Tools for Strengthening Implementation of Largescale Nutrition Programs: An Evaluation of the Program Assessment Guide (PAG).

Objectives: The Program Assessment Guide (PAG) is a 44 page 9 module workshop facilitation guide developed as "a tool to strengthen the design and implementation of large-scale nutrition programs." It has been used to guide workshops for this purpose in Kyrgyzstan, Bolivia, Tanzania, Nepal and Haiti, among others. There is growing interest in the PAG but experience with its use has not been previously evaluated. We report on an external evaluation to learn from these experiences, as a basis for understanding its performance, factors that influence its performance and potential refinements. Methods: The evaluation was guided by the PAG's underlying theory of change and was based on a review of workshop reports, outputs and evaluations, field visits, assessment of outcomes from selected workshops, programs and locations and an overall synthesis of experience to date. Results: The PAG has been well-accepted by implementers in the workshops, identified bottlenecks not previously recognized and generated concrete action plans for program strengthening. A major challenge has been to ensure implementation of the action plans after the workshop. Conclusions: The PAG shows promise as a tool for strengthening implementation of large-scale nutrition programs but greater efforts and clear expectations of required human and financial resources are needed to secure commitments in order to ensure implementation of the action plan.

Building Strategic Capacities to Strengthen the Enabling Environment for Nutrition Policies and Programs in Four African Countries.

Objectives: Undernutrition has received significant attention at global and national levels in recent years but translating this attention into effective action at the country and district levels poses many challenges. We describe the observed national environments that support and challenge actors in moving national multisectoral nutrition policies and plans forward and how this on-going action research (AR) project seeks to strengthen strategic capacities and leadership in Burkina Faso, Mali, Ethiopia and Uganda. Methods: Participant observation and meetings with stakeholders provide insight into the enabling environment and its challenges. This AR then uses boundary-spanning tools such as shared history, practitioner profiles, PAG workshops among others to engage stakeholders in collaborative learning and to facilitate informal strategic and adaptive management approaches to nutrition policies and program implementation. Results: All four countries have developed multisectoral national nutrition policies and/or plans and created coordinating committees. Further multisectoral progress however faces challenges seen elsewhere, such as the dominance of sectoral goals and incentives, uneven understanding of multisectoral roles, responsibilities and leadership; uneven participation and ownership; uneven human and institutional capacities; lack of effective sub-national multisectoral platforms; and persistence of unaligned donor- and NGO-driven approaches. On-going work focuses on the formation of strategic alliances, leadership development, strengthening of sub-national platforms and experiences to inform the design of multisectoral strategies at the national level and strengthening linkages with global initiatives. Conclusions: Together these activities help create crucial elements of a sustainable enabling environment for reducing malnutrition in these countries.