Linkages between health and agriculture sectors in Ethiopia: a formative research study exploring barriers, facilitators and opportunities for local level coordination to deliver nutritional programmes and services

Girmay Ayana,Masresha Tessema,Aweke Kebede,Desalegn Kuche,Cami M Allen,Andinet Abera,Mihretab M Salasibew,Solomon Eshetu,Alemnesh Petros,Alan D Dangour,Tesfaye Hailu

doi:10.1186/s40795-017-0189-4

Abstract

BackgroundIn Ethiopia, poor infant and young child feeding practices and low household dietary diversity remain widespread. The Government has adopted the National Nutrition Programme that emphasizes the need for multi-sectoral collaboration to effectively deliver nutrition-sensitive and nutrition-specific interventions. The Sustainable Undernutrition Reduction in Ethiopia (SURE) programme is one such Government-led initiative that will be implemented jointly by the health and agriculture sectors across 150 districts in Ethiopia. Prior to the design of the SURE programme, this formative research study was conducted to understand how the governance structure and linkages between health and agriculture sectors at local levels can support implementation of programme activities.MethodsData were collected from eight districts in Ethiopia using 16 key informant interviews and eight focus group discussions conducted with district and community-level focal persons for nutrition including health and agriculture extension workers. A framework analysis approach was used to analyze data.ResultsFew respondents were aware of the National Nutrition Programme or of their own roles within the multi-sectoral coordination mechanism outlined by the government to deliver nutritional programmes and services. Lack of knowledge or commitment to nutrition, lack of resources and presence of competing priorities within individual sectors were identified as barriers to effective coordination between health and agriculture sectors. Strong central commitment to nutrition, increased involvement of other partners in nutrition and the presence of community development workers such as health and agriculture extension workers were identified as facilitators of effective coordination.ConclusionsFederal guidelines to implement the Ethiopian National Nutrition Programme have yet to be translated to district or community level administrative structures. Sustained political commitment and provision of resources will be necessary to achieve effective inter-sectoral collaboration to deliver nutritional services. The health and agriculture extension platforms may be used to link interventions for sustained nutrition impact.

Highlights

In Ethiopia, poor infant and young child feeding practices and low household dietary diversity remain widespread
Findings from this study are intended to inform the design of the Sustainable Undernutrition Reduction in Ethiopia (SURE) programme and other integrated interventions that depend on effective multi-sectoral coordination for nutrition. Study aim This aim of this qualitative study was to identify barriers, facilitators and opportunities for local level coordination between health and agriculture sectors to deliver nutritional services in Ethiopia
A functional multi-sectoral coordination committee was defined as a committee composed of representatives of all 9 relevant sectors and actively conducting activites as demonstrated by joint planning, regular meetings based on a set of agenda and record of providing supportive supervision to the provision of nutritional services in the community

Summary

Introduction

In Ethiopia, poor infant and young child feeding practices and low household dietary diversity remain widespread. The Sustainable Undernutrition Reduction in Ethiopia (SURE) programme is one such Government-led initiative that will be implemented jointly by the health and agriculture sectors across 150 districts in Ethiopia. Prior to the design of the SURE programme, this formative research study was conducted to understand how the governance structure and linkages between health and agriculture sectors at local levels can support implementation of programme activities. Ethiopia has diverse agro-climatic environments and produces a variety of foods, but child dietary diversity remains poor [2]. Promotion of nutrition-sensitive agriculture can contribute to improved dietary diversity and increased income (from agricultural activities) can facilitate the purchase of nutritious food and health services [7]. Intra-sectoral political commitment to nutrition-sensitive approaches is often limited in agriculture [8]

Methods

Results

Discussion

Conclusion