No programme exists in a vacuum. It is rooted in a country where conditions prevail that will affect the functioning and achievements of that programme. Such conditions include the socio-economic situation, the distribution of wealth and level of development (including the level of literacy and the condition of women), political ideology, culture, degree of diversity in terms of agro-ecological zones, climatic conditions and ethnicity. These provide the background within which the programme must function and which it must take into account if it is to be successful.
We use the term “macroenvironment” to refer to those specific factors which indicate the degree of commitment of that country to a particular issue, in this case to the improvement of the nutritional well-being of its people.
|The macroenvironment: some lessons learned|
|FAO's in-depth study of nine programmes (2003) indicated that the following are important elements of a supportive macroenvironment:|
A supportive and enabling macroenvironment is essential to the success of a programme. A government and a population that recognizes the importance of food security and good nutrition and accepts nutritional well-being as a key indicator of national development provides such an environment. The reality, however, is that few countries can boast of a fully supportive macroenvironment. Working towards creating it thus becomes a responsibility of the programme itself. To decide what you need to do to achieve a supportive macroenvironment, you need first to identify and assess the strengths and deficiencies of the environment in your country. This includes assessing the following:
|Assessing the Macroenvironment|
A number of supportive national policies are needed to ensure that nutrition issues are adequately addressed. As a minimum, the country should have a well-formulated food and nutrition policy (and a national plan of action for nutrition), a poverty alleviation strategy and a rural (and/or urban, as appropriate) development strategy.
Furthermore, over the last few decades there have been a number of international position statements, often linked to international conferences and signed by most countries. Among those relevant to nutrition, the following are important:
|“Thailand's experience has indicated that policy decisions which bring about deliberate actions are often in response to political concerns, public opinion and awareness.”|
|Quoted from: Winichagoon et al (1992).|
By signing international declarations and by formulating relevant policies, the country has taken the first step towards political commitment to improving nutrition. You need to assess the extent to which the government has acted to implement its stated commitment:
What you are asked to do here is to find tangible evidence of progress towards achieving stated goals. Such ‘evidence-based’ assessment is crucial. Good intentions and political rhetoric are not enough.
You need to determine who has ultimate responsibility for the political commitments implicit in the international declarations and initiatives which the government has signed. Ask the question: who oversees progress towards achieving stated goals? If no high-level government official or ministry has this task, then the likelihood is high that political commitment to improving nutrition is inadequate.
To assess the macropolicy environment, answer the following questions through discussions with key informants, observation and by examining documents.
What supportive policies, strategies and initiatives are in existence to address, directly or indirectly, food security and nutrition issues?
Is your country a signatory to major relevant international declarations, initiatives and codes?
To what extent are these political ‘commitments’ actively implemented?
At what level are the commitments implemented and monitored? At the Ministerial level, the Head of State level, or by a senior ministry such as the Ministry of Planning?
|Assessing the Macroenvironment|
Nutrition is a cross-cutting issue. To achieve nutrition improvement, active collaboration is needed from a range of sectors, such as health, agriculture, education, trade, as well as within sectors. For such action to take place, there needs to be an effective mechanism for collaboration and a recognition of nutrition as an essential indicator of national development reflected in sectoral priorities. Collaboration with the civil society, non-governmental organizations, international agencies and research institutions is also important. Food and nutrition councils or committees exist in many countries, but few are effective or active. If participation is insufficiently broad, or if sectoral representation is insufficiently high, then nutrition is not viewed as a priority.
There is an assumption on the part of some sectors that nutrition will somehow improve as a result of their plans and programmes and that no specific attention to nutrition is needed. Agriculture, for example, may assume that by increasing national food production, household food security will improve and, hence, nutritional status. Experience has shown that explicitly stated nutrition outcomes are needed in order to ensure a positive impact on nutritional status. This is true also of other sectors. As a minimum, you should assess the health and agriculture sectors.
Answers to the following questions will help to assess the extent of intersectoral collaboration at the national level:
Is there a mechanism (a food and nutrition committee or council, for example) for intersectoral collaboration in nutrition? If yes:
Has the committee influenced national decision-making?
Are nutrition outcomes included in sectoral policies and programmes?
|Achieving intersectoral collaboration|
|Effective intersectoral collaboration is difficult to achieve. Two essential preconditions are the acceptance at the highest level of nutritional well-being as an indicator of national development, and the recognition of the need for an integrated approach to tackling nutrition problems.|
|Assessing the Macroenvironment|
If the nutritional well-being of its population is indeed considered a key goal and indicator of a country's development, then there should be evidence of this in the form of a budget devoted to nutrition activities.
Most countries provide some funding to nutrition activities, to support a few staff positions and a very limited number of activities. What is important is not the absolute amount of government funding for nutrition, but the proportion this represents of the national budget, or at least of the sectoral budget of which it is a part, and how this proportion compares with the proportion devoted to other key activities. These figures can be obtained from the Ministry of Finance or from the ministry that houses the nutrition unit14. You need to consider also whether funding for nutrition is included in budgets of other sectors or units e.g. agriculture may fund relevant food-based activities, clinic-based nutrition services may be provided by the maternal and child health unit, and information, education and communication (IEC) activities by the health promotion unit.
|Is national funding important, or should we rely on external support?|
|Some quotes from FAO's in-depth study of nine programmes (2003):|
|“The Governments of the Philippines and Zimbabwe and, to a large extent, Brazil have shown a clear commitment in this regard, and national funding has been made available and sustained for many years. In these countries, the supportive macropolicy environment is translated into a tangible investment in nutrition.”|
|“There is a danger in such reliance [on external funding]: …political events can lead to the withdrawal of donor support. There is also the danger of donor-fatigue: simply put, the donor's decision that it is time to move on to something else or somewhere else.”|
You should try to answer the following question:
Does the government provide adequate funding for the provision of basic nutrition services?
|Assessing the Macroenvironment|
International, bilateral and non-governmental agencies can make important contributions to improving nutrition in a country: by raising the profile of nutrition, lobbying national governments, by demonstrating their own commitment to nutrition through investment in nutrition programmes and by making available technical expertise.
In some cases, however, there is a tendency for the international community to impose its own priorities and to support only those activities which fall within such priorities. In some cases too there is a lack of coordination among the agencies, leading to both overlaps and gaps in the range of nutrition issues addressed and the absence of an integrated approach to tackling nutrition problems. In recent years, there has been an attempt to resolve these difficulties by creating a coordinating committee that brings together all agencies with an interest in nutrition.
Look at your programme to see how and why it came into being. Through discussions and an examination of documents, you should find out who made the decisions, who chose the specific nutrition activities and why these were selected. You should also seek to determine whether priority national nutrition problems are being addressed, and if not, why not.
To assess the role and contribution of the international community, answer the following questions:
Is there a coordinating committee15 and, if so, what is its membership, how regularly does it meet and what decisions does it take?
Are nationals (nutritionists and other) members of the coordinating committee and, if so, what positions do they hold in government?
What is the real contribution of nationals to decision-making?
If no active committee exists, how does the international community decide what nutrition activities to support? Is there evidence of donor-driven decision-making? Can nationals influence decision-making and secure support for activities that they have assessed as priorities?
|Assessing the Macroenvironment|
A precondition for the success of a nutrition programme is the availability of high-quality technical expertise. If such national expertise does not exist, funders provide international experts but, unless there is a serious effort to build capacity, the programme's sustainability will be in doubt and the country will consistently fail to achieve self-reliance. The country's ability to successfully negotiate for support for its own priorities will also be severely constrained.
To create (and replenish) a body of national technical expertise to run its programmes, a country needs at least one of the following:
Ultimately a country should seek to establish a national institution, or participate fully in a regional one. In addition to training, such institutions provide excellent support to nutrition programmes: they can undertake small research studies within programmes to answer specific questions and can also assume responsibility for its monitoring and evaluation. They can also assume some responsibility for maintaining a focus and momentum for action on nutrition issues.
|The importance of national research and training institutions|
|FAO's in-depth study of nine programmes (2003) revealed that those of Mexico, Thailand and the Philippines benefited from close collaboration with strong national research and training institutions. These institutions provided programme staff, training inputs and technical advice, as well as undertaking small research activities within the programmes. In the case of Mexico, programme evaluation was contracted out to a research institution, with the result that this programme can provide strong evidence of its positive impact on nutritional status.|
You can assess the adequacy of national technical expertise by answering the following questions:
If there has been a recent human resource needs assessment for nutrition, what were its findings and is there any effort to fill identified gaps?
Is there any intention to replace international experts with nationals and, to this end, is training (both external and on-the-job) foreseen within the programme?
Are well-trained nutritionists employed at national and subnational levels17?
Is there a national research and training institute (or does the country have access to one in the region)? Does the institution provide training in nutrition to the postgraduate level? Does it have an active programme of research?
Is there a funded programme of human resource development for nutrition? If so, does this programme encompass training at all levels? Is it being actively implemented and are suitable positions available to employ returning graduates?
You should now have the information you need to make an assessment of the macroenvironment within which the nutrition programme functions. Turn to the Summary Report (Annex 1) and answer the questions in Section II. Then carry out a SWOC analysis.
Your programme will be most effective in a fully supportive macroenvironment. If you assess the macroenvironment in your country to be insufficiently supportive (in any or all of the key subcomponents), then you need to take one or more of the following actions:
Design and implement a high-profile campaign to create public and political awareness, using all means at your disposal. The emphasis of the campaign should be on food security and nutritional well-being as outcome indicators of national development and of access to an adequate diet as a human right18. Here are some ideas for the campaign:
Establish strategic partnerships with the private sector and universities.
Include specific activities (such as components of the campaign described above) within the nutrition programme you are assessing. This is possible if you have judged your overall environment to be supportive, but have identified a few weaknesses that can be addressed within the nutrition programme.
If intersectoral collaboration is poor, you can seek to establish such collaboration first at the district or community level. This is often easier to achieve than collaboration at the national level. If you then implement the campaign described above, it may be possible to extend intersectoral collaboration upwards to the national level in the future.
If the adequacy of suitably-trained human resources is a constraint, then you need either to address this within the nutrition programme20 or secure funding21 for a programme of human resource development. You should also establish strong working relations with national or regional research and training institutions. Such links are of mutual benefit, since they serve also to strengthen the institutions. Finally, draw up a schedule to replace international staff with trained nationals in your programme.
FAO's in-depth study of nine programmes (2003) highlighted the following strengths, weaknesses, opportunities and constraints in relation to the macroenvironment:
Constraints (and threats):
14 These figures are difficult to obtain in many countries. If you cannot obtain such figures, then you must turn to qualitative information, based largely on an assessment of the extent of dependence on external resources and on the size of the nutrition unit in comparison to the size of other units.
15 The coordinating committee may in some cases be the same as the intersectoral committee referred to in the previous subcomponent. It may also be a committee charged with overseeing the Poverty Alleviation Strategy or the Rural Development Strategy. What you are seeking is a committee that brings together a substantial number of relevant international agencies, bilaterals and non-governmental organizations and that focuses on nutrition improvement as a first step in the development process.
16 Some countries are too small to support a national institution. In such cases, research and training is provided at regional institutions. Examples of such regional institutions are the University of the West Indies and the University of the South Pacific. Some countries also offer programmes in nutrition that are open to other countries in the region. Kenya, the Philippines and Guatemala (INCAP) offer such regional masters’ level programmes.
17 The availability of technical expertise at subnational levels is especially important in countries that have either achieved full decentralization, or are moving towards it.
18 In general, it is preferable to avoid treating nutrition as a welfare issue. Such an approach tends to lead to unsustainable food distribution activities and curative rather than preventive measures.
19 In some situations, it may be acceptable to draw comparisons with other countries, both in the prevalence of malnutrition and in the actions taken to address the problems. Such comparisons can spur governments to action. In this context, you can make use of United Nations’ publications (such as FAO's State of Food Insecurity reports, UNICEF's State of the Children reports, UNDP's development reports) to highlight the position of your country in relation to others.
20 In general, short courses can be accommodated, but lengthy senior-level training is too costly.
21 Bilateral agencies are often willing to provide scholarships for training in their countries.