Post on 07-Aug-2015
Building Multisectoral Nutrition Systems:Challenges, Strategies, Capacities, Tools and Lessons from
the African Nutrition Security Partnership (ANSP)
The ANSP Cornell TeamDavid Pelletier, DirectorSuzanne Gervais, Project CoordinatorDia Sanou, Coordinator for Burkina Faso and MaliJackson Tumwine, Coordinator for UgandaHajra Hafeez-ur-Rehman, Coordinator for Ethiopia
Functional Capacity Workshop Nairobi, June 11-12, 2015
Acknowledgments:Our Co-Learners and Co-llaborators
Ethiopia, Uganda, Burkina Faso and Mali:• Nutrition focal points, advisors and staff in government• UNICEF Country Offices• Collaborating partners in-countryUNICEF Regional Offices:• Eastern/Southern Africa• Western/Central AfricaEuropean Union Funding
Objectives
1. Brief overview and rationale for the Africa Nutrition Security Partnership (ANSP)
2. Multisectoral Nutrition as a System3. Tools, Strategies and Capacities for Building the System4. Emerging Lessons
Multisectoral Nutrition: The Basic Storyline
1. Government decides nutrition is important, a multisectoral approach is appropriate and drafts a national plan
2. A multisectoral coordinating structure is created at national level and sub-nat’l levels, with focal points from all relevant sectors
3. Focal points and their sectors, identify nutrition-specific and nutrition-sensitive interventions
4. The interventions are costed and resources are mobilized from govt and partners
5.Interventions are implemented by each sector and coordinated by coordinating/governance structures at sub-national levels
6.The national and sub-national governance structures exercise overall monitoring and oversight, while sectors apply M&E to their own interventions
7. IMPACT ON NUTRITION
Governance of Multisectoral Nutrition: Three Perspectives
World Bank Transform Nutrition
MSN is a dynamic, emergent, non-linear, multi-scale, chaordic, open system
African Nutrition Security Partnership• UNICEF/EU, 4 year project• Objective: Reduce stunting by:
promoting, developing and adopting a multisectoral approach through: 1. Up-stream policy
development and nutrition security awareness
2. Institutional development & capacity building
3. Develop useful information systems and data analysis
4. Scale-up multisectoral interventions
ANSP
MultisectoralNutrition Plan,Program orPolicy
MultisectoralNutrition Structures
FunctionalMultisectoral
Nutrition Structures
• Operationalizing the Plan by Building “the System”
The Overall Challenge:
ANSP
Cornell Roles Within ANSP1. Build on experiences from other countries (strategic capacity and
adaptive management)2. Facilitate co-learning and co-building of the multisectoral nutrition
systems with partners:– Bring an “insider/outsider” perspective– Bring a ‘systems lens’ to multisectoral nutrition– Play multiple roles as boundary-crossing agent, knowledge broker,
alliance broker, learning/reflection facilitator, etc.3. Document lessons and experiences for external audiences:
– Country efforts to operationalize multisectoral nutrition– Experience working in/with complexity adaptive systems
ANSP
Some Key Methods
• Tools: devices that help stakeholders solve a problem or perform a task
• Sensitizing Concept: an idea presented in a way that is simple, resonates with experience, memorable and stimulates thinking and action in a productive direction
• Knowledge brokering: facilitating the exchange of knowledge (global, cross-national and contextual) among stakeholders in the system
Tools, Sensitizing Concepts and Knowledge Brokering Within and Across Countries
Illustrations
ANSP
Input Type
1. Multisectoral Nutrition System Model A sensitizing concept and a tool
2. Working model at district-community level Knowledge brokering
3. Voltage drop A sensitizing concept
4. Implementation teams Knowledge brokering
5. Decision matrix A tool
6. Practitioner profiles Strategic capacity building
7. Horizontal sharing Knowledge brokering
Land Cruiser as a Sensitizing Concept fora Functional and Effective System
1. Clear Purpose2. Components3. Connections & Alignment4. Fuel5. Designers and Engineers6. Servicing and Repairs7. Resources
ANSP
1. The Purpose of Multisectoral Nutrition
What is needed?Nutrition-specific actionsNutrition-sensitive actions
Consequences:1. Child survival2. Child health3. Adult health4. Cognitive development5. School performance6. Adult income7. Economic growth8. Equity9. Human Rights
ANSP
2. The Components of a Multisectoral Nutrition System
Multi-sectoral: Health, Agriculture, Education, Gender, Water, Trade, Industry…
Multi-level: National, regional, district, sub-district, community, household
Multi-stakeholder: government, bilaterals, UN, NGOs, CSOs, academia
ANSP
Health Agric Educ WCY etc
National
Regional
Zonal(in some Regions)
Woreda
Kebele(frontlineworkers)
NNCBNNTC
RNCBRNTC
ZNTC
WNTC
Figure 2: Structures in the Working Model for the NNP
3. Connections and Alignment ANSP
4. Fuel for the Multisectoral Nutrition System
Leadership
Commitment
MotivationExpectations
Accountability
Incentives Solidarity
ANSP
5. Designers and Engineers for the Multisectoral Nutrition System
Developmentof CommonUnderstandingVision &Purpose
DesignTeam
CommonWork Spaces &Opportunities
Communicationand AlignmentWith OtherStakeholders
EngineeringTeam
ANSP
6. Resources for the Multisectoral Nutrition System
• People• Knowledge• Experience• Skills• Facilities
• Tools• Equipment• Finances• Partners
ANSP
• Operations Manuals• Guidelines• ToRs• etc.
2.Common understanding
3.Common communications
4.Consensus on actions
6.Commitment& Leadership
8.Consistent Incentives &Accountability
1.Strategic Capacities and Adaptive Management at National & Sub-National Levels
1. Requirements for an Effective Multisectoral Nutrition System
7.Clear Roles & Responsibilities(ToRs)
5.Common Results Framework
10.Community, NGO, Partner & Private Sector Alignment
12.Consistent Financing
11.Capacities,Facilities, Tools,Equipment…
ALIGNMENT COMPONENTS AND CONNECTIONS FUEL
RESOURCES 9.Coordinated M&E,Learning Platforms,
Operations Research,Adaptive Management
SERVICING and REPAIRS
DESIGN, ENGINEERING AND MAINTENANCE
Tools, Sensitizing Concepts and Knowledge Brokering Within and Across Countries
Illustrations
ANSP
Input Type
1. Multisectoral Nutrition System Model A sensitizing concept and a tool
2. Working model at district-community level Knowledge brokering
3. Voltage drop A sensitizing concept
4. Implementation teams Knowledge brokering
5. Decision matrix A tool
6. Practitioner profiles Strategic capacity building
7. Horizontal sharing Knowledge brokering
2. Clarify “The Working Model”
Mali
Burkina Faso Uganda
Ethiopia
“I understand theImportance of nutrition.”
“Now what exactly do you want me to do?”
Tools, Sensitizing Concepts and Knowledge Brokering Within and Across Countries
Illustrations
ANSP
Input Type
1. Multisectoral Nutrition System Model A sensitizing concept and a tool
2. Working model at district-community level Knowledge brokering
3. Voltage drop A sensitizing concept
4. Implementation teams Knowledge brokering
5. Decision matrix A tool
6. Practitioner profiles Strategic capacity building
7. Horizontal sharing Knowledge brokering
National
Regional
Zonal
Woreda
Household/Mother/Child
Zone of Desired Impact
ImplementationQuality
3. Voltage Drop
Kebele
High
Low
?
ANSP
Federal
Regional
Zonal
Woreda
Household/Mother/Child
Zone ofNational Control
Zone of Desired Impact
Control/Quality
Some Ways to Prevent “Voltage Drop”
Kebele
High
Low
Business as usual
Strong, clear ToRs
Strong training. guides, tools, etc
Strong monitoring& support
Strong localcapacity
Strong localAAA
etc
ANSP
Tools, Sensitizing Concepts and Knowledge Brokering Within and Across Countries
Illustrations
ANSP
Input Type
1. Multisectoral Nutrition System Model A sensitizing concept and a tool
2. Working model at district-community level Knowledge brokering
3. Voltage drop A sensitizing concept
4. Implementation teams Knowledge brokering
5. Decision matrix A tool
6. Practitioner profiles Strategic capacity building
7. Horizontal sharing Knowledge brokering
4. Implementation Teams
• Tacit assumption: sectoral focal points are the team• The reality: nutrition is an ‘added responsibility’ for them• Transitional team: MOH/nutrition + partners• Longer-term arrangement: full-time sectoral focal points
Tools, Sensitizing Concepts and Knowledge Brokering Within and Across Countries
Illustrations
ANSP
Input Type
1. Multisectoral Nutrition System Model A sensitizing concept and a tool
2. Working model at district-community level Knowledge brokering
3. Voltage drop A sensitizing concept
4. Implementation teams Knowledge brokering
5. Decision matrix A tool
6. Practitioner profiles Strategic capacity building
7. Horizontal sharing Knowledge brokering
5. Decision Matrix: A Tool for Facilitating Agreements on Governance Arrangements (and many other matters)
Criteria
Governance Arrangements (Options)MOH MOA OPM etc.
1. Has convening power
2. Has Enforceable authority
3. Consistent with statutory mandate
4. Will give proper attention to nutrition
5. Will foster shared ownership
6. Has access to necessary technical knowledge
7. Likelihood of consensus among govt stakeholders
8. Likelihood of broad and sustained partner support
9 . etc
ANSP
Tools, Sensitizing Concepts and Knowledge Brokering Within and Across Countries
Illustrations
ANSP
Input Type
1. Multisectoral Nutrition System Model A sensitizing concept and a tool
2. Working model at district-community level Knowledge brokering
3. Voltage drop A sensitizing concept
4. Implementation teams Knowledge brokering
5. Decision matrix A tool
6. Practitioner profiles Strategic capacity building
7. Horizontal sharing Knowledge brokering
Strategic Capacity
The human and institutional capacity to:• build commitment, vision and consensus
towards a long-term national nutrition agenda,
• broker agreements,• resolve conflicts, • respond to recurring challenges and
opportunities, • build relationships,• etc.
In other words:The ability to work withina Complex Adaptive System
Tools, Sensitizing Concepts and Knowledge Brokering Within and Across Countries
Illustrations
ANSP
Input Type
1. Multisectoral Nutrition System Model A sensitizing concept and a tool
2. Working model at district-community level Knowledge brokering
3. Voltage drop A sensitizing concept
4. Implementation teams Knowledge brokering
5. Decision matrix A tool
6. Practitioner profiles Strategic capacity building
7. Horizontal sharing Knowledge brokering
Emergent Lessons
1. Most nutrition programming in the past has involved implementing interventions within existing delivery systems
2. MSN includes this but also requires new structures, functions, interventions and capacities at the organizational and whole system level
3. Building, facilitating and sustaining these requires strategic (or functional) capacity - a set of actors at national level with an eye on the big picture and able to work strategically and effectively across sectors, administrative levels and stakeholder groups
4. Cascading these new structures, functions, interventions and capacities to lower levels (with high quality) requires an implementation team (full-time staff) - to develop guidelines, ToRs, reporting templates, etc. and to orient, train, support and track the work at lower levels
5. Learning Platforms at each level are important for systematizing and institutionalizing the “learning and adjusting as we go”