Decentralising nutrition management and coordination in Chad
Mohamed Cheik Levrak is the international REACH facilitator in Chad, building on his REACH experience as the national facilitator in Mauritania. Before that he worked for 17 years in the Ministry of Planning in Mauritania, mainly on policy/strategy and capacity building.
Dimanche San San worked with Mohamed Cheik Levrak as national REACH facilitator. He was a former director of the Learning Centre for Nutrition for the World Vision Regional Office in West Africa
Background
Chad joined the REACH initiative1 in 2012 and the Scaling UpNutrition (SUN) Movement in 2013, confirming the country's recognition of nutrition as an essential factor in its development. In 2015 it adopted a National Food and Nutrition Policy (NFNP 2014-2025) and in 2017 adopted an Inter-sector Food and Nutrition Action Plan (IFNP). Their purpose is to establish a clear vision to reduce various forms of malnutrition by improving coordination and the scale-up of effective nutrition inteventions that are both targeted/specific and sensitive.
A Permanent Technical Food and Nutrition Committee (PTNC, or Permanent Committee) was established in 2014 following a prime ministerial decree instituting the national nutrition coordination and management system. The system includes the National Food and Nutrition Committee (NFNC), led by the Prime Minister; the PTNC, led by the SUN Focal Point hosted in the National Nutrition and Food Directorate (DNTA); and the Regional Food and Nutrition Committees (RFNCs), led by regional governors.
Of the above coordination mechanisms, the Permanent Committee is functioning well, with meetings convened regularly. All relevant sectors and actors as well as the respective SUN networks are represented in the PTNC. The SUN Government Focal Point, the Director of the DNTA, presides over the Permanent Committee. The PTNC has an annual action plan which is regularly monitored through status reports provided in monthly meetings. Despite the progress made in nutrition coordination at the national level, the regional coordination mechanisms are not functioning.
Decentralising nutrition
Five RFNCs were created in October 2016 (in the regions of Logone Occidental, Tandjilé, Wadi Fira, Ouaddai and Guera) as part of efforts to operatinalise the nutrition coordination architechture. They were chosen as pilots to test the regional committees, which will be extended to other regions if successful. The pilot regions all have high rates of malnutrition, but they were also selected due to the existing presence of multiple stakeholders and are targeted by the European Union 11th Development Fund (11e FED).
The mission of the RFNCs is to coordinate and facilitate implementation of the National Food and Nutrition Policy; specifically, to ensure a coherent multi-sector approach. Their performance varies by region, although it is too early to draw concrete conclusions. The committees of Ouaddai, Western Logone and Wadi Fira have convened several times to explore prospects for integrated programming. The other regional committees have not progressed, underscoring the need for REACH support at the regional level.
The RFNCs have generally not functioned very well to date, due to the following factors:
• Coordination with different actors. People are used to working in their individual sectors and it is challenging to bring them together to work on common objectives;
• Weak governance and coordination. There is a strong need for capacity building of government institutions for managing and coordinating multi-sector programmes and multiple actors;
• Lack of human resources to conduct the work. Each sector has its own action plan and related staff, but dedicated staff are also needed to coordinate all the sectors; and
• Lack of financial support. According to the 2017 Global Nutrition Report, the Government of Chad allocates 19 per cent of its budget to nutrition, but funding is a real challenge and is primarily based on traditional agencies such as international NGOs and UN agencies operating at the regional level. These agencies fund specific activities, which are mostly focused on humanitarian interventions2.
After ten months of their establishment, the five RFNCs were granted Focal Points (FPs) through an ordinance of the Ministry of Public Health in 2016, tasked with promoting and operationalising the REACH facilitation-based, multi-sector approach at the regional level.
REACH support
REACH offers neutral facilitation, coordination and analytical services on nutrition at the country level. It catalyses SUN processes thanks to its impartial facilitators, who are dedicated to supporting the SUN Focal Point and other government officials and representatives with multi-sector and multistakeholder coordination, including that of the various SUN Networks. The REACH facilitators are also able to leverage and apply lessons learned from REACH engagements in other countries in the region, such as Mauritania and Niger. This includes tactics and tools (e.g. Dashboard) to help raise awareness among actors working in different nutrition-related sectors and engage them in policy formulation and nutrition planning. In addition, REACH has provided guidance on the country’s nutrition coordination architecture and institutional arrangements, both at the central and decentralised levels, as well as the links between the two.
The REACH engagement in Chad was initiated at the national level. Among other functions, it actively supported the establishment of the SUN Networks and the formulation of their respective work plans. The mediation and networking skills of the REACH facilitators helped bring together the diverse actors for a common goal. To this end they shepherded the development of a common work plan for all the SUN Networks. Thanks to new EU funding, the REACH approach has been replicated at the regional level this year in an effort to support the operationalisation of the national nutrition policy and plan and address the coordination challenges at regional level.
In collaboration with DNTA, REACH organised a training for RFNC Focal Points in August 2017 to give impetus to regional processes. The workshop unpacked the terms of reference of the RFNC Focal Points and equipped them with expertise required for effective multi-sector coordination at the regional level. A process was then initiated to develop a common work plan for the RFNCs, again with the support of REACH. Joint monitoring missions in September 2017 aimed to facilitate the work of the five RFNC Focal Points and were supported by REACH. The missions also included discussions with RFNC members on coordinating and managing nutrition across sectors and how to bridge their work with ongoing national coordination; i.e. the roles that the RFNCs will have to play to implement the national nutrition and food policy and plan in their regions. Mission participants also discussed details of mobilising resources, advocacy and joint programming.
Emerging lessons on regional coordination
The launch of the RFNCs has been a participatory process that requires actors to develop a sufficient understanding of their roles and responsibilities in promoting the multi-sector, multi-stakeholder approach to nutrition. However, RFNC effectiveness largely depends on the leadership skills of the regional governor, where the RFNC Focal Points are hosted, and the representative of the public health services, who assumes the role of RFNC secretariat.
Next steps
Now that Focal Points for the five pilot RFNCs have been recruited and trained in coordination, REACH will continue to support them. A nutrition capacity assessment will be launched in early 2018 with the support of REACH which will cover both technical and functional capacities. Functional capacities refer to the management skills that enable national and regional actors to plan, manage, adapt and maintain technical capacities, irrespective of a given sector or organisation. The assessment of functional capacities will be organised in close collaboration with government institutions. This assessment will in turn inform the formulation of a capacity development plan for nutrition, which will be integrated into the joint RFNC action plan.
Some challenges can be solved at the regional level (for example, a clear understanding of the roles and tasks required to coordinate nutrition regionally and locally, as well as the roles of the RFNC Focal Points). Others can be addressed at the national level (such as the need for a deeper understanding of nutrition policy provisions and strategies for implementing them, leading to more effective multisector efforts in the fight against malnutrition). As part of the REACH engagement, the links between the coordination efforts and mechanisms at national level (e.g. SUN Focal Point) and the RFNC Focal Points will be strengthened. An official secretariat of the PTNC/NFNC will also be established to reinforce the PTNC’s important coordination role. The new secretariat will be led by the SUN Focal Point in order to track progress, support the organisation of both the PTNC and NFNC meetings and liaise with the various RFNCs.
1REACH (Renewed Efforts against Child Hunger and undernutrition) is a country-centred, multi-sector approach to help strengthen national capacities for nutrition governance. It works in collaboration with nutrition coordination structures and SUN Networks, including the UN Network.
2This is being taken into account in trying to include long-term development interventions and funding for joint action plans. Furthermore, the possibility of better linking humanitarian and development programmes was discussed as part of UN strategic planning and was captured in the country’s new joint UN Nutrition Agenda, likewise facilitated by REACH.