SCN News No 36 - UNSCN

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42 FEATURES www.unsystem.org/scn “[] for the development of national guidelines, one thing that was really helpful in many of the countries, was establishing a technical working group. [] the establishment of these technical working groups helped to sort of rally some commitment, some ownership, for the national guideline process. [] And in some countries, that working group and that momentum continued beyond national guidelines, where they were able to then help with implementation, and in others, less so.” (International NGO) “[] it is important to apply modern management practices. In (my country), most traditional management is not working well. We try to have a strategic plan, action plan oriented, staff evaluations, and progress review of our action plans. These things are not very common in the current administration in (my country). We have set up our vision, mission statement, core values and try to apply them.” (Country nutrition actor) “If you look at the plans, on paper they look very good. But then you look into how much money do they actually put into activities that matter? Who actually takes charge? Who’s accountable? How do they measure whether their objectives are met? These things are either not specified in the plans, or they’re um, not clear. And those are the things that will make those linkages really become a reality.” (University professor in developing country) Although not mentioned in many sources, there has been some experience using strategies to forge a more constructive working relationship between donors and government actors: “All of us, going in and saying this is wrong and you should do this. You are doing food supplementation, no, do growth promotion. We really went against them instead of working with them. We have lost a lot of goodwill and opportunities that way. We have been more successful with whatever opportunities came up. Education and schools, ok let us work with them. Let us see which has the best effect. Go ahead and take the risk for two years and see effects then maybe they will see.” (Donor agency) “It is again like what you do with governments. You do not shut them out; you do not tell them they are doing the wrong thing. You just try to work with them. Its negotiations and trade-offs and trying to find a consensus.” (Donor agency) Moving forward The accounts of the policy process analyzed in this paper have a number of implications for future efforts to improve nutrition. First, they suggest that the ability to mobilize a wide variety of strategies and tactics, as shown in Table 1, plays a crucial role in strengthening commitment, coherence, consensus and coordination in relation to the nutrition agenda. This ability, here termed strategic capacity, involves the human and institutional capacity to build commitment and consensus towards a long-term strategy. Strategic capacity includes brokering agreements and resolving conflicts, responding to recurring challenges and opportunities, building relationships among nutrition actors, undertaking strategic communications with varied audiences, and many other tasks. At the individual level this demands socially-attuned leadership, management and communication, negotiation and conflict management skills At the institutional level it requires formal and/or informal venues and practices for nutrition actors and others to exchange information, discuss common concerns, strategize, coordinate efforts, build relationships, seek consensus, resolve conflicts and sustain momentum. The notion of strategic capacity as used here implies that all of the nutrition actors share a responsibility to form and support a coherent national nutrition agenda. In some of the countries studied here, these individual and institutional capacities were in evidence and played a key role in advancing the nutrition agenda; in most of the countries, they were either not present or they were not effective in overcoming the particular structural factors at work in those settings. This is an area that has received virtually no systematic attention in nutrition capacity building and should be a priority for the future. A second implication is that many of the enduring themes in national nutrition policy might be re-examined in relation to strategic capacity, especially from a sustainability perspective (Figure 2). These themes include the role of political will, institutional arrangements (formal) and operational capacity for acting at scale. The accounts analyzed here reveal that political will, in the sense of the commitment of politicians to nutrition, is an asset that can be created through the application of strategic capacity, but also undermined through disagreements and conflicts that persist among mid-level actors when strategic capacity is lacking. This is very similar to the findings related to the maternal mortality policy community (Shiffman and Smith 2007). Moreover, commitment to nutrition is needed in many sectors beyond national politicians, such as ministry officials and staff, international partners, the private sector and civil society. These areas can only become the focus of sustained attention if strategic capacity exists. This is an especially important consideration in the context of decentralization in which commitment building must be undertaken at multiple sub-national levels. Indeed, in SCN NEWS # 36 back to contents
www.unsystem.org/scn FEATURES 43 Figure 2: The central importance of strategic capacity for advancing nutrition at country level Common understanding Common communications Consensus on actions Commitment at all levels Strategic Capacity Coherent & coordinated national nutrition agenda Strategic and operational capacities at sub-national levels Design, implement & manage actions Monitor, evaluate and adjust actions Incentives & accountability for performance some contexts strong subnational commitment might compensate for weak commitment at the national level. Although formal institutional arrangements for nutrition leadership, coordination and implementation are crucial assets when they exist they are more often serious constraints when they do not. However, the present study documents a wide range of strategies available to nutrition actors, especially non-state actors, for strengthening, working within or circumventing sub-optimal institutional arrangements. A third implication relates to implementation and acting at scale. In the first instance the strengthening of strategic capacity is intended to correspondingly strengthen commitment and coherence to the nutrition agenda. But it will also enhance implementation and acting at scale insofar as the strengthening of operational capacity should be a core part of the national nutrition agenda. Operational capacity here refers to the totality of individual and institutional capacities for program and policy design, management, implementation, training, monitoring, evaluation, research and analysis. Strengthening this range of capacities in a sustainable way requires resources well beyond the means of most governments as well as time horizons and resources well beyond that of most donors. This is a major reason why it has been neglected in most countries. As such, the strengthening of operational capacities should be a major component of the long-term nutrition agenda of a country and the focus of strategic attention alongside that given to intervention programs and policies. This is unlikely to occur in the absence of stronger strategic capacity at country level. In summary, we are well aware of the many external factors that stand in the way of advancing nutrition at country level and often are perceived as being outside our immediate control, such as political will, competing priorities of governments and other actors, fragmented institutional agendas, and so on. The discomfiting message coming from country experiences is that the failure to forge common agendas among ourselves (as mid-level nutrition actors) is also an important factor holding back nutrition agendas. The encouraging message is that it is possible to forge common agendas, as demonstrated in some countries, and once this is accomplished it becomes possible to manage the external constraints and advance the nutrition agenda. In other words, commitment building for nutrition begins at home and it begins with a commitment to working together towards common purposes. “There’s so much human resource and so much potential to really think about solutions. We are just not all on the same page so we never can come up with a solution and I think it’s got to go back to looking at the failings of nutrition and what do they want to see nutrition look like and what kind of orientations should [nutrition actors] have in [this country] to make nutrition work. I hope these aren’t too negative and too complicated.” (International NGO) Contact: dlp5@cornell.edu References Shiffman J and Smith S (2007) Generation of Political Priority for Global Health Initiatives: A Framework and Case Study of Maternal Mortality. The Lancet 370(9595):1370-9. Pelletier et al (forthcoming) back to contents SCN NEWS # 36
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