Why is this issue important to MSPs?
Most countries set up an initial MSP at national level, in order to cultivate nutrition champions, advocate for resources for nutrition, and coordinate action for nutrition policy and strategy at the highest levels. When coordinated nutrition implementation is required however, there is a need to bring these structures closer to the ground where programmes are enacted. Decentralised MSPs serve several functions: To provide a structure for bringing central-level MSP plans and strategies to local action; to coordinate planning and implementing actors at local levels; and to feed information and learning back from activities on the ground.
Setting up a decentralised MSP requires all of the same steps as setting up a national-level MSP – all of the steps outlined in this toolkit are relevant for decentralised MSPs and should be followed when designing local MSPs. There are however some general differences in context at sub-national level, which will affect the way some steps are undertaken:
The ‘context’ for a decentralised MSP is very often simpler geographically and politically than at national level, but can be more complex socially because it is closer to affected communities and might require more participation from groups with diverse ideas on nutrition action. While the reason for setting up an MSP might be that the national level has mandated it, there is nonetheless scope for taking potential stakeholders on ‘learning journeys’ into communities to clarify the multisectoral nature of the issue. These can define the local nutrition context, identifying local issues and opportunities for creating the MSP.
Identifying and engaging stakeholders
Stakeholder mapping is generally simpler at local levels, with fewer stakeholders involved in the issue of nutrition. But this does not mean that mutual understanding and trust are more easily built: There may be a large diversity of views on nutrition and the governance structure needed, and a range of types of power wielded, so attention to deepening mutual understanding over time is still vital for a functioning and sustainable MSP. Learning journeys with key stakeholders can build stakeholder support in non-traditional organisations for nutrition by showing actors how nutrition is inherently multisectoral in the lived experience of communities.
Establishing structure and process
As the local level may be a smaller context with fewer actors, the balance of formal and informal processes for running the MSP may be different at local level, particularly if actors already know each other. Even so, it will be important to understand existing government structures that exist (such as local development coordination committees or government coordination or planning bodies locally), so that the MSP can be set up to work through these structures rather than in parallel to them. The same goes for understanding how budgets flow to sub-national level through various routes, which needs to be factored in when deciding where and how to set up the MSP. Given that there is generally less strategic facilitation capacity at local levels, it may be advisable to bring in external facilitation from national level to guide the initial stages of decentralised MSP design and setup.
Reviewing and improving
Very often, the criteria by which an MSP will be judged effective will already have been decided at national level. It is important however to have some flexibility in helping decentralised MSPs to define some of their own criteria also, for improved ownership and local relevance. Progress review, monitoring and lesson-learning is done on two levels in decentralised MSPs: Locally, for ongoing monitoring and course-correction; and in collaboration with national level, in order to share lessons and progress with national level and with other decentralised MSPs. A key issue for decentralised MSPs is capacity development: generally stakeholders will have good technical capacity at local level, but may lack strategic capacity to organise an MSP, so initial support and ongoing management training are key to successful MSPs.
Zambia was an early adopter of decentralised MSPs. An initial pilot was funded and facilitated by the NGO Concern Worldwide in one district initially from 2011, and the eventual model and ‘lessons learned’ were scaled up to 13 more high-stunting districts four years later, with others planned for later. This phased approach allowed for gradual learning, and also was not too much of a burden on national capacity and budgets. In the pilot district, an external facilitator with strong management training skills and technical nutrition knowledge was brought in for a few days every few months, in order to set the MSP off to a good start.
In the pilot district, an initial steering group of capable and interested individuals from key ministries at local level was identified. The capacity of this group was cultivated through learning journeys into local communities to understand the context and need for coordinated multisectoral action; through management training retreats for strategic capacity building; and through review and reflection trips to the capital city to share lessons learned.
Through discussions and consultation between the steering group and other stakeholders, it was decided that a District Nutrition Coordination Committee (DNCC) should be constituted as a formal structure under existing government systems so that it would have formal reporting and budgeting lines to national level. The DNCC brought together stakeholders from government, NGOs and civil society, and community groups in the District. Meetings happened every two months, and were initially called and convened by Concern Worldwide, though after two years this role rotated with the chair among steering group members and their ministries.
A key part of building stakeholder support at national level was the feedback of this pilot district at national events. The lessons learned in this district were distilled into a simplified programme for later districts without such dedicated support. This was rolled out through the support of the national-level MSP, whose members visited other districts in turn to set up MSPs and help them develop detailed action plans which aligned with the national nutrition strategic plan. In some cases, lower-level Ward nutrition coordination committees were established to help with community integration of nutrition programmes.