Nutrition agenda setting, policy formulation and implementation: lessons from the Mainstreaming Nutrition Initiative
Nutrition agenda setting, policy formulation and implementation: lessons from the Mainstreaming Nutrition Initiative
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DOI：
10.1093/heapol/czr011
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发表时间：
2012-01-01
影响因子：
3.2
通讯作者：
Ahmed, Tahmeed
中科院分区：
文献类型：
--
作者：
Pelletier, David L.;Frongillo, Edward A.;Ahmed, Tahmeed
营养不足是造成全球疾病负担的最大因素，可以通过一些非常有效的干预措施加以解决。然而，营养不良问题在全球和国家两级的政策议程中普遍没有得到相应的重视，在国家一级实施这些有效的干预措施已证明是困难的。本文件报告了在孟加拉国、玻利维亚、危地马拉、秘鲁和越南进行的研究的结果，这些研究旨在查明政策进程中的挑战和克服这些挑战的方法，特别是在承诺、议程制定、政策制定和执行方面。通过参与者观察、文件和访谈收集数据。数据收集、分析和综合以已公布的概念框架为指导，以了解营养不良、承诺、议程制定和执行能力。这些国家的经验为今后的努力提供了几点启示：（a）可以通过多种方式引起对营养问题的高级别政治关注，但政治承诺和系统承诺的产生需要政策企业家和倡导者的持续努力;（B）中-来自各部委和外部伙伴的一级行为者很难将营养方面的政治机会转化为具体的业务活动，由于能力制约、对营养不良问题的不同专业观点以及对干预措施、自主权、作用和责任的分歧，执行计划的速度和质量在大多数情况下受到严重制约，原因是从国家到一线各级的人力和组织能力薄弱。这些研究结果加深了我们对可能影响承诺、议程制定、政策制定和执行的因素的理解。它们还证实并扩大了人们日益认识到的一点，即除非或直到这些系统性的能力制约得到解决，并首先强调战略和管理能力，否则为确定有效的营养干预措施而进行的大量投资不太可能减轻营养不良的负担。
Undernutrition is the single largest contributor to the global burden of disease and can be addressed through a number of highly efficacious interventions. Undernutrition generally has not received commensurate attention in policy agendas at global and national levels, however, and implementing these efficacious interventions at a national scale has proven difficult. This paper reports on the findings from studies in Bangladesh, Bolivia, Guatemala, Peru and Vietnam which sought to identify the challenges in the policy process and ways to overcome them, notably with respect to commitment, agenda setting, policy formulation and implementation. Data were collected through participant observation, documents and interviews. Data collection, analysis and synthesis were guided by published conceptual frameworks for understanding malnutrition, commitment, agenda setting and implementation capacities. The experiences in these countries provide several insights for future efforts: (a) high-level political attention to nutrition can be generated in a number of ways, but the generation of political commitment and system commitment requires sustained efforts from policy entrepreneurs and champions; (b) mid-level actors from ministries and external partners had great difficulty translating political windows of opportunity for nutrition into concrete operational plans, due to capacity constraints, differing professional views of undernutrition and disagreements over interventions, ownership, roles and responsibilities; and (c) the pace and quality of implementation was severely constrained in most cases by weaknesses in human and organizational capacities from national to frontline levels. These findings deepen our understanding of the factors that can influence commitment, agenda setting, policy formulation and implementation. They also confirm and extend upon the growing recognition that the heavy investment to identify efficacious nutrition interventions is unlikely to reduce the burden of undernutrition unless or until these systemic capacity constraints are addressed, with an emphasis initially on strategic and management capacities.