Multi-sectoral Action Teams Help District Officers Implement - PowerPoint PPT Presentation

Multi-sectoral “Action Teams” Help District Officers Implement Nutrition Policies and Strengthen Coordination Across Sectors for Nutrition in Tanzania Rosemary Kayanda Research Coordinator, IMA World Health August 2019 Tanzania Food and Nutrition Centre

Acknowledgements Funding for this research was provided by UK aid from the UK government through the Department of International Development (DFID) Lead : IMA World Health, Tanzania Collaborating Partners : Tanzania Food and Nutrition Centre, Dar es Salaam and Cornell University, United States Co-authors: Gina C Klemm, Aidan Kazoba, Luitfrid P Nnally, Juliet McCann, and Katherine L Dickin Cornell University Tanzania Food Division of Nutritional and Nutrition Centre Sciences

Health Background and (Nutrition ) Social WASH Welfare (Water Objectives and Multi- sanitation ) Sectoral Nutrition Agriculture  Multi-sectoral nutrition (MSN) policies Education Community are important for reducing stunting Dev.  Tanzania has excellent MSN policy but factors affecting implementation are not well-known  Knowledge gap exists in how to translate policies at the implementation level  Study Objective: Explore “Action Teams” United Republic of and mentoring as low cost strategies to Tanzania (2016): National support local coordination across sectors Multi-sectoral Nutrition Action Plan for nutrition (NMNAP), 2016-2021

Sampling  Conducted in 5 regions with high childhood stunting rates, >30% (MoH, 2018)  Presence of “ASTUTE” program—aimed to Regions in Tanzania, n=20 strengthen community-based maternal, infant and child health programs to prevent stunting  In each region, the Regional Nutrition Officer was recruited to mentor a multi-sectoral team  Regional Nutrition Officers chose 1 district to pilot the “Action Team” approach, with variation in accessibility and officer experience

Study Setting  In the 5 districts, District Nutrition Officers had limited availability and were over-committed, some working as full-time clinicians  Collaboration across sectors was challenging given the coordination required to get all stakeholders involved  Districts had MSN Steering Committees but they weren’t meeting regularly—when they did, other sectors had little to report  Nutrition not considered a multi-sectoral issue; need to change mindsets and mobilize stakeholders

Strengthening MSN Capacity POLICY National Multi- and Collaboration sectoral Nutritional (MSN) Action Plan IMPLEMENTATION COORDINATION District MSN Steering Committee National MSN Steering Committee Health Sector Heads of other Sectors: Regional MSN Steering Committee Head: District Agriculture, Medical Officer Education, Community Health Sector Development, etc. Head: Regional Medical Officer MSN ACTION TEAM District Regional Nutrition Agricultural, Education, Nutrition Officer & Community Officer Development Officers Regional Nutrition Officers supported District Nutrition Officers to create an MSN Action Team of 3-4 officers from other sectors

Implementation Process month 0 month 3-4 month 4-5 month 10-13 month 14-15 Mentoring MSN MSN goals Activity MSN workshop Action and proposal activities conducted Teams activities developed implemented created planned by action in teams communities Midstream of study, we identified lack of funding in other sector’s budgets as a major barrier for implementation of actions

Research Methods  Held quarterly support calls with Regional Nutrition Officers to address emergent challenges, including lack of funding  Interviewed participants 3-4 times over 15 months using a semi-structured interview guide to capture barriers and facilitators to MSN planning and collaboration  Transcribed interviews with 29 regional and district officers; analyzed transcripts thematically

Nutrition Officers created Action Teams despite “silo mentality”  Action Teams formed and met regularly in 4 of 5 sites  Most teams included officers from Health, Agriculture, Community Development, and Education Sectors  Motivated, social conscience officers who were well-connected in communities were critical for membership  Mentoring happened, most Regional Officers were supportive  Connecting teams to sector leaders provided credibility  Delays due to workload, transfer of officers, and lack of funding

Action Teams planned & implemented nutrition actions in a multi-sectoral way Advocacy 1. Increased priority for nutrition Budgeting 2. Improved budgeting for nutrition 3. Developed capacity at community level Implementation

Action Teams planned and implemented nutrition actions in a multi-sectoral way “Ever since the Regional Nutrition Officer started coming, nutrition is now being seen as an activity in this department. Before it was not even 1. Increased known if there are nutrition priority for activities to focus on.” nutrition - Community Development Officer

Action Teams planned and implemented nutrition actions in a multi-sectoral way “Previously nutrition wasn’t budgeted for. We’ve been able to advocate to government officials and emphasize funds be set aside for nutrition. It’s common to have leaders budget for 2. Improved nutrition but never release the funds. budgeting We’re now working on a strategy to for nutrition improve this issue.” - District Nutrition Officer

Action Teams planned and implemented nutrition actions in a multi-sectoral way  One team established multi-sectoral nutrition committees at the level below the district to cascade implementation to local levels. 3. Developed  Structured way for district officers capacity at to build capacity of implementation community staff and better understand local level challenges  Started with 5 committees; has since scaled-up to 21.

Dissemination and Sustainability  We disseminated preliminary findings and recommendations in the 4 research sites that completed study activities  Dissemination meetings included Regional Nutrition Officers, Action Team members, and key regional and district leaders  Attendees were very enthusiastic and generated ideas for how to sustain and scale-up study approaches

Recommendations  Have Action Team members sign a “nutrition compact” to acknowledge their role  Create a vehicle share for the Action Team to implement several multi-sectoral actions per trip  Use current policy to fund Action Team activities (e.g. 1,000 TSH per child)  Share strategies—Teams were motivated to try new activities after learning what others did  Scale-up—Initial Action Team members to serve as mentors for others interested in the approach

Thank You Artwork by David Kyungu, Matatizo Media Productions

Mentoring:  A mutual, supportive, learning relationship where someone with more experience passes on knowledge and skills, and opens doors to otherwise out of reach opportunities  Strengthens mentee knowledge and ability to communicate and network with stakeholders to better meet professional goals  Encourages mentees to ask important questions, promote greater self-awareness, and make more informed decisions  Helps leaders gain a greater understanding of the challenges facing implementers and helps them to overcome barriers

MSN Action Team:  An organized and active group comprised of stakeholders from key nutrition-sensitive sectors  Supports the implementation, sustainability, and scale-up of effective interventions and activities in communities  Is guided by and actively engages with policy recommendations, sector leaders, and community members

Examples of other activities implemented by Action Teams  Implemented a supportive supervision tool to use in schools and health facilities that was nutrition-sensitive  Held a workshop on importance of school feeding program and a plan to establish school gardens  Trained Primary Health Teachers, Community Health Workers and Extension Officers on MSN strategy to reduce stunting  Developed and advertised promotional materials for Vitamin A supplementation campaign