Leveraging political commitments to strengthen nutrition governance in local governments and cities in Uganda

Brenda Shenute Namugumya

Nutrition governance is the interactive process of steering different societal actors towards achieving the collectively negotiated goals of improved nutrition outcomes. The process involves various means of convening, articulating interests and goal-setting, selecting policy interventions, mobilising resources, implementing and providing feedback and accountability (Bump 2018, Peters and Pierre 2016). Policies, plans, programs and funding to improve food and nutrition security are key indicators of good nutrition governance. However, inadequate awareness and misinterpretation of the policy ambitions, discontinued action on the ground and power differences among participating actors are some of the factors that compromise effective nutrition governance. So how can city governments best create nutritional policies to improve the outcomes, better support for food security and access to nutritious food by city populations? Drawing from a recent case study on Uganda’s multi-sector nutrition policies, Brenda Namugumya (2021) suggests some strategies for city authorities and local governments to encourage participation, responsiveness and accountability to improve the local nutritional outcomes.

Many African governments have expressed high-level political commitment to improve the nutrition, health and human capital outcomes of their nations. These commitments are often specified in their national multi-sector nutrition policies[1], encouraging collective action involving different ministries, local government councils, city authorities and non-state actors. It is the government ministries and non-government institutions who need to understand these national ambitions and interpret them within the context of their own organisations. In addition, city authorities and local governments need to become familiar with the national nutrition policies, and interpret the objectives as part of their local agendas and policy priorities. Implementing these cross-cutting policy objectives will often prove challenging for different city authority departments, given their focus on specific issues (such as health, urban agriculture, water). Based on lessons learned from Uganda, here are some of the strategies that cities and local governments could adopt to lessen this challenge:

Increase resilience of the nutrition governance process

In Uganda, international organisations, such as UN agencies and bilateral organisations, played a central role in both bolstering and undermining the legitimacy of the nutrition policies. To strengthen integration of nutrition programs into political and administrative agendas, international organisations use financial incentives and technical assistance committed to promote specific global nutrition projects. However, these interventions often only addressed a few nutritional determinants, had short term project horizons, and compromised the local government’s capacity to make serious long-term nutrition investments (Namugumya et al. 2020a). There is urgent need to increase the resilience of the nutrition governance system to maintain or adapt its functions following conditions of uncertainty or transformation, such as, beyond the time-bound projects.

To make nutrition governance more resilient, city governments could work towards developing robust context-informed policies that intentionally help the different departments to continue articulating the prioritised nutritional objectives and interventions in the annual workplans and budgets. The process should encourage (re)framing policy goals aligned to the cities’ nutrition concerns and consensus to generate a shared nutrition agenda. This is to increase local ownership of the process, expediate the policy approval processes, facilitate human and financial resource mobilisation as well as accountability means. For example, ten local governments in Uganda used a participatory process, involving different departments[2], to develop and officially adopt context-informed nutrition action plans. The process was facilitated by the USAID Food and Nutrition Technical Assistance Project as an intervention to strengthen local nutrition leadership and governance.     

Strengthen integrative capacity

Another strategy is to strengthen the capacity of politicians, bureaucratic leaders and citizens so they can integrate nutrition actions into the local government or cities plans. Integrative leadership and capacity are important to influence policy decisions, advocate for investments in nutrition, monitor policy implementation and ensure the continued prioritisation of nutrition in future updated policy processes (Namugumya et al. 2020).  As revealed by the Uganda case study, the inclusion of nutrition in the some ministry policies and department plans (e.g., health, agriculture and social development) was helped by the bureaucrats’ ability to gain access to strategic policy dialogues, and to frame the issue in line with their sectoral interests.

City authorities need to consider investing in local ownership of nutrition integration, including building the capacity of individuals who can work across sectors and administrative levels to integrate a diversity of perspectives.  Such individuals are important to engage in strategic policy negotiations, influence policy agendas to integrate nutrition issues and lobby for budget allocation. However, high turnover in leaders, struggles to manage project portfolios, unclear job roles, and short-term staff contracts reduces the ability of government officers to be able to do this.

Support frontline workers 

To support and sustain daily nutrition service delivery, city governments should aim to strengthen the nutritional and food system knowledge and competencies of all frontline workers (i.e., those directly engaged in delivering services to citizens). In Uganda, most agricultural and community development departments had little understanding of nutrition-sensitive roles and did not have specific budgets for this work. Where there were nutrition projects, these departments were not involved (Namugumya et al. 2021). Clear details of nutritional responsibilities in job descriptions and projects, as well as allocation of explicit budgets in all departments will support government departments and staff to implement the nutritional and food security strategies.

Create incentives

The case study revealed some non-monetary incentives which motivated nutrition service provision, such as, having a person focussed on and champion nutrition, a guarantee of technical assistance, performance rewards (e.g., best nutrition health centre in district), feedback from sector ministries, specific finance allocations for nutrition, continued strengthening of capacity, improved professional collaborations, and increasing community relationships.  Further, using multiple incentives is recommended to inspire positive motives in frontline workers, reduce uncertainties about who is responsible for the implementation, and make nutrition-based interventions a part of every service delivery.

Adjust monitoring

Systems for monitoring the performance of multi-sector nutrition policies and projects are important. Cities can adopt the indicators in current global and national databases (for example, the Global database on Implementation of Nutrition Actions, Global Nutrition Report, Global Hunger Index) which monitor changes in nutrition governance. However, this should be done with caution, because the databases often have a narrow focus on ambiguous country-level variables, which do not necessarily reflect the diversity and disparities existing across local governments, and can contribute to the misinterpretation, and misrepresentation, of the variances within national contexts.

It would be helpful if state (national, local and city governments) and non-state organizations could collaborate to set context specific multi-sectoral nutrition indicators and develop an inclusive monitoring system. This could incorporate capturing the various interventions of different departments and administrative levels, and their impact on the community.

When looking at indicators of progress it is useful to not just look at the numbers but to understand the processes and practices (the journey) as key components for changing the nutrition system. For instance, a city’s nutrition policy could be assessed based on the policy frameworks, goals, interventions, and emerging practices that are developed. By supporting organisations to understand how, why and when to collect the nutrition indicators it will improve the nutrition data quality and its utilisation in future policy processes.

Support cross sector learning

When designing nutrition policies and projects, it is important for city governments to prioritise cross-sector learning. This includes the design of multi-sector nutrition monitoring systems, and the creation of forums to enable dialogue, build trust and meaningful connections among nutrition and food system actors. Fostering integrative learning might incur challenges in the beginning because it may cross departments, donor projects, and company boundaries. But the need for continuous dialogue about what comprises and enables integrative learning, who facilitates and leads the processes, what data are important and what motivates policy actors to utilise new knowledge is important.

This involves identifying key cross-cutting learning objectives, creating strategies to accumulate different data types, and nurturing capacity which can be analysed and used as collated evidence for policy and implementation decisions (cf. Walshe et al. 2013). City governments can encourage integrative leadership to support learning, data collection and promote using this new knowledge in decision making. They can work to establish regular cross sector groups, such as a city nutrition forum or coordination committee, to enable collective learning throughout all departments (for example SNV 2018, FANTA 2017²).

City governments are crucial in scaling up investment in nutrition. To be successful they need to invest in developing sustained nutrition integration in policies and, ultimately, a more effective delivery of nutrition services. Investing in the local capacities at different government levels is important, to make the nutrition governance system resilient and continue working after external support is phased out. However, this is a long-term process − not easily sustained through short-term funded projects − and means going beyond just tracking nutrition integration in sectoral policies and checking off performance indicators. Ultimately, this approach offers a robust course of action to realising long-term global and national nutrition goals, such as, Sustainable Development Goal 2 –  moving beyond ‘policies on paper’ to tangible delivery.

[1] Overview of multi-sector food and nutrition policies for African countries is provided in the WHO web page Global database on the Implementation of Nutrition Action (GINA). https://extranet.who.int/nutrition/gina/en/home.

[2] Representatives of the departments of health, agriculture, planning, water and technical services, community development, education, Office of the Chief Administrative Officer, local elected officials, civil society organisations participated in the policy processes (https://www.fantaproject.org/countries/uganda).

References

Bump, J. B. (2018). Undernutrition, obesity and governance: a unified framework for upholding the right to food. BMJ Global Health, 3(Suppl 4), e000886, doi:10.1136/bmjgh-2018-000886.

Namugumya, B. S., Candel, J. J. L., Talsma, E. F., & Termeer, C. J. A. M. (2020). A mechanisms-based explanation of nutrition policy (dis)integration processes in Uganda. Food Policy, 92, 101878, doi:https://doi.org/10.1016/j.foodpol.2020.101878.

Namugumya, B. S., (2021). Beyond paper realities: fostering integrated nutrition governance in Uganda. PhD thesis, Wageningen University and Research, ISBN: 978-94-6395-671-0.  doi:https://doi.org/10.18174/538348.

Peters, B. G., & Pierre, J. (2016). Comparative Governance: Rediscovering the Functional Dimension of Governing: Cambridge University Press.

SNV, Wageningen University & Research, The Royal Tropical Institute, Swiss Agency for Development Cooperation. (2018). The power of multi-sectoral governance to address Malnutrition. Insights from Sustainable Nutrition for All in Uganda and Zambia. SN4A technical brief 1. https://snv.org/update/power-multi-sectoral-governance-address-malnutrition

Walshe, N., O’Brien, S., Murphy, S., & Hartigan, I. (2013). Integrative Learning Through Simulation and Problem-Based Learning. Clinical Simulation in Nursing, 9(2), e47-e54, doi:https://doi.org/10.1016/j.ecns.2011.08.006.