The Role of Political and Governance Factors in Scaling up Maternal and Child Micronutrient Interventions.

ABSTRACT

Objectives: Scaling up nutrition interventions could save 900,000 lives annually (Bhutta et al, 2013), yet effectively doing so has been slower than expected and the results uneven. There is a growing recognition that technical knowledge alone is insufficient for achieving positive outcomes (Natalicchio et al, 2009) and political and governance factors play a critical role in successfully delivering nutrition interventions (Pelletier, 2002; Pinstrup-Anderson, 1993). However, the governance of the nutrition sector remains an underexplored area (Acosta and Fanzo, 2012) and many are calling for a closer examination of political and policy processes (Gillespie et al, 2013). Our objective is to shed light on this neglected area, specifically as it relates to scaling up micronutrient interventions. Methods: We used Yamey's (2011) article, Scaling Up Global Health Interventions: A Proposed Framework for Success, to identify relevant political and governance factors (including leadership/governance, the state and its relations with non-state actors, the state's ability to facilitate decentralized delivery, and national policies). We then did a literature review using Medline, Web of Science, Econlit, ELDIS, and Google Scholar, focusing on nutrition interventions. This will be complemented with interviews with practitioners working to scale up micronutrient interventions. Results: Our preliminary results suggest that political and governance factors play a critical role, but further research in needed to understand the causal mechanisms for how these act as facilitators of or barriers to scaling up. Conclusions: Successfully navigating political and governance factors will increase the likelihood that intervention coverage can be expanded.