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Nutrition agenda setting, policy formulation and implementation: lessons from the Mainstreaming Nutrition Initiative.

机译：营养议程的制定，政策的制定和实施：主流营养倡议的经验教训。

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Undernutrition is the single largest contributor to the global burden of disease and can be addressed through a number of highly efficacious interventions. Undernutrition generally has not received commensurate attention in policy agendas at global and national levels, however, and implementing these efficacious interventions at a national scale has proven difficult. This paper reports on the findings from studies in Bangladesh, Bolivia, Guatemala, Peru and Vietnam which sought to identify the challenges in the policy process and ways to overcome them, notably with respect to commitment, agenda setting, policy formulation and implementation. Data were collected through participant observation, documents and interviews. Data collection, analysis and synthesis were guided by published conceptual frameworks for understanding malnutrition, commitment, agenda setting and implementation capacities. The experiences in these countries provide several insights for future efforts: (a) high-level political attention to nutrition can be generated in a number of ways, but the generation of political commitment and system commitment requires sustained efforts from policy entrepreneurs and champions; (b) mid-level actors from ministries and external partners had great difficulty translating political windows of opportunity for nutrition into concrete operational plans, due to capacity constraints, differing professional views of undernutrition and disagreements over interventions, ownership, roles and responsibilities; and (c) the pace and quality of implementation was severely constrained in most cases by weaknesses in human and organizational capacities from national to frontline levels. These findings deepen our understanding of the factors that can influence commitment, agenda setting, policy formulation and implementation. They also confirm and extend upon the growing recognition that the heavy investment to identify efficacious nutrition interventions is unlikely to reduce the burden of undernutrition unless or until these systemic capacity constraints are addressed, with an emphasis initially on strategic and management capacities.
机译：营养不良是造成全球疾病负担的最大因素，可以通过许多有效的干预措施来解决。在全球和国家层面，营养不足通常没有得到应有的重视，但是事实证明，在国家范围内实施这些有效干预措施是困难的。本文报告了孟加拉国，玻利维亚，危地马拉，秘鲁和越南的研究结果，这些研究旨在确定政策进程中的挑战以及克服这些挑战的方法，特别是在承诺，议程制定，政策制定和实施方面。通过参与者的观察，文件和访谈收集数据。数据收集，分析和综合以已发布的概念框架为指导，以了解营养不良，承诺，议程设置和执行能力。这些国家的经验为未来的努力提供了一些见解：（a）可以通过多种方式引起人们对营养的高层政治关注，但是政治承诺和系统承诺的产生需要政策企业家和支持者的持续努力; （b）由于能力限制，营养不足的专业观点不同以及干预，所有权，作用和责任的分歧，来自各部委和外部伙伴的中层行动者很难将获得营养的政治机会转化为具体的行动计划; （c）在大多数情况下，执行的速度和质量受到国家和前线各级人员和组织能力的弱化的严重制约。这些发现加深了我们对可能影响承诺，议程设置，政策制定和实施的因素的理解。他们还确认并扩大了人们的认识，除非确定或直到解决了这些系统能力的限制，而首先侧重于战略和管理能力，否则为确定有效的营养干预措施而进行的大量投资不可能减轻营养不足的负担。

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