Ayana Girmay, Hailu Tesfaye, Kuche Desalegn, Abera Andinet, Eshetu Solomon, Petros Alemnesh, Kebede Aweke, Tessema Masresha, Allen Cami M, Salasibew Mihretab M, Dangour Alan D
1Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
2London School of Hygiene & Tropical Medicine, London, UK.
BMC Nutr. 2017 Aug 2;3:69. doi: 10.1186/s40795-017-0189-4. eCollection 2017.
In Ethiopia, poor infant and young child feeding practices and low household dietary diversity remain widespread. The Government has adopted the National Nutrition Programme that emphasizes the need for multi-sectoral collaboration to effectively deliver nutrition-sensitive and nutrition-specific interventions. The Sustainable Undernutrition Reduction in Ethiopia (SURE) programme is one such Government-led initiative that will be implemented jointly by the health and agriculture sectors across 150 districts in Ethiopia. Prior to the design of the SURE programme, this formative research study was conducted to understand how the governance structure and linkages between health and agriculture sectors at local levels can support implementation of programme activities.
Data were collected from eight districts in Ethiopia using 16 key informant interviews and eight focus group discussions conducted with district and community-level focal persons for nutrition including health and agriculture extension workers. A framework analysis approach was used to analyze data.
Few respondents were aware of the National Nutrition Programme or of their own roles within the multi-sectoral coordination mechanism outlined by the government to deliver nutritional programmes and services. Lack of knowledge or commitment to nutrition, lack of resources and presence of competing priorities within individual sectors were identified as barriers to effective coordination between health and agriculture sectors. Strong central commitment to nutrition, increased involvement of other partners in nutrition and the presence of community development workers such as health and agriculture extension workers were identified as facilitators of effective coordination.
Federal guidelines to implement the Ethiopian National Nutrition Programme have yet to be translated to district or community level administrative structures. Sustained political commitment and provision of resources will be necessary to achieve effective inter-sectoral collaboration to deliver nutritional services. The health and agriculture extension platforms may be used to link interventions for sustained nutrition impact.
在埃塞俄比亚，婴幼儿喂养方式不当以及家庭饮食多样性低的情况仍然普遍存在。政府已通过国家营养计划，该计划强调需要多部门合作，以有效提供具有营养敏感性和针对性的干预措施。埃塞俄比亚可持续减少营养不良（SURE）计划就是这样一项由政府主导的倡议，将由埃塞俄比亚卫生和农业部门在150个地区联合实施。在设计SURE计划之前，开展了这项形成性研究，以了解地方层面卫生和农业部门之间的治理结构及联系如何支持计划活动的实施。
通过对埃塞俄比亚八个地区的16次关键信息人访谈以及与包括卫生和农业推广人员在内的地区及社区层面营养协调人进行的八次焦点小组讨论收集数据。采用框架分析方法对数据进行分析。
很少有受访者了解国家营养计划或其在政府概述的多部门协调机制中为提供营养计划和服务所扮演的角色。缺乏对营养的了解或投入、资源短缺以及各部门内部存在相互竞争的优先事项被确定为卫生和农业部门有效协调的障碍。对营养的坚定中央承诺、其他伙伴更多参与营养工作以及卫生和农业推广人员等社区发展工作者的存在被确定为有效协调的促进因素。
实施埃塞俄比亚国家营养计划的联邦指导方针尚未转化为地区或社区层面的行政结构。要实现提供营养服务的有效部门间合作，持续的政治承诺和资源投入将必不可少。卫生和农业推广平台可用于联系各项干预措施，以产生持续的营养影响。
