Lessons learned
- Political commitment for the MSP in Sri Lanka is high, with the MSP positioned in the Presidential Council, led by the President, and well-funded by government.
- Sri Lanka has made significant progress in decentralising its MSPs, and the structure of the decentralised MSP is layered on existing administrative arrangements, meaning it is well integrated into government systems. However, the MSP at national level has to some extent replaced previous ways of collaborating, and is not always as efficient.
- While government is well represented on the MSP, engagement with non-government stakeholders is weaker, and accountability mechanisms do not provide for adequate feedback.
- Issues such as a lack of strategic capacity among staff and siloed action points continue to limit coordination despite the presence of the MSP.
- Strong government ownership and a designated nutrition budget line are important factors for the sustainability of the MSP, but greater collaboration across ministries, and with other stakeholders on a regular and consistent basis can multiply some of these benefits and help address the challenge of undernutrition in the country.
Purpose of MSP
Undernutrition is an important public health issue in Sri Lanka and is a key development priority for the country. Though Sri Lanka has achieved better outcomes on several health indicators when compared to countries at similar income levels these improvements have not translated into better nutritional status. It is for these reasons that nutrition sensitive actions have received considerable policy attention in the past few years. High wasting prevalence, slow progress on stunting, and regional inequities in nutritional outcomes (with high undernutrition prevalence in the Tea Estate sector) prompted the government and several donors to undertake various multisectoral interventions from 2010 onwards. Sri Lanka joined the SUN Movement in 2012 and launched its first Multisectoral Action Plan for Nutrition (MSAPN) in 2013.
Since 2010, various departments have attempted to mainstream nutrition in their interventions. However cross-sectoral engagement at the level of policy making is still quite limited. Sri Lanka established its Multi-sectoral Platform (MSP), the National Nutrition Council (NNC), in 2011 following the recommendation made in the National Nutrition Policy (2010). The main objective of the MSP is the implementation of the MSAPN. For this purpose, the NNC has dedicated considerable resource and manpower in developing the National Nutrition Information database for at-risk households. This is currently in the pilot stage.
Positioning
The NNC is chaired by the President and the National Nutrition Secretariat (NNSSL) is based within the Presidential Secretariat. This not only provides strong convening power to the MSP but also demonstrates the highest level of commitment to nutrition in the country. Having the NNSSL within the Presidential Secretariat has helped in coordinating and facilitating the multi-sectoral approach in nutrition because ‘orders come from the top level’. It has worked positively at the sub-national level because the NNSSL is identified with the Presidential Secretariat and therefore performance monitoring is taken extremely seriously at the local level. Collaborative links through the MSPs at multiple levels appear to be stronger because the nutrition steering committees are layered over existing administrative committees put in place to review the implementation of development programmes at the sub-national level.
Leadership
The Council is headed by the President (the highest political authority in the country). The NNSSL is a key division of the Presidential Secretariat and part of the policy evaluation and monitoring unit. Thus the officers are also required to focus on various other development programmes and projects, nutrition being just one among them. MSAPN and related activities of the NNSSL are coordinated by senior bureaucrats, assisted by other bureaucrats who handle several portfolios. Overburdening of the staff at the national level and limited technical capacity (on nutrition) within the NNSSL affects their capacity for cross-sectoral engagement at the national level.
Despite strong leadership, accountability and feedback mechanisms are seen to be one of the weakest links in the MSP framework. Regular reporting mechanisms are established and the sub-national units are expected to send their reports to the NNSSL. At the national level, NNSSL coordinates with the focal points in the respective line ministries. However, there are limited mechanisms established for feedback and accountability. There is a general frustration among the sub-national staff about poor feedback regarding the data that is collected. The front-line staff feels burdened with regular rounds of data collection and is unaware of how that data is being fed back into national policy interventions.
Structure
The NNC brings together various government departments and agencies engaged in nutrition sensitive and specific activities. The NNC is also administratively supported by three key bodies: the National Steering Committee on Nutrition (NSCN), Technical Advisory Committee on Nutrition (TACN) and the National Nutrition Secretariat of Sri Lanka (NNSSL). The NNSSL is the nodal agency for coordination and implementation between different departments, ministries and sub-national units.
The MSAPN provides a joint framework to achieve nutritional outcomes but the key action points are designed as department/ministry specific interventions and no guidelines are established for collaboration across sectors. Each Department has a specific focal point and the NNSSL plays the key role in coordinating and following up with these officers. This line of communication has displaced more formal structures of collaborative meetings between diverse stakeholders thus limiting collaboration at the national level.
In 2015, the national MSP framework was decentralised to the sub-national level. At the sub-national level, a National Steering Committee on Nutrition (NSCN) structure is decentralised to the provincial, district and division level. Village level nutrition committees have also been formed and consist of frontline workers in agriculture, health, Samurdhi (poverty alleviation) programme, and education. At each of these levels, the respective Steering Committees on Nutrition consist of representatives from nutrition sensitive and specific sectors as well as local civil society organisations. Regular meetings take place within the framework of the provincial/district/division coordination committee. Leveraging existing governance structures at the sub-national level rather than creating new ones has helped to strengthen collaboration between various actors here.
Overview of the ‘Nutrition Governance’ System – ensuring that all key ministries are mobilised for improved nutrition outcomes in Sri Lanka:
Representation
The MSP includes sixteen sectoral ministries, donors and development partners, civil society organisations, and academic partners. With a change in staffing and secretariat composition in 2015, and a corresponding shift in the focus of the MSP from national to sub-national level, there has also been a considerable shift in the level of engagement with stakeholders outside of the government. There is strong government involvement and ownership of the MSP platform, which has meant the limited integration of actors (UN networks, Civil Society alliance) outside of the government structure at the national and sub-national level. The development partners largely play an advisory role and provide technical and (at times) financial assistance for nutritional programmes and interventions. The Civil Society Alliance has carried out periodic reviews of the MSAPN but is not very well integrated into the working and decision-making structures of the platform. An Academic Network was launched in 2016 and is still in its inception.
Resources
The government has demonstrated a strong financial commitment towards nutrition. From 2015 onwards, a dedicated budget line for nutrition was created. Each department/ministry has created a separate budget line for nutrition, for which allocations are made from the actual Government budget. Public finance constitutes 95% of the allocations for nutrition programmes. While a majority of the funding comes from the state, UN partners also provide financial assistance where possible. In contrast with the initial years of the MSP formation, the secretariat activities are solely funded by the government which is good for long – term sustainability of the MSP institutional framework.
Other important aspects of MSP design
Overlapping responsibilities with the health sector
The NNSSL plays a pivotal role in vertical and horizontal collaboration on nutritional activities. However, there are overlaps between the activities of the NNSSL and the Ministry of Health, Nutrition and Indigenous Medicine (MoH). The MoH operates through a fairly robust and decentralised structure and has various nodal units that also work towards inter-sectoral and intra-department coordination. These include the Nutrition Division (ND), the Family Health Bureau (FHB), and the Medical Research Institute (MRI) among others. The MoH is an important actor in the functioning of the MSP at the sub-national level. At this level, the steering committee meetings are generally co-chaired by the health officer. Lack of clarity in roles and functions has also created parallel reporting structures thereby overburdening the staff at the local level, and limiting collaboration at the national level.
‘Bright spots’ at the sub-national level
Within the decentralised framework of the MSP, innovations and champions are emerging at the local level. The case of Bibile (Monoragala district) is often showcased as a ‘success story’ where Sanhida committees (multisector collaborative committees which included community members) were established at the local level. The health officer played a pivotal role in establishing these committees. In other contexts (such as Hanguranketha in Nuwara Eliya district), the success of the divisional MSP could be attributed to : (1) trust and communication built through formal and informal ties between government stakeholders; (2) strong accountability frameworks across different governance tiers; (3) strong monitoring and leadership provided by the divisional secretary; and (4) clear action points for various sectors.