Multisectoral Approach to Nutrition in Ethiopia Assessed Through the Lens of the Collective Impact Framework: A Qualitative Study.

Abstract

The drivers of malnutrition are complex and multifaceted, requiring multisectoral interventions. The benefits of effective multisectoral approaches to nutrition have been recognised by nutrition policies in Ethiopia, but in practice, multisectoral coordination remains a challenge. This study aimed to identify facilitators and challenges to effective multisectoral coordination by applying the collective impact framework. Key informant interviews (KIIs; n = 63) were conducted among stakeholders representing various sectors and playing various roles in nutrition governance at the national level. Focus-group discussions (FGDs; n = 39) were conducted with stakeholders involved in nutrition programme implementation and governance from local kebele to national level. Addressing malnutrition through a multi-sectoral approach is identified as a unifying and common agenda across sectors. However, the other four conditions of collective impact, namely shared measurement, reinforcing activities, continuous communication, and backbone support, were suboptimal and varied by region and administration level. Limitations in resources, governance and accountability structures impeded the full realisation of effective multisectoral coordination. The application of the collective impact framework helped identify the impediments to a more effective multisectoral coordination in Ethiopia, providing guidance to improve the design and implementation of nutrition programmes for impact at scale.