Prospective analysis of the development of the national nutrition agenda in Vietnam from 2006 to 2008

Abstract

Improved understanding of how to advance national nutrition policy is critical to ensure greater policy investments in nutrition. We used a participant-observer, change-agent model to prospectively study why and how national nutrition policy advanced in Vietnam between 2006 and 2008. Our goal was to understand strategies used, factors that shaped policy advancement, and the interaction of strategies with factors in this context. Data were collected using questionnaires, informant interviews, programme visits, document reviews and documentation of key events. For analysis, we created a chronology of events, examined strategies and actions used and their results by event, coded interviews and summarized findings using a well-known framework for policy analysis. Our analysis shows that the following elements were critical to bring greater attention to nutrition policy in this context: (1) building a cohesive nutrition policy community through creation and support of an alliance; (2) clearly defining internal and external frames for the nutrition problem; (3) using and creating high-profile internal and external policy windows; and (4) capitalizing on cultural motivations and values. Findings indicate that that rapid nutrition policy advancement is possible if purposeful, contextually sensitive strategies are used where favourable conditions exist, or can be created. The participant-observer, change-agent model was successful in both contributing to policy advancement and documenting it.

The politics of reducing malnutrition: building commitment and accelerating progress

“…10,23,27 Moreover, translation of any such momentum into eff ect on nutrition status is far from automatic and needs the deliberate alignment of several factors and processes. 10,[18][19][20][21][22] Our review also emphasises three linked factors as being crucial for building and sustaining of momentum and for conversion of that momentum into results.…”

“…Although scientifi c literature is emerging for decentralisation of health systems, 77,135 the research base is limited to a handful of studies. 20,27,[135][136][137] In Vietnam for instance, the role of provincial planning for nutrition has been identifi ed as an important bottleneck to translation of national policy intent and frameworks into plans and actions at the provincial level. 27 …”

Assessment of Epidemiologic, Operational, and Sociopolitical Domains for Mainstreaming Nutrition

“…BOX 2. Examples of constraints from assessment in Vietnam of the three domains (see Lapping et al [42] for further details of the Vietnam case study) Assessment process. Document review, stakeholder interviews, program field visits, attendance and participation at nutrition workshops and events, hosting of workshop on assessment results with national and provincial officials; facilitated by an in-country focal person.…”

“…In late 2006, an assessment was led by an expatriate with experience in Vietnam, in collaboration with a nongovernmental organization and the National Institute of Nutrition [42]. The assessment methods included document review, key informant interviews about current challenges and history of nutrition policy decisions, mapping of nutrition program activities and services delivered by national and international organizations, and program site visits.…”

“…This led to the inclusion of specific IYCN-related activities in the project's work plan, including a review of successful IYCN programs, development of an approach for rapid assessment of local constraints to IYCN, and national-level advocacy around IYCN. The influence of the assessment and the overall engagement in Vietnam is described in detail in Lapping et al [42].…”