The role of evidence in nutrition policymaking in Ethiopia:institutional structures and issue framing

Motivation Malnutrition is the single greatest contributor to the global burden of morbidity and mortality, with the majority of cases arising in low‐ and middle‐income countries. However, the multi‐sectoral nature of nutrition policymaking adds considerable complexity to the implementation of effective programmes. This raises questions about why or how relevant policy change may come about within different country settings. Purpose This paper examines multi‐sectoral nutrition policymaking from the health sector perspective, specifically focusing on different sectorial perspectives and the role and use of evidence within this. The case study of Ethiopia provides a unique example of the challenging nature of multi‐sectoral nutrition policy‐making, even with a strong coordinating infrastructure. Approach and methods We undertook 23 in‐depth semi‐structured interviews held in December 2014 with stakeholders from key health sector organisations, and a related documentary analysis. Participants represented a diverse range of perspectives, including government representatives, policy stakeholders, aid providers from multi‐lateral organisations, and academic researchers. Findings Our respondents described how nutrition framing in Ethiopia is changing, with greater consideration of overweight, obesity and non‐communicable diseases, as well as undernutrition and micronutrient deficiencies. However, overweight‐ and obesity‐related concerns are still less evident in key documents. Some health actors described the challenge of enacting structural policy changes when doing so requires engagement from the agriculture sector. Whilst multi‐sectoral plans and infrastructure to address malnutrition are in place, respondents suggested that the mandate for addressing nutrition lying with the health sector was reinforced by the nature of evidence collected. Conclusion This study of nutrition policymaking in Ethio
Motivation Malnutrition is the single greatest contributor to the global burden of morbidity and mortality, with the majority of cases arising in low‐ and middle‐income countries. However, the multi‐sectoral nature of nutrition policymaking adds considerable complexity to the implementation of effective programmes. This raises questions about why or how relevant policy change may come about within different country settings. Purpose This paper examines multi‐sectoral nutrition policymaking from the health sector perspective, specifically focusing on different sectorial perspectives and the role and use of evidence within this. The case study of Ethiopia provides a unique example of the challenging nature of multi‐sectoral nutrition policy‐making, even with a strong coordinating infrastructure. Approach and methods We undertook 23 in‐depth semi‐structured interviews held in December 2014 with stakeholders from key health sector organisations, and a related documentary analysis. Participants represented a diverse range of perspectives, including government representatives, policy stakeholders, aid providers from multi‐lateral organisations, and academic researchers. Findings Our respondents described how nutrition framing in Ethiopia is changing, with greater consideration of overweight, obesity and non‐communicable diseases, as well as undernutrition and micronutrient deficiencies. However, overweight‐ and obesity‐related concerns are still less evident in key documents. Some health actors described the challenge of enacting structural policy changes when doing so requires engagement from the agriculture sector. Whilst multi‐sectoral plans and infrastructure to address malnutrition are in place, respondents suggested that the mandate for addressing nutrition lying with the health sector was reinforced by the nature of evidence collected. Conclusion This study of nutrition policymaking in Ethio