Mapping multi-sector actions in Burundi and Myanmar: Towards more effective coordination
Ernest Niyokindi is Deputy Chief of Cabinet in the Second Vice President’s Office for the Republic Burundi and the SUN Movement Government Focal Point.
Dr Célestin Sibomana joined the Second Vice President’s Office in 2014 as a Health Advisor, providing technical support to the SUN Secretariat.
Francis Muhire is Technical Assistant to the SUN Focal Point, managing daily activities at Burundi’s SUN Secretariat.
Dr Lwin Mar Hlaing is Deputy Director of Myanmar’s National Nutrition Centre, which is based in the Ministry of Health.
Dr Sansan Myint is the national REACH1 facilitator in Myanmar.
UN Network Secretariat.
Background
Multi-stakeholder mapping is intended to provide an overview of actions being implemented to address malnutrition. The mapping exercise aims to identify who is doing what, where and how to provide a comprehensive picture of interventions in terms of geographic and population coverage. Such information places national governments in a better position to lead data-driven, multi-sector, multi-stakeholder discussions to accelerate progress towards national nutrition targets.
REACH (Renewed Efforts against Child Hunger and Undernutrition)1 has been working since 2008 to use effective tools, such as the Stakeholder and Nutrition Action Mapping Tool2, to support a range of actors across multiple sectors to engage with nutrition. In 2017 the tool was put into a web platform, making it more compatible with information systems such as District Health Information Systems (DHIS, Version 2). To date, the mapping exercise has been conducted in 15 countries and is currently underway in a further six.
This article describes the use of this tool in two very different contexts: Burundi in East Africa and Myanmar in south-east Asia.
Burundi
Burundi is a small, landlocked country in East Africa with just over 10.5 million inhabitants. It has high levels of malnutrition, including stunting prevalence of 58 per cent and wasting prevalence of 6 per cent3 in children under five years of age (CU5).
The Government of Burundi (GoB), through its SUN Secretariat managed by the SUN Focal Point, expressed interest in conducting the mapping exercise to gain a better understanding of the country’s nutrition landscape. Launched in January 2018 with the support of the UN Network Secretariat, the multi-sector mapping is enabling the GoB to gather valuable coverage data, by stakeholder and programme coverage.
This, in turn, enables the GoB to identify gaps, duplication and opportunities to coordinate nutrition actions across sectors and stakeholders more effectively. Where there is duplication, the mapping exercise will enable the government (and those supporting it) to reallocate scarce resources to other localities with a high malnutrition burden but which are receiving less attention. The GoB also hopes to attract increased investment for nutrition by pursuing this more efficient approach to scale-up.
Engaging different sectors
The mapping exercise has also provided an entry point for engaging a notable number of sectors, including staff from seven ministries: Health; Agriculture; Trade and Industry; Planning and Finance; Environment; Local Development; and Social Security and Human Rights. Such wide-ranging engagement and government support has given rise to a dynamic mapping process in Burundi, which is being championed by the SUN Focal Point. The efforts are being coordinated by the Office of the Second Vice President, where the SUN Focal Point is based, and supported by a national mapping team. To date, more than 30 stakeholders have submitted data.
The mapping exercise can also contribute to creating a demand for multi-sector collaboration and instil this new way of working among sector-specific actors. Some actors reportedly do not see how their ‘regular’ work is related to nutrition or how it can be made more nutrition-sensitive. Others are preoccupied with their ‘regular’ sector work and struggle to devote time to multi-sector processes. Such challenges also include extending a multi-sector process to the provincial level4. The formulation of the new National Strategic Plan on Nutrition and Food Security (2019-2023) offers another opportunity to reinforce a multi-sector approach to nutrition. Key findings from the mapping process have been timed to feed into the review of the GoB’s strategic plan.
For example, a new multi-sector approach to implementing nutrition interventions is being implemented in two southern provinces, Makamba and Rutana. This combines the efforts of public administrative actors, NGOs, local civil society and religious authorities, grouping these stakeholders into a Steering Committee and Technical Committee. The Steering Committee, chaired by the SUN Focal Point, is responsible for monitoring the implementation of nutrition interventions and for better mobilisation of the various actors.
Remaining challenges
It was important to emphasise the purpose of mapping when collecting data to overcome problems with sharing data, since some actors initially perceived the exercise as a means to control their work. The exercise also highlighted the need to better account for the coverage of interventions that are delivered through varying approaches (e.g. one-off campaigns versus routine services).
Myanmar
Like Burundi, the mapping exercise was government-led and used the same tool adapted to the Myanmar context. The Republic of the Union of Myanmar is home to approximately 54 million Burmese, with 135 recognised ethnic groups. The prevalence of stunting in CU5 is 29 per cent and 7 per cent are wasted5. However, these figures mask stark regional disparities, with some states and regions reporting wasting prevalence as high as 13.9 per cent and stunting of 41 per cent6.
The mapping exercise in Myanmar was successfully completed in 2017, with support from REACH facilitators. Mapping provided an entry point for mobilising a greater number of sectors to engage in nutrition (i.e. those beyond the health sector), including the four key ministries: Agriculture, Livestock and Irrigation; Social Welfare, Relief and Resettlement; Health and Sports; and Education. In addition, the head of the National Nutrition Centre (NNC) and her team, who provide technical support to the SUN Government Focal Point, were actively engaged throughout the process, coordinating and engaging other stakeholders. The Ministry of Health (MoH) houses both the Focal Point (who is the MoH Director General) and the NNC.
The mapping tool is enabling the government and development partners to identify both geographic regions and interventions in need of intensified action, thereby guiding prioritisation. It is also helping to highlight areas with resource gaps. Furthermore, the mapping has been instrumental in strengthening the UN Network and developing more effective working between the SUN networks (UN, government, donor and civil society) with a view to achieving greater impact.
Figure: Excerpt from Myanmar's multi-sector overview
The mapping exercise has also underscored the importance of strengthening data collection and reporting systems within the four ministries involved and has helped identify specific weaknesses, such as the need for a common results framework. It has raised awareness among country actors about the role of data in evidence-generation.
Remaining challenges
Each sector and agency has its own organisational mandate and existing plan. It was sometimes difficult to motivate staff to become more transparent and share information on existing sector/agency-specific programmes and budgets. This is in part due to the decision-making processes of individual institutions, which are not always conducive to accommodating joint activities. The mapping opened the door for such sharing and has led to the establishment and functioning of technical teams in the four participating ministries. While much progress has been made towards collective action, continued efforts are needed to consolidate these gains.
Next steps
Staff from the NNC and the Central Statistics Bureau were trained on the mapping tool and methodology, helping to institutionalise the mapping function within the government so that it can be replicated in the future. The tool will be included in the M&E framework for the new Multi-sector National Plan of Action for Nutrition (2017-2022). Country actors are also exploring the possibility of using future mapping data to track the implementation status of the new plan, as proposed in Tanzania and being implemented in Senegal.
1 REACH is a country support mechanism under the UN Network, which plays a catalytic role in the Scaling Up Nutrition (SUN) Movement in selected SUN countries.
2For an overview of the nutrition mapping tool, visit www.securenutrition.org/resource/multisectoral-mapping-nutrition-la-cartographie-multisectorielle-des-actions-de-nutrition
3GNR 2017. Global Nutrition Report Nutrition Country Profiles: Burundi. Bristol, UK: Development Initiatives.
4To date, two provinces have established decentralised platforms, under the chairmanship of the governor of the province, and are developing Provincial Strategic Food Security and Nutrition Plans, inspired by the Provincial Community Development Plans.
5GNR 2017. Global Nutrition Report Nutrition Country Profiles: Myanmar. Bristol, UK: Development Initiatives.
6DHS 2015-16.