Despite high levels of political will to address hunger and undernutrition at the national level, in many countries coordination and programming at the sub-national level remains challenging. While more and more countries are setting targets to address maternal and child malnutrition in order to achieve World Health Assembly targets, there are few examples of sub-national nutrition targets or targeted advocacy occurring at the sub-national level.
At this year’s African Day for Food and Nutrition Security, held in Accra, Ghana, from the 26-28 October, IDS and the New Partnership for African Development (NEPAD) hosted a workshop to explore opportunities for, and constraints to, conducting advocacy for improved nutrition at multiple levels of government. The workshop explored how existing initiatives can build upon and support each other to ensure high levels of government commitment to nutrition at the district, national, regional and international levels.
Moving up from national to subnational nutrition advocacy
Meeting national level nutrition targets will not simply happen without government commitment and accountability mechanisms. Tools are needed which allow civil society, and governments themselves, to measure actions taken to address hunger and undernutrition, allowing for greater accountability at the sub-national level, where many decisions around nutrition programming take place.
Advocacy at the sub-national level for improved nutrition
For the last three years IDS has been producing the Hunger and Nutrition Commitment Index (HANCI), which seeks to rank countries on their political commitment to addressing issues of hunger and undernutrition. The index looks across three broad categories of laws, policies and spending to rank countries according to specific actions they have taken to address hunger and undernutrition. The index has been used by partners in five countries (Tanzania, Malawi, Zambia, Bangladesh and Nepal) to inform national level advocacy messages.
However, one comment often made by participants in workshops was that often high levels of national commitment were not being matched by commensurate government commitment at the sub-national level.
Bringing the country level back down to districts
Building on this idea, IDS, in collaboration with the Partnership for Nutrition in Tanzania developed scorecards which measure government commitment to nutrition at the district level. This work builds upon other similar initiatives such as the district nutrition scorecards developed by the International Food Policy Research Institute (IFPRI) for five Indian states to monitor progress at the district level and spark a discussion around why rates of malnutrition are so high and what potential solutions might be.
To ensure that these scorecards captured the correct information, they worked directly with district officials from different sectors including, health, education, planning, water and sanitation and finance to compile a list of potential indicators. This was then shared with district officials who contributed to the indicators, especially in answering critical questions such as:
- Is the data available at the sub-national level?
- Is this something the district itself can control?
- Do you think it is a good indicator of district level commitment?
Reflections on opportunities for and constraints to multilevel advocacy
Participants at the African Day for Nutrition and Food Security in Accra also shared their experiences of opportunities and constraints for multilevel advocacy, including the need for more district level accountability mechanisms.
Some of the challenges participants identified included:
- The invisibility of malnutrition issues such as stunting and anaemia. People are not aware of nutrition being a problem in their community and thus are not pushing their elected officials for more services.
- Budget allocation for nutrition. Because nutrition is multisector, nutrition budgets sit in many different departments, but are not usually the priority area for that department. This means nutrition budget lines are often the first to be cut.
- There is often poor data availability at the district level, and large nutrition surveys such as the demographic and health survey can only be disaggregated at the regional level. Because data which is collected is usually only used to report upwards, often those at the district level don’t see the point in collecting data as it may not have direct impact in their programmes.
Moving forward, it’s critical to make sure that political will to tackle undernutrition is being effectively translated to the sub-national level and into policies and programmes for the most affected communities. This will enable communities themselves to become advocates for themselves.