Multi-sector programmes at the sub-national level: Insights from Ethiopia and Niger
ENN’s SUN Knowledge Management team
As part of ENN’s knowledge management role to support the Scaling Up Nutrition (SUN) Movement, in-depth documentation on how multi-sector programmes (MSPs) are being implemented at the sub-national level began in 2017, initially in Kenya, Senegal and Nepal1 . In 2018, ENN conducted additional case studies in Ethiopia and Niger. Countries were selected based on either national progress in reducing undernutrition; the presence of multi-sector structures and strategies at a national and sub-national level; or evidence of large-scale, multi-sector implementation at sub-national level. Although programming looks very different in each of these countries, they offer examples of how to develop coordination structures to enable MSPs at a sub-national level.
In Ethiopia, ENN, with the support of the Government of Ethiopia (GoE), examined sub-national developments in relation to the Seqota Declaration, a commitment made by the GoE in 2015 to end stunting among children under the age of two by 2030. In Niger, ENN looked at the ‘Commune de Convergence’ (C2C) approach, which offers a promising example of how the Government of Niger and partner agencies can improve convergence and multi-sector collaboration by working through communes (the lowest level of governance in the country).
The Seqota Declaration
The main goal of the Seqota Declaration (SD) is zero stunting among children under two years of age by 2030. The SD is implemented by six sectoral ministries: Agriculture and Natural Resources; Livestock and Fishery Resource Development; Health, Water, Irrigation and Electricity; Education and Labour; and Social Affairs. Their activities are aligned to the second National Nutrition Plan (2016-2020) and are being piloted in 33 woredas (districts) in two regions (Amhara and Tigray) and involve six innovations to accelerate the delivery of existing evidence-based interventions. The innovations (outlined below) were selected based on global experience of successful delivery of stunting prevention approaches, as well as gaps identified during the final review of the first National Nutrition Plan (2008-2015):
- A coordination team, known as the Programme Delivery Unit, consists of multi-sector experts at both a federal and regional level and employs advisors to regional presidents to ensure that nutrition remains a priority;
- Community Labs in which communities are able to contextualise solutions to problems through a participatory approach;
- Web-based data platforms to facilitate the monitoring and evaluation of multi-sector interventions and create a data revolution in Ethiopia;
- Demonstration farms, known as Agriculture Innovation and Technology Transfer Centres, that aim to improve the nutrition outcomes of the agriculture sector;
- Developing local level/woreda-based costed multi-sector plans;
- Utilising a ‘First 1,000 days plus public movement’ approach in which critical sociocultural barriers to undernutrition prevention are identified and utilised for opportunities to intervene.
Added to the innovations, another key difference between the Seqota Declaration and other multi-sector programme approaches in Ethiopia is the political ‘face’ that has been mainstreamed into its day-to-day roll-out. Having regional presidential sign-off on the SD and the appointment of advisors at this level have both enabled political buy-in to the SD agenda at the sub-national level that has so far ensured nutrition remains a political priority at regional level.
The communes de convergence (C2C) approach
The C2C approach was rolled out in 35 pilot communes over a four-year period from 2013- 2018, led by the UN agencies and the ‘ les Nigeriens nourrissent les Nigeriens’ (3N initiative), a high-level government body mandated to coordinate nutrition across different sectors and implementing agencies in the country. Communes were selected based on vulnerability. The core concept of the approach involves each commune developing its own annual plan through a consultative process, bringing together all the main agencies involved in implementing nutrition activities in that commune. This is formalised into a commune plan, which aims to provide a complete picture of what is to be done, how much each agency is committing to spending on what, which specific activities are to be carried out, and a timeline. The UN has played a critical and central role in developing and designing the C2C, including changing its own ways of working to support the convergence approach. Government partners, implementing actors and UN agencies worked together to design and plan nutrition programmes to be delivered in the chosen communes.
While, as expected, the two approaches to MSP differ greatly between Ethiopia and Niger, certain similarities emerged that are worth highlighting:
1. Government priorities are gradually being seen to influence partner and sector planning: Evidence of increased government cohesion, as realised through the development of joint policies and plans, seems to have influenced many partners to reflect government’s priorities in their own plans. In Ethiopia a number of implementing partners identified the need for breaking down their future plans by woreda and using government timelines. This alignment has been attributed to the political framework of the SD. In Niger the C2C approach compelled agencies to combine individual plans and activities, which in turn enabled them to reduce duplication and address coverage gaps.
2. Interventions proposed in multi-sector plans are similar, but convergence at the household level is challenging at times: Proposed interventions outlined for each sector in these multi-sector plans were similar between the two countries. For example, in the C2C approach, water, sanitation and hygiene (WASH) interventions focused on community-led total sanitation, improving drinking water and water and sanitation facilities in schools and health centres. Similarly, the SD focused on increasing coverage of safe and adequate water supplies.
- In both countries the multi-sector plans enabled joint planning at a local level in relation to these interventions. By undertaking shared work plans, the health, agriculture, livestock and education sectors in Ethiopia were able to use a shared beneficiary list of vulnerable children. This enabled a convergence of services to the most vulnerable in the communities. In Niger the C2C offered a platform for stakeholders, particularly UN partners, to plan together and implement in a more coordinated and aligned manner. The focus on a local level further facilitated the development of context-specific services that were appropriate to each commune. However, while the plan enabled convergence of interventions at the commune level, it did not result in convergence of interventions at the household level due to different targeting criteria; thus, it is critical for multi-sector nutrition plans to consider joint targeting to converge interventions to reach the most vulnerable households.
3. The level of multi-sector engagement is varied: The level of engagement of the different sectors and implementing partners varies between the countries. In Ethiopia this has been based on the prior existence of nutrition-sensitive plans and the presence and availability of nutrition staff in other sectors, such as agriculture. An over-reliance on non-governmental institutions for implementation was noted in Niger, given the limited resources available to government.
4. Monitoring and evaluating plans are challenging: In both Ethiopia and Niger, monitoring and evaluating multi-sector plans remains a challenge. In Ethiopia the need for a ‘data revolution’ was recognised. However, it was hampered by a lack of consistency in terms of indicators collected and frequency of data collection across the sectors. As a means of mitigating this, quarterly and six monthly review meetings were held that enabled sectors to jointly appraise their progress.
- In Niger M&E mechanisms to measure impact had not been given sufficient consideration at the time ENN documented the learning. There was no visible alignment across M&E systems in the C2C and, while a baseline survey was conducted, a mid-term survey was not carried out. Thus, while there is a broad understanding or widely held view that the C2C approach has improved the nutrition situation in the country, it is not possible through data evidence to say whether this has been the result of the C2C approach or other activities.
5. Understanding the financial aspects of multi-sector plans is critical: In Ethiopia ensuring financing for the SD has been critical. One of the initial actions was to develop a detailed cost for the Declaration’s innovation phase (estimated to cost US$538 million). Based on the costed woreda-based plans, the Government has contributed an estimated 37.2% thus far, with partners contributing an estimated 14%. Although there has been good progress in this area, there is still an absence of a routine, GoE-embedded system to monitor and track funding and financing remains a challenge. In Niger most of the funding for the C2C approach has been funnelled directly to national and international NGOs and UN agencies, rather than through government, who have no oversight of the funds. This is reported to have created distrust between government and UN agencies, which at times is viewed as having impacted the quality of C2C implementation.
Following these two case studies, a third case study on Bangladesh was conducted examining the enabling environment for implementing the country’s second National Plan of Action for Nutrition (NPAN 2). Further information can be found here.
Footnote
1www.ennonline.net/nex/9/mspkenyanepalsenegal