Drilling down to sub-national level:                Multi-sector implementation in Kenya, Nepal and Senegal

ENN’s SUN Knowledge Management team

There has been substantial progress in advocating for the scaling-up of multi-sector nutrition programmes through the establishment of coordination mechanisms embedded within national governments. Initiatives like the Scaling Up Nutrition (SUN) Movement are among the catalysts for bringing multiple sectors together.

Countries are being encouraged to develop multi-sector nutrition action plans with targets to reduce malnutrition that engage multiple sectors and stakeholders. Working multi-sectorally and implementing multi-sector activities, however, is not straightforward and many countries experience challenges to bring these approaches to scale.

As part of ENN’s knowledge management (KM) role to support the SUN Movement, in-depth documentation on how multi-sector programmes are being implemented at the sub-national level is being conducted in three SUN countries (Kenya, Senegal and Nepal), focusing on six districts (two in each country).

The choice of diverse countries and districts was intentional in order to highlight how national plans are translated indifferent contexts and to understand how much local direction is put into the rollout of these plans. While the SUN Movement has 60 member countries, in reality this is really many hundreds of regions and districts, all of which play a vital role in determining national nutrition achievements and reaching global targets.

ENN’s regional KM team mapped out the key stakeholders and conducted detailed key informant interviews with people at national and district/county levels. Communities were also visited in each district to see programmes on the ground and interview community workers from the relevant sectors.

Some of the broad questions being asked in this study are:

• How are national multi-sector plans and programmes interpreted and implemented on the ground?

• What happens in highly decentralised and devolved country contexts?

• How is multi-sector action working in practice and how do people at district/implementation level understand it?

• What nutrition-sensitive programmes are being implemented; how and by whom; and what are the successes, lessons learnt and challenges?

What are we learning about multi-sector and nutrition-sensitive programme implementation?

Although ENN is in the early stages of the study, the following important lessons are emerging and will be reported more fully in NEX issue 10 (July 2018) and elsewhere.

First, we are finding that different types of multi-sector programmes are being implemented; those where new components are being added to an existing sectorspecific programme to make it more nutrition-sensitive, and those where new programmes are planned and designed by multiple sectors but, when implemented, may not have convergence (i.e. they are not coming together geographically or in terms of target populations) as sectors work separately to deliver their plans.

In Senegal, the PRN¹ is an example of a nutrition-specific programme (growth monitoring, growth promotion and treatment of moderate acute malnutrition) to which new components are being added to make it more nutritionsensitive. The new components, including social protection, water sanitation and hygiene (WASH) and food security, are being added in certain districts based on needs and availability of funding. In the Matam region, for example, a household food security component is being added to the PRN to support nutritious food and animal production.

The P2RS² programme in Senegal is another example. Implemented in the two regions where ENN’s in-depth analysis is being carried out, P2RS combines nutrition, food security and resilience through four main pillars that include rural infrastructures, forest resources protection, nutrition reinforcement and youth employment, and development of value chains across all sectors. These different components of P2RS are implemented by different ministries such as Agriculture and Environment, but with little geographic or target convergence.

The Multi Sector Nutrition Plan (MSNP) in Nepal has brought sectors closer together at the district level and there are examples of making sectoral activities more nutritionsensitive. For example, the agriculture sector – whose key purpose traditionally is increasing production of staples and raising income – is now looking to provide training on the development of kitchen gardens to improve dietary diversity.

The health sector, which had previously focused on the treatment of acute malnutrition, has now understood the importance of prevention activities through the MSNP approach and now provides counselling on WASH activities (such as promoting handwashing and dietary practices) through its frontline workers.

In some districts there are efforts to implement all newly designed activities from all sectors together in one small geographical area such as clusters of 200-300 households, so that changes can be observed based on results, then replicated.

The targeting process has become very transparent. This has been achieved because the importance of the golden 1,000 days (pregnancy plus first two years of life) has been widely emphasised; the concept has been well understood at all levels through an intensive campaign and is described as the ‘buzz phrase’ now in Nepal. In Kenya the Accelerated Value Chain Development programme (AVCD) has mainstreamed nutrition objectives into agriculture programmes. For instance, Makueni, one of 47 devolved counties, is a drought-prone county where the growth and consumption of nutrient-rich, drought-tolerant cereals and pulses is actively promoted. The inclusion of nutrition into agriculture is done through a shared database of beneficiaries between the Ministries of Agriculture, Health and Education. The Ministry of Agriculture selects beneficiaries who receive agricultural inputs (seeds, training, farming equipment) and this list is then shared with Ministry of Health community health workers, who carry out householdlevel sensitisation of key dietary diversity messages. The Ministry of Education then adopts the same beneficiary list to identify parents of children in early childhood development centres to carry out cooking demonstrations on preparation of the same foods. In this way, the farmer who grows the foods is a beneficiary of both agricultural services and nutrition education services further along the value chain.

Second, we are finding that vertical structures/budgets make convergence extremely difficult and that there is limited evidence that this is changing, although there are meaningful changes going on in relation to targeting and to sectors understanding the importance of their work to nutrition.

The implementation of the Nepal MSNP at the district level was coordinated through the District Development Committee (DDC), where a Food and Nutrition Security Committee was formed. This included MSNP focal points from all sectors and was chaired by the local development officer of the district. This structure, though clearly understood by all, depended too much on the personality of the MSNP focal point. Frequent staff changes have had an impact on the functioning and continuity of activities.

With devolution in Kenya, the County Integrated Development Plan (CIDP) is the document that brings together the different sectors. As it currently exists, this simply consolidates the sector-specific plans, i.e. it does not yet amalgamate the different sector plans. It can therefore be considered an administrative arrangement for consolidating sector-specific plans. Some of the gaps in this include the inability to enable inter-sector accountability; inability to articulate joint monitoring; and inability to provide for joint budgeting. Government budgeting and monitoring and evaluation systems are still sector-specific.

Third, multi-sector collaboration on the ground is often enabled/catalysed by development partners or local partners by making resources available for transport, meetings and coordination, as well as outlining the approach and sensitisation. However, coordination can be both costly and time-consuming, underlining the importance of recognising how long these processes can take and that dedicated resources are needed for coordination to be sustained. This in turn can lead to ‘fatigue’ when there are many cross-sector meetings at district level on nutrition, taking up a significant amount of district-level staff time.

In Nepal the Ministry of Federal Affairs & Local Development (MoFALD), the nodal ministry for district-level implementation, set up programme monitoring units supported by UNICEF-EU and run by a local NGO. These units serve to monitor and nudge the district-level committees to meet frequently and ensure regular financial and activity reporting. Most government stakeholders acknowledged the usefulness of this mechanism; more so because the MSNP budget did not provide for extra staff either at the DDC level or in the different sector departments.

In Kenya the Food Nutrition and Security Policy is a key document that provides a national framework for multisector engagement. Actors from the Ministries of Agriculture and Health operating at the management level in counties and below cite it as a key guiding policy document. However, its implementation framework is yet to be rolled out and the sectors lack inter-sector funding mechanisms.

Fourth, learning by doing is inevitable; therefore there is a need for long-term/sustained efforts and commitment that allow for adaptation to a changing environment, learning from mistakes/course correction, and time for new approaches to ‘trickle down’ and become districtowned and embedded.

Multi-sector approaches can be measured through soft and hard achievements. Soft achievements may be intangible but are crucial for facilitating the promotion and trickling down of the multi-sector programming agenda. It may include key actors buying into the need to work multi-sectorally and being willing to try out a previously untested multi-sector approach. An example is the AVCD-supported coordination meetings in Kenya, which were the first platform where actors from these ministries discussed a programme of joint interest. The soft achievement was in the ministries ‘getting to know’ each other and finding agenda items of interest to both sectors.

¹Programme de renforcement de la nutrition (Nutrition enhancement programme).

²Programme de renforcement de la résilience au Sahel (Sahel resilience enhancement programme).