Nutrition Policy and Governance in Ethiopia: What Difference Does 5 Years Make?
Two studies, ENGINE (Empowering New Generations to Improve Nutrition and Economic opportunities) and Growth through Nutrition, were conducted in the same 4 regions of Ethiopia approximately 5 years apart. A similar protocol using a quantitative and qualitative survey of key informants at the subnational level was used to explore barriers and facilitators for implementation of the country’s national multisector nutrition plan. Noticeable differences were observed, including a change in the perception of the nutrition problems in pregnant women and preschool aged children and greater awareness of the multisector plan. Poor coordination and collaboration were still noted in both time periods. A key issue highlighted was the need to keep up the momentum for multisector approaches to improve nutrition in the policy agenda. Collaboration with the Ethiopian Public Health Institute (EPHI).
The study conducted in Ethiopia under the ENGINE program examined the facilitators and constraints to implementing a multisector nutrition program. Results indicate that awareness of the multisectoral plans at the subnational level under ENGINE was extremely limited. This was problematic, since much of the implementation of the NNP occurs at the subnational level.
Fortunately, progress has been made in the subsequent years. Awareness of the nutrition plans which was low in 2013 increased dramatically from 14% in 2013 to 43.7% in 2017-2018. Even more impressive is the fact that the model woredas increased awareness of the NNP to 66%. Clearly this is only one variable to measure success. However, if sector staff are not aware of a specific program, it is unlikely that programs will be developed. Asked if continuing awareness was a challenge to future implementation going forward, only 2.8% of respondents in the regions under Growth through Nutrition reported this as a barrier.
Staffing constraints for implementation have taken on lower importance over time with only 9.9% of the 4 regions reporting this as a barrier in the later period of the study. Lack of attention to the NNP also changed substantially from 35% in ENGINE to 12.7% in Growth through Nutrition. Poor coordination is a critical barrier to launching an effective multisector program; only 14.1% reported lack of coordination as a limiting constraint to the NNP under Growth through Nutrition.
Taken together these results reflect several phenomena. First, the multisector plans have existed for several years, so it is not surprising that there would be more awareness. It is the consistency of progress based on awareness, ownership, collaboration, and more attention to nutrition that suggest a package of policy and governance issues that are important in the sustainability of efforts. A challenge going forward will be to build on progress made and continue the high-level support that the multisector nutrition programs have garnered.