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

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

“this is all new and we are learning as we go”

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

Fragmented Views of Multisectoral Nutrition

A Common UnderstandingIs Required!!

ANSP

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.

7. Servicing and Repairs for the Multisectoral Nutrition System

ANSP

“The System”

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

A Day in the Life of the Government Multisectoral Nutrition Leader

ANSP

A Day in the Life of the UNICEF Multisectoral Nutrition Leader

ANSP

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

6. Practitioner Profiles: Discovering Strategic Capacity from Within

Example from Uganda

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

7. “Horizontal” Sharing

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”