Effects of Governance Structures in Ethiopia on Implementation of Nutrition Interventions
Eileen Kennedy *
Tufts University, Boston MA, USA.
Masresha Tessema
Ethiopian Health and Nutrition Research Institute, Addis Ababa, Ethiopia.
Aregash Samuel
Ethiopian Health and Nutrition Research Institute, Addis Ababa, Ethiopia.
Tarik Kassaye
Tufts University, Boston MA, USA.
Habtamu Fekadu
Save the Children, Addis Ababa, Ethiopia.
Tesfaye Hailu
Ethiopian Health and Nutrition Research Institute, Addis Ababa, Ethiopia.
Tsehay Assefa
Ethiopian Health and Nutrition Research Institute, Addis Ababa, Ethiopia.
Desalegn Kuche
Ethiopian Health and Nutrition Research Institute, Addis Ababa, Ethiopia.
Girmay Ayana
Ethiopian Health and Nutrition Research Institute, Addis Ababa, Ethiopia.
Dilnesaw Zerfu
Ethiopian Health and Nutrition Research Institute, Addis Ababa, Ethiopia.
Tibebu Moges
Ethiopian Health and Nutrition Research Institute, Addis Ababa, Ethiopia.
Adamu Belaye
Ethiopian Health and Nutrition Research Institute, Addis Ababa, Ethiopia.
Abinet Tesfaye
Ethiopian Health and Nutrition Research Institute, Addis Ababa, Ethiopia.
*Author to whom correspondence should be addressed.
Abstract
Objectives:
1. Assess factors that enhance or constrain implementation of nutrition interventions at national and sub national levels.
2. Analyze how direct nutrition interventions and multi sector approaches are implemented at national, regional, zonal and woreda levels.
3. Identify models of effective governance for nutrition interventions.
Methods: Key informants were interviewed using a structured questionnaire. National level interviews from the agricultural, health, education, finance, economic development, social protection sectors and UN agencies, civil society and donors were included. Parallel interviews were conducted in four regions - Amhara, Oromia, SNNPR and Tigray - and 16 woredas for a total of 312 interviews at the subnational level.
Results: While there was general awareness of the Government's activities as part of the SUN movement, key individuals at the national level were, in general, not able to identify specific actions that had been launched as a result of the 2013 National Nutrition Programme.
Linkages between policy and program initiatives between national and sub national levels varied. The vertical and horizontal collaborations were most active where a specific, coordinating body or mechanism had been established.
Several models of effective implementation are identified and most often originate outside the health sector.
Conclusions: Two dominant models of implementing a multi pronged strategy to alleviate malnutrition exist in Ethiopia. The appropriateness of these models and factors associated with each are discussed.