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"#2063"--handwritten on cover, Includes bibliographical references

In this report, authors Jim Levinson and Yarlini Balarajan of UNICEF New York and Alessandra Marini of the World Bank present three major case studies from Peru, Brazil and Bangladesh, but also a historical review of multisectoral nutrition activities in several other countries around the world. The report offers conclusions and lessons learned focusing on the value of combining nutrition-specific and nutrition-sensitive interventions that functions together in targeted areas, the importance of nutrition-related related results-based incentives to generate action on sub-national levels, and the importance of advocacy at the policy level., MDG Achievement Fund Secretariat, Cooperación Española

PR, IFPRI1, PHND, According to Richard Heaver, “multisectoral programs are the most effective way to tackle malnutrition” (2005a, 20). Still, despite general agreement that multisectoral actions (if not programs per se) are the best way to reduce malnutrition, many observers believe that multisectoral planning and coordination are simply too difficult to carry out.

PR, IFPRI1, PHND, Multisectoral thinking has long been attractive in the field of development, especially in the social sector, because social problems and their determinants are so complex and multifaceted. For nutrition, UNICEF’s (1990) conceptual framework of the causality of child malnutrition illustrates the multisectoral nature of the problem (Figure 2.1). It shows the immediate determinants of malnutrition at the individual level (inadequate dietary intake and disease) as products of underlying causes at the family or household level (insufficient access to food, inadequate maternal and child practices, poor water and sanitation, and inadequate access to quality health services). These, in turn, are influenced by basic causes at a societal level, including the quality and quantity of human, economic, and organizational resources and the way (or by whom) they are controlled. More fundamentally, these factors operate within a given—although dynamic—economic, political, cultural, and social structure, where each actor has specific resources.

PR, IFPRI1, PHND, Drawing on the key issues illustrated by the framework (internal and external contexts, linking mechanisms, and dynamics) developed in Chapter 3, we have developed four primary sets of questions, following a rough chronology, to guide the empirical studies: • How do initiatives to work multisectorally get started? What are the triggers? • How does the collaboration work? How does it evolve over time? What are the dynamics and mechanisms of the collaboration process? • What are the issues surrounding the sustainability of collaboration? • What characterizes the broader environment in which the collaboration takes place? How does it affect the collaboration? Constructing a narrative around these questions should give us an idea of the key factors, or approaches, that affect how multisectoral collaboration comes about, how it operates, and how it might be sustained.

PR, IFPRI1, PHND, The motivation for a multisectoral approach to nutrition applies whether we are talking about complex multicomponent programs or more straightforward integration of nutrition activities into programs being undertaken by sectors outside health. Adding a nutrition education component to a home-gardening project being promoted by the Ministry of Agriculture, for instance, is one example of straightforward integration. The focus of this volume, however, is on programs that address the more complex institutional challenge of working across sectors. By this we mean programs that attempt to integrate activities or components across ministries, institutions, or agencies that have fundamentally different missions, such as agriculture, education, or health. So here we are looking beyond cross- or intersectoral programs in which nutrition activities might simply span or link two or more sectors. Rather, our case studies are of programs that comprehensively involve multiple institutions (ministries or agencies) in systematic efforts to address problems of malnutrition.

PR, IFPRI3; ISI, FCND, Background. Positive deviance is increasingly employed in international development activities to permit the utilization of proven local solutions. Including positive deviance methods in evaluation analysis, particularly in places like Bihar, India, where the rates of child underweight hover at 55%, can help identify project activities and household characteristics that affect key outcomes. These can, in turn, inform decision-making regarding the intensification of particularly promising activities. Objectives. To apply positive deviance analysis to the Dular program in Bihar, a community-based nutrition program that seeks to improve the impact of India’s Integrated Child Development Services on young children. Methods. In order to assure that desired program outcomes were not dependent on higher economic status, the analysis isolated a subset of program beneficiaries—the poorest children with the best nutritional outcomes—and examined the behavioral and project factors that may have brought about positive results in this subgroup. The data for this analysis were drawn from a 2005 program evaluation with a sample of 1,560 children. Results. The analysis found that positive deviant children with normal nutritional status in the poorest 50% of Dular households were introduced to complementary food almost 2 months earlier (7.18 vs. 9.02 months of age) than severely malnourished children, were more than twice as likely to use soap for handwashing after defecation (25.0% vs. 11.8%), and were more than seven times as likely to have literate mothers (25.0% vs. 3.5%). Conclusions. The analysis suggests that programmatic efforts relating to these activities have been particularly effective and may well deserve increased investment.