Measuring Governance: Developing a Novel Metric for Assessing Whether Policy Environments are Conducive for the Development and Implementation of Nutrition Interventions in Nepal

Abstract

Background: The Nutrition Governance Index (NGI) defines a first standardized approach to quantifying the ‘quality of governance’ in relation to national plans of action to accelerate improvements in nutrition. It was created in response to growing demand for evidence-based measures that reveal opportunities and challenges as nutrition-related policies on paper are translated into outcomes on the ground. Numerous past efforts to measure ‘governance,’ most notably World Health Organization’s (WHO’s) NGI and the separate Hunger and Nutrition Commitment Index (HANCI), both of which lack granularity below the national level and each of which fails to capture pinch points related to necessary cross-sectoral actions. This paper addresses such caveats by introducing an innovative metric to assess self-reported practices of, and perceptions held by, administration officials tasked with implementing government policy at the sub-national level. The paper discusses the development of this metric, its methodology, and explores its application in the context of Nepal. Methods: Conducted as part of a nationally representative longitudinal survey across 21 of Nepal’s 75 districts, the substudy on which this paper is based used data from 520 government and non-government officials at different geographic and administrative tiers of authority. Using robust statistical techniques, structured questionnaire data were condensed into a score using a scale from 0 to 100. Results: Six domains were identified through the analysis: Understanding Nutrition and related responsibilities; Collaboration; Financial Resources; Nutrition Leadership, Capacity, and Support. About half of all health sector representatives achieved a high score (>3 on 5-point scale) compared to representatives in other sectors of government activity (such as agriculture or education) (χ2=12.99, P<.003). The health sector also showed the most improvement in mean NGI score over a two-year follow-up period. Conclusion: This paper shows that self-reported perceptions and behaviors of those responsible for policy implementation can be usefully quantified. The NGI can be used to assess countries’ readiness for the application of nutrition policies.

Barriers and Facilitators to the Implementation of Large-Scale Nutrition Interventions in Africa: A Scoping Review

“…With respect to the policy and legislation theme, this review revealed how supportive political environments and nutrition-specific guidelines ease the implementation process by removing logistical barriers and increasing the motivation or commitment of personnel. This idea was echoed by a recent study conducted by Namirembe et al (2020), where researchers stated that individual nutrition programs are more sustainable and cost effective when they are supported by structures and policies that fit with program goals. Interventions do not exist in a vacuum; thus, factors such as political commitment to carrying out nutrition-relevant policies are part of the requirement for achieving desirable nutrition outcomes (Namirembe et al 2020).…”

“…This idea was echoed by a recent study conducted by Namirembe et al (2020), where researchers stated that individual nutrition programs are more sustainable and cost effective when they are supported by structures and policies that fit with program goals. Interventions do not exist in a vacuum; thus, factors such as political commitment to carrying out nutrition-relevant policies are part of the requirement for achieving desirable nutrition outcomes (Namirembe et al 2020). For example, South Africa's integrated nutrition strategy, later known as the Integrated Nutrition Program (INP), aimed to incorporate nutritional promotion at various policy levels (Labadarios et al 2005).…”

Utilising emerging perspectives at the global and regional level to frame multisectoral nutrition governance landscape in Kenya

“…The five recent and widely cited indices to assess MNG are as follows: (i) the WHO Nutrition Governance Index (WHO's NGI) which ranks governments on their 'commitment' (willingness to act) and 'capacity' (readiness to act) to improve nutrition, (ii) the Hunger and Nutrition Commitment Index (HANCI) which ranks governments on their political commitment to addressing undernutrition while seeking to measure what governments achieve and where they fail (65) , (iii) the Political Commitment (for Nutrition) Rapid Assessment Tool which measures a country's level of political commitment and identifies opportunities to advance food and nutrition on governmental agendas (66) , and (iv) MNG framework by World Bank which aims at qualitatively assessing enablers and barriers of MNG at the country level (45) . The recently developed NGI by Tufts University is the first standardised approach to quantifying the MNG in relation to national plans of action to accelerate improvements in nutrition (64) . In addition to these global frameworks and tools, individual countries have also developed their metrics to assess MNG.…”

“…Challenges in achieving multisectoral nutrition governance Several challenges that developing countries are encountering as they strive to establish effective MNG have been identified. These challenges can be attributed to various factors, including inadequate leadership and guidance, limited resources, weak institutional capacity, fragmented coordination mechanisms, and competing priorities among others (18,25,37,45,48,64) . Challenges specific to Kenya are given in the following sections.…”

‘Getting the Right Nutrients to Those Who Need Them Most’: towards nutrition-sensitive governance of fisheries in the Global South

“…Adding nutrition-related objectives to official policies or strategies is not sufficient as even attempts at measuring results and decisions in nutrition governance can be problematic, for instance how to measure (e.g. what indicators to include) governments' 'commitment' or 'capacity' in addressing nutrition-related questions (Namirembe et al 2021(Namirembe et al , 2022. To tackle these complexities and make headways in its endevours, a nutrition-sensitive governance of fisheries requires breaking outside of the technical arena of 'implementation' and develop links between theory and practice, values and actions, and between different forms of knowledge, requiring changes in the current ways fisheries are thought of and managed.…”