Vision, relationships, patience … and power: A qualitative analysis of how policy agents scale up cross-sectoral policy for nutrition.

Malnutrition in all its forms presents an urgent global health challenge and food systems transformation is a critical component of the necessary policy response. However, cross-sectoral policy engagement between nutrition policy makers and the policy sectors responsible for food systems change has proved challenging. This policy analysis focused on how policy makers act as agents within institutions to advance cross-sectoral policy making on food systems and nutrition, informed by theories of policy making and power. Forty-three interviews were conducted with policy actors working at global, regional and national level, in relevant sectors. The interview data were analysed iteratively, informed by theory, with a focus on actor roles, characteristics, skills and capacities and the dynamics between these dimensions. We found that successful cross-sectoral policy engagement for nutrition resulted from a dynamic interaction between agents and institutional structures, within which policy agents were able to exert 'power to' influence outcomes, and exert 'power with' multidisciplinary teams and cross-sectoral colleagues to effect change. These policy actors were able to shape ideas and create cultures and norms that supported cross-sectoral engagement, which led to effective engagement between policy sectors, characterised by constructive dialogue, shared decisions, trust, goodwill and balancing objectives across sectors. The result of this engagement was consideration of nutrition in policy making in sectors other than health, in ways that resulted in tangible policy outcomes. Success in cross-sectoral policy engagement was seen as strengthening both institutional support for cross-sectoral action on nutrition, and the ability of policy actors to overcome barriers.