Nutrition agenda setting, policy formulation and implementation: Lessons from the Mainstreaming Nutrition Initiative

This paper reports on the findings from studies in Bangladesh, Bolivia, Guatemala, Peru and Vietnam which sought to identify the challenges in the policy process to address undernutrition, and ways to overcome them, notably with respect to commitment, agenda setting, policy formulation and implementation.
Data were collected through participant observation, documents and interviews. Data collection, analysis and synthesis were guided by published conceptual frameworks for understanding malnutrition, commitment, agenda setting and implementation capacities.

The experiences in these countries provide several insights for future efforts:

• high-level political attention to nutrition can be generated in a number of ways, but the generation of political commitment and system commitment requires sustained efforts from policy entrepreneurs and champions;
• mid-level actors from ministries and external partners had great difficulty translating political windows of opportunity for nutrition into concrete operational plans, due to capacity constraints, differing professional views of undernutrition and disagreements over interventions, ownership, roles and responsibilities; and
• the pace and quality of implementation was severely constrained in most cases by weaknesses in human and organizational capacities from national to frontline levels.

These findings deepen our understanding of the factors that can influence commitment, agenda setting, policy formulation and implementation. They also confirm and extend upon the growing recognition that the heavy investment to identify efficacious nutrition interventions is unlikely to reduce the burden of undernutrition unless or until these systemic capacity constraints are addressed, with an emphasis initially on strategic and management capacities.

To read the article, go to the website of the Health and Policy Planning Journal.

D. Pelletier et al, Health Policy and Planning Journal - February 2011.