During
my first term at the University
of York one of the issues we discussed during weekly online discussions
with students from around the globe was policy failure. It was interesting how frequent
it seemed that public systems didn’t live up to citizens’ expectations, no
matter which part of the world we were writing from. Policy success appeared as
rather elusive.
It
therefore is a pleasant surprise to sing to a slightly different tune and consider
a more positive trend with regards to the nutrition sector of Kenya’s Ministry
of Health. In 2012, the World Health Organisation (WHO) developed a set of 6 targets
that were deemed by member states as essential to comprehensively address the
main nutrition concerns to be attained by 2025. Through the annual tracking of
these targets, the 2015 Global nutrition
report showed Kenya as the only country on track to meet all six targets.
So, what can explain this positive trend in Kenya’s nutrition sector, what
could we learn from it about public policy success?
Before
delving into this, it is important to highlight just how complex nutrition
issues can be. Malnutrition may appear simply as a food deficit and should hence
easily be resolved by providing enough food to the people who lack it, when they
need it. But nutrition issues are far more complex than
that:
Primarily,
nutrition is an outcome, not just of the food ingested, but of how the body
handles it – meaning a person with illness, for example a child with diarrhoea,
is likely to have a poorer nutrition status compared to a child without, even
with equal food intake. Secondarily, complex dynamics affect when and how a
child is fed and cared for, such as: the mother’s access to information and
education; access to health services; hygiene and sanitation practices and food
availability. On a tertiary level these outcomes are again affected by broader
state issues: how does the culture perceive a woman’s education – is it
encouraged? Does a government prioritise healthcare and facilitate optimal
coverage of health services? What about policies that support livelihoods and
enable communities to absorb shocks from volatile markets? And of course, there
is the issue of political stability.
These
factors affect the nutrition situation in complex ways, and to varying degrees.
The challenge of sound nutrition policy is being able to address these diverse
complex issues appropriately, and all the while in a rapidly changing environment.
The interventions required to relevantly address nutrition problems require an understanding
of the broader issues’ contribution to nutrition so that these issues are
addressed from the three levels previously expounded, and not just at outcome
level.
While
many little things built up to contribute to the nutrition sector’s success,
the overarching one could be strategic positioning. From 2010-2012, the Kenyan government’s
nutrition sector together with nutrition-focused UN bodies and non-governmental
organisations aligned all nutrition actions and strategies within one global
strategy called the scaling up nutrition
movement. This led to well-coordinated actions and a harmonised approach
that influenced a compelling
vision for change. With all actors speaking with one voice, the experience,
capacity and opportunities of agencies were amplified.
The
sector then sought to address the legal and policy arenas that would provide
institutional legitimacy to bring on board influential actors. For example an article
on the right to basic nutrition was enshrined in Kenya’s constitution. The
sector also developed two guiding policies: a budgeted national nutrition
action plan under control of the Ministry of Health that expounded 11 strategic
objectives to be adopted and contextualised to devolved counties; and the Kenya Food and
Nutrition Security Policy that was developed as a platform to engage ministries
that are complementary to nutrition such as education, agriculture and food
industries. These two policies are deemed to direct and streamline actions from
allied agencies by highlighting government priorities.
This
streamlining of actions meant two things: First, at the organisational level,
agencies executing a nutrition mandate (local or international) adopted
government priorities for nutrition as their priorities. Thus, an agency’s
implementation plan was not guided by its resources and the organisation’s
priorities but in line with the government’s priorities. Secondly, at implementation
level, this reduced the redundant duplication of actors’ efforts as roles were
clarified and mapped in line with the harmonised policy. Coupled with a cohesive coordination mechanism,
agencies and actors regularly appraised their actions, processes and outcomes
against the common sector plan, to adjust off-course actions and reinforce the
on-course ones. This gradually led to the identification of actions that were
appropriate for a scale-up of nutrition services with the government taking
lead in the execution of the services.
So
what’s next for Kenya’s nutrition sector? For one, a cautious approach to the
successes gained is necessary. The sector needs to appraise the meaning of the
gains by looking a little deeper. For instance, while the 2015 Global Nutrition
Report revealed no increase in childhood overweight, unfortunately the same
report revealed an increase in adult overweight in Kenya. There is also need
for increased nuance in linking the underlying causal issues that impact
nutrition outcomes, i.e. to elaborate exactly how these issues actually contribute to
change. One simple example is how an increase in a woman’s workload
negatively impacts on her ability to offer improved care to her child,
including having an impact on the time available to feed her child (Hailey,
2015). Such nuance could rally the different sectors that engage women to do so
by taking into consideration the impact of empowerment opportunities on the amount
of time she spends with her child.
In
summary, Kenya has made great strides in combating malnutrition based on the six
global priorities. It greatly owes this first to a growing understanding of the
complex issues that contribute to malnutrition and then aligning and
streamlining policies, and actions, to this understanding. While this is
definitely worth celebrating, maintaining a little caution and assessing more
thoroughly the meaning of these successes would enable the sector to
consolidate the gains made and to build on them, thus, to address the nutrition
challenge not just holistically but also sustainably.
Hailey, P. (2015). Theory of Change Framework Nutrition
Resilience. Centre For Humanitarian Change.