Working together for nutrition: Changes in Kenya’s health and agriculture ministries
ENN’s Lillian Karanja interviewed Veronica Kirogo, Deputy Director of Nutrition and Dietetics Services and the Head of the Nutrition and Dietetics Unit housed in the MoH, and Jane Wambugu, Deputy Director of Agriculture and Head of the Agri-nutrition Department in the MoA, about their views on how to bring nutrition and agriculture closer together.
Introduction
The Government of Kenya is committed to improving food and nutrition security, which is a basic right enshrined in the country’s constitution. Efforts to strengthen agriculture-nutrition linkages is evident in the various policies and strategies and the realignment of nutrition units in the Ministries of Health (MoH) and Agriculture (MoA). The appointment of a Head of Nutrition MoH who has a background in agriculture and converting the Home Economics department within the MoA into an Agri-nutrition department reaffirms this commitment. One year on from this vision, how are the two sectors working together?
1. We understand that there has been an increased focus on nutrition within the MoA. Can you explain how this came about when you were there?
Veronica (MoH): I headed the food and nutrition unit in the MoA for five years and later, Home Economics, now known as Agri-nutrition department, which is a policy-level branch. This involved working with the MoH when we realised that there was a missing link between agriculture and nutrition. A food and nutrition linkages technical working group was set up to address this, which falls under the MoH but is chaired by the MoA. This technical working group has been instrumental in developing strategies with increased nutrition focus for the MoA, such as the food composition tables, which were co-published to inform key programming areas cutting across both ministries. We also have the Kenya food recipes, which analyse and compute the nutritive value of local foods to guide households and communities to make informed decisions on food preparation.
The Food Security Policy [launched in 2012] was also key in ensuring that the conversation is not just about food production and access in the MoA, but also that dietary diversity and overall nutrient improvement are considered alongside increased food production. The development of the policy implementation framework has been completed in 2018.
2. Tell us about recent changes to upgrade nutrition in the MoA. Why was this necessary and what will it result in?
Jane (MoA): We are now calling it the Agri-nutrition Division, which is a transition and elevation from the previous Home Economics branch, which only considered household consumption and utilisation. With agri-nutrition, every stage of the agricultural value chain from food production to household food consumption is considered. The main implication [of this move] is first within the Ministry itself. A transition to agri-nutrition means the nutrition arm is elevated to a position to influence nutrition considerations within all five departments of the MoA: Fisheries, Livestock, Research, Irrigation and Crops. This also has implications for funding, as we will be able to position agri-nutrition as a project which would then obtain resources that are crucial in enabling us to embed nutrition in the value chain of all five departments in the MoA. Nutritionists, however, are currently only in the Department of Crops under the home economics programme. This is why we changed it to agri-nutrition so that we are able to cut across the other departments. So far we have been able to sensitise some departments, such as livestock and fisheries, where we already have desk officers.
3. What are the key policies or frameworks in which these two ministries align around nutrition?
Veronica: The key policy document that guides nutrition is the National Food and Nutrition Security Policy, which is the government blueprint in terms of nutrition commitment and strategies. The National Nutrition Action Plan is actually the implementation framework of the nutrition component in that policy. The action plan is not just developed by the MoH, but also by other sectoral ministries (Education, Agriculture, Devolution, Labour and Social Protection) that create enabling environments for nutrition. Through the food and nutrition linkages technical working group, the two ministries have jointly developed strategies such as the National Healthy Diets and Physical Activities Guidelines, Kenya Food Composition Tables and Kenyan Food Recipes.
4. Does the closer alignment mean that programmes on the ground will converge or become more integrated, and can you describe how you work with the county level to help them deliver nutrition programmes?
Veronica: A recent example is the flour-blending initiative led by the MoA with the Nutrition & Dietetics Unit [in the MoH] in an advisory role on the nutritive value of flour blending. We have been working together to develop flour-blending standards and discussing how the initiative is going to be implemented.
Considering that both health and agriculture are devolved functions, at national level our mandate is to develop policies, capacity building to the counties and providing technical assistance where needed. At national level, we have been developing several policies and strategies, but in consultation with the counties because that’s where implementation happens. Once we launch a strategy [such as the Healthy Diets and Physical Exercise] we do not want it to stay at the national level, so we are mobilising resources to accompany the national launch with dissemination at county level. In terms of capacity building, we have been running capacity assessment to identify the gaps and when we identify the gaps, especially in technical areas, we organise training for trainers so that the county is able to cascade the training to the facility level and to the community.
Jane: There is need for a higher-level coordination body to align the joint actions that can actually be done by the ministries mandated to roll out the overarching policy. The ‘higher level’, structures such as the proposed Food and Nutrition Security Council, look promising, but the roll-out needs to be worked out; for example, around resources and the working modalities.
We have two role model counties, Muranga and Nakuru, that have sensitised [their staff] on the agri-nutrition resource manual with stakeholders such as universities and they have contextualised the key messages to their county needs. They used county resources to conduct the sensitisation. Recently we went on a programme of ‘sustainable diets for all’ in Nakuru county and the Members of County Assembly were in the forum discussing agri-nutrition improvement because of the sensitisation. Muranga County Executive Committee is very strong and they are discussing policies the national level had not thought of, such as organic agriculture to ensure food safety and security. This is what the national policy can trigger the county to do - domesticate national policies and use it at the county level.
[Veronica was able to allot more time for the interview, so the following responses outline her thoughts on aspirations for convergence and on the challenges remaining.]
5. Are you seeing an increase in the Government allocation to nutrition in your two ministries? If so, what specifically is the increased budget for?
The MoH has developed a financial tracking tool for the allocation of budgets to nutrition, which is a useful advocacy tool. Finance officers in about eight counties so far have been trained to cost the various activities and interventions. However, we have barely scratched the surface, because there are so many counties that have not been sensitised, but we are currently trying to mobilise resources to roll this out.
6. What other gains are you seeing or hoping for in bringing the two sectors to work more closely together?
When looking at the two sectors, nutrition-specific interventions alone cannot contribute to stamping out malnutrition. We require the food security sector to work with us so closer alignment of the two ministries may help us to realise sustainable gains, because the Ministry of Agriculture will ensure that the food is of the right quality and quantity and that it is safe.
7. What main challenges still remain?
The main challenge is inadequate funding in both health and agriculture; even more so since the Government recently imposed a budget freeze on all departments. The budget allocation [within MoH] for nutrition is very minimal. The Government has been improving the amount for emergency responses but when it comes to the routine nutrition activities, we are currently mobilising resources, which has also been a challenge because you find that most of the partners we have are based in the areas where crises arise. Over half the counties are underfunded in terms of nutrition improvements and this also includes counties with pockets of high malnutrition. These counties have very high needs for interventions, but due to current budget restraints they do not really receive enough of our current services.