nutrition innovation lab process research: understanding processes that support nutrition program...

7/21/2019 Nutrition Innovation Lab Process research: Understanding processes that support nutrition program impacts, Sept 2013

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Nutrition Innovation Lab Processresearch: Understanding

processes that support nutritionprogram impacts

Shibani GhoshNutrition Innovation Lab- Asia and Africa

Tufts University



esearch !uestions

• "o# and #hy $arge-sca$e% mu$tisector po$icies and programs achievenutrition goa$s&

• "o# can po$icy and programimp$ementation be enhanced tosupport both nutrition-speci'c andnutrition-sensitive actions&



Leroy J L , Menon P J. Nutr. 2008;138:628-629

©2008 by American Society for Nutrition

Program Steps and

Sta(eho$ders



)

*or$

d +an( ,./.0 What can we learnfrom nutrition impact evaluations? *ashington% 1232



Legen

d

Terai "i$$

1istricts

5ountain 1istricts

Sentine$ 6

Service 1e$ivery

Sector 3oordination

3ross-ministry coordination

3ross-Po$icy and donor coordination



7

Key Issues in vertical and horizontal

coherence

Individual capacity :Skills, knowledge, training, experience,

attitudes to multi- sector actions, nutrition goals, priorityproblems

Institutional capacity :

erceived constraints to multi-sectorcollaboration, resource use e!ciency,

System capacity :

"isincentives to collaboration, innovation,venues #or Gi$$espie et a$2 ,./80 Lancet Series Paper 9



!uestions

• Perceived constraints in #or(ingacross sectors

• Incentives for co$$aboration acrossinstitutions and sectors

• ;pected hurd$es to mu$ti-sectorcoordination

• <no#$edge and training in nutrition



5ethods

• Structured open ended=uestionnaires

• > 7.. intervie#s ,nationa$ do#n to#ard0

• Annua$ surveys

• ?irst survey conducted: ?ebruary to @une ./8

• 1ata entry in process

•Pre$iminary 'ndings: September./8



Level Institution$Individual

Nationa$ Po$icy ma(ers% donors% INGs% academics

egiona$ Administrator% 1 "ea$th% 1 Agricu$ture% 1Livestoc(% 1 ducation% 1 1*S% 1 *1

1istrict L1% 1"B1P"% Agricu$ture% Livestoc(%

ducation% 1*S% 3hamber of 3ommerceProgram Cce Socia$ 1ev Sec 113% P$anningD% 113% 3hair NG federation% NGs

I$a(a "ea$th% Agricu$ture% Livestoc(%du esource 3enter

E13 E13 Secretary% "ea$th% Agricu$ture%Livestoc(% ducation ,schoo$ teacher0% NGs

*ard ?3"E% epresentative F *ard 3itien ?orum%epresentative 5G% epresentative3ooperativeBGroups



Ana$ysis

• 1egree of vertica$ coherence #ithin sector

• 1egree of co$$aboration across sectors,horionta$ concurrence0

– *ithin region% district% E13% #ard

• Dect of concurrence and coherence onvariabi$ity of outcomes on the ground

,community0• 3hange in concurrence or coherence overtime ,5SNP and program imp$ementation0



esu$ts ,1emographics0 ?re=uency PercentLevel

egiona$ H 72)1istrict 7 7

I$a(a 7H .2)%espondenttype

Government

oCcia$ 8 7828NG oCcia$ H7 )2/ING oCcia$ 6 /26

Tota$ 86 /..



Sectors Intervie#ed

Sector ?re=uencyEa$idPercent

Loca$ and Socia$

1eve$opment 76 /H27"ea$th 96 //2H

Agricu$ture and Livestoc( H 82/

ducation 96 //2H

*ater Supp$y 6 627NGBPrivate /.8 627

Tota$ 86 /..



Priority Prob$ems

• ?ood Security

• Uti$iation

• Production

• 1iseaseBI$$ness

• Lac( of ducationBA#areness

• Practices ,cu$tura$ practices% breast

feeding0• No signi'cant diDerences in identi'cation

of priority prob$emsJ



egiona$ 1istrict I$a(a 3ount K 3ount K 3ount K

?oodsecurity /) )/27. /)H )72. 97 )H2).

Uti$iation 7)2H. /9/ ).27. 97 )H2).

Production /6 ))2. /88 972. 8) 9928.

1iseaseBI$$ness /6 ))2. //) 9/29. 87 962.

Practices 7 92/. 8 H2H. / 2.

ducation 6 H27. 6 H92. 76 H62.

3hiS=uare,pM.2./0 NMH NM7 NM7H



1isaggregation egiona$ 1istrict I$a(a P va$ue

3ount K 3ount K 3ount K

1e-#orming 6 .27.K 72H.K 8 82.K .2./6

Lac( of

a#areness ofsupp$ementaryfoods%micronutrientde'ciencies 9 /82.K H 82.K . .2..K .2..

"igh *or($oad

and $ac( ofcare of chi$dren,hunger0 . .2..K 9 /)2/.K / 2.K .2./9

NMH NM7 NM7H



3onsu$tation ,egiona$% 1istrict%I$a(a0

?re=uency Percent

1o you fee$ that your department is suCcient$y consu$ted #ith on nutrition issuesSuCcient 3onsu$tation of1epartmentsBUnits ,a$$Leve$s0

A$$/9 82/

egiona$ ) /72 1istrict H6 892) I$a(a 8 H2/

InSuCcient 3onsu$tation of1epartmentsBunits ,a$$ $eve$s0

A$$ / 927

egiona$ /6 ))2 1istrict /8/ 972/ I$a(a 9/ )/2HSome#hat SuCcient3onsu$tation

A$$ 6. /)2)

egiona$ 6 .27 1istrict 8H /92. I$a(a /) /H2.1ont <no# A$$ /9 826 egiona$ 62H

1istrict / 928 I$a(a /9 826



3oherence on ease to #or(

districtBregion0

egiona$ 1istrict I$a(a p va$ue

3ount K 3ount K 3ount K

asy / 62/. /H8 6H29. )9 629.NS

1iCcu$t // 872H. 7 2/. 9 8.29.NS

NMH NM7 NM7H



Incentives to co$$aborate ,5u$ti-sectora$0

egiona$ 1istrict I$a(a

3ount K 3ount K 3ount Kpva$ue

Support 9 /82.K . 72.K 6726.

K .299H

Shared o#nership,coordinationBgoa$s0 6 .27.K H9

882.K /H

92/.K .2//H

5andatory

*or(ingmechanism ) /72 //9 9/ / /)2 .

3apacity bui$ding,training 9 /82 99 /)2 /.2/ .2999

Shared resources / 62/ /9 )/2/ 9. ).26 .2)/)

A$$o#anceB'sca$

bene'ts toem $o ees /6 ))2 ) .2H /9 /727 .

NMH NM7 NM7H



1isincentives to co$$aborate ,mu$ti-

sectora$0

egiona$ 1istrict I$a(a

1isincentives 3ount K 3ount K 3ount K p va$ue

Oes // 872H 66 827 8)29 .2.9

No / 62/ // 7)2H )/ 6926 .2.)

1ont <no# . . / .29 . . .28

NMH NM7 NM7H



1isincentives to 3o$$aborate

• Lac( of a$$o#ance% fue$Btransportation faci$ities to 'e$d% trave$a$$o#ances% dai$y a$$o#ances

• Lac( of interestBmotivation

• *or($oad

• *or(space environment ,inc$udes $ac( of support fromsuperior0

• InsuCcient esources ,'nance% "% budget0

• Lac( of s(i$$s and capacity

• +ureaucratic constraints

• Po$itica$ Upheava$• Lac( of p$anning% coordination and imp$ementation

• Lac( of transparency

• Lac( of representative



Training and 3apacity ,Ade=uate Training0

Loca$1eve$opmentand Socia$1eve$opment

"ea$th

Agricu$ture andLivestoc(

ducation

*aterSupp$y

NGBprivatesector

3ount K 3ount K 3ount K 3ount K 3ount K 3ount K

Oes ) 82H. 7 )27. 8. 8827. 8 ).2.. /7 6)29. 7 6H2H.

Oes butneedrefreshertraining /6 /2/. /. /27. 9 72.. // 82H. 6 82/. // /.27.

No 8) 962/. H /H26. 8) 8H28. / 62/. 8 //2). . /H29.

*ithin your o#n department

pM.2...



Training and 3apacity*ithin other departments

Loca$1eve$opment andSocia$1eve$opment

"ea$th

Agricu$tureandLivestoc(

ducation

*aterSupp$y

NGBprivatesector

3ount K 3ount K 3ount K3ount K

3ount K 3ount K

Oes /729

. /) 826. H826

. /6892

. // 928. 8) 892..

Oes but

needrefreshertraining 6 72H. 8 62). /

.2. )

/.2H. 727. // /.27.

No 9/)82H

. / 62/. 6H2

. /62/

. 6 82/. 99 927.

1ont(no# /

/)2. /6 892. /6

/2.. /8

28. 7 62H. /8 /26.

PM.2..



3onc$usions

• Some coherence observed across $eve$s

• 5ore coherence bet#een district and i$a(a – Priority prob$ems

– Incentives to co$$aborate• 5ore coherence bet#een region and i$a(a

– 1is-incentives to co$$aborate

• Training and capacity concurrence ,#ithin0 – "ea$th% education and #ater sector% NG and

$oca$ private sector

– Agricu$ture% $oca$ and socia$ deve$opment sectors



3onc$usions

• Training and capacity ,in other departments0 – Loca$ deve$opment and NGBprivate sector

– Agricu$ture% hea$th% nutrition% #ater andsanitation

• 3ontinued ana$yses – e'ning

– 3oherence by speci'c region% district% i$a(a% #ard%

E13 – 3oncurrence by sector at each $eve$

– Lin(ing to outcomes data and programmonitoring data



esearch Team

• Patric( *ebb

• <edar +ara$

• i$een <ennedy• Shibani Ghosh

• 1ip$av Sap(ota

• Sriu Sharma• Ea$$ey esearch Group ,survey 'rm0

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