Inter-sectoral coordination for nutrition in Zambia

Summary of research¹

The underlying determinants of nutritional status are adequate food, health and care. The goods and services related to these will be available from a range of sectors, which means inter-sectoral coordination is key to addressing malnutrition. However, the nutrition community in general has not yet managed to foster this necessary level of coordination. The authors of a recently-published paper suggest that several barriers exist, including low political commitment and space for new ways of working; limitations of existing routines and structures within sectors; weak coordinating bodies; lack of human resources; and inadequate strategic, management and technical capacity.

The authors present the example of Zambia, where the estimated national prevalence of stunting among children under five years of age is 45%. There is currently very little national or sub-national level inter-sectoral coordination for nutrition in Zambia. Against this backdrop, the non-governmental organisation (NGO) Concern Worldwide facilitated a unique initiative in the Mumbwa District of the country to coordinate ministries and NGOs involved in the provision of nutrition-related services. This paper describes the process of establishing this initiative, as well as subsequent learning and challenges.  

In February 2012, Concern Worldwide began bringing together relevant ministries and civil society organisations under the DNCC in order to improve understanding and align activities for nutrition at local level. To do this, the DNCC set out to build on the strengths of existing actors, systems and capacities to facilitate a shift in how stunting is understood and addressed, so that coordinated strategies and joint interventions for stunting prevention can occur. 

This process was strongly informed by ‘Theory U’, which promotes a creative, learning approach that moves from changing the perceptions of participating actors to experiential learning and sharing; to transforming actors’ sense of responsibility for change; and ultimately to acting on this. In practice, this has involved bringing together carefully selected, relevant actors in Mumbwa to share, understand and learn from each other’s experiences and perceptions. 

An important aspect of the coordination process was the acceptance of the DNCC meetings as a space for learning, sharing and reflection, and that multiple perspectives are something of value. As a result, a common understanding of stunting has emerged. This was exemplified when the DNCC developed a ‘problem tree’ analysis of stunting in Mumbwa, as seen from a multi-sectoral perspective, and a ‘solution tree’ to guide responses. The exercise revealed a number of overlapping themes that enabled the DNCC to identify areas of possible collaboration. Having reviewed and agreed this analysis, DNCC members travelled to a village two hours by road from Mumbwa town to engage with community members. This resulted in the DNCC adjusting the problem tree to reflect aspects of stunting that the community felt were important. This process helped DNCC members gain a deeper understanding of the realities of people most affected by stunting, and achieve a deeper engagement with one another about how to address these realities. 

Since its inception, the DNCC has participated in ‘upwards advocacy’. There is currently little inter-sectoral coordination in Zambia at national level. However, with the momentum created by the SUN Movement, the NFNC (as the national steering body for nutrition) is ideally located to become a force for nutrition advocacy, planning and implementation. Recognising this, the DNCC prioritised a national-level forum, whereby the emerging experiences from Mumbwa could be shared. Concern Worldwide facilitated a national meeting in October 2012 for this purpose, with support from the DNCC and engagement from the relevant national actors. The DNCC shared experiences from local level; as a result, the committee was identified as a possible model for coordination across Zambia. The NFNC now intends to replicate the committees in 14 pilot districts.

Several inter-sectoral programming developments have emerged through the DNCC. These include a clear commitment from actors to work together, share ideas and information, keep each other informed, and attend meetings. This type of commitment cannot be taken for granted as numerous disincentives exist within individual government ministries to avoid working outside their core mandates. Other developments include attempts to recognise and include new stakeholders in the district who may have a bearing on addressing undernutrition. For example, recognition among DNCC members of the importance of women’s land rights in addressing undernutrition led the DNCC to invite the Ministry of Lands to join the committee. Another tangible example of inter-sector collaboration was the sharing of vehicles, fuel and staff for cooking demonstrations, which each Ministry was undertaking separately but is now combining. There has been criticism that progress has been slow and more coordinated strategies and joint interventions should have taken place. However, the authors state that, as undernutrition is socially, dynamically and generatively complex, it will take time for effective solutions to emerge.

Another challenge is how to raise the issue of coordination and alignment to address undernutrition higher up the Government’s agenda. Part of the answer may lie with the SUN Movement, while another lies with securing high-level champions within the key line ministries to advocate for change. However, the experience of the DNCC shows that, while structures are important, sufficient attention must also be paid to the individuals involved in the coordination process and to the quality of relationships and interactions between them. In this example, the concerted support and commitment of an external agent (Concern Worldwide) from the outset was invaluable in making this happen. These will be key points to address as similar committees are replicated under the SUN Movement.

The authors conclude that the creation of a DNCC, while slow and difficult at times, was useful and sustained facilitation has built trust and mutually supportive learning between diverse stakeholders. While recognising that it will take time for fully effective and implementable solutions to emerge, the DNCC is a potentially durable and effective way of addressing undernutrition in Zambia in the long term.