Understanding the role of intersectoral convergence in the delivery of essential maternal and child nutrition interventions in Odisha, India: a qualitative study.

BACKGROUND: Convergence of sectoral programs is important for scaling up essential maternal and child health and nutrition interventions. In India, these interventions are implemented by two government programs - Integrated Child Development Services (ICDS) and National Rural Health Mission (NRHM). These programs are designed to work together, but there is limited understanding of the nature and extent of coordination in place and needed at the various administrative levels. Our study examined how intersectoral convergence in nutrition programming is operationalized between ICDS and NRHM from the state to village levels in Odisha, and the factors influencing convergence in policy implementation and service delivery. METHODS: Semi-structured interviews were conducted with state-level stakeholders (n = 12), district (n = 19) and block officials (n = 66), and frontline workers (FLWs, n = 48). Systematic coding and content analysis of transcripts were undertaken to elucidate themes and patterns related to the degree and mechanisms of convergence, types of actions/services, and facilitators and barriers. RESULTS: Close collaboration at state level was observed in developing guidelines, planning, and reviewing programs, facilitated by a shared motivation and recognized leadership for coordination. However, the health department was perceived to drive the agenda, and different priorities and little data sharing presented challenges. At the district level, there were joint planning and review meetings, trainings, and data sharing, but poor participation in the intersectoral meetings and limited supervision. While the block level is the hub for planning and supervision, cooperation is limited by the lack of guidelines for coordination, heavy workload, inadequate resources, and poor communication. Strong collaboration among FLWs was facilitated by close interpersonal communication and mutual understanding of roles and responsibilities. CONCLUSIONS: Congruent or shared priorities and regularity of actions between sectors across all levels will likely improve the quality of coordination, and clear roles and leadership and accountability are imperative. As convergence is a means to achieving effective coverage and delivery of services for improved maternal and child health and nutrition, focus should be on delivering all the essential services to the mother-child dyads through mechanisms that facilitate a continuum of care approach, rather than sectorally-driven, service-specific delivery processes

Understanding Drivers of Stunting Reduction in Nigeria from 2003 to 2018: a Regression Analysis

Nigeria is a high burden country for stunting. Stunting reduction has been slow and characterized by unequal progress across the 36 states and federal capital territory of the country. This study aimed to assess the changes in prevalence of stunting and growth determinants from 2003 to 2018, identify factors that predicted the change in stunting, and project future stunting prevalence if these predicted determinants improve. Trend and linear decomposition analyses of growth outcomes and determinants were conducted using 2003, 2008, 2013, and 2018 Nigeria Demographic and Health Survey data. Pooled data included 57,507 children 0 to 59 months old. Findings show that stunting and severe stunting significantly reduced from 43 to 37% and 23% to 17%, respectively (p < 0.001), between 2003 and 2018. Disturbingly, height-for-age z-scores at birth significantly decreased, indicating risks of potential future stunting increase. Improvements in nine stunting determinants (maternal body mass index, maternal height, ≥ 4 antenatal care visits, health facility delivery, reduced child illnesses, asset index, maternal education, paternal education, and preceding birth interval) predicted stunting reductions in children 0–59 months. Few of these nine determinants improved in subpopulations with limited stunting progress. Intra-sectoral and multisectoral coordination were potentially inadequate; 12% of children had received all of three selected health sector interventions along a continuum of care and 6% had received all of six selected multisector interventions. Forward looking projections suggest that increased efforts to improve the nine predictors of stunting change can reduce under-five stunting in Nigeria to ≤ 27% in the short term.Bill and Melinda Gates Foundatio

Stories of Change in Nutrition: Lessons from a New Generation of Studies from Africa, Asia and Europe

How does nutrition improve? We need to understand better what drives both positive and negative change in different contexts, and what more can be done to reduce malnutrition. Since 2015, the Stories of Change in Nutrition studies have analysed and documented experiences in many different African and Asian countries, to foster empirically-grounded experiential learning across contexts. This article provides an overview of findings from 14 studies undertaken in nine countries in South Asia, sub-Saharan Africa, and Europe between 2017 and 2021. The studies used a combination of methods, including regression-decomposition analyses of national datasets to assess determinants of nutritional change; policy process and food environment analyses; and community-level research assessing attitudes to change. This article takes a narrative synthesis approach to identify key themes across the studies, paying particular attention to multisectoral determinants, changes in the food environment, the role of structural factors (including longstanding social inequities), and changes in political commitment, cross-sectoral coherence and capacity. Given the inherent multisectoral nature of nutrition, many countries are experimenting with different models of ensuring coherence across sectors that are captured in this body of work. The relative immaturity of the policy sector in dealing with issues such as obesity and overweight, and associated influences in the wider food environment, adds a further challenge. To address these interrelated issues, policy must simultaneously tackle nutrition’s upstream (social/economic/equity) and downstream (health and dietary) determinants. Studies synthesised here provide empirically-driven inspiration for action.Bill and Melinda Gates Foundation (BMGF) Grant No. OPP1170621

Leveraging agriculture for nutrition in South Asia: What do we know, and what have we learned?

Despite significant improvements over recent decades, rates of undernutrition remain high in South Asia, with adverse impacts on morbidity and mortality. Overweight/obesity, among children and adults, is now an additional and major public health concern. While agriculture has the potential to improve nutrition through several pathways, this potential is currently not being realised in the region. The Leveraging Agriculture for Nutrition in South Asia (LANSA) research consortium (2012–2018) set out to improve understanding about how agriculture and related food policies and programs in South Asia (specifically in India, Bangladesh, Pakistan and Afghanistan) can be better conceptualised and implemented in order to enhance impacts on nutrition outcomes, especially those of young children and adolescent girls. This paper provides a snapshot of the agriculture-nutrition nexus in the region, outlines the pathways through which agriculture can influence nutrition outcomes, elaborates on the objectives of the LANSA research consortium within this context, and highlights the core findings of the six papers that form the body of this Special Issue. The paper ends with five key lessons that have emerged from this research, during this decade

Leveraging agriculture for nutrition in South Asia and East Africa: examining the enabling environment through stakeholder perceptions

South Asia and sub-Saharan Africa are the two regions of the world with the highest concentration of undernutrition. The majority of the nutritionally vulnerable populations in both regions is dependent in some way upon agriculture as a primary source of livelihood. The agriculture sector and wider agri-food system is considered to be central to sustained progress in reducing undernutrition – and yet not enough is known about how to unleash this potential. Recent scoping assessments have also revealed a paucity of information on wider political, institutional and policy-related challenges relating to the agriculture-nutrition nexus globally. Contextualized research into policy processes and the political economy of agriculture and nutrition is needed to better characterize “enabling environments” for agriculture to benefit nutrition, and how these environments can be shaped and sustained. This study aims to contribute to filling this gap, by drawing upon evidence from a set of case studies in South Asia (India, Bangladesh and Pakistan) and eastern Africa (Ethiopia, Uganda and Kenya). In synthesizing results across countries, while recognizing important nuance and detail, we conclude by highlighting four key issues to be addressed. First, improving knowledge and perception of undernutrition and its links to agriculture, on the part of agricultural policymakers and programme managers. Second, generating system-wide incentives for decisions and actions to become more pro-nutrition. Third, developing transparent systems of accountability for nutrition-relevant action throughout the agriculture sector, through linking timely and actionable data and evidence with incentives. And fourth, cultivating and strengthening leadership and capacities at different levels, underpinned by adequate financing.UK AidDepartment for International Development (DFID

Discursive trends and their socio-ecological implications in Senegal's renewable energy turn

By 2025, Senegal's energy mix will have shifted from one reliant on heavy fuel oil to one consisting primarily of solar and wind energy as well as liquefied natural gas. The expectation is that this will lead to lower greenhouse gas emissions, more affordable power, and broad-based growth and development. Despite the necessity of a transition to renewable energy, scholarship in critical energy geographies has cautioned that such a transition could (re)produce socio-environmental injustices. Yet only a relatively small (but growing) number of studies in the political ecology of renewable energy literature examines how energy transitions are framed and justified as part of national-level narratives in the global South. Understanding this is critical because framing (renewable) energy in relation to national development objectives is a strategy central to the material development of renewable energy projects. Through a case study of Senegal, this paper examines the national-level discourses that underlie the country's turn towards utility-scale renewable energy by analyzing key documents and institutional interviews (carried out between 2018 and 2020). Findings show that a dominant group of development actors along with state institutions mobilizes a “grand narrative” on economic growth and poverty reduction vis a vis renewable energy development to facilitate a shift to renewables that rests on market logics, with questionable implications for equity and justice. The paper reflects on the implications of this narrative for the potential of a just energy transition in Senegal, as well as the broader theoretical and empirical implications of the research