What are the Challenges and Opportunities for Multi-level Advocacy for Nutrition?

"Over the last decade, policy advocacy has made critical contributions towards the development of nutrition policies, laws and strategies in many countries with high burdens of malnutrition."

This policy briefing from the Institute for Development Studies (IDS) discusses multi-level nutrition advocacy across administrative levels and throughout the policy cycle, in order to strengthen and support multi-level advocacy (MLA) for nutrition, as well as explain the challenges and opportunities. 

As stated here, "advocacy has made critical contributions towards the development of nutrition policies, laws and strategies in many countries with high burdens of malnutrition..." and has raised awareness among policymakers and elected officials of its causes and " human and economic consequences which include poor health outcomes, reduced economic productivity and lower educational attainment." Work at the national and international levels is not effectively bringing policy action to sub-national levels. Thus multi-level advocacy at the implementation level is limited. Three constraints are listed as: 

1. "The nature of the policy environment
2. Features of networks and actors operating in these
3. Characteristics of nutrition as a policy issue."

Advocacy actors change from the national to the sub-national level - whereas academics and donors may operate at the national level, the sub-national actors include community-based organisations, councillors, street-level bureaucrats, and service providers. Service delivery is likely from local CSOs and is more results- than value-oriented, with temporary alliances.

Authors suggest that local level work can be accomplished by joining with local bureaucrats and politicians to persuade local officials to work with frontline workers. "This compels policy advocates to develop framings and narratives of nutrition that actively reference local issues, norms and opportunities based in local democratic/governance structures – including potential local ‘vote-winners’" - possibly filling service gaps where state-level service is not following through. Creating alliances with accountability campaigners can build capacity to link with communities, including education on malnutrition and consequences and mobilise communities.

Because nutrition results are driven by cross-sectoral factors (gender, access, sanitation, etc.), challenges may arise, but sub-national coordination may be facilitated by proximity of departments working on related issues. However, dis-aggregated data on the local level may be difficult to obtain, but pride and shame among local officials may be used if data comparisons are feasible (e.g., district level nutrition commitment scorecards - click here for more on scorecards). Such data-driven tools can assist capacity building locally and challenge preconceptions, e.g., on "caring practices, access to health, and environmental sanitation."

Recommendations include:

• "... To facilitate tangible improvements in the nutritional status of vulnerable groups, different actors need to translate and safeguard these achievements [nutrition policies, laws and strategies] throughout the policy cycle, which requires effective MLA.
• Delivering on national policy and strategies will be facilitated by adopting a ‘whole of policy process’ approach in carrying out advocacy for nutrition. Policy advocates need to expand their focus beyond agenda-setting to be actively involved in the subsequent processes that contest, (re)formulate, translate and ultimately implement nutrition policy.
• Donors interested in supporting MLA for nutrition must recognise its need for long-term funding. Changes in policy and implementation take place over long timeframes beyond short project cycles. Funders should set ambitious but realistic expectations: advocacy influence is not a given; however, advocacy efforts can be evaluated for their coherence and strength.
• Further research on empirical cases of MLA is required to better understand its opportunities and constraints."