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Multi-sectoral nutrition programming; exploring impact

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This is a summary of the following article: Ogada E, Bahwere P, Lelijveld N, Sessions N, Desplats G & Khara T (2021) Multi-sectoral nutrition programming – exploring impact. ENN, Oxford, UK. Available at: https://www.ennonline.net/mspexploringimpact

Multi-sector nutrition programmes (MSNPs) have gained increasing prominence over the last two decades to address the many direct and underlying determinants of malnutrition. Both the recent Lancet Maternal and Child Undernutrition Progress series1 and the Lancet Series on Adolescent Nutrition2 stress the importance of effective multi-sector programmes to prevent and tackle malnutrition at every life stage. However, there are still large gaps in our knowledge on the efficacy, effectiveness and impact of multi-sector approaches compared to single sector interventions, due to limited information on appropriate methods for monitoring and evaluating MSNPs.

This report synthesises the available evidence on the impact of MSNPs and documents the type and quality of monitoring and evaluation systems established to measure impact. The authors conducted a systematic search to identify relevant evaluation reports, programme implementation reports, programme description documents, programme proposals, research reports, peer-reviewed publications, systematic reviews and meta-analyses, and country assessments and case studies.

The authors found that most evaluations were of the pre- and post-test design with no comparison group. Even the most rigorously designed evaluations noted the difficulty in attributing any or all impacts on the outcome indicators to the intervention alone. Secondary nutrition outcomes (such as household dietary diversity scores, food insecurity scores, indicators of infant and young child feeding (IYCF) and water, sanitation, and hygiene practices, standardised measures of women’s empowerment, and indicators of household finances) were more widely measured and likely to show a positive improvement in household dietary diversity and IYCF indicators. Of the reviews that had a control group, the majority showed a positive impact on primary nutrition outcomes (child stunting, wasting, underweight, or anaemia). Few evaluations included coverage estimates. In addition, while all of the evaluations reviewed were of programmes engaging multiple sectors, interventions were often not delivered jointly or in a coordinated way, and most programmes had yet to go to national scale.

It is therefore recommended that careful attention is needed when implementing MSNPs so that they are implemented in a convergent manner. The scale-up of programmes needs improvement and this may be achieved by better embedding these in government structures. Indicators to assess programme coverage should be integrated into national information systems (within health, agriculture, and education) and a more objective way of comparing levels of programme convergence should be explored.

The authors also recommend that more guidance on effective and standardised MSNP evaluations is needed, as well as greater availability of funding for quality, large-scale evaluations. A minimum level of rigour should be set, ideally allowing for the assessment of change in outcomes between time points interpreted against the backdrop of secular trends. Ensuring the inclusion and importance of secondary nutrition outcomes rather than largely focusing on stunting impact is both important and more realistic for many programmes.

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Multi-sectoral nutrition programming; exploring impact. Field Exchange 67, April 2022. p87. www.ennonline.net/fex/67/multisectoralnutritionprogramming1

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