Nutrition Innovation Lab Process

research: Understanding processes

that support nutrition program
impacts
Shibani Ghosh
Nutrition Innovation Lab- Asia and Africa
Tufts University

Research Questions
How and why large-scale, multi sector policies
and programs achieve nutrition goals?
How can policy and program implementation
be enhanced to support both nutritionspecific and nutrition-sensitive actions?

Program Steps and Stakeholders

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

2008 by American Society for Nutrition

World Bank (2010) What can we learn from

nutrition impact evaluations? Washington, D.C.

Cross-Policy and donor coordination

Cross-ministry coordination
Sector Coordination
Service Delivery

Legend
Mountain Districts
Hill Districts
Terai

Sentinel Sites

Key Issues in vertical and horizontal coherence

Individual capacity:
Skills, knowledge, training, experience, attitudes to multisector actions, nutrition goals, priority problems
Institutional capacity:
Perceived constraints to multi-sector collaboration,
resource use efficiency,
System capacity:
Disincentives to collaboration, innovation, venues for
dialogue, roles and responsibilities,
Gillespie et al. (2013) Lancet Series 2 Paper 4

Questions
Perceived constraints in working across
sectors
Incentives for collaboration across institutions
and sectors
Expected hurdles to multi-sector coordination
Knowledge and training in nutrition

Methods

Structured open ended questionnaires

~ 700 interviews (national down to ward)
Annual surveys
First survey conducted: February to June 2013
Data entry in process
Preliminary findings: September 2013

Level

Institution/Individual

National

Policy makers, donors, INGOs, academics

Regional

Administrator, RD Health, RD Agriculture, RD Livestock,

RD Education, RD DWS, RD WD

District

LDO, DHO/DPHO, Agriculture, Livestock, Education,

DWS, Chamber of Commerce
Program Office Social Dev Sec DDC, Planning Off, DDC,
Chair NGO federation, NGOs

Ilaka

Health, Agriculture, Livestock,

Edu Resource Center

VDC

VDC Secretary, Health, Agriculture, Livestock,

Education (school teacher), NGOs

Ward

FCHV, Representative Ward Citizen Forum,

Representative MG, Representative Cooperative/Groups

Analysis
Degree of vertical coherence within sector
Degree of collaboration across sectors
(horizontal concurrence)
Within region, district, VDC, ward

Effect of concurrence and coherence on

variability of outcomes on the ground
(community)
Change in concurrence or coherence over
time (MSNP and program implementation)

Results (Demographics)
Frequency
Level
Regional
District
Ilaka
Respondent type
Government
official
NGO official
INGO official
Total

Percent
29
278
79

7.5
72
20.5

283
97
6
386

73.3
25.1
1.6
100

Sectors Interviewed
Sector
Local and Social Development
Health
Agriculture and Livestock
Education
Water Supply
NGO/Private
Total

Frequency
76
46
89
46
26
103
386

Valid Percent
19.7
11.9
23.1
11.9
6.7
26.7
100

Priority Problems

Food Security
Utilization
Production
Disease/Illness
Lack of Education/Awareness
Practices (cultural practices, breast feeding)
No significant differences in identification of
priority problems

Regional

District

Ilaka

Count

Count

Count

Foodsecurity

15

51.70

159

57.20

47

59.50

Utilization *

22

75.90

141

50.70

47

59.50

Production

16

55.20

133

47.80

35

44.30

Disease/Illness

16

55.20

115

41.40

37

46.80

Practices

24.10

83

29.90

18

22.80

Education

26

89.70

262

94.20

76

96.20

*Chi
Square(p=0.021) N=29

N=278

N=79

Disaggregation
Regional
Count
De-worming
Lack of awareness
of supplementary
foods,
micronutrient
deficiencies
High Workload and
lack of care of
children (hunger)

N=29

District
%

Ilaka

Count

P value

Count

20.70%

22

7.90%

3.80%

0.016

13.80%

3.20%

0.00%

0.002

0.00%

42

15.10%

18

22.80%

0.014

N=278

N=79

Consultation (Regional, District, Ilaka)

Frequency
Do you feel that your department is sufficiently consulted with on nutrition issues
Sufficient Consultation of
124
All
Departments/Units (all Levels)

InSufficient Consultation of
Departments/units (all levels)

Somewhat Sufficient Consultation

Don't Know

Percent

32.1

5
96

17.2
34.5

All

23
188

29.1
48.7

Regional
District
Ilaka
All
Regional
District
Ilaka
All
Regional
District
Ilaka

16
131
41
60
6
39
15
14
2
12
14

55.2
47.1
51.9
15.5
20.7
14.0
19.0
3.6
6.9
4.3
3.6

Regional
District
Ilaka

Coherence on ease to work

district/region)

Regional
Count

District
%

Count

Ilaka
%

p value

Count

Easy

18

62.10

193 69.40

54

68.40 NS

Difficult

11

37.90

78 28.10

24

30.40 NS

N=29

N=278

N=79

Incentives to collaborate (Multi-sectoral)

Support
Shared ownership
(coordination/goals)
Mandatory Working
mechanism
Capacity building
(training
Shared resources
Allowance/fiscal
benefits to employees
Other
No incentive
Don't know

Regional
District
Ilaka
p value
Count
%
Count
%
Count %
4
13.80%
20 7.20%
6 7.60% 0.449

N=29

20.70%

94 33.80%

17.2

114

41

12

15.2

4
18

13.8
62.1

44
142

15.8
51.1

8
40

10.1 0.444
50.6 0.515

16
1
1
0

55.2
3.4
3.4
0

58
0
5
0

20.9
0
1.8
0

14
0
20
1

17.7
0
0 0.002
25.3
0
1.3 0.143

N=278

19 24.10% 0.119

N=79

Disincentives to collaborate (multisectoral)

Regional
Disincentives

District

Count

Ilaka

Count

Count

p value

Yes

11

37.9

66

23.7

28

35.4

0.048

No

18

62.1

211

75.9

51

64.6

0.058

0.4

0.823

Don't Know

N=29

N=278

N=79

Disincentives to Collaborate
Lack of allowance, fuel/transportation facilities to field, travel
allowances, daily allowances
Lack of interest/motivation
Workload
Workspace environment (includes lack of support from superior)
Insufficient Resources (finance, HR, budget)
Lack of skills and capacity
Bureaucratic constraints
Political Upheaval
Lack of planning, coordination and implementation
Lack of transparency
Lack of representative

Training and Capacity (Adequate Training)

Within your own department
Local Development
and Social
Development
Health
Count
Yes
Yes but
need
refresher
training
No

Agriculture and
Livestock

Education

Water Supply

NGO/private
sector

Count %
Count
%
Count %
Count %
Count %
25 32.90
27 58.70
30
33.70
23 50.00
17 65.40
72 69.90

16 21.10
35 46.10

p=0.000

10
9

21.70
19.60

24
35

27.00
39.30

11 23.90
12 26.10

6
3

23.10
11.50

11
20

10.70
19.40

Training and Capacity

Within other departments

Local
Development
and Social
Development Health

Agriculture
and Livestock Education

NGO/private
Water Supply sector

Count %

Count %

Count %

Count %

Yes
Yes but
need
refresher
training

17 22.40

Count %

15

32.60

29 32.60

16 34.80

7.90

6.50

18 20.20

5 10.90

No

41 53.90

12

26.10

26 29.20

Don't know

12 15.80

16

34.80

16 18.00

P=0.002

Count %

11 42.30

35

34.00

7.70

11

10.70

12 26.10

6 23.10

44

42.70

13 28.30

7 26.90

13

12.60

Conclusions
Some coherence observed across levels
More coherence between district and ilaka
Priority problems
Incentives to collaborate

More coherence between region and ilaka

Dis-incentives to collaborate

Training and capacity concurrence (within)

Health, education and water sector, NGO and local

private sector
Agriculture, local and social development sectors

Conclusions
Training and capacity (in other departments)
Local development and NGO/private sector
Agriculture, health, nutrition, water and sanitation

Continued analyses

Refining
Coherence by specific region, district, ilaka, ward, VDC
Concurrence by sector at each level
Linking to outcomes data and program monitoring
data

Research Team

Patrick Webb
Kedar Baral
Eileen Kennedy
Shibani Ghosh
Diplav Sapkota
Sriju Sharma
Valley Research Group (survey firm)