Nutrition Innovation Lab Process

research: Understanding
processes that support nutrition
program impacts
Shibani Ghosh
Nutrition Innovation Lab- Asia and Africa
Tufts University

Research Questions
How and why large-scale, multi
sector policies and programs achieve
nutrition goals?
How can policy and program
implementation be enhanced to
support both nutrition-specific and
nutrition-sensitive actions?

Program Steps and

Stakeholders

Leroy J L , Menon P J. Nutr. 2008;138:628-629

2008 by American Society for Nutrition

World Bank (2010) What can we learn

from nutrition impact evaluations?
Washington, D.C.

Cross-Policy and donor coordination

Cross-ministry coordination
Sector Coordination
Service Delivery

Legen
d
Mountain Districts

Hill
Terai
Districts

Sentinel

Key Issues in vertical and horizontal

coherence
Individual capacity:
Skills, knowledge, training, experience,
attitudes to multisector actions, nutrition goals, priority
problems
Institutional capacity:
Perceived constraints to multi-sector
collaboration,
resource use efficiency,
System capacity:
Disincentives to
collaboration,
innovation,
Gillespie
et al. (2013) Lancet
Series 2 Paper 4
7
venues for

Questions
Perceived constraints in working
across sectors
Incentives for collaboration across
institutions and sectors
Expected hurdles to multi-sector
coordination
Knowledge and training in nutrition

Methods
Structured open ended
questionnaires
~ 700 interviews (national down to
ward)
Annual surveys
First survey conducted: February to
June 2013
Data entry in process
Preliminary findings: September
2013

Level

Institution/Individual

National

Policy makers, donors, INGOs, academics

Regional

Administrator, RD Health, RD Agriculture, RD

Livestock, RD Education, RD DWS, RD WD

District

LDO, DHO/DPHO, Agriculture, Livestock,

Education, DWS, Chamber of Commerce
Program Office Social Dev Sec DDC, Planning
Off, DDC, Chair NGO federation, NGOs

Ilaka

Health, Agriculture, Livestock,

Edu Resource Center

VDC

VDC Secretary, Health, Agriculture,

Livestock, Education (school teacher), NGOs

Ward

FCHV, Representative Ward Citizen Forum,

Representative MG, Representative
Cooperative/Groups

Analysis
Degree of vertical coherence within sector
Degree of collaboration across sectors
(horizontal concurrence)
Within region, district, VDC, ward

Effect of concurrence and coherence on

variability of outcomes on the ground
(community)
Change in concurrence or coherence over
time (MSNP and program implementation)

Results (Demographics)

Level
Regional
District
Ilaka
Respondent
type
Government
official
NGO official
INGO official
Total

Frequency

Percent

29
278
79

7.5
72
20.5

283
97
6
386

73.3
25.1
1.6
100

Sectors Interviewed
Sector
Local and Social
Development
Health
Agriculture and Livestock
Education
Water Supply
NGO/Private
Total

Valid
Frequency Percent
76
46
89
46
26
103
386

19.7
11.9
23.1
11.9
6.7
26.7
100

Priority Problems

Food Security
Utilization
Production
Disease/Illness
Lack of Education/Awareness
Practices (cultural practices, breast
feeding)
No significant differences in identification
of priority problems

Foodsecurity
Utilization *
Production
Disease/Illnes
s
Practices
Education

Regional
Count
%
15 51.70
22 75.90
16 55.20

*Chi
Square(p=0.0
21)
N=29

16
7
26

55.20
24.10
89.70

District
Count
%
159 57.20
141 50.70
133 47.80
115
83
262

N=278

41.40
29.90
94.20

Ilaka
Count
%
47 59.50
47 59.50
35 44.30
37
18
76

N=79

46.80
22.80
96.20

Disaggregation

Regional

District

Ilaka

P value

Count %
Count %
Count %

De-worming
6 20.70%
22 7.90%
3 3.80%
Lack of
awareness of
supplementary
foods,
micronutrient
deficiencies
4 13.80%
9 3.20%
0 0.00%
High Workload
and lack of
care of children
(hunger)
0 0.00%
42 15.10%
18 22.80%

N=29

N=278

N=79

0.016

0.002

0.014

Consultation (Regional, District,

Ilaka)

Frequency
Percent
Do you feel that your department is sufficiently consulted with on nutrition issues
Sufficient Consultation of
124
Departments/Units (all
All
Levels)

Regional
5

District
Ilaka

InSufficient Consultation of
Departments/units (all levels) All

Regional

Somewhat Sufficient
Consultation

Don't Know

District
Ilaka
All
Regional
District
Ilaka
All
Regional
District
Ilaka

32.1

96
23
188

17.2
34.5
29.1
48.7

16
131
41
60

55.2
47.1
51.9
15.5

6
39
15
14
2
12
14

20.7
14.0
19.0
3.6
6.9
4.3
3.6

Coherence on ease to work

district/region)

Regional

Count %

District
Count

Ilaka
%

p value

Count

Easy

18

62.10

193 69.40

54 68.40 NS

Difficult

11

37.90

78 28.10

24 30.40 NS

N=29

N=278

N=79

Incentives to collaborate (Multi-sectoral)

Regiona
l

Count

District
Count

Ilaka

p
value

Count %
7.60
20 7.20%
6
% 0.449

Support
4 13.80%
Shared ownership
(coordination/goal
33.80
s)
6 20.70%
94
%
Mandatory
Working
mechanism
5
17.2
114
41
Capacity building
(training
4
13.8
44 15.8
Shared resources
18
62.1
142 51.1
Allowance/fiscal
benefits to
N=29
N=278
employees
16
55.2
58 20.9

24.10
19
% 0.119
12

15.2

8
40

10.1 0.444
50.6 0.515

N=79
14

17.7

Disincentives to collaborate (multisectoral)

Regional

Disincentives Count

District

Ilaka

Count %

Count %

p value

Yes

11

37.9

66

23.7

28 35.4

0.048

No

18

62.1

211

75.9

51 64.6

0.058

0.4

Don't Know

N=29

N=278

N=79

0.823

Disincentives to Collaborate
Lack of allowance, fuel/transportation facilities to field, travel
allowances, daily allowances
Lack of interest/motivation
Workload
Workspace environment (includes lack of support from
superior)
Insufficient Resources (finance, HR, budget)
Lack of skills and capacity
Bureaucratic constraints
Political Upheaval
Lack of planning, coordination and implementation
Lack of transparency
Lack of representative

Training and Capacity (Adequate

Training)
Within your own department

Yes
Yes but
need
refreshe
r
training
No

Local
Development
and Social
Agriculture and
Water
NGO/private
Development
Health
Livestock
Education
Supply
sector

Count
%
Count %
Count %
Count %
Count %
Count %
25 32.90
27 58.70
30 33.70
23 50.00
17 65.40
72 69.90

16 21.10
35 46.10

p=0.000

10 21.70
9 19.60

24 27.00
35 39.30

11 23.90
12 26.10

6 23.10
3 11.50

11 10.70
20 19.40

Training and Capacity

Within other departments

Yes
Yes but
need
refresher
training
No
Don't
know

Local
Developme
nt and
Social
Developme
nt
Health

Agriculture
and
Water
NGO/private
Livestock
Education Supply
sector

Coun
Coun
Count %
Count %
Count %
t
%
t
%
Count %
22.4
32.6
34.8
17
0
15 32.60
29
0 16
0
11 42.30
35
34.00

6 7.90
53.9
41
0
15.8
P=0.002
12
0

6.50

12

26.10

16

34.80

20.2
18
0
29.2
26
0
18.0
16
0

10.9
5
0
26.1
12
0
28.3
13
0

7.70

11

10.70

6 23.10

44

42.70

7 26.90

13

12.60

Conclusions
Some coherence observed across levels
More coherence between district and ilaka
Priority problems
Incentives to collaborate

More coherence between region and ilaka

Dis-incentives to collaborate

Training and capacity concurrence (within)

Health, education and water sector, NGO and
local private sector
Agriculture, local and social development sectors

Conclusions
Training and capacity (in other departments)
Local development and NGO/private sector
Agriculture, health, nutrition, water and
sanitation

Continued analyses
Refining
Coherence by specific region, district, ilaka, ward,
VDC
Concurrence by sector at each level
Linking to outcomes data and program
monitoring data

Research Team

Patrick Webb
Kedar Baral
Eileen Kennedy
Shibani Ghosh
Diplav Sapkota
Sriju Sharma
Valley Research Group (survey firm)