What drives and constrains effective leadership in tackling child undernutrition? Findings from Bangladesh, Ethiopia, India and Kenya. By Nick Nisbett, Institute of Development Studies

1. What drives and constrains effective leadership
in tackling child undernutrition? Findings from
Bangladesh, Ethiopia, India and Kenya.
Nicholas Nisbett1
Institute of Development Studies, UK
n.nisbett@ids.ac.uk
Based on collaborative research reported in : Nisbett, N.,Wach, E., Haddad, L., & El Arifeen, S. (2015).What drives and constrains
effective leadership in tackling child undernutrition? Findings from Bangladesh, Ethiopia, India and Kenya. Food Policy, 53, 33-45.

2. Pillar 3
•What are the features of an enabling
environment; key preconditions, drivers?
•How to assess, monitor and strengthen
leadership and capacity?
•How to assess, monitor and strengthen
accountability and responsiveness?
“How can an enabling environment be promoted so as to
use existing political and economic resources more
effectively, and so to generate new resources to improve
nutrition?”

3. Creating and sustaining
momentum for undernutrition
reduction
Converting momentum to impact
on nutrition status
Framing, generating and communicating knowledge and evidence
• Framing and narratives
• What works?
• How well do nutrition interventions work relative to
other interventions?
• Evidence/data on outcomes and benefits
• Advocacy to increase priority (civil society)
• Evidence on coverage and scale
• Implementation research (what works, why and
how)
• Monitoring coverage
• Programme evaluation (impact pathways)
• Generating demand for evidence of impact
• Learning during crisis
Political economy of actors, ideas and interests
• Incentivising and delivering horizontal coherence
(multisectoral coordination)
• Building up accountability to citizens
• Civil society: galvanizing commitment
• Enabling and incentivizing positive contributions from
the private sector
• Delivering horizontal and vertical coherence
• The role of civil society in delivery & impact
• The role of private sector
Capacity (individual, organizational, systemic) and financial resources
• Leadership/championing
• Systemic capacity to sustain commitment
• Understanding financing and making the case for
additional resource mobilisation
• Prioritisation and sequencing of nutrition action
• Capacity for Implementation and scaling up
• New forms of resource mobilisation
Gillespie S, Haddad L, Mannar V, Menon P, Nisbett N (2013) and the
Maternal and Child Nutrition Study Group. The politics of reducing
malnutrition: building commitment and accelerating progress. Lancet 2013

4. • Why some countries address nutrition better than others
is still an enigma
• Evidence on ‘what to do’ is relatively clear. What’s not clear
is why it’s not done.
• Individuals have been recognised as essential in championing
the policy changes necessary to address undernutrition
• But…how much do we know about the people who are, or
could be, leaders in the field of nutrition?
Why nutrition leadership and champions?

5. “capacities that are needed urgently include the knowledge,
skills, leadership, and human resources for envisioning,
shaping, and guiding the national and subnational nutrition
agendas”
(Bryce et al 2008 in Lancet Nutrition Series)
–WPHNA – Competencies for Global Public Health
Nutrition Workforce. (Hughes et al 2011)
–Leadership as central in tackling other complex public
health agendas (Horton 2011; Day et al 2014 –The Lancet)
Existing literature

6. Existing literature
– Leadership as critical factor in country case studies (e.g.
Mainstreaming Nutrition Initiative - Pelletier et al 2012;
IDS’ Analysing Nutrition Governance work – Mejia Acosta
& Fanzo 2012).
– Leadership as part of political commitment to nutrition –
Heaver 2005
• Decision makers  Champions
• Influencers  Policy Entrepreneurs
• Clients  Supporters

7. Existing literature
– Development Leadership Programme – existing
development scholarship on leadership draws on e.g. US
business/management literature – individual traits… lacks
attention to wider political processes:
• “Leadership is a political process involving the skills of mobilising people
and resources in pursuit of a set of shared and negotiated goals” (Leftwich
and Wheeler 2011, p.5)
– Systemic and adult development studies literature –
adaptive leadership; leadership is what people do not how
they are labelled

8. Key questions
• What is motivating people to become leaders in nutrition, is there
anything common in their background which may have led to them
to champion nutrition?
• What enables leaders to operate effectively in the nutrition policy
sphere; In particular, what are their analytical and political
capabilities?
• What are the external challenges and barriers to their effective
operation?
• What do leaders assess as knowledge gaps that are important to fill;
how do they employ their existing knowledge?
• How can the international policy community better support and
nurture emerging leaders?

9. Identifying
organisations, people,
power
Net-map sessions in Kenya,
India, Bangladesh, Ethiopia
Understanding issues
and context
Nutrition context analysis
+other desk research Draft list of
influential
individuals in
nutrition;
verify with
local partners
(60-70 per
country)
Stakeholder
Interviews
With some of these
people
(n=89; 15-27 per
country;
Sampling :
purposive/snowballing
Further analysis of
capacities; politics
and knowledge
Further analysis of
capacities; politics
and knowledge
Nutrition Leadership
Thematic coding
(NVIVO) (both
emergent and pre-
selected analytical
themes)
Thematic coding
(NVIVO) (both
emergent and pre-
selected analytical
themes)
Confirmation of
influential
individuals
Confirmation of
influential
individuals

10. Who is involved?

11. How are they connected?

12. How influential are they?

13. * from Gillespie et al. 2013
Capacities
Knowledge, evidence
and narratives
Political economy of
actors and ideas
Section 6 –
understanding
individual motivations,
knowledge and
capacities
Section 8 –
knowledge
environment
Section 7 – political
environment
What is motivating people to become
leaders in nutrition, is there anything
common in their background which may
have led them to champion nutrition?
What do leaders assess as the knowledge
gaps, how do they employ their existing
knowledge?
What are the external challenges and
barriers to their effective operation?
What enables people to become effective in
the nutrition policy sphere? In particular, what
are their political and analytical capabilities? How can the
international
community
better
support and
nurture
emerging
leaders?
Interview
analysis
Conceptual
framework*
Research
Questions
Figure 1 – conceptual framework mapped to research questions and paper structure
Section 9 –
summary of
findings and
implications

14. Individual attributes and capacities
• Wide range of actors: clinical research / practice ; nutrition qualifications vs
career CS, donors, NGOs
• Several influenced by earlier experience of humanitarian/natural disaster –
e.g. famine, drought; cyclones;
• Many drawn increasingly into nutrition – wanting to understand the ‘roots’
of undernutrition and its consequences
• National political landscape (e.g. G’ment power/donor power) contributed
to who and why powerful
• Actors demonstrated ability to locate themselves within complex systems
of policy, knowledge and power...
• Those seen as effective were often those able to transcend particular
disciplinary boundaries/framings; learn new disciplinary boundaries in order
to work with others
“We are brought up in silos so
we don’t know the world.
What you need to do is listen
for days and then start talking”
“multisectorality is not about making
everyone an expert across all sectors, but
is about how everyone can measure their
outcomes in terms of the collective
impact on a single person”

15. Political Economy of Actors and Ideas
• Policy challenges described echoed a range of existing literature - e.g.
evidence/politics/resources (Gillespie & Haddad et al 2013) or on horizontal &
vertical co-ordination: (Mejia Acosta et al 2012);
• Decisions and actions have been stymied by
– fragmented co-ordination (e.g. between donors or civil society), unclear
internal or external framing of issues (Shiffman 1997), competing interests,
varying donor interests and narratives;
– Lack of institutional home and lack of high level / executive champions
– Vertical co-ordination; bureaucratic/programmatic capacity and a lack of
ground level ‘champions’
‘Nutrition is the problem one.
Nutrition is no one’s baby. Presently it
is under the Ministry of Health, but
there’s more focus on health than
nutrition then…we haven’t got enough
emphasis to nutrition and there’s a lack
of coordination. There’s too much
focus on the health side, but we need
the other sides, such as women…
awareness raising, etc.’
“USAID is having program with govt that is
more focused on boosting agricultural
production agricultural diversity plus
behavioural change then comes DFID that
believes strongly in micro nutrients supply
and behavioural change communication,
[...then] FAO has it this is not the way to
go and I think we confuse govt more than
we assist them”

16. Knowledge, evidence and narratives
• Competing ‘framings’ and different knowledge claims – leads to
fractured nutrition community; limits political effectiveness
• Frustration with lack of data and evidence – stress on locally
collected and commissioned research, knowledge and data
• importance of local brokers of research
• (although external actors can add to ‘kudos’ to particular
decisions – when externally evidenced/advocated – particularly
difficult policy decisions)
‘Are nutritionists all talking about the same thing? One
group says only breast feeding; another says
breastfeeding plus complementary feeding; another
says micronutrients, another says RUTF...At senior
levels in government, do they really understand what
is meant by nutrition?’
“We organise meetings and these
are sometimes informal, these
are sometimes formal. Informal
meetings are very helpful. Just go
to some place with a cup of
tea...But the guy whom we are
talking to he must be influential.
So it’s quality that matters.”

17.
Research Question
Findings
Implications
What is motivating people to
become leaders in nutrition, is
there anything common in their
background which may have led
to them to champion nutrition?
o No common origin/catalyst drivers
o But several common pathways including
exposure in situations of high
malnutrition prevalence or wanted to
understand the root of health problems
o Nutrition is ‘sticky’ for some –
expose as many potential leaders as
possible to the realities of
undernutrition
What enables leaders to operate
effectively in the nutrition policy
sphere; In particular, what are
their analytical and political
capabilities?
o Most effective leaders able to deal with
complexity; systemic thinkers; post-
conventional levels of adult development
o Roles depend on networks: in
fragmented networks, they may be
boundary spanners; in less fragmented
but not cohesive networks they may be
co-creators; Individuals may change roles
depending on need and capacities
o Find ways to support these
capabilities & build them in others
o Encourage development of networks
What are the external challenges
and barriers to their effective
operation?
o Donor / CS politics
o Fragmentation / lack of coherent frames
o Lack of executive level political
commitment (rhetoric not backed by
reality)
o Knowledge and data gaps (below)
o Consensus building
o Accountability mechanisms for top-
level commitment
o Consult identified leaders on
political constraints
What do leaders assess as the
knowledge gaps; how do they
employ their existing knowledge?
o Gaps– effective multisectorality, timely
data, operational research
o Effective use – locally sourced and or
translated for policy audiences
o Consult identified leaders on
knowledge/data gaps
o Support local research supply &
demand & local knowledge brokers

18. Motivators
Personal experience
Exposure
Training
Data
Political &
communication skills
Strategy/vision
Alliance building
Use of evidence
Communication
Boundary crossing
Knowledge
Technical / nutrition
specific
Programming/practice
Decision makers Influencers Clients
Find the framing
Advocacy/campaigns
Electoral pressure
Persuade individuals
around them
Training:
Mobilisation skills
Grassroots
accountability and
advocacy skills
‘Leadership Training’
Workplace
competency, performance &
rewards criteria
Support networks/ alliances
Consensus building
Bring others in
Reward and exemplify
other champions and
cases of success
Bring champions
together
Training and education –
how to recognise nutrition.
Information on rights and
responsibilities and what
are the politicians doing?
Clear narratives
Clear evidence
Brief multisec training
Immersions
Support think tanks, other
knowledge brokers, media
Improve curricula
Clear narratives
Clear evidence
Brief multisec training
Immersions
Make nutrition visible at the
community level – real time
monitoring; community
accountability; support for
community mobilisers
Find the framing
Advocacy/campaigns
Electoral pressure
Persuade individuals
around them
Nutrition Champions
Nutrition Policy
Entrepreneurs
Nutrition Supporters
Nisbett, N., Wach, E., Haddad, L., El-Arifeen, S., Wach
(2014) What are the factors enabling and constraining
effective leaders in Nutrition? A four country Study.
IDS Working Paper 447 IDS: Brighton

19. Can we build leadership competencies?
Hughes R, Shrimpton R, Recine E, Margetts B. A competency framework for global public health nutrition
workforce development : A background paper.2011. World Public Health Nutrition Association.

20. Transforming Nutrition: Ideas,
Policy and Outcomes
Can we build and recognise nutrition
champions?