Menu ENN Search

Multi-sectoral Nutrition Programming – Exploring Impact

Author: Edna Ogada, Paluku Bahwere, Natasha Lelijveld, Natalie Sessions, Gwenola Desplats and Tanya Khara
Year: 2021
Resource type: Report

Executive Summary 

Multi-sector nutrition programmes (MSNPs) have gained increasing prominence over the last two decades in order to address the many direct and underlying determinants of malnutrition. The Scaling Up Nutrition (SUN) Movement has played a critical role in mobilising governments and partners to drive forward such initiatives. However, given the challenges of setting up multi-sector monitoring and evaluation (M&E) systems, and due to the design of many multi-sector programmes, the ability to determine the impact of such programmes in achieving their ultimate objective of stunting reduction is often limited. Growing evidence of national and sub-national success stories, including in the most recent Maternal and Child Undernutrition Progress series, reinforces the crucial importance of MSNPs to address the underlying determinants of undernutrition. However there remains little exploration of the efficacy, effectiveness and impact of such approaches compared to single sector interventions and limited information on appropriate designs of M&E systems for MSNPs. This report, commissioned by Irish Aid, synthesises the available evidence on the impact of MSNPs and documents the type and quality of M&E systems established to measure impact. It aims to answer the question: Do MSNPs collect data that allows for the generation of evidence on impact and, if so, what is the level of reported impact?

Specifically, the following questions are explored:

1. Were evaluation designs sufficiently rigorous to allow for impact to be evaluated?

2. As precursors to impact, what is the level of coverage1 and convergence2 of interventions within MSNPs? Are these indicators assessed and, if so, how are they assessed?

3. What impact, if any, do MSNP evaluations demonstrate on primary nutrition outcomes (stunting, wasting, underweight and anaemia?)

4. Are MSNP evaluations able to demonstrate an impact on secondary nutrition outcomes such as infant and young child feeding (IYCF) indicators, Water, sanitation and hygiene (WASH), food security, household dietary diversity score (HDDS), minimum acceptable diet (MAD) and income/ expenditure?

5. Do MSNP evaluations consider the scale-up of interventions?  

A systematic search was conducted to identify relevant evaluation reports, programme implementation reports, programme description documents, programme proposals, research reports, peer-reviewed publications and systematic reviews/ meta-analyses. Forty-five evaluation reports were identified that met the inclusion criteria (30 of which have impact data for analysis). To enrich the answers to the questions posed, these were accompanied by 11 country assessments from the 2018 Joint assessment by the multi-stakeholder SUN platform (JAA) (from Bangladesh, Burundi, Cambodia, Ethiopia, Guatemala, Kenya, Malawi, Nepal, Niger, Philippines and Senegal), eight country case studies developed by the Emergency Nutrition Network (ENN) (from Ethiopia, Senegal, Kenya, Niger, Zimbabwe, Nepal, Bangladesh and Philippines) and a broader synthesis by Maximising the Quality of Scaling Up Nutrition Plus (MQSUN+) which included an additional six SUN country case studies (from El Salvador, Madagascar, Benin, Lao PDR, Pakistan and Guatemala).

Key findings:

Recommendations:

Programme design and scale-up: Careful attention is needed when designing multi-sector programmes so that interventions or services from multiple sectors are able to reach the same target households or individuals in a coordinated manner. This convergence of sector programming is important for providing a comprehensive package of services that has the potential to impact the multiple interconnected drivers of malnutrition in a given context. MSNPs should be embedded in government structures and services and placed under government ownership to ensure programme coverage, convergence and scale-up at national level. Indicators to assess programme coverage should be integrated into national information systems within a broad range of sectors (health, agriculture, education) and a more objective way of comparing levels of programme convergence and reviewing lessons learnt in this regard should be explored. Process evaluations that look more qualitatively at project implementation with a particular focus on the integration of sectors should also be encouraged by the donors funding interventions.

Measuring impact: Guidance on effective and standardised MSNP evaluations is needed, as well as greater availability of funding for quality, largescale evaluations to take place. A minimum level of rigour should be set, ideally allowing for at least 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 (such as HDDS, food insecurity scores, indicators of IYCF and WASH practices, standardised measures of women’s empowerment and indicators of household finances) rather than largely focusing on stunting impact is both important and more realistic for many programmes. Donors can play a key role in ensuring these standards are set and met and that programmes have sufficient funding allocated to enable rigorous evaluations and the measurement of impact. Innovative solutions allowing for the regular monitoring of undernutrition need to be developed to reduce reliance on standard impact-evaluation and periodic surveys. The use of the growth monitoring programme as a means of tracking improvements in nutrition should be explored. This could be achieved without rolling out national measurement of length or height through sentinel site surveillance or targeting children at certain ages.

A number of interesting articles on multisectoral programming in FEX 65 can be accessed here and are reflected on by Natalie Sessions in a recent blog here

Downloads

MSP_Exploring-Impact_WEB.pdf (PDF, 9.2mb)

MSP_Exploring-Impact_ANNEX1.pdf (PDF, 1.7mb)

More like this

FEX: Multi-sectoral nutrition programming; exploring impact

View this article as a pdf This is a summary of the following article: Ogada E, Bahwere P, Lelijveld N, Sessions N, Desplats G & Khara T (2021) Multi-sectoral nutrition...

FEX: Multi-sectoral nutrition programming: exploring impact

This is a summary of a Field Exchange report summary that was included in issue 67. The original article summarised the following report: Ogada E, Bahwere P, Lelijveld N,...

FEX: Exploring multi-sector programming at district level in Senegal, Nepal and Kenya

By Tui Swinnen, Jeremy Shoham and Carmel Dolan, with input from Charulatha Banerjee, Lillian Karanja-Odhiambo and Ambarka Youssoufane View this article as a pdf Tui Swinnen...

NEX: Drilling down to sub-national level: Multi-sector implementation in Kenya, Nepal and Senegal

Drilling down to sub-national level: Multi-sector implementation in Kenya, Nepal and Senegal ENN's SUN Knowledge Management team Read the case studies here: Kenya, Nepal,...

FEX: A journey to multi-sector nutrition programming in Nepal: evolution, processes and way forward

By Pradiumna Dahal, Anirudra Sharma and Stanley Chitekwe View this article as a pdf Lisez cet article en français ici Pradiumna Dahal is a nutrition specialist with...

en-net: Are there good guidelines to design impact evaluation of multisector nutrition programmes?

We are planning to conduct an impact evaluation of a multisector EU funded programme to reduce chronic malnutrition and food insecurity in Mozambique. The programme includes a...

NEX: Multi-sector programmes at the sub-national level: Insights from Ethiopia and Niger 

Lisez cet article en français ici View this article as a pdf ENN's SUN Knowledge Management team As part of ENN's knowledge management role to support the Scaling Up...

NEX: Voices from the field in Nepal: programming at district level

Nischal Raj Pandey (NRP) has served in the district government office, most recently as a Local Development Officer (LDO) in Parsa district and previously in Khotang...

NEX: Editorial

Listen to an interview with the editors (podcast) on ENN's MediaHub Welcome to this eighth issue of Nutrition Exchange (NEX), in which we have widened our geographical...

FEX: Complementary feeding in emergencies programming – Sudan case study

This is one of four case studies in this special section of FEX to highlight the importance of a strong contextual analysis to guide the appropriate design, implementation and...

FEX: Review of integrated nutrition programming by ACF International

A pond to breed fish as a part of an income generation scheme in West Timor, Indonesia Summary of review1 Action Against Hunger International Network (ACF) recently...

FEX: Nutrition-sensitive agriculture: What have we learned and where do we go from here?

Summary of research1 Location: Global What we know: Agriculture has strong potential to improve nutrition outcomes through improving food availability and access and through...

FEX: Introduction to the special issue

The most recent Lancet series on maternal and child undernutrition (Bhutta et al, 2013) calculated that even with 90% coverage of specific nutrition interventions (addressing...

FEX: Early lessons from Swabhimaan, a multi-sector integrated health and nutrition programme for women and girls in India

View this article as a pdf By Monica Shrivastav, Abhishek Saraswat, Neha Abraham, R.S. Reshmi, Sarita Anand, Apolenarius Purty, Rika Shalima Xaxa, Jagjit Minj, Babita...

NEX: Filling the Nutrient Gap in Pakistan: Insights to address malnutrition

Dr Aliahmad Khan is a nutritionist with the World Food Programme Pakistan Country Office in Islamabad. Muhammad Aslam Shaheen is Chief of Nutrition and SUN Focal Point in...

FEX: Humanitarian-development nexus: nutrition policy and programming in Kenya

By Carmel Dolan and Jeremy Shoham View this article as a pdf Carmel Dolan is an ENN Technical Director, co-editor of the ENN publication Nutrition Exchange, and co-lead on...

FEX: Seasonality of acute malnutrition and its drivers: a case study from eastern Chad

View this article as a pdf Summary of research 1 By Anastasia Marshak, Gwenaëlle Luc, Anne Radday and Helen Young Anastasia Marshak is a Senior Researcher at the...

FEX: Food assistance for nutrition: Evidence Summit

By Lindsey Green Ongoing food crises around the world underscore the need for effective food assistance (defined as in-kind food aid and/or cash and voucher programming). As...

FEX: Improving nutritional outcomes of rural households through a community-based approach in Ethiopia

This article has been updated since the original version was published in March 2020. View this article as a pdf Lisez cet article en français ici By Haimanot Abebe,...

FEX: Municipal budget allocation and utilisation for nutrition in Nepal

View this article as a pdf Lisez cet article en français ici By Shraddha Manandhar, Pramila Shrestha, Bishow Raman Neupane, Satya Narayan Acharya, Harendra Bahadur...

Close

Reference this page

Edna Ogada, Paluku Bahwere, Natasha Lelijveld, Natalie Sessions, Gwenola Desplats and Tanya Khara (2021). Multi-sectoral Nutrition Programming – Exploring Impact. www.ennonline.net/mspexploringimpact

(ENN_7135)

Close

Download to a citation manager

The below files can be imported into your preferred reference management tool, most tools will allow you to manually import the RIS file. Endnote may required a specific filter file to be used.