalam pembangunan ketahanan pangan dan gizi saat ini belum tersedia. Index yang mengukur komitmen pemerintah terhadap ketahanan pangan dan gizi secara nasional adalah HANCI. Oleh karena itu, studi ini bertujuan untuk mengembangkan metode evaluasi komitmen pemerintah daerah provinsi dalam pembangunan ketahanan pangan dan gizi.Tujuan: Penelitian ini bertujuan untuk mengembangkan metode evaluasi komitmen pemerintah daerah provinsi dalam pengembangan ketahanan pangan dan gizi.Metode: Desain penelitian ini adalah cross-sectional study dengan menggunakan data sekunder yang mengacu pada pengukuran HANCI. Tahap penelitian terdiri dari identifikasi indikator potensial, seleksi calon indikator secara kualitatif, perhitungan skor menggunakan metode scoring, dan aplikasi metode pada provinsi di Indonesia.Hasil: Hasil menunjukkan shortlist 42 indikator komitmen ketahanan pangan dan gizi dan skor agregat provinsi. Berdasarkan hasil penelitian diketahui bahwa hanya 2,9% provinsi yang memiliki komitmen tinggi dan 17,6% provinsi memiliki tingkat komitmen rendah. Provinsi Jawa Timur berada pada peringkat pertama sedangkan peringkat terakhir ditempati oleh Provinsi Nusa Tenggara Timur. Komitmen politik yang rendah dapat menyebabkan rendahnya prioritas intervensi pangan dan gizi. Pemerintah perlu membuat peraturan/kebijakan dan menyiapkan anggaran yang memadai untuk program pangan dan gizi secara spesifik maupun sensitif.Kesimpulan: Pengembangan metode telah relevan digunakan untuk melihat komitmen pemerintah daerah provinsi. Pemerintah perlu meningkatkan upaya berupa pembuatan peraturan dan kebijakan serta anggaran untuk penanganan masalah pangan dan gizi.
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Botero-Tovar N, Arocha Zuluaga GP, Ramírez Varela A. Factors influencing delivery of intersectoral actions to address infant stunting in Bogotá, Colombia - a mixed methods case study. BMC Public Health 2020; 20:925. [PMID: 32534569 PMCID: PMC7293129 DOI: 10.1186/s12889-020-09057-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/04/2020] [Indexed: 11/21/2022] Open
Abstract
Background Intersectoral actions (ISA) are a recognized relationship between the health sector and other sectors to improve health outcomes. Although a frequent topic in public health studies, evidence for systematic evaluation of implementation of ISA is scarce. An intersectoral health intervention for infants under one-year-old with, and at risk of, stunting (low height-for-age) was developed by a public-private partnership in Bogotá, Colombia, during 2018 and 2019. Here we report a case study conducted in parallel to the intervention designed to assess factors that influenced implementation of the ISA. Methods The case study was developed using a concurrent mixed-methods design, with the qualitative component giving context to the quantitative results. The qualitative component was obtained from four workshops, three focus groups, and 17 semi-structured interviews with actors involved in the intersectoral intervention. The quantitative component was obtained with two questionnaires that evaluated perceptions on improvement and partnership functioning of the ISA. Results This study collected information from 122 participants. The intervention demanded intersectoral collaboration. Political will, motivated human resources, and recognition that health improvement results from collaboration, were factors that facilitated intersectoral actions. Intersectoral actions were limited by difficulties in engaging the health sector, communication challenges related to local health service decentralization, and administrative barriers. Conclusions Intersectoral actions have recently been discussed in the literature due to challenges in implementation and doubts regarding economic outcomes. The implementation of intersectoral public health interventions can be jeopardized by a lack of coordination and management skills.
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Affiliation(s)
- Natalia Botero-Tovar
- Population Health Division, Fundación Santa Fe de Bogotá, Bogotá, D.C., Colombia.
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Rajpal S, Joe W, Kim R, Kumar A, Subramanian SV. Child Undernutrition and Convergence of Multisectoral Interventions in India: An Econometric Analysis of National Family Health Survey 2015-16. Front Public Health 2020; 8:129. [PMID: 32391305 PMCID: PMC7188776 DOI: 10.3389/fpubh.2020.00129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/31/2020] [Indexed: 11/21/2022] Open
Abstract
In India and worldwide, there has been increased strategic focus on multisectoral convergence of nutrition-specific and nutrition-sensitive interventions to attain rapid reductions in child undernutrition. For instance, a Convergence Action Plan in India has been formed to synchronize and converge various nutrition-related interventions across ministries of union and state governments under a single umbrella. Given the large variation in number, nature and impact of these interventions, this paper aims to quantify the contribution of each intervention (proxied by relevant covariates) toward reducing child stunting and underweight in India. The interventions are classified under six sectors: (a) health, (b) women and child development, (c) education, (d) water, sanitation, and hygiene, (e) clean energy, and (f) growth sector. We estimate the potential reduction in child stunting and underweight in a counterfactual scenario of “convergence” where all the interventions across all the sectors are simultaneously and successfully implemented. The findings from our econometric analysis suggests that under this counterfactual scenario, a reduction of 18.37% points (95% CI: 16.77; 19.95) in stunting and 20.26% points (95% CI: 19.13; 21.39) in underweight can be potentially achieved. Across all the sectors, women and child development and clean energy were identified as the biggest contributors to the potential reductions in stunting and underweight, underscoring the importance of improving sanitation-related practices and clean cooking fuel. The overall impact of this convergent action was relatively stronger for less developed districts. These findings reiterate a clear role and scope of convergent action in achieving India's national nutritional goals. This warrants a complete outreach of all the interventions from different sectors.
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Affiliation(s)
- Sunil Rajpal
- Institute of Health Management Research, IIHMR University, Jaipur, India
| | - William Joe
- Institute of Economic Growth, University of Delhi Enclave, New Delhi, India
| | - Rockli Kim
- Division of Health Policy and Management, College of Health Sciences, Korea University, Seoul, South Korea.,Department of Public Health Sciences, Graduate School, Korea University, Seoul, South Korea.,Harvard Center for Population and Development Studies, Cambridge, MA, United States
| | - Alok Kumar
- National Institution for Transforming India (NITI Aayog), Government of India, New Delhi, India
| | - S V Subramanian
- Harvard Center for Population and Development Studies, Cambridge, MA, United States.,National Institution for Transforming India (NITI Aayog), Government of India, New Delhi, India.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Dodd M, Ivers R, Zwi AB, Rahman A, Jagnoor J. Investigating the process of evidence-informed health policymaking in Bangladesh: a systematic review. Health Policy Plan 2020; 34:469-478. [PMID: 31237941 PMCID: PMC6736329 DOI: 10.1093/heapol/czz044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2019] [Indexed: 02/02/2023] Open
Abstract
Over the last four decades, Bangladesh has made considerable improvements in population health, this is in part due to the use of evidence to inform policymaking. This systematic review aims to better understand critical factors that have facilitated the diffusion of scientific evidence into multiple phases of health policymaking in Bangladesh. To do this an existing policy framework designed by Shiffman and Smith in 2007, was used to extract and synthesize data from selected policy analyses. This framework was used to ensure the content, context and actors involved with evidence-informed policymaking were considered in each case where research had helped shape a health policy. The 'PRISMA Checklist' was employed to design pre-specified eligibility criteria for the selection of information sources, search strategy, inclusion and exclusion criteria, and process of data extraction and synthesis. Through our systematic search conducted from February to May 2017, we initially identified 1859 articles; after removal of duplicates, followed by the screening of titles, abstracts and full-texts, 24 articles were included in the analysis. Health policy issues included the following topics: maternal and child health, tobacco control, reproductive health, infectious disease control and the impact and sustainability of knowledge translation platforms. Findings suggested that research evidence that could be used to meet key targets associated with the Millennium Development Goals (MDGs) were more likely to be considered as a political (and therefore policy) priority. Furthermore, avenues of engagement between research organizations and the government as well as collective action from civil-society organizations were important for the diffusion of evidence into policies. Through this article, it is apparent that the interface between evidence and policy formulation occurs when evidence is, disseminated by a cohesive policy-network with strong leadership and framed to deliver solutions for problems on both the domestic and global development agenda.
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Affiliation(s)
- Madeleine Dodd
- Injury Division, The George Institute for Global Health, UNSW Sydney, 1 King Street, Newtown, Sydney, New South Wales, Australia
| | - Rebecca Ivers
- Injury Division, The George Institute for Global Health, UNSW Sydney, 1 King Street, Newtown, Sydney, New South Wales, Australia.,School of Public Health & Community Medicine, UNSW; The George Institute for Global Health Australia, UNSW, Australia
| | - Anthony B Zwi
- Health, Rights and Development (HEARD@UNSW), Faculty of Arts and Social Sciences, School of Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Aminur Rahman
- Centre for Injury Prevention and Research (CIPRB), Dhaka, Bangladesh
| | - Jagnoor Jagnoor
- Injury Division, The George Institute for Global Health, UNSW Sydney, 1 King Street, Newtown, Sydney, New South Wales, Australia
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Okeyo I, Lehmann U, Schneider H. The impact of differing frames on early stages of intersectoral collaboration: the case of the First 1000 Days Initiative in the Western Cape Province. Health Res Policy Syst 2020; 18:3. [PMID: 31918724 PMCID: PMC6953299 DOI: 10.1186/s12961-019-0508-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While intersectoral collaboration is considered valuable and important for achieving health outcomes, there are few examples of successes. The literature on intersectoral collaboration suggests that success relies on a shared understanding of what can be achieved collectively and whether stakeholders can agree on mutual goals or acceptable trade-offs. When health systems are faced with negotiating intersectoral responses to complex issues, achieving consensus across sectors can be a challenging and uncertain process. Stakeholders may present divergent framings of the problem based on their disciplinary background, interests and institutional mandates. This raises an important question about how different frames of problems and solutions affect the potential to work across sectors during the initiating phases of the policy process. METHODS In this paper, this question was addressed through an analysis of the case of the First 1000 Days (FTD) Initiative, an intersectoral approach targeting early childhood in the Western Cape Province of South Africa. We conducted a documentary analysis of 34 policy and other documents on FTD (spanning global, national and subnational spheres) using Schmidt's conceptualisation of policy ideas in order to elicit framings of the policy problem and solutions. RESULTS We identified three main frames, associated with different sectoral positionings - a biomedical frame, a nurturing care frame and a socioeconomic frame. Anchored in these different frames, ideas of the problem (definition) and appropriate policy solutions engaged with FTD and the task of intersectoral collaboration at different levels, with a variety of (sometimes cross) purposes. CONCLUSIONS The paper concludes on the importance of principled engagement processes at the beginning of collaborative processes to ensure that different framings are revealed, reflected upon and negotiated in order to arrive at a joint determination of common goals.
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Affiliation(s)
- Ida Okeyo
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535 Republic of South Africa
| | - Uta Lehmann
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535 Republic of South Africa
| | - Helen Schneider
- School of Public Health and UWC/SAMRC Health Services to Systems Research Unit, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535 Republic of South Africa
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Onono MA, Brindis CD, White JS, Goosby E, Okoro DO, Bukusi EA, Rutherford GW. Challenges to generating political prioritization for adolescent sexual and reproductive health in Kenya: A qualitative study. PLoS One 2019; 14:e0226426. [PMID: 31856245 PMCID: PMC6922405 DOI: 10.1371/journal.pone.0226426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/26/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Despite the high burden of adverse adolescent sexual and reproductive health (SRH) outcomes, it has remained a low political priority in Kenya. We examined factors that have shaped the lack of current political prioritization of adolescent SRH service provision. METHODS We used the Shiffman and Smith policy framework consisting of four categories-actor power, ideas, political contexts, and issue characteristics-to analyse factors that have shaped political prioritization of adolescent SRH. We undertook semi-structured interviews with 14 members of adolescent SRH networks between February and April 2019 at the national level and conducted thematic analysis of the interviews. FINDINGS Several factors hinder the attainment of political priority for adolescent SRH in Kenya. On actor power, the adolescent SRH community was diverse and united in adoption of international norms and policies, but lacked policy entrepreneurs to provide strong leadership, and policy windows were often missed. Regarding ideas, community members lacked consensus on a cohesive public positioning of the problem. On issue characteristics, the perception of adolescents as lacking political power made politicians reluctant to act on the existing data on the severity of adolescent SRH. There was also a lack of consensus on the nature of interventions to be implemented. Pertaining to political contexts, sectoral funding by donors and government treasury brought about tension within the different government ministries resulting in siloed approaches, lack of coordination and overall inefficiency. However, the SRH community has several strengths that augur well for future political support. These include the diverse multi-sectoral background of its members, commitment to improving adolescent SRH, and the potential to link with other health priorities such as maternal health and HIV/AIDS. CONCLUSION In order to increase political attention to adolescent SRH in Kenya, there is an urgent need for policy actors to: 1) create a more cohesive community of advocates across sectors, 2) develop a clearer public positioning of adolescent SRH, 3) agree on a set of precise approaches that will resonate with the political system, and 4) identify and nurture policy entrepreneurs to facilitate the coupling of adolescent SRH with potential solutions when windows of opportunity arise.
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Affiliation(s)
- Maricianah Atieno Onono
- Center for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
- Institute of Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Claire D. Brindis
- Institute of Global Health Sciences, University of California, San Francisco, California, United States of America
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, United States of America
- Adolescent and Young Adult Health National Resource Center, San Francisco, California, United States of America
| | - Justin S. White
- Institute of Global Health Sciences, University of California, San Francisco, California, United States of America
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, United States of America
| | - Eric Goosby
- Institute of Global Health Sciences, University of California, San Francisco, California, United States of America
| | | | | | - George W. Rutherford
- Institute of Global Health Sciences, University of California, San Francisco, California, United States of America
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Gonzalez W, Bonvecchio Arenas A, García-Guerra A, Vilar-Compte M, Villa de la Vega A, Quezada L, Rosas C, Lozada-Tequeanes AL, Hernández A. An Iterative Process for Training Design and Implementation Increased Health Workers' Knowledge for Taking Nutrition Behavior Change to Scale. J Nutr 2019; 149:2323S-2331S. [PMID: 31793649 PMCID: PMC6887730 DOI: 10.1093/jn/nxz203] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/05/2019] [Accepted: 07/26/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The shortage of skilled, motivated, and well-supported health workers is a major barrier to scaling up nutrition interventions and services. OBJECTIVE The objective of this study is to describe the process for developing and implementing a training of health personnel for the delivery of the Integrated Strategy for Attention to Nutrition (EsIAN), an evidence-based strategy for promoting infant and young child feeding through primary health care in Mexico. The specific objective is to provide a case study and highlight challenges, as well as elements to successfully mitigate these, and discuss potential applications of findings beyond the Mexican context. METHODS The design and implementation of training followed a 5-phase process: situation analysis, formative research, large-scale feasibility study, redesign and scale up, and evaluation. We conducted document reviews, surveys, and focus groups during the first phases to inform and refine the training, as well as a pre- and posttraining telephone survey to evaluate change in knowledge. RESULTS The initial phases of the design provided a clear understanding of the opportunities and challenges for promoting infant and young child feeding, as well as health workers' routines and practices, which informed training design. The feasibility study allowed tailoring and refinement of training. The vertical coherence and coordination between the federal and state levels during redesign and scale up facilitated compliance with training timeline and process. Evaluation results showed significant improvement in knowledge posttraining of up to 19 percentage points. CONCLUSIONS The EsIAN training component for health providers was developed using a systematic approach to consolidate and generate relevant evidence, following an iterative process to test, learn, and improve both design and implementation. This process allowed for flexibility to take advantage of new opportunities and respond to findings from iterations. Garnering and ensuring political support allowed for continuity and sustainability of actions.
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Affiliation(s)
- Wendy Gonzalez
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | | | | | | | | | - Laura Quezada
- Instituto Nacional de Salud Pública (INSP), Cuernavaca, México
| | - Cynthia Rosas
- División de Capacitación y Adiestramiento Técnico, Instituto Mexicanos del Seguro Social (IMSS), Alcaldía Cuauhtémoc, Ciudad de México, Mexico
| | | | - Amira Hernández
- Instituto Nacional de Salud Pública (INSP), Cuernavaca, México
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Baker P, Brown AD, Wingrove K, Allender S, Walls H, Cullerton K, Lee A, Demaio A, Lawrence M. Generating political commitment for ending malnutrition in all its forms: A system dynamics approach for strengthening nutrition actor networks. Obes Rev 2019; 20 Suppl 2:30-44. [PMID: 31245905 DOI: 10.1111/obr.12871] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/07/2019] [Accepted: 03/29/2019] [Indexed: 12/01/2022]
Abstract
Generating political commitment for ending all forms of malnutrition represents a key challenge for the global nutrition community. Without commitment, the policies, programs, and resources needed to improve nutrition are unlikely to be adopted, effectively implemented, nor sustained. One essential driver of commitment is nutrition actor network (NAN) effectiveness, the web of individuals and organizations operating within a given country who share a common interest in improving nutrition and who act collectively to do so. To inform new thinking and action towards strengthening NAN effectiveness, we use a systems dynamics theoretical approach and literature review to build initial causal loop diagrams (CLDs) of political commitment and NAN effectiveness and a qualitative group model building (GMB) method involving an expert workshop to strengthen model validity. First, a "nutrition commitment system" CLD demonstrates how five interrelated forms of commitment-rhetorical, institutional, operational, embedded, and system-wide-can dynamically reinforce or diminish one another over time. Second, we present CLDs demonstrating factors shaping NAN effectiveness organized into three categories: actor features, resources, and capacities; framing strategies, evidence, and norms; and institutional, political, and societal contexts. Together, these models generate hypotheses on how political commitment and NAN effectiveness could be strengthened in future and may provide potential starting points for country-specific conversations for doing so.
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Affiliation(s)
- Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Andrew D Brown
- Global Obesity Centre, Deakin University, Geelong, Australia
| | - Kate Wingrove
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Steve Allender
- Global Obesity Centre, Deakin University, Geelong, Australia
| | - Helen Walls
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Amanda Lee
- School of Public Health, The University of Queensland, Brisbane, Australia
| | | | - Mark Lawrence
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
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Harris J. Advocacy coalitions and the transfer of nutrition policy to Zambia. Health Policy Plan 2019; 34:207-215. [PMID: 31006019 PMCID: PMC6528744 DOI: 10.1093/heapol/czz024] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2019] [Indexed: 11/13/2022] Open
Abstract
Stunted growth in children and multisectoral action to address it are dominant ideas in the international nutrition community today, and this study finds that these ideas are increasingly evident over time in nutrition policy in Zambia, with stunting largely displacing other framings of nutrition. This study is based on key informant interviews (70 interviews with 61 interviewees), policy document review, and social network mapping, with iterative data collection and analysis taking place over 6 years (2011-2016). Analysis was based on two established political science theories: policy transfer theory and the Advocacy Coalition Framework. Policy changes in Zambia are shown to result from the international community's nutrition agenda, transferred to national policy through the normative promotion of certain ways of understanding the issue of malnutrition, largely propagated through advocacy, technical assistance and funding. With its focus on multisectoral action to reduce stunting, the recent nutrition policy narrative impinges directly on an existing food security narrative as it attempts to alter agriculture policy away from maize reliance. The nutrition policy sub-system in Zambia is therefore split between an international coalition promoting action on child stunting, and a national coalition focused on food security and hunger, with implications for both sides on progressing a coherent policy agenda. This study finds that it is possible to understand policy processes for nutrition more fully than has so far been achieved in much nutrition literature through the application of multiple political science theories. These theories allow the generalization of findings from this case study to assess their relevance in other contexts: the study ultimately is about the transfer of policy being explained by the presence of advocacy coalitions and their different beliefs, resources and power, and these concepts can be investigated wherever the nutrition system reaches down from international to national level.
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Affiliation(s)
- Jody Harris
- Institute of Development Studies, Library Road, University of Sussex, Brighton, UK
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Browne J, Gleeson D, Adams K, Minniecon D, Hayes R. Strengthening Aboriginal and Torres Strait Islander health policy: lessons from a case study of food and nutrition. Public Health Nutr 2019; 22:2868-2878. [PMID: 31115277 PMCID: PMC10260607 DOI: 10.1017/s1368980019001198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 02/28/2019] [Accepted: 03/11/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To examine key factors influencing the prioritisation of food and nutrition in Aboriginal and Torres Strait Islander health policy during 1996-2015. DESIGN A qualitative policy analysis case study was undertaken, combining document analysis with thematic analysis of key informant interviews. SETTING Australia. PARTICIPANTS Key actors involved in Aboriginal and Torres Strait Islander health policy between 1996 and 2015 (n 38). RESULTS Prioritisation of food and nutrition in policy reduced over time. Several factors which may have impeded the prioritisation of nutrition were identified. These included lack of cohesion among the community of nutritionists, Aboriginal and Torres Strait Islander leaders and civil society actors advocating for nutrition; the absence of an institutional home for nutrition policy; and lack of consensus and a compelling policy narrative about how priority nutrition issues should be addressed. Political factors including ideology, dismantling of public health nutrition governance structures and missing the opportunities presented by 'policy windows' were also viewed as barriers to nutrition policy change. Finally, the complexity and multifaceted nature of nutrition as a policy problem and perceived lack of evidence-based solutions may also have constrained its prioritisation in Aboriginal and Torres Strait Islander health policy. CONCLUSIONS Future advocacy should focus on embedding nutrition within holistic approaches to health and building a collective voice through advocacy coalitions with Aboriginal and Torres Strait Islander leadership. Strategic communication and seizing political opportunities may be as important as evidence for raising the priority of Aboriginal and Torres Strait Islander health issues.
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Affiliation(s)
- Jennifer Browne
- School of Psychology and Public Health, La Trobe University, Kingsbury Drive, Bundoora, VIC 3086, Australia
| | - Deborah Gleeson
- School of Psychology and Public Health, La Trobe University, Kingsbury Drive, Bundoora, VIC 3086, Australia
| | - Karen Adams
- Gukwonderuk Unit, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Deanne Minniecon
- Brisbane South Primary Health Network, Eight Mile Plains, Queensland, Australia
| | - Rick Hayes
- School of Psychology and Public Health, La Trobe University, Kingsbury Drive, Bundoora, VIC 3086, Australia
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From Amsterdam to Bamako: a qualitative case study on diffusion entrepreneurs’ contribution to performance-based financing propagation in Mali. Health Policy Plan 2019; 34:656-666. [DOI: 10.1093/heapol/czz087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
For the past 15 years, several donors have promoted performance-based financing (PBF) in Africa for improving health services provision. European and African experts known as ‘diffusion entrepreneurs’ (DEs) assist with PBF pilot testing. In Mali, after participating in a first pilot PBF in 2012–13, the Ministry of Health and Public Hygiene included PBF in its national strategic plan. It piloted this strategy again in 2016–17. We investigated the interactions between foreign experts and domestic actors towards PBF diffusion in Mali from 2009 to 2018. Drawing on the framework on DEs (Gautier et al., 2018), we examine the characteristics of DEs acting at the global, continental and (sub)national levels; and their contribution to policy framing, emulation, experimentation and learning, across locations of PBF implementation. Using an interpretive approach, this longitudinal qualitative case study analyses data from observations (N = 5), interviews (N = 33) and policy documentation (N = 19). DEs framed PBF as the logical continuation of decentralization, contracting policies and existing policies. Policy emulation started with foreign DEs inspiring domestic actors’ interest, and succeeded thanks to longstanding relationships and work together. Learning was initiated by European DEs through training sessions and study tours outside Mali, and by African DEs transferring their passion and tacit knowledge to PBF implementers. However, the short-time frame and numerous implementation gaps of the PBF pilot project led to incomplete policy learning. Despite the many pitfalls of the region-wide pilot project, policy actors in Mali decided to pursue this policy in Mali. Future research should further investigate the making of successful African DEs by foreign DEs advocating for a given policy.
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Ouedraogo O, Doudou MH, Drabo KM, Garnier D, Zagré NM, Sanou D, Reinhardt K, Donnen P. Policy overview of the multisectoral nutrition planning process: The progress, challenges, and lessons learned from Burkina Faso. Int J Health Plann Manage 2019; 35:120-139. [PMID: 31271224 DOI: 10.1002/hpm.2823] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Malnutrition is a multifactorial problem, and multisectoral planning is an indispensable tool. The objective of this study was (a) to evaluate the extent to which nutrition is integrated into policies and (b) to describe the process used by the government of Burkina Faso to reform its policy frameworks and multisectoral nutrition planning. METHODS This was a qualitative study, and data were collected in two key steps: first, through a policy overview conducted in 2015 and, second, in November 2017, through a document review and individual stakeholder interviews with 32 key actors involved in national nutrition planning. RESULTS The extent to which nutrition is integrated into development policies varied from one sector to another. Since 2014, Burkina Faso has initiated nutrition planning through a multisectoral approach involving six sectors. This process was implemented in three key stages. Progress includes revision of national nutrition policy towards multisectoral perspective, formulation of a consensual and quality multisectoral nutrition strategic plan, creation of nutrition budget line, and establishment of nutrition technical secretariat. CONCLUSION To improve the anchoring of multisectoral coordination bodies at the supra-ministerial level, mobilizing resources and promoting sector accountability are key next steps that would contribute to the success of the implementation.
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Affiliation(s)
- Ousmane Ouedraogo
- Université Libre de Bruxelles (ULB), School of Public Health, Brussels, Belgium
| | - Maimouna Halidou Doudou
- Université Libre de Bruxelles (ULB), School of Public Health, Brussels, Belgium.,REACH, Ouagadougou, Burkina Faso
| | - Koiné Maxime Drabo
- Department of Public Health, Research Institute of Health Sciences, Ouagadougou, Burkina Faso
| | - Denis Garnier
- Child Survival and Development Programme, UNICEF, Abidjan, Ivory Coast
| | | | - Dia Sanou
- Subregional Office for Eastern Africa, FAO, Addis Ababa, Ethiopia
| | | | - Philippe Donnen
- Université Libre de Bruxelles (ULB), School of Public Health, Brussels, Belgium
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Schneider H, van der Merwe M, Marutla B, Cupido J, Kauchali S. The whole is more than the sum of the parts: establishing an enabling health system environment for reducing acute child malnutrition in a rural South African district. Health Policy Plan 2019; 34:430-439. [PMID: 31280321 PMCID: PMC6735808 DOI: 10.1093/heapol/czz060] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2019] [Indexed: 11/29/2022] Open
Abstract
There is a gap in understanding of how national commitments to child nutrition are translated into sub-national implementation. This article is a mixed methods case study of a rural South African health district which achieved accelerated declines in morbidity and mortality from severe acute malnutrition (SAM) in young children, following a district health system strengthening (HSS) initiative centred on real-time death reporting, analysis and response. Drawing on routine audit data, the declining trends in under-five admissions and in-hospital mortality for SAM over a 5-year period are presented, comparing the district with two others in the same province. Adapting Gillespie et al.'s typology of 'enabling environments' for Maternal and Child Nutrition, and based on 41 in-depth interviews and a follow-up workshop, the article then presents an analysis of how an enabling local health system environment for maternal-child health was established, creating the conditions for achievement of the SAM outcomes. Embedded in supportive policy and processes at national and provincial levels, the district HSS interventions and the manner in which they were implemented produced three kinds of system-level change: knowledge and use of evidence by providers and managers ('ways of thinking'), leadership, participation and coordination ('ways of governing') and inputs and capacity ('ways of resourcing'). These processes mainstreamed responsibility, deepened accountability and triggered new service delivery and organizational practices and mindsets. The article concludes that it is possible to foster enabling district environments for the prevention and management of acute malnutrition, emphasizing the multilevel and simultaneous nature of system actions, where action on system 'software' complements the 'hardware' of HSS interventions, and where the whole is more than the sum of the parts.
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Affiliation(s)
- Helen Schneider
- School of Public Health and SAMRC Health Services to Systems Unit, University of the Western Cape, Robert Sobukwe Road, Bellville, South Africa
| | - Maria van der Merwe
- Mpumalanga Department of Health, No 7 Government Boulevard, Mbombela, South Africa
| | - Beauty Marutla
- Mpumalanga Department of Health, No 7 Government Boulevard, Mbombela, South Africa
| | - Joseph Cupido
- National Department of Health, Civitas Building, 222, Thabo Sehume St, Pretoria, South Africa
| | - Shuaib Kauchali
- National Department of Health, Civitas Building, 222, Thabo Sehume St, Pretoria, South Africa
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Food security, food safety & healthy nutrition: are they compatible? GLOBAL FOOD SECURITY 2019. [DOI: 10.1016/j.gfs.2019.05.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Anjorin O, Okpala O, Adeyemi O. Coordinating Nigeria's micronutrient deficiency control programs is necessary to prevent deficiencies and toxicity risks. Ann N Y Acad Sci 2019; 1446:153-169. [PMID: 30942488 DOI: 10.1111/nyas.14055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/15/2019] [Accepted: 02/22/2019] [Indexed: 12/16/2022]
Abstract
Nigeria has an alarming prevalence of micronutrient deficiencies that has persisted over decades. National Micronutrient Deficiency Control (MNDC) guidelines describe several interventions to address the issue. This study identified and described currently implemented interventions, assessed coverage and coordination of the interventions, and considered the risk of overdosage and gaps. Methods included reviews of policy and program documents, key informant interviews, market, and pharmacy visits. The study found that an array of MNDC interventions were being implemented, including public health supplementation, mandatory fortification, point-of-use fortification, biofortification, promotion of dietary diversity, voluntary fortification, and ad hoc individual supplement use. Insufficient coordination existed for government, private, and civil society interventions within the health sector and between health and other sectors. Dosages of micronutrients supplied by different interventions were set independently of each other and target populations overlapped. Inadequate implementation of various interventions appeared to reduce the risk of excessive micronutrient intakes, but increased the risk of deficiencies. The risk of excessive intakes will likely increase with improved implementation and scale-up. There is a need to develop effective coordination structures for MNDC in Nigeria that will critically examine the landscape, decide modalities for different interventions, and ensure that both deficiencies and risk of excessive intakes are minimized.
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Affiliation(s)
- Olufolakemi Anjorin
- Department of Human Nutrition, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Oluchi Okpala
- Division of Human Nutrition, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Olutayo Adeyemi
- Department of Human Nutrition, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
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Swinburn BA, Kraak VI, Allender S, Atkins VJ, Baker PI, Bogard JR, Brinsden H, Calvillo A, De Schutter O, Devarajan R, Ezzati M, Friel S, Goenka S, Hammond RA, Hastings G, Hawkes C, Herrero M, Hovmand PS, Howden M, Jaacks LM, Kapetanaki AB, Kasman M, Kuhnlein HV, Kumanyika SK, Larijani B, Lobstein T, Long MW, Matsudo VKR, Mills SDH, Morgan G, Morshed A, Nece PM, Pan A, Patterson DW, Sacks G, Shekar M, Simmons GL, Smit W, Tootee A, Vandevijvere S, Waterlander WE, Wolfenden L, Dietz WH. The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report. Lancet 2019; 393:791-846. [PMID: 30700377 DOI: 10.1016/s0140-6736(18)32822-8] [Citation(s) in RCA: 1218] [Impact Index Per Article: 243.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 10/10/2018] [Accepted: 10/29/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Boyd A Swinburn
- School of Population Health, University of Auckland, Auckland, New Zealand; Global Obesity Centre, School of Health & Social Development, Deakin University, Geelong, VIC, Australia.
| | - Vivica I Kraak
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
| | - Steven Allender
- Global Obesity Centre, School of Health & Social Development, Deakin University, Geelong, VIC, Australia
| | | | - Phillip I Baker
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC, Australia
| | - Jessica R Bogard
- Commonwealth Scientific and Industrial Research Organisation, Brisbane, QLD, Australia
| | | | | | - Olivier De Schutter
- Institute for Interdisciplinary Research in Legal Sciences, Catholic University of Louvain, Louvain-la-Neuve, Belgium
| | - Raji Devarajan
- Public Health Foundation of India, Centre for Chronic Disease Control, New Delhi, India
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Sharon Friel
- School of Regulation and Global Governance, Australian National University, Canberra, ACT, Australia
| | - Shifalika Goenka
- Public Health Foundation of India, Centre for Chronic Disease Control, New Delhi, India
| | - Ross A Hammond
- Center on Social Dynamics & Policy, The Brookings Institution, Washington, DC, USA; Public Health & Social Policy Department, Brown School, Washington University in St Louis, St Louis, MO, USA
| | - Gerard Hastings
- Institute for Social Marketing, University of Stirling, Stirling, UK
| | - Corinna Hawkes
- Centre for Food Policy, City University, University of London, London, UK
| | - Mario Herrero
- Commonwealth Scientific and Industrial Research Organisation, Brisbane, QLD, Australia
| | - Peter S Hovmand
- Social System Design Lab, Brown School, Washington University in St Louis, St Louis, MO, USA
| | - Mark Howden
- Climate Change Institute, Australian National University, Canberra, ACT, Australia
| | - Lindsay M Jaacks
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ariadne B Kapetanaki
- Department of Marketing and Enterprise, Hertfordshire Business School, University of Hertfordshire, Hatfield, UK
| | - Matt Kasman
- Center on Social Dynamics & Policy, The Brookings Institution, Washington, DC, USA
| | - Harriet V Kuhnlein
- Centre for Indigenous Peoples' Nutrition and Environment, McGill University, Montreal, QC, Canada
| | | | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Michael W Long
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Victor K R Matsudo
- Physical Fitness Research Laboratory of São Caetano do Sul, São Caetano do Sul, São Paulo, Brazil
| | - Susanna D H Mills
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Alexandra Morshed
- Prevention Research Center, Brown School, Washington University in St Louis, St Louis, MO, USA
| | | | - An Pan
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Gary Sacks
- Global Obesity Centre, School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
| | - Meera Shekar
- Health, Nutrition, and Population Global Practice, The World Bank, Washington, DC, USA
| | | | - Warren Smit
- African Centre for Cities, University of Cape Town, Cape Town, South Africa
| | - Ali Tootee
- Diabetes Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Stefanie Vandevijvere
- School of Population Health, University of Auckland, Auckland, New Zealand; Scientific Institute of Public Health (Sciensano), Brussels, Belgium
| | - Wilma E Waterlander
- Department of Public Health Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
| | - William H Dietz
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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Carroll G, Atuobi-Yeboah A, Hromi-Fiedler A, Aryeetey R, Safon C, Pérez-Escamilla R. Factors influencing the implementation of the Becoming Breastfeeding Friendly initiative in Ghana. MATERNAL AND CHILD NUTRITION 2019; 15:e12787. [PMID: 30665255 DOI: 10.1111/mcn.12787] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 12/21/2018] [Accepted: 01/09/2019] [Indexed: 11/29/2022]
Abstract
Becoming Breastfeeding Friendly (BBF) is an initiative designed to help countries assess their readiness to scale-up breastfeeding programs and develop key recommendations to strengthen their breastfeeding environment. In 2016, Ghana was one of two countries to first pilot BBF. In applying BBF, a committee of 15 Ghanaian nutrition, health, and breastfeeding experts implemented the BBF toolbox over 8 months. Following implementation, semistructured interviews were conducted with 12 committee members (CMs) to (a) identify facilitators and barriers to implement BBF and (b) determine factors needed to strengthen the breastfeeding environment in Ghana. Using a grounded theory approach, five domains were identified. First, a dynamic committee of key stakeholders drove the implementation of BBF. Second, CMs faced some logistical and methodological challenges, including difficulty accessing data and the need for strong in-country technical support for adhering to the BBF process. Third, CMs felt well positioned to facilitate and lead the dissemination and implementation of recommendations. Fourth, accountability would be essential to properly translate recommendations. Fifth, to move recommendations to action, advocacy would be a required first step, and BBF was proposed to facilitate this step. BBF provided an in-depth analysis of Ghana's current breastfeeding environment to help Ghana strengthen its breastfeeding governance, policies, and programs while informing CMs' government and non-governmental organizations' breastfeeding efforts.
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Affiliation(s)
- Grace Carroll
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | | | - Amber Hromi-Fiedler
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | | | - Cara Safon
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
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Hoe C, Rodriguez DC, Üzümcüoğlu Y, Hyder AA. Understanding political priority development for public health issues in Turkey: lessons from tobacco control and road safety. Health Res Policy Syst 2019; 17:13. [PMID: 30728038 PMCID: PMC6364388 DOI: 10.1186/s12961-019-0412-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 01/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tobacco use and road traffic injuries are major public health problems in Turkey. During the last decade, the former issue received political priority in the country, while the latter did not despite the immense health and economic burden that road traffic injuries pose on the Turkish population. Political priority can facilitate the attainment of public health goals. Unfortunately, however, limited cross-case analyses exist to help us understand why it emerges for certain public health issues but fails to develop for others in low- and middle-income countries. METHODS This study utilised Kingdon's Multiple Streams Framework to explore the political priority development process in Turkey. A cross-case analysis was conducted, using data gathered from three different sources, namely key informant interviews (n = 42), documents (n = 307) and online self-administered surveys (n = 153). The Wilcoxon-Mann-Whitney test was also employed to examine whether the relationships within the tobacco control and road safety networks differed significantly. RESULTS In Turkey, political priority emerges when four streams - problem, policy, political and global - converge while a policy window is open. While these findings are largely consistent with the Multiple Streams Framework, this study also shed light on (1) the need to consider global health treaties for urgent public health issues as these instruments can accentuate global norms and standards, (2) the disproportionate strength of the political stream, (3) the need to develop in-depth understanding of national political context, (4) the importance of fostering meaningful ties between global and domestic health networks, and (5) the need for policy network cohesion. CONCLUSIONS Findings from this study can be used by advocates striving to promote public health issues in other similar contexts.
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Affiliation(s)
- Connie Hoe
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, 21205, United States of America.
| | - Daniela C Rodriguez
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, 21205, United States of America
| | - Yeşim Üzümcüoğlu
- Department of Psychology, Middle East Technical University, Ankara, Turkey
| | - Adnan A Hyder
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, 21205, United States of America
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50
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Cordon A, Asturias G, De Vries T, Rohloff P. Advancing child nutrition science in the scaling up nutrition era: a systematic scoping review of stunting research in Guatemala. BMJ Paediatr Open 2019; 3:e000571. [PMID: 32099904 PMCID: PMC7015046 DOI: 10.1136/bmjpo-2019-000571] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/17/2019] [Accepted: 11/22/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Ever since the 1960s, Guatemala has been a principle site for global academic research on child growth and nutrition. Nevertheless, Guatemala still has one of the highest rates of child stunting in the world. Since 2012, Guatemala has had a comprehensive national policy on stunting, calling for a renewed investment in innovative, multilevel nutrition interventions and implementation science. Our objective was to perform a systematic search and scoping review of the literature on stunting in Guatemala to identify gaps in research and opportunities for responding to this unique policy opportunity. METHODS We conducted a systematic search and scoping review on stunting in Guatemala, searching the PubMed, Web of Science and PsycINFO databases. Eligible articles were of any design or format, published in English and Spanish from 2000 to 2018. Articles were thematically grouped by those published before (2000-2011) and after (2012-2018) the new national policy initiatives. RESULTS We identified a total of 1934 articles through database searches. After full-text review, 104 were included in the synthesis. The volume of published articles on stunting increased from a mean of 3.2 to 9.4 articles/year before and after 2012. There was a shift toward articles generating new data on priority populations, including rural indigenous Maya populations (34% vs 61%, χ2 test, p=0.01). However, the proportion of studies conducting implementation evaluations or testing new interventions was low and did not change significantly (34% vs 18%, χ2 test, p=0.07). Among 17 identified intervention studies, only 4 tested multilevel interventions, and there were no published interventions incorporating nutrition-sensitive interventions. CONCLUSIONS A systematic search and scoping review of the literature on child stunting in Guatemala identified critical opportunities for new research in multilevel interventions, nutrition-sensitive interventions and implementation science.
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Affiliation(s)
- Ana Cordon
- Centre for Research in Indigenous Health, Wuqu' Kawoq
- Maya Health Alliance, Tecpán, Chimaltenango, Guatemala
| | - Gabriela Asturias
- Centre for Evidence-Based Development, Fundación Desarrolla Guatemala para la Educación y Salud (FUNDEGUA), Guatemala City, Guatemala
| | - Thomas De Vries
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Peter Rohloff
- Centre for Research in Indigenous Health, Wuqu' Kawoq
- Maya Health Alliance, Tecpán, Chimaltenango, Guatemala.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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