Role of communication and advocacy in scaling up nutrition: lessons and plans from the Zambian experience

Location: Zambia

What we know: Undernutrition in Zambia remains prevalent; overnutrition and non-communicable diseases are an emerging problem.

What this article adds: Zambia joined the SUN Movement in 2010. A strong Civil Society SUN Alliance was formed to raise the profile of nutrition on the national (political) agenda, network key stakeholders across sectors, advocate for resource commitments to nutrition, and hold those in office to account. Largely focused on undernutrition, achievements of advocacy and communication activities to date include securing high-level political commitments on nutrition, influence on national social protection and agriculture policies, development of an all-party parliamentary group on food and nutrition, agreement for legislative review to enable stronger multi-sectoral coordination, and community activities around global days of action on nutrition. Informal cross-country learning has been an added benefit of the SUN Movement. Challenges relate to multi-sectoral coordination and costing and implementation of nutrition interventions across sector ministries; development of implementation plans linking policy with action is needed. Spend on nutrition-sensitive programming has increased but remains very low. Civil society advocacy and communications has a continued and evolving key role in scale-up.

The SUN Movement in Zambia

The Republic Zambia has continued to record some of the highest rates of malnutrition in the world. Current in-country Demographic Health Survey (DHS) statistics show stunting in children under the age of five to be at 40% or 1.2 million children; wasting at 6%; and high levels of a combination of micronutrient deficiencies: 53% of school-aged children are deficient in vitamin A, while 46% have iron deficiency. Over the years, there has been an increase in overnutrition and non-communicable diseases. In 2013-14, nearly 23% of women were recorded to be overweight or obese in Zambia. What makes this even more challenging is that, in many cases, households with undernourished children usually had overweight or obese mothers, making the double burden of malnutrition a living reality for many Zambian homes (Zambia DHS, 2013).

The Government of Zambia is fully alive to the problem of malnutrition and has taken steps over the years to redress the situation, with varying success. On 22 December 2010 Zambia joined the Global Scaling up Nutrition (SUN) Movement with a letter of commitment from the Minister of Health, thereby becoming one of the first countries to sign up to SUN. This fostered the development of a national Nutrition Plan that is focused on addressing malnutrition from a multi-sectoral and multi-stakeholder perspective. As a result, for the first time, the government, civil society, the private sector and cooperating partners are all collectively engaged in fighting malnutrition. The SUN Framework in Zambia is designed so that the National Food and Nutrition Commission (NFNC), the statutory body charged with responsibility to coordinate action on nutrition in Zambia under the Ministry of Health, is placed at the centre of efforts to scale up nutrition and houses the SUN Focal Point.  The SUN Focal Point coordinates action across other SUN networks, including academia, UN and business and civil society networks.

The role of advocacy and communication in scaling up nutrition

Advocacy and communication form the bedrock of driving and empowering nutrition outcomes. It is through advocacy and communication that policy changes are influenced and communities are sensitised. Advocacy targeted at high-level decision-makers can lead to government commitments that have the potential to improve nutrition programming and accountability. Through strategic lobbying, increased resources (financial and otherwise) are allocated to nutrition interventions. For nutrition interventions to be properly planned and implemented, there must be a good understanding of nutrition among political players, policymakers, policy implementers and the general public. Advocacy and communication play the unique role of creating demand and building consciousness about the importance of nutrition at all levels and among all key stakeholders in nutrition development. Sensitisation and demand-creation are key components of the story of change that has seen community mobilisation around nutrition progress, thereby creating a symbiotic relationship between the population and its leaders and fostering accountability and involvement.

The role of civil society in the SUN Movement in Zambia

Civil society is uniquely positioned to play a crucial role in advocacy and communications. In Zambia, CSO-SUN is the umbrella organisation under which all civil society actors with a nutrition focus are coordinated. Established in October 2012, the CSO-SUN Alliance is a movement of civil society organisations (CSOs) working together to raise the profile of nutrition on the national development agenda. The Alliance is part of the global SUN Movement and unites actors from different sectors such as government, the United Nations, donors, the private sector, civil society and researchers, in an effort to scale up nutrition interventions. CSO-SUN’s goal is to increase coverage of effective and integrated nutrition programmes by ensuring political commitment to tackle malnutrition, increasing financial resources and ensuring accountability by government. In order to achieve this, CSO-SUN works to raise public awareness and national consensus about the problem of and solutions to malnutrition through contributing to policy, legal and budgetary frameworks that address the needs of the poorest and most vulnerable. Furthermore, the Alliance works to strengthen in-country accountability for progress in tackling malnutrition and, through networks, enhance learning between organisations and between countries to maximise the effectiveness of their efforts.

CSO-SUN is the first and only nutrition advocacy platform for civil society in Zambia and has so far engaged 75 members of local and international non-governmental organisations (NGOs) and civil society groups. These members form the General Assembly (GA) of the Alliance and, guided by the CSO-SUN constitution, are the supreme authority of the Alliance. The GA elects a board at the annual general meeting (AGM) who are responsible for supervising the day-to-day activities of the CSO-SUN Secretariat. The AGM reviews the performance of the Alliance, evaluates audit reports, plans for the next year and appraises the Board and Secretariat’s performance. The Secretariat comprises fixed-term, employed staff charged with the responsibility of coordinating the efforts of the Alliance members. Members are organised into different technical committees to leverage their competencies for effective programming. The technical committees are organised under the following thematic areas:

• Research and policy analysis – deals with matters of policy and research on nutrition;
• Advocacy and communications – spearheads the implementation of the Advocacy and Communications Strategy and deals with strategic engagement and lobbying;
• Networking and coalition-building – focuses on creating smart partnerships with organisations and individuals and fosters relationships with national and sub-national nutrition champions;
• Governance and institutional capacity building – provides direction on governance, management and administrative issues, institutional strengthening and resource mobilisation.

The technical committees are headed by a member of the CSO-SUN board whose organisation belongs to a specific thematic area. These committees regularly interact via email and meet on a quarterly basis to plan and review tasks for the quarter. They also convene in extraordinary situations where their expertise may be required. For example, the Advocacy and Communications technical committee may meet to strategise on how to maximise coverage of nutrition news and issues during a big national event. In this way, Alliance members are often in contact with each other and collectively contribute to achieving the objectives of the Alliance. CSO-SUN also has structures at district level that are coordinated by the District Focal Point Organisation (DFPO). The Alliance currently operates in three districts of Zambia: Samfya (Luapula Province – northern Zambia), Mumbwa (Central Province – central Zambia), and Lundazi (Eastern Province – eastern Zambia). Each DFPO coordinates a network of local CSOs and community-based organisations (CBOs) who form part of the larger membership of the CSO-SUN Alliance. The DFPOs are supervised by the Advocacy and Communications specialist based at the CSO-SUN Secretariat. The specialist leads the Advocacy and Communications agenda for CSO-SUN and serves as a key point of contact to engage the Alliance members. He/she is responsible for coordinating nutrition communications and advocacy activities for all members, ensuring that programmes are well-integrated and non-duplicative, and supporting the priorities of the national nutrition programmes at national and district level.

CSO-SUN activities

Civil society plays a crucial role in creating demand, securing political commitment and ensuring accountability in efforts to scale up nutrition. The work of the CSO-SUN was necessitated by the fact that civil society involved in nutrition was uncoordinated and fragmented. Furthermore, there was weak participation of civil society in advocacy for nutrition. CSO-SUN has therefore championed the campaign to raise awareness and create demand for knowledge on nutrition through the following key activities:

Building political will for nutrition

CSO-SUN has worked successfully with politicians to build political will to combat malnutrition. For example, CSO-SUN supported Zambian political parties to include nutrition messages in the January 2014 presidential campaigns via a Vote Nutrition campaign that advocated for increased focus on nutrition by presidential candidates during the 20 January  2015 presidential election. The Alliance engaged with several political parties to plan for nutrition activities should they form office. At the same time, the Alliance assembled a team of influential celebrities to endorse a campaign advertisement that urged the electorate to vote only for a party/candidate that had a clear nutrition policy and mandate. Also, the Alliance supported the televising of the country’s second-ever presidential debate and created a platform for candidates to debate nutrition strategies. These strengthened commitments from the presidential aspirants and, as a follow up to these commitments, CSO-SUN has developed and submitted nutrition ‘quick wins’ to the President of Zambia; a set of nutrition policy alternatives that the President should focus on during his tenure. For 2016, in preparation for the country’s general election, CSO-SUN will engage with political parties to ensure that their party manifestos clearly indicate a plan for nutrition. The Alliance will also revamp its Vote Nutrition campaign to ensure wider coverage. Additionally, the Alliance will engage with the current and aspirant political leadership to secure attainable commitments in preparation for the Nutrition for Growth summit (N4G2) in August 2016.

Influencing national policies

CSO-SUN has been at the centre of making public sector policies nutrition-sensitive in Zambia. Recently, the Alliance mobilised CSOs to work towards including an objective for nutrition in Zambia’s first-ever Social Protection Policy, giving the policy a strong nutrition focus. The policy is currently being implemented under the Ministry of Community Development and nutrition is high among its priorities. CSO-SUN also organised CSOs to make recommendations to the draft National Agriculture Policy to make the policy more responsive to the nutritional needs of the population. The Ministry of Agriculture is in the process of finalising the draft National Agriculture policy. The Alliance became aware that the Ministry had closed the consultation period without consulting nutrition actors on the policy’s implication for nutrition outcomes. The Alliance mobilised CSOs and persuaded the Ministry to allow it to make recommendations for strengthening the nutrition sensitivity of the policy. These recommendations have been incorporated into the version of the policy that will soon be adopted by government.  Note that nutrition is mainstreamed in other sectoral policies, including the National Health Policy, National Health Strategic Plan and Agriculture Investment Plan; the Food and Drugs Act is under review. Furthermore, CSO-SUN is regularly invited to make submissions and appear before various committees of the Zambian Parliament.  In recent years, it has appeared before the Committee on Budget Estimates, Committee on Community Development and Social Services and Committee on Agriculture. This has helped Parliament to make better-informed decisions on, and be more accountable for, actions that impact on nutrition.

All-party Parliamentary Caucus on food and nutrition (APPCON)

Members of Parliament play an essential role in promoting the cause of nutrition, both at national level as influencers of legal and budgetary reforms and at constituency level as change agents and community leaders. In recognising the unique role that MPs play, CSO-SUN facilitated the formation of the All-Party Parliamentary Caucus on Food and Nutrition (APPCON), a committee of MPs dedicated to food and nutrition development through the National Assembly. APPCON prioritises policy and financial issues through parliamentary debate mediums such as question time, private member motions and points of order for the purposes of strengthening the voice and accountability mechanism for nutrition through Parliament. The caucus works towards enhancing nutrition legislation and building political will to address the burden of malnutrition and facilitate the effective implementation of the national nutrition policy among others. Members of the caucus have so far been successful in raising issues with regard to nutrition and policy on the floor of Parliament. 

Strengthening legislative and budgetary frameworks for nutrition

In an effort to improve coordination of nutrition actors through strengthening the National Food and Nutrition Commission (NFNC), CSO-SUN successfully ran a campaign that culminated in the review of the National Food and Nutrition Act of 1967. The Act, which provides for the establishment of the NFNC, had not been reviewed since its enactment in 1967. In its current form, it does not reflect the nutrition problems affecting various sub-populations and therefore does not support the attainment of optimal nutrition status for all. Furthermore, it does not empower the NFNC to adequately coordinate across different actors in a multi-sectorial response to malnutrition. It was therefore necessary to review the Act. The new Bill, currently before Parliament for deliberation, aims to strengthen the NFNC through the following amendments and additions. Firstly, the Bill has provided for the constitution of a multi-stakeholder representative board of directors to head the NFNC. This will improve governance of the institution as the current board was operating without legal legitimacy. Secondly, in its current form, the Bill has given statutory status to the Special Committee of Permanent Secretaries on Nutrition and clearly defined its role and responsibilities. This committee will assist the NFNC to strengthen accountability for nutrition actors across sector ministries. Finally, the Bill has redefined the overall role of the NFNC and, considering the institution’s regulatory powers, given it more clout to perform its mandate.

Similarly, CSO-SUN has conducted national budget analysis and tracking for nutrition sector spending for 2013, 2014 and 2015. The Alliance’s analysis for these years has shown perennial low spending of nutrition-specific and nutrition-sensitive interventions as a percentage of the national budget; 0.001% (2013), 0.03% (2014) and 0.1% (2015). Although this represents a mathematical increase annually, it is still extremely low and does not respond to the magnitude of the problem. This budget analysis work, which has been developed with the guidance of the SUN Movement, has gained national buy-in and is the only source of nutrition spending information in Zambia (budget lines are identified and weighted on pre-agreed terms; see: www.scalingupnutrition.org/resources-archive/financial-tracking-resource-mobilization/budget-analysis). The analysis tool-kit has been adopted by the Government and the budget analysis has contributed to several national and international publications on nutrition spending, including the Government’s annual sector reports, Global Nutrition Report and the Institute of Development Studies (IDS) Hunger and Nutrition Commitment index (HANCI).

Community mobilisation and demand-creation

Community mobilisation is an effective way to raise awareness and create demand for improved nutrition at community level. CSO-SUN has been engaged in community mobilisation efforts to organise communities to act collectively for improved nutrition planning and programming. One way in which CSO-SUN does this is through the annual commemoration of the Global Day of Action (GDA), when civil society across the globe speaks out together for improved nutrition, highlighting the power of coming together and making the case publicly for strong action by national and global leaders. In Zambia, CSO-SUN commemorates the GDA with events in different communities across its areas of operation. These events, which range from sporting competitions between constituencies to sanitation and clean-up exercises, are aimed at bringing the community and their leaders together to dialogue and share grievances and ideas on the best approach for improving nutrition. These events have, in the past, led to the formation of community Nutrition Groups comprising of members of the community who engage directly with community leadership on nutrition-development issues. Another way in which CSO-SUN mobilises communities is by organising vulnerable groups, such as breastfeeding mothers, targeting them with nutrition information and empowering them with the skills and knowledge to improve nutrition in their households. These groups regularly feature on communication platforms such as gatherings and community radio shows to encourage their peers and lobby their leaders. 

Media engagement

CSO-SUN has been very successful in engaging the media to sustain the nutrition dialogue in the Country. The Alliance has trained the media on nutrition reporting and recognised deserving institutions and individuals at its annual award-giving ceremony. This has continued to inspire accurate nutrition coverage in Zambia. On average, the Zambian media covers nutrition issues around four times a week across print, radio, online and TV media. This sustains the narrative on nutrition, ensuring that it is always a prime topic when discussing development issues. It also creates demand from the public and keeps government leaders accountable.    

Status of SUN

Efforts to scale up nutrition in Zambia have seen significant strides, with the Government having recognised the far-reaching effects of malnutrition. The Government also recognises that undernutrition is complex and requires an integrated approach across various sectors including health, HIV/AIDS, social protection, food security and agriculture, education, water and sanitation, and should involve the private sector, civil society and communities. Nutrition has been integrated into the Revised Sixth National Development Plan 2013-2016 (R-SDP) by its mainstreaming across all sector-specific implementation plans of the R-SDP (in addition to governance, HIV/AIDS, gender disability and environment and disaster risk management). The R-SDP is aimed at achieving the objectives set out in the Vision 2030 of becoming a prosperous middle-income country by 2030. This integrated approach requires effective coordination, human resources and delivery structures. Furthermore, the Government, through the National Food and Nutrition Strategic Plan (NFNSP) for 2011-2015, committed itself to prevention of stunting in children under two years of age.  The Government has also made several commitments, including revising the National Food and Nutrition Commission Act, strengthening accountability of the NFNC to adequately coordinate across key sectors (which is at an advanced stage), and establishing a Special Committee of Permanent Secretaries on Nutrition to meet and agree on policy directives as well as service-delivery channels and track progress against targets.

Despite greater commitments to nutrition by the Government, it should be noted that coordination has remained a challenge for scaling up nutrition efforts in Zambia, with the NFNC still under the Ministry of Health and the high-level steering committee not meeting regularly enough to concretise high-level management of nutrition programmes in the country. Added to these have been the challenges of implementation of nutrition interventions across sector ministries. Although sound policies and strategic plans are in place, the lack of a general implementation plan fails to link policy to action. Whilst there is increased attention to overnutrition and NCDs, these are not yet reflected in policy and strategies.

Lessons learned

Through the Alliance’s advocacy and communication efforts, it has been learnt that there is goodwill from stakeholders including CSOs, media, Parliament and Government towards collaborating to achieve improved nutrition. Civil society actors need to be strategic in their messaging in order to capture the commitment of stakeholders. Packaging of messages is very important as nutrition concepts are often difficult to understand, depending on a variety of factors (target audience literacy level, familiarity with nutrition issues, etc.). For example, when targeting community groups, it is necessary to synthesise and break down information as needed into simple, meaningful language for better uptake and understanding. When communities are sensitised, they will demand better nutrition programming; farmers who understand the value of growing a variety of crops for diversified consumption will demand farming inputs that support this and will reject mono-crop strategies from the Government. In turn, the Government could be persuaded into restructuring its agriculture policies to be more responsive to the people’s needs and demands. Furthermore, in working with Parliamentarians, it is essential to adopt an approach that strengthens their knowledge base regarding constituency needs in way that appreciates MPs’ existing capacity. In order to secure their buy-in, stakeholders need to be empowered with information so they can understand their role and execute their responsibilities, be involved at every step and have resources invested in them for their sustainability. It has also been learnt that belonging to a global network of nutrition actors through the SUN Movement makes for easy access to information between countries, which includes pairing member countries. For instance, Zambia has been paired with Malawi on several occasions to facilitate cross-learning, especially as the two are neighbouring countries facing similar challenges.

Conclusion

The SUN is rising in Zambia and it is prime time for concerted advocacy and communication efforts. As the world heads into the post-2015 development era and the N4G2, civil society in Zambia will focus on ensuring that all actors implement planned nutrition programmes and are held accountable to their commitments. Through advocacy and communications, CSOs have an important role to play in ensuring that nutrition is considered a high priority in political and development agendas. As such, CSO-SUN will continue to leverage the support and collaboration of national and international partners in achieving the nutrition objectives that all agree are needed for Zambia.

For more information, contact Eneya Phiri

References

Horton S., Shekar M., McDonald C., Mahal A.,  Krystene Brooks J (2010). Scaling Up Nutrition What Will It Cost? The World Bank. 

Central Statistical Office (CSO) [Zambia], Ministry of Health (MOH) [Zambia], and ICF International. 2014. Zambia Demographic and Health Survey 2013-14. Rockville, Maryland, USA: Central Statistical Office, Ministry of Health, and ICF International.