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David Pelletier, Associate Professor of Nutrition Policy Division of Nutritional Sciences, Cornell University

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This document discusses building multisectoral nutrition systems in Africa through the African Nutrition Security Partnership (ANSP). It provides an overview of ANSP's objectives to reduce stunting through policy development, capacity building, information systems, and scaling up interventions. It then discusses conceptualizing multisectoral nutrition as a complex system and presents tools and strategies for building functional multisectoral nutrition structures, including sensitizing concepts, knowledge brokering, and lessons learned across countries.

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Building Multisectoral Nutrition Systems: Challenges, Strategies, Capacities, Tools and Lessons from the African Nutrition Security Partnership (ANSP) The ANSP Cornell Team David Pelletier, Director Suzanne Gervais, Project Coordinator Dia Sanou, Coordinator for Burkina Faso and Mali Jackson Tumwine, Coordinator for Uganda Hajra 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-country UNICEF Regional Offices: • Eastern/Southern Africa • Western/Central Africa European Union Funding
Objectives 1. Brief overview and rationale for the Africa Nutrition Security Partnership (ANSP) 2. Multisectoral Nutrition as a System 3. Tools, Strategies and Capacities for Building the System 4. 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
Multisectoral Nutrition Plan, Program or Policy Multisectoral Nutrition Structures Functional Multisectoral 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 ANSP 1. 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 Understanding Is Required!! ANSP
Land Cruiser as a Sensitizing Concept for a Functional and Effective System 1. Clear Purpose 2. Components 3. Connections & Alignment 4. Fuel 5. Designers and Engineers 6. Servicing and Repairs 7. Resources ANSP
1. The Purpose of Multisectoral Nutrition What is needed? Nutrition-specific actions Nutrition-sensitive actions Consequences: 1. Child survival 2. Child health 3. Adult health 4. Cognitive development 5. School performance 6. Adult income 7. Economic growth 8. Equity 9. 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 (frontline workers) NNCB NNTC RNCB RNTC 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 Motivation Expectations Accountability Incentives Solidarity ANSP
5. Designers and Engineers for the Multisectoral Nutrition System Development of Common Understanding Vision & Purpose Design Team Common Work Spaces & Opportunities Communication and Alignment With Other Stakeholders Engineering Team 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 the Importance 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 Implementation Quality 3. Voltage Drop Kebele High Low ? ANSP
Federal Regional Zonal Woreda Household/Mother/Child Zone of National 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 local capacity Strong local AAA 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 within a 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”

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David Pelletier, Associate Professor of Nutrition Policy Division of Nutritional Sciences, Cornell University

  • 1. Building Multisectoral Nutrition Systems: Challenges, Strategies, Capacities, Tools and Lessons from the African Nutrition Security Partnership (ANSP) The ANSP Cornell Team David Pelletier, Director Suzanne Gervais, Project Coordinator Dia Sanou, Coordinator for Burkina Faso and Mali Jackson Tumwine, Coordinator for Uganda Hajra Hafeez-ur-Rehman, Coordinator for Ethiopia Functional Capacity Workshop Nairobi, June 11-12, 2015
  • 2. 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-country UNICEF Regional Offices: • Eastern/Southern Africa • Western/Central Africa European Union Funding
  • 3. Objectives 1. Brief overview and rationale for the Africa Nutrition Security Partnership (ANSP) 2. Multisectoral Nutrition as a System 3. Tools, Strategies and Capacities for Building the System 4. Emerging Lessons
  • 4. 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
  • 5. Governance of Multisectoral Nutrition: Three Perspectives World Bank Transform Nutrition MSN is a dynamic, emergent, non- linear, multi-scale, chaordic, open system
  • 7. 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
  • 9. “this is all new and we are learning as we go” ANSP
  • 10. Cornell Roles Within ANSP 1. 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
  • 11. 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
  • 12. 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
  • 13. Fragmented Views of Multisectoral Nutrition A Common Understanding Is Required!! ANSP
  • 14. Land Cruiser as a Sensitizing Concept for a Functional and Effective System 1. Clear Purpose 2. Components 3. Connections & Alignment 4. Fuel 5. Designers and Engineers 6. Servicing and Repairs 7. Resources ANSP
  • 15. 1. The Purpose of Multisectoral Nutrition What is needed? Nutrition-specific actions Nutrition-sensitive actions Consequences: 1. Child survival 2. Child health 3. Adult health 4. Cognitive development 5. School performance 6. Adult income 7. Economic growth 8. Equity 9. Human Rights ANSP
  • 16. 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
  • 17. Health Agric Educ WCY etc National Regional Zonal (in some Regions) Woreda Kebele (frontline workers) NNCB NNTC RNCB RNTC ZNTC WNTC Figure 2: Structures in the Working Model for the NNP 3. Connections and Alignment ANSP
  • 18. 4. Fuel for the Multisectoral Nutrition System Leadership Commitment Motivation Expectations Accountability Incentives Solidarity ANSP
  • 19. 5. Designers and Engineers for the Multisectoral Nutrition System Development of Common Understanding Vision & Purpose Design Team Common Work Spaces & Opportunities Communication and Alignment With Other Stakeholders Engineering Team ANSP
  • 20. 6. Resources for the Multisectoral Nutrition System • People • Knowledge • Experience • Skills • Facilities • Tools • Equipment • Finances • Partners ANSP • Operations Manuals • Guidelines • ToRs • etc.
  • 21. 7. Servicing and Repairs for the Multisectoral Nutrition System ANSP
  • 23. 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
  • 24. 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
  • 25. 2. Clarify “The Working Model” Mali Burkina Faso Uganda Ethiopia “I understand the Importance of nutrition.” “Now what exactly do you want me to do?”
  • 26. 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
  • 28. Federal Regional Zonal Woreda Household/Mother/Child Zone of National 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 local capacity Strong local AAA etc ANSP
  • 29. 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
  • 30. A Day in the Life of the Government Multisectoral Nutrition Leader ANSP
  • 31. A Day in the Life of the UNICEF Multisectoral Nutrition Leader ANSP
  • 32. 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
  • 33. 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
  • 34. 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
  • 35. 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
  • 36. 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 within a Complex Adaptive System
  • 37. 6. Practitioner Profiles: Discovering Strategic Capacity from Within Example from Uganda ANSP
  • 38. 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
  • 40. 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”