Sengchaleun Viengsamay, Kounnavong Sengchanh, Reinharz Daniel
Department of Social and Preventive Medicine, Laval University, Quebec, QC, Canada.
Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao PDR.
Trop Med Health. 2023 Aug 8;51(1):43. doi: 10.1186/s41182-023-00532-w.
In most developing countries, addressing malnutrition involves a coalition of stakeholders that includes the government and international development partners. This study explores the evolution of the malnutrition actor coalition landscape before and after the emergence of the National Nutrition Policy in the Lao People's Democratic Republic (Lao PDR) in 2008.
A qualitative study was conducted based on the theory of coalition structuring. Twenty semi-structured interviews were performed with representatives of national and international organisations involved in addressing malnutrition in Lao PDR. The information obtained from the interviews was complemented by an analysis of relevant documents dating back to 1990. Interviews were recorded and transcribed verbatim. A thematic analysis was performed using NVivo 11 software and the diagrams of collaboration drawn by the participants were turned into a visual collaboration map using SocNetV software. We relied on various types of triangulation to increase the analysis's credibility, reliability, and confirmability.
The results showed that before the emergence of the National Nutrition Policy, three coalitions representing the health, agriculture, and education sectors coexisted. These colalitions worked largely in silos, although with some interactions when deemed necessary mainly by United Nations agencies. The emergence of the National Nutrition Policy provided the government with an effective political tool for coalescing the three coalitions into a unique coalition involving all major stakeholders in the nutrition field. All three forces that incite actors to collaborate inside a coalition according to the theory of coalition structuring (transactions, control, intangible factors) were mobilised in the creation of the single coalition.
Combating malnutrition is a government priority in the Lao PDR. The current study showed that the National Nutrition Policy in Lao PDR has led to a significant evolution in the malnutrition coalition landscape, resulting in improved collaboration among stakeholders. This finding highlights the effectiveness of public policies in facilitating intersectoral activities to tackle complex problems, such as malnutrition.
在大多数发展中国家，解决营养不良问题需要包括政府和国际发展伙伴在内的多方利益相关者组成联盟。本研究探讨了2008年老挝人民民主共和国（老挝）国家营养政策出台前后，营养不良问题行动者联盟格局的演变。
基于联盟构建理论进行了一项定性研究。对老挝参与解决营养不良问题的国家和国际组织的代表进行了20次半结构化访谈。通过对可追溯到1990年的相关文件进行分析，对访谈获得的信息进行补充。访谈进行了录音并逐字转录。使用NVivo 11软件进行了主题分析，并使用SocNetV软件将参与者绘制的合作关系图转化为可视化合作地图。我们依靠多种三角验证方法来提高分析的可信度、可靠性和可证实性。
结果表明，在国家营养政策出台之前，代表卫生、农业和教育部门的三个联盟并存。这些联盟在很大程度上各自为政，尽管在联合国机构认为必要时会有一些互动。国家营养政策的出台为政府提供了一个有效的政治工具，将这三个联盟合并为一个由营养领域所有主要利益相关者组成的独特联盟。根据联盟构建理论，在创建单一联盟的过程中，调动了促使行动者在联盟内部进行合作的所有三种力量（交易、控制、无形因素）。
在老挝，抗击营养不良是政府的一项优先工作。当前的研究表明，老挝的国家营养政策导致了营养不良联盟格局的重大演变，从而改善了利益相关者之间的合作。这一发现凸显了公共政策在促进跨部门活动以解决诸如营养不良等复杂问题方面的有效性。
