Nutrition coordination mechanisms: the whats, whys and wherefores
Stefano Fedele, UNICEF Regional Nutrition Specialist for Latin America and the Caribbean (LAC), is the coordinator of GRIN-LAC (Grupo de Resiliencia Integrada de Nutrición), a regional coordination and technical support platform aimed at strengthening emergency nutrition preparedness and response.
The interview is based on a GRIN-LAC webinar, prepared by Yvette Fautsch Macias, consultant on Nutrition in Emergencies with UNICEF LAC region.
1. What is a coordination mechanism and why is it needed?
A nutrition coordination mechanism is a group of organisations/stakeholders committed and willing to support nutrition by jointly coordinating their activities to achieve better nutrition results.
Historically, coordination mechanisms in the Latin America and Caribbean region (as elsewhere) have been related to emergencies, based on the ‘Cluster’ approach used in a humanitarian response. However, despite having drastically reduced undernutrition in the LAC region, the persistence of stunting and anaemia in some areas and groups and the generalised increase in overweight and obesity mean that malnutrition remains a national priority in all countries and scaling up of national efforts may be strongly facilitated by a dedicated sectoral table, led by national authorities and open to all key stakeholders.
An ongoing and inclusive nutrition-specific sectoral table may be very important to improve the effectiveness, efficiency and timeliness of national nutrition programmes, for most countries in LAC; and in areas more prone to crisis, an ongoing mechanism can also strengthen the humanitarian-development nexus with short-term needs linked to medium and longer-term goals, plans and funding. To make the coordination mechanism functional, it is important to find different ways of working together, define ways to communicate and have a mechanism to follow up actions, such as regular meetings. Also, when initiatives are backed up by a wider consensus among key stakeholders, they have greater weight in terms of advocacy, helping to raise nutrition at the highest levels of national political agendas.
2. Is there usually a single nutrition coordination mechanism at country level or can there be many of them?
There are different models but frequently there is a general nutrition group that can host specific sub-groups that work on specific nutrition issues, such as: micronutrient deficiencies, care of acute malnutrition, prevention of overweight and obesity in schools, etc. and refer back to the main group. Nutrition coordination mechanisms at sub-national levels (e.g. regional, state, department or district level) may also be very useful in ensuring that work focuses on the most prevalent nutrition issues at the local level and encompasses community engagement and ownership, to achieve stronger and longer lasting impact.
3. In some countries nutrition is part of food security coordination mechanisms. Is that sufficient to tackle nutrition problems?
As undernutrition persists in many vulnerable areas or groups, child overweight is rising in almost all countries and natural disasters continue to increase in frequency, severity, and unpredictability. It may make more sense to consider a nutrition-specific coordination mechanism to give greater time and inclusiveness to initiatives specific to nutrition, and then use the broader consensus achieved to carry the agenda in wider intersectoral fora.
If the transition from a coordination mechanism, which combines nutrition with food security or health to a specific nutrition mechanism, is too politically controversial to achieve in the short term, it may be easier to create a separate, less formal technical group specific to nutrition, which then reports its work to the wider sectoral group, while at the same time strengthening the advocacy to establish a more formal nutrition mechanism. Improvement in nutrition results may then strengthen the argument for transitioning to a more formal mechanism status.
4. When is the best time to establish a coordination mechanism in order to prepare a nutrition response in emergencies?
It takes time to create a coordination mechanism from scratch when a major disaster is taking place, e.g. identifying the key stakeholders, developing coordinating tools and defining the various roles and responsibilities. Any delay has a cost in financial terms but also in human suffering. It may be more cost effective to raise the minimum programmatic and coordinating capacity to address the more regular development issues, which can then be more easily scaled-up at times of emergency. Key preparedness actions include the establishment of an inclusive and functional coordination mechanism at the national and sub-national level, and the development of a nutrition response plan in emergency situations.
5. Who should be leading at country level?
National authorities have the primary responsibility to ensure the wellbeing of their population and as such, the leadership of a nutrition coordination mechanism should lie with the highest nutrition institution to ensure full ownership of both the determinants of malnutrition and of the potential solutions. It is important to ensure that representatives of the nutrition mechanism also actively participate in the sectoral platforms of other key sectors such as health, water and sanitation and hygiene (WASH) and food security.
6. How can you maintain a nutrition coordination mechanism when governments change?
If addressing malnutrition is seen as a state issue, rather than a government one, a dedicated coordination mechanism may facilitate the transfer of key initiatives across subsequent governments. To ensure continuity it is important to include civil society organisations, representatives of communities, UN agencies etc, for example, in Guatemala, when there is a change in government, the nutrition coordination mechanism sends a letter to the new government authorities giving the background of the mechanism, their objectives and current activities, while inviting them to take a leadership role.
7. What should the private sector role be in such mechanisms?
The private sector may play an important role in preventing malnutrition in the production of fortified staple foods, ready-to-use therapeutic food (RUTF) and ensuring access to healthier foods at a reasonable cost. However, an important aspect to consider is the potential for conflict of interest. While engagement of the food and beverage industry may be needed to carry out wider reaching advocacy, it may be important to ensure that the development of public health policies is guided firstly by the national interest and secondly by private financial gain. WHO has developed guidelines for this purpose1.
8. Are Terms of Reference (TORs) necessary?
On the one hand, having defined TORs can make the group’s work more systematic, and support greater understanding and formal recognition by those outside the process. On the other hand, care should be taken since TORs can sometimes be inflexible and create a barrier or challenge rather than a facilitator to coordination. The lack of TORs should not prevent nutrition stakeholders from meeting, having discussions or finding ways to work together. In other words, it is recommended to develop TORs but not to let the process slow down progress.
9. Do you have any final recommendations for countries?
There are no set rules for establishing such mechanisms, but it is important to have discussions in an open space for policy development with different nutrition stakeholders at the country level. Small groups can be created to do the work and report back to the general nutrition coordination mechanism, but this will depend on whether countries decide if they are needed or not. Also, in order to have a more timely, efficient and effective impact in emergency situations, the coordination mechanism should be in place beforehand.
GRIN-LAC support is available here.
Footnote
1WHO. 2016. Addressing and managing conflicts of interest in the planning and delivery of nutrition programmes at country level: www.who.int/nutrition/events/2015_conflictsofinterest_nut_programmes/en/ WHO. 2017. Safeguarding against possible conflicts of interest in nutrition programmes www.who.int/nutrition/consultation-doi/comments/en/.