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

Abstract

Background: In 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 multisectoral 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. Methods: Data 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. Results: Few 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. Conclusions: Federal 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.

Assessment of linkage between Productive Safety Net Program and Health Services in Somali Region, Ethiopia: Lessons, Challenges and Missed Opportunities

“…This is similar to other studies 25,26 that review the practical implication of linkages between agriculture and health sector which reported that funding and budget controls as the core reason why there was little interaction between the two sectors. A similar study 27 in Ethiopia also identi ed lack of resources within individual sectors as barriers to effective coordination between health and agriculture and these studies recommended development of joint work plan with budget allocated for all activities to be implemented by both sectors for effective integration of intervention.…”

“…Another study in 27 Ethiopia on linkages between health and agriculture sectors also identi ed presence of competing priorities within individual sectors as barriers to effective coordination between the two sectors and the studies recommended inclusion of the integrated activities in the workplan or deliverables of the staffs in the health and agriculture sectors.…”

Challenges to joint planning, monitoring, and evaluation for nutrition-sensitive agriculture in Ethiopia: an exploratory qualitative study

“…Malnutrition has been identified as a target public health problem among children and women in Ethiopia [ 13 , 14 ]. Improving collaboration across the nutrition and agriculture sectors in planning, monitoring, and evaluation to link nutrition and agriculture is crucial for the country to address the continued high prevalence of malnutrition.…”

Lessons learned from operationalizing the integration of nutrition-specific and nutrition-sensitive interventions in rural Ethiopia

“…Ethiopia has implemented multiple nutrition-specific and nutrition-sensitive programs such as the Ethiopian national nutrition program, and the Seqota declaration program, that have required the development of structures and processes that facilitate multisectoral coordination [15]. But, collaborations between the health and agriculture sectors are suboptimal at community levels [16]. The multi-sectoral nutrition programs and interventions lack strong coordination that brings on board all the relevant stakeholders.…”