What does an enabling environment for infant and young child nutrition look like at implementation level? Perspectives from a multi-stakeholder process in the Breede Valley Sub-District, Western Cape, South Africa.

BACKGROUND: Breede Valley is a sub-district of the Cape Winelands district, Western Cape Province, South Africa. The administrative capital of the district is situated in the semi-rural town Worcester. Findings of a baseline survey in Worcester revealed poor infant feeding practices and childhood under- and overnutrition, with particular concern over high levels of stunting and low dietary diversity. Maternal overweight and obesity was high. These characteristics made the site suitable to study multi-sectoral arrangements for infant and young child nutrition (IYCN). The purpose of this study was to explore elements of an enabling environment with key stakeholders aimed at improving IYCN at implementation level. METHODS: Focus group discussions and interviews were conducted with representatives from two vulnerable communities; local and district government; higher education institutions; business; and the media in the Breede Valley. Audio recordings were transcribed and data were analysed with the Atlas.TI software programme. RESULTS: The participants viewed knowledge and evidence about the first 1000 days of life as important to address IYCN. The impact of early, optimal nutrition on health and intellectual development resonated with them. The IYCN narrative in the Breede Valley could therefore be framed around nutrition's development impact in a well-structured advocacy campaign. Participants felt that capacity and resources were constrained by many competing agendas spreading public resources thinly, leaving limited scope for promotion and prevention activities. "People" were viewed as a resource, and building partnerships and relationships, could bridge some shortfalls in capacity. Conversations about politics and governance elicited strong opinions about what should be done through direct intervention, policy formulation and legislation. A lead government agency could not be identified for taking the IYCN agenda forward, due to its complexity. Participants proposed it should be referred to a local, informal, inter-governmental body where directors and senior managers meet to address issues of cross-cutting importance. CONCLUSION: The study illustrated that knowledge and evidence; politics and governance; and capacity and resources, elements of the international definition of an enabling environment, also apply at implementation level. In addition, our findings indicated that a people-centred approach is critical in shaping the enabling environment at this level.

The NOMA track module on nutrition, human rights and governance: Part 1. Perceptions held by Master's students

Background. A module on nutrition; human rights and governance was developed and presented jointly by academic institutions in Norway; South Africa and Uganda; under the NOrway MAsters (NOMA) programme; for their respective Master's degree programmes in nutrition. Consisting of three study units; it was presented consecutively in the three countries; with each study unit building on the previous one. Objectives. To document the perceptions of participating students on various aspects of the module; informing future curriculum endeavours. Methods. A mixed methods approach was followed. A module evaluation form completed by students for each study unit was analysed. In-depth telephonic interviews were voice recorded and transcribed. Through an inductive process; emerging themes were used to compile a code list and content analysis of the unstructured data.Results. An overall positive module evaluation by 20 participants (91% response rate) can be ascribed to the module content; enlightening study visits; expertise of lecturers and an interactive teaching style. Logistical issues regarding time management and administrative differences among the academic institutions caused some concerns. Students experienced some resistance against qualitative research in natural science faculties. Students benefited from being exposed to different teaching styles and education systems at universities in different countries. Constructive alignment of teaching and learning activities could be optimised through involvement and empowerment of all relevant lecturers.Conclusion. Successful implementation of the module not only provides nutrition Master's students with knowledge to operationalise a human rights-based approach during future interactions in their professional practice; but also serves as an example of the benefits and challenges of interdisciplinary and transnational collaboration in module development

The NOMA track module on nutrition, human rights and governance: Part 2. A transnational curriculum using a human rights-based approach to foster key competencies in nutrition professionals

Background. In response to the challenge of the global health needs of the 21st century; four academic institutions in Norway; South Africa and Uganda; each offering a Master's degree in nutrition; collaboratively developed the NOrwegian MAsters (NOMA) track module on nutrition; human rights and governance; integrating a human rights-based approach into graduate education in nutrition. Objective. To capture students' perceptions about the NOMA track module; focusing on the development of key competencies. Methods. Employing a qualitative approach; 20 (91% response rate) in-depth telephonic interviews were conducted with participating students; voice recorded and transcribed. Through an inductive process; emerging themes were used to compile a code list for content analysis of the transcribed text. Relevant themes were reported according to the professionals' roles described by the CanMEDS competency framework. Results. Participation in the module enhanced key competencies in the students; e.g. communication skills and the adoption of a holistic approach to interaction with people or communities. Their role as collaborator was enhanced by their learning to embrace diversity and cultural differences and similarities. Students had to adapt to different cultures and educational systems. They were inspired to contribute in diverse contexts and act as agents for change in the organisations in which they may work or act as leaders or co-ordinators during interaction with community groups and policy makers. Higher education institutions offering transnational modules should support lecturers to manage the inherent diversity in the classroom as a way of enhancing student performance.Conclusion. The development of future transprofessional modules will benefit from the inclusion of desirable key competencies as part of the module outcomes by following a competency by design process