Strengthening nutrition coordination and advocacy in Papua New Guinea: Role of the SUN Pooled Fund

Published:

26 March 2020

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Otto Tean is National Coordinator of the Nutrition Programme Management Unit (NPMU) and the Papua New Guinea (PNG) SUN country Focal Point. He has worked for the Department of National Planning and Monitoring for almost 20 years in the Project Implementation Programme wing.

Sahr Nouwah is the Senior Advocacy Coordinator for Save the Children in PNG and coordinator of the SUN Movement Civil Society Alliance in the country.

Douglas Apeng is a public health practitioner and Director of SUSU Mamas, a national civil society organisation, with experience working for both provincial health authorities and international organisations in PNG.

Tony Basse is the Deputy Director of Curative Health (Districts) in the Eastern Highlands Provincial Health Authority, where he manages clinical functions in rural health facilities.

Introduction

Papua New Guinea (PNG) is a country in Oceania that occupies the eastern half of the island of New Guinea and its offshore islands in Melanesia, a region of the southwestern Pacific Ocean. The population of eight million is one of the most culturally diverse in the world and one of the most rural. Only 18% of people live in urban centres and the majority still live in strong traditional social groups based on farming.

PNG is experiencing a serious problem of malnutrition. As of 2010, the prevalence of under-five stunting is nearly 50%, which is twice the developing-country average of 25%¹. The wasting prevalence of 14% is also greater than the developing-country average of 8.9%¹. Among the under-five population, the national prevalence of overweight is 13.7% (2010), which has increased significantly from 3.4% in 2005¹. Meanwhile, nearly 26% of women and 17% of men are obese¹.

Catalysing action in PNG

In 2016, PNG joined the Scaling Up Nutrition (SUN) Movement and embarked on a number of initiatives to tackle the country’s malnutrition crisis. The Government, with support from development partners, developed the first National Nutrition Policy (NNP) (2016-2026), a policy process that brought together multiple stakeholders³. To build on these efforts, nutrition actors applied for the SUN Movement Pooled Fund (see Box 1) in order to strengthen nutrition coordination efforts and mount an advocacy campaign for increased investment⁴.

Box 1 What is the SUN Movement Pooled Fund?

The SUN Movement Pooled Fund (2018-2020)² was set up as a last-resort, catalytic source of grant funding to support SUN Civil Society Alliance (CSA) activities at the national and sub-national level. The grants were administered by the United Nations Office for Project Services (UNOPS). Recommendations from the SUN Civil Society Network members, the SUN Movement Strategy and Roadmap (2016-2020), and the lessons learned from the SUN Movement Multi-Partner Trust Fund informed the design of the grant programme.

Window II of the Pooled Fund (2019) aims to strengthen linkages and joint collaboration in the multi-sector/ stakeholder platform at both the national and sub- national level (funding for Window II has now closed).

With initial funding of USD113,000 for 12 months, the Pooled Fund has enabled the formation of a SUN CSA and advocated for the appointment of the SUN Focal Point (SUN FP), based in the National Planning Department. The CSA aims to ensure that local civil society organisations (CSOs) contribute to nutrition policy and action plans, while also advocating for funding to implement and monitor commitments already made in nutrition plans. The CSA was formed with 39 members from both national and provincial level. Until now, the Project Management Unit has held ad hoc meetings, but the Pooled Fund project is advocating for stakeholders to establish a SUN multi-stakeholder platform coordinated by the SUN FP.

Developing a costed action plan

Another milestone is the development of a costed National Nutrition Strategic Action Plan (NNSAP) (2018-2022), which prioritises nutrition interventions that focus on the first 1,000 days of life, the treatment of acute malnutrition, and improving infant and young child feeding practices: there are currently no national programmes treating severe acute malnutrition, only fragmented activities implemented in a few selected provinces. Other sectoral approaches in the NNSAP include programmes to incentivise water and sanitation practices and those that promote dietary diversity. The activities in the plan cover the first three objectives of the NNP (2016-2026): governance, coordination, communication, partnerships, M&E and research; building nutrition capacity; and prevention and treatment of undernutrition. The country’s high prevalence of overweight and obesity are not currently being addressed through the plan, but will be integrated and mainstreamed in other programmes in the future.

Creating sub-national linkages to strengthen coordination

One of the most successful aspects of recent nutrition advocacy in PNG is the forging of much-needed links between national and sub-national government stakeholders. Leadership and accountability for malnutrition reduction in the country has been weak to date, but attention is now focused on six out of 22 provinces in which to strengthen multi-sector coordination, collaboration and joint nutrition actions through rollout of the NNSAP. The inclusion of sub-national stakeholders such as members of the SUN CSA at the planning stage has contributed to provincial government providing ownership and leadership for nutrition, as described below.

The six target provinces have been selected based on mixed criteria (high levels of malnutrition, local capacity, potential for improving dietary diversity, etc.) and include a range of highland and coastal provinces with active CSOs in order to inform the learning process. The CSA has collaborated with provincial authorities (especially the health authorities) in conducting nutrition-advocacy workshops for CSOs and district-level decision-makers in Jiwaka and Eastern Highlands provinces. For example, in Jiwaka province, work with women’s groups via this training led to the establishment of a provincial nutrition committee, a model that will be replicated in the other provinces. An important part of the work of these committees is to submit funding proposals to sub-national government to undertake nutrition activities. By the end of 2020, the sub-national and national budgets are expected to include fiscal budgetary lines that directly fund multi-sector platform activities specified in the NNSAP.

Budgetary challenges

While the sub-national developments are encouraging, a 2018 Government budget analysis in PNG found that little was being spent or currently allocated to nutrition. There are signs of serious challenges; for example, the current NNSAP, with its focus on Objectives 1-3 of the NNP (2016-2026) will cost more than USD120 million. Further advocacy is needed to increase investments for the remaining four objectives of the NNP (including tackling micronutrient deficiencies and overweight and obesity). To sustain current efforts through the SUN Pooled Fund, there is an urgent need for high-level political commitments, culminating in funding from government and donors.

Lessons learned

Key lessons to emerge from the SUN Pooled Fund project concern budgets and cost sharing, including the experience that most efforts are more locally driven than national. For instance, advocacy efforts have been more fruitful at convincing provinces to allocate a budget line to nutrition than at national-government level. In the future, the focus of budget advocacy will continue to be on provincial departments, while national budget advocacy will focus on highlighting the need to accept provincial nutrition budgets. In addition, coordinating with other organisations has been found to provide a big dividend, reducing duplication of activities and increasing joint actions.

Next steps

A number of key actions going forward into 2020 have been identified, although these will need additional funding, support and technical guidance if they are to be achieved. Efforts will focus on establishing a national nutrition multi-stakeholder platform and similar platforms at provincial level; developing a monitoring and evaluation framework; setting up SUN networks for academia and business; and securing urgent increased investment in nutrition from the Government and the donor community.