Challenges to joint planning, monitoring, and evaluation for nutrition-sensitive agriculture in Ethiopia: an exploratory qualitative study

Agriculture and Food Security, Volume 11, No. 1, Year 2022

Interpretação

Background: Nutrition-sensitive agriculture is an effective multi-sectoral approach to address the underlying causes of malnutrition. However, successful implementation requires the involvement of different sectors to jointly plan, monitor, and evaluate key activities, which is often challenged by contextual barriers. Previous studies in Ethiopia have not adequately explored these contextual barriers. Hence, the current study aimed to qualitatively explore the challenges to joint planning, monitoring, and evaluation for nutrition-sensitive agriculture among sectors in Ethiopia. Methods: A qualitative exploratory study was conducted in Tigray and Southern Nations, Nationalities, and Peoples (SNNP) of Ethiopia regional states in 2017. Ninety-four key informants were purposively selected from government agencies primarily in health and agriculture, from local (kebele) to national levels, and ranging from academic organizations, research institutions, and implementing partners. Researchers developed a semi-structured guide and conducted key informant interviews which were audiotaped, transcribed verbatim in local language, and translated to English. All transcriptions were imported into ATLAS.ti Version 7.5 software for coding and analysis. The data analysis followed an inductive approach. Transcriptions were coded line by line; then similar codes were grouped into categories. Subsequently, non-repetitive themes were identified from the categories using thematic analysis methodology. Results: The following themes were identified as challenges that hinder joint planning, monitoring, and evaluation to link nutrition to agriculture: (1) limited capacity, (2) workload in home sector (agriculture or nutrition), (3) lack of attention to nutrition interventions, (4) inadequate supportive supervision, (5) problematic reporting system, and (6) weak technical coordinating committees. Conclusions and recommendations: Gaps in human and technical resources, limited attention from different sectors, and absence of routine monitoring data hindered joint planning, monitoring, and evaluation activities for nutrition-sensitive agriculture in Ethiopia. Short-term and long-term training for experts and intensification of supportive supervision may address gaps in capacity. Future studies should address whether routine monitoring and surveillance in nutrition-sensitive multi-sectoral activities provides long-term improvement in outcomes. This study was undertaken in Tigray and SNNP regions where International Potato Center (CIP) and partners implemented projects aimed at promoting production and consumption of nutritious OSFP in both regions of Ethiopia. The regions are among areas with a high prevalence of maternal and child chronic and acute malnutrition according to recent indicators. Despite rapid agriculture led economic progress in Ethiopia over the last two decades, malnutrition continues with high levels of stunting (37%), underweight (21%), and wasting (7%) [13]. Recently, there has been a national movement toward developing policy, strategies, and programs to address severe public health problems through involvement of multiple sectors. The current study was part of a larger systems diagnostic study on implementation challenges and opportunities for nutrition-sensitive agriculture interventions in Ethiopia. Here, the current study specifically targeted challenges that hinder joint planning, monitoring, and evaluation of activities that link nutrition to agriculture in the context of Ethiopia. This study was conducted from September to October, 2017. An exploratory qualitative study utilizing key informant interviews (KII) was conducted to understand the challenges for joint planning, monitoring, and evaluation across sectors to link nutrition with agriculture in Ethiopia. Thematic analysis was utilized to assess findings throughout. The primary method of data collection was in-person, in-depth KII undertaken with a purposively selected sample of key informants chosen by expertise, administrative position, work experience, and year of stay in the position related to the topic (6 months and above). During desk review, researchers identified and framed the existing coordinating platforms and key stakeholders in nutrition-sensitive agriculture in the regions (see Table Table1).1). Participants were experts and administrative representatives from the Federal Ministry of Health, five from Agriculture and Natural Resources, six from Regional Health and Agriculture Bureaus, ten from Health and Agriculture zonal offices, and twenty four from Health and Agriculture woreda offices. Six health extension workers at health posts, six heads of Farmers’ Training Centers (FTCs), and ten experts working in the centers were also part of this study at kebele level. In addition, four participants were recruited from Agricultural Technical and Vocational Education and Training centers (ATVETs), while two were from Health Science Colleges. Implementing partners operating in nutrition-sensitive and -specific sectors at national and regional levels were also included in this study (see Table Table1).1). Participants were approached before the actual interview and asked for convenient time and place to reduce possibility of interrupting the interview for office works. Each interview was conducted in place where privacy of the participants was kept and recording was possible with minimal disturbance. Each interview lasted a minimum of 45 min and the filed notes and the recorded audio were labeled, transferred into personal files that deny access to others than the investigators. Categorization and recruitment of study participants National (n = 05) Training institutions (n = 12) * = Save the children, REST, World vision, FAO, MUMs for MUMs, SURE, EPHI, and others A pretested semi-structured guide was used for the key informant interviews. The tool was developed by researchers following review of literature, government policy documents, existing platforms, possible stakeholders, and existing strategies in agriculture and health sectors to link nutrition with agriculture. The review provided a broader study on systems diagnostic of implementation challenges and opportunities for nutrition-sensitive agriculture interventions in Ethiopia which informed the interview guide. The broader study consisted of basic diagnostic principles including joint planning, monitoring, and evaluation. The current manuscript specifically focused on challenges to PME jointly done across sectors. The questions mainly asked participants awareness and perception on the necessity of integrating agriculture to nutrition and health, specific activities that their institution is doing to link agriculture and nutrition with specific examples (if any), efforts the institution is doing to jointly plan, implement, and evaluate activities that link agriculture to nutrition, and the challenges their institutions faced. Probes were employed for each questions and emerging concepts were incorporated in to the tool for the successive interviews. The investigators considered their prior conceptions, expectations, and experiences to counteract potential bias during data collection, transcription, and analysis. Data from key informants at different levels were triangulated for congruence and variation. During the in-depth interview, participants were probed using follow-up questions for points that needed clarification, completion, and depth. Data collection and analysis were undertaken concurrently. Preliminary analysis of collected data was done to incorporate emerging insights and views into the interview guide. Investigators also conducted debriefing sessions on daily basis to enhance trustworthiness of the data. Thematic analysis as outlined by Braun and Clarke provided the analytic strategy [19]. Each audiotaped interview was listened to repeatedly, transcribed verbatim, and imported into ATLAS.ti qualitative data analysis software version 7.5 (ATLAS.ti Scientific Software Development GmbH, Berlin, 2015) for coding and analysis. Field notes and investigator memos were also linked to files in the software to assist analysis. Text was coded based on its relevance to the central topic of inquiry. Two investigators openly coded the generated transcripts using an inductive approach. The two investigators checked consistency in coding on a daily based during peer debriefing. In the case of inconsistency, a third investigator was called for achieving shared understanding of the coding. Then, the two investigators assessed the revised set of codes for text congruency and linkage using axial coding. Consequently, similar codes were systematically categorized and categories were labeled. Finally, the labeled categories were transformed into candidate themes and final, non-repetitive themes. The investigators also engaged in debriefing and discussions during analysis to assure emerging themes and results were grounded in the data and the dimensions of the challenges were well captured. Description of the themes, the sub-categories under each theme, and illustrative quotes supporting the descriptions were used in writing the result. The institutional review board (IRB) of the College of Health Sciences at Mekelle University approved the protocol of the study. Written consent was sought from each participant after the objectives and the purposes of this study were explained and confidentiality was maintained.

AI Digest

Study Justification:

– The study aimed to explore the challenges to joint planning, monitoring, and evaluation for nutrition-sensitive agriculture in Ethiopia.
– Previous studies in Ethiopia did not adequately address these contextual barriers.
– Nutrition-sensitive agriculture is an effective multi-sectoral approach to address the underlying causes of malnutrition.

Study Highlights:

– The study was conducted in Tigray and Southern Nations, Nationalities, and Peoples (SNNP) regions of Ethiopia.
– Ninety-four key informants from government agencies, academic organizations, research institutions, and implementing partners were interviewed.
– The study identified six challenges that hinder joint planning, monitoring, and evaluation for nutrition-sensitive agriculture: limited capacity, workload in the home sector, lack of attention to nutrition interventions, inadequate supportive supervision, problematic reporting system, and weak technical coordinating committees.
– Gaps in human and technical resources, limited attention from different sectors, and absence of routine monitoring data were identified as hindrances to joint planning, monitoring, and evaluation activities.
– Short-term and long-term training for experts and intensification of supportive supervision were recommended to address capacity gaps.
– Future studies should assess whether routine monitoring and surveillance in nutrition-sensitive multi-sectoral activities lead to long-term improvement in outcomes.

Recommendations for Lay Reader and Policy Maker:

– Increase capacity through short-term and long-term training for experts.
– Intensify supportive supervision to address gaps in implementation.
– Improve attention to nutrition interventions across sectors.
– Strengthen the reporting system for better monitoring and evaluation.
– Enhance the functioning of technical coordinating committees.
– Conduct future studies to assess the long-term impact of routine monitoring and surveillance in nutrition-sensitive activities.

Key Role Players:

– Government agencies in health and agriculture sectors at local, regional, and national levels.
– Academic organizations and research institutions.
– Implementing partners operating in nutrition-sensitive and specific sectors.
– Health extension workers, heads of Farmers’ Training Centers, and experts working in the centers.
– Agricultural Technical and Vocational Education and Training centers.
– Health Science Colleges.

Cost Items for Planning Recommendations:

– Training programs for experts.
– Supportive supervision activities.
– Improvement of the reporting system.
– Strengthening technical coordinating committees.
– Research and evaluation activities for long-term impact assessment.
– Coordination and communication efforts among key role players.

Força da prova

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a qualitative exploratory study conducted in Ethiopia. The study utilized key informant interviews and thematic analysis to identify challenges to joint planning, monitoring, and evaluation for nutrition-sensitive agriculture. The study provides specific themes and recommendations based on the findings. However, the evidence could be strengthened by including information on the sample size, selection criteria, and potential limitations of the study. Additionally, providing more details on the methodology and data analysis process would enhance the transparency and replicability of the study.

Resumo

This study was undertaken in Tigray and SNNP regions where International Potato Center (CIP) and partners implemented projects aimed at promoting production and consumption of nutritious OSFP in both regions of Ethiopia. The regions are among areas with a high prevalence of maternal and child chronic and acute malnutrition according to recent indicators. Despite rapid agriculture led economic progress in Ethiopia over the last two decades, malnutrition continues with high levels of stunting (37%), underweight (21%), and wasting (7%) [13]. Recently, there has been a national movement toward developing policy, strategies, and programs to address severe public health problems through involvement of multiple sectors. The current study was part of a larger systems diagnostic study on implementation challenges and opportunities for nutrition-sensitive agriculture interventions in Ethiopia. Here, the current study specifically targeted challenges that hinder joint planning, monitoring, and evaluation of activities that link nutrition to agriculture in the context of Ethiopia. This study was conducted from September to October, 2017. An exploratory qualitative study utilizing key informant interviews (KII) was conducted to understand the challenges for joint planning, monitoring, and evaluation across sectors to link nutrition with agriculture in Ethiopia. Thematic analysis was utilized to assess findings throughout. The primary method of data collection was in-person, in-depth KII undertaken with a purposively selected sample of key informants chosen by expertise, administrative position, work experience, and year of stay in the position related to the topic (6 months and above). During desk review, researchers identified and framed the existing coordinating platforms and key stakeholders in nutrition-sensitive agriculture in the regions (see Table Table1).1). Participants were experts and administrative representatives from the Federal Ministry of Health, five from Agriculture and Natural Resources, six from Regional Health and Agriculture Bureaus, ten from Health and Agriculture zonal offices, and twenty four from Health and Agriculture woreda offices. Six health extension workers at health posts, six heads of Farmers’ Training Centers (FTCs), and ten experts working in the centers were also part of this study at kebele level. In addition, four participants were recruited from Agricultural Technical and Vocational Education and Training centers (ATVETs), while two were from Health Science Colleges. Implementing partners operating in nutrition-sensitive and -specific sectors at national and regional levels were also included in this study (see Table Table1).1). Participants were approached before the actual interview and asked for convenient time and place to reduce possibility of interrupting the interview for office works. Each interview was conducted in place where privacy of the participants was kept and recording was possible with minimal disturbance. Each interview lasted a minimum of 45 min and the filed notes and the recorded audio were labeled, transferred into personal files that deny access to others than the investigators. Categorization and recruitment of study participants National (n = 05) Training institutions (n = 12) * = Save the children, REST, World vision, FAO, MUMs for MUMs, SURE, EPHI, and others A pretested semi-structured guide was used for the key informant interviews. The tool was developed by researchers following review of literature, government policy documents, existing platforms, possible stakeholders, and existing strategies in agriculture and health sectors to link nutrition with agriculture. The review provided a broader study on systems diagnostic of implementation challenges and opportunities for nutrition-sensitive agriculture interventions in Ethiopia which informed the interview guide. The broader study consisted of basic diagnostic principles including joint planning, monitoring, and evaluation. The current manuscript specifically focused on challenges to PME jointly done across sectors. The questions mainly asked participants awareness and perception on the necessity of integrating agriculture to nutrition and health, specific activities that their institution is doing to link agriculture and nutrition with specific examples (if any), efforts the institution is doing to jointly plan, implement, and evaluate activities that link agriculture to nutrition, and the challenges their institutions faced. Probes were employed for each questions and emerging concepts were incorporated in to the tool for the successive interviews. The investigators considered their prior conceptions, expectations, and experiences to counteract potential bias during data collection, transcription, and analysis. Data from key informants at different levels were triangulated for congruence and variation. During the in-depth interview, participants were probed using follow-up questions for points that needed clarification, completion, and depth. Data collection and analysis were undertaken concurrently. Preliminary analysis of collected data was done to incorporate emerging insights and views into the interview guide. Investigators also conducted debriefing sessions on daily basis to enhance trustworthiness of the data. Thematic analysis as outlined by Braun and Clarke provided the analytic strategy [19]. Each audiotaped interview was listened to repeatedly, transcribed verbatim, and imported into ATLAS.ti qualitative data analysis software version 7.5 (ATLAS.ti Scientific Software Development GmbH, Berlin, 2015) for coding and analysis. Field notes and investigator memos were also linked to files in the software to assist analysis. Text was coded based on its relevance to the central topic of inquiry. Two investigators openly coded the generated transcripts using an inductive approach. The two investigators checked consistency in coding on a daily based during peer debriefing. In the case of inconsistency, a third investigator was called for achieving shared understanding of the coding. Then, the two investigators assessed the revised set of codes for text congruency and linkage using axial coding. Consequently, similar codes were systematically categorized and categories were labeled. Finally, the labeled categories were transformed into candidate themes and final, non-repetitive themes. The investigators also engaged in debriefing and discussions during analysis to assure emerging themes and results were grounded in the data and the dimensions of the challenges were well captured. Description of the themes, the sub-categories under each theme, and illustrative quotes supporting the descriptions were used in writing the result. The institutional review board (IRB) of the College of Health Sciences at Mekelle University approved the protocol of the study. Written consent was sought from each participant after the objectives and the purposes of this study were explained and confidentiality was maintained.

Materiais

N/A

Inovações

Based on the provided description, the study focuses on exploring the challenges to joint planning, monitoring, and evaluation for nutrition-sensitive agriculture in Ethiopia. The aim is to improve access to maternal health through the implementation of multi-sectoral approaches to address the underlying causes of malnutrition. Here are some potential innovations that can be used to improve access to maternal health:

1. Mobile Health (mHealth) Solutions: Develop mobile applications or SMS-based platforms that provide pregnant women and new mothers with access to information and resources related to maternal health, nutrition, and agriculture. These platforms can also facilitate communication between healthcare providers and patients, allowing for remote monitoring and support.

2. Community Health Workers: Train and deploy community health workers who can provide education, counseling, and support to pregnant women and new mothers in their communities. These workers can help bridge the gap between healthcare facilities and remote areas, ensuring that women have access to essential maternal health services.

3. Telemedicine: Establish telemedicine programs that allow pregnant women in remote areas to consult with healthcare providers through video conferencing or phone calls. This can help overcome geographical barriers and ensure that women receive timely and appropriate care during pregnancy and childbirth.

4. Integrated Service Delivery: Implement integrated service delivery models that bring together healthcare providers from different sectors, such as health and agriculture, to jointly plan, monitor, and evaluate maternal health interventions. This can help ensure a comprehensive and coordinated approach to addressing the nutritional needs of pregnant women and improving maternal health outcomes.

5. Capacity Building: Invest in training programs and capacity building initiatives for healthcare providers, agricultural extension workers, and other relevant stakeholders. This can enhance their knowledge and skills in nutrition-sensitive agriculture and maternal health, enabling them to effectively plan, implement, and evaluate interventions.

6. Data Collection and Monitoring: Develop robust data collection and monitoring systems that capture relevant indicators related to maternal health and nutrition-sensitive agriculture. This can help track progress, identify gaps, and inform evidence-based decision-making for improved access to maternal health services.

These innovations can help address the challenges identified in the study and contribute to improving access to maternal health through nutrition-sensitive agriculture interventions in Ethiopia.

AI Innovations Description

The study mentioned focuses on the challenges to joint planning, monitoring, and evaluation for nutrition-sensitive agriculture in Ethiopia. While the study does not directly address access to maternal health, it provides insights into the barriers that hinder the integration of agriculture and nutrition, which can indirectly impact maternal health outcomes. Based on the findings of the study, the following recommendations can be made to develop innovations that improve access to maternal health:

1. Strengthen capacity: Address the limited capacity of different sectors by providing short-term and long-term training for experts. This can help build the necessary knowledge and skills to effectively plan, monitor, and evaluate nutrition-sensitive agriculture interventions.

2. Enhance coordination: Establish and strengthen technical coordinating committees that bring together representatives from various sectors, including health and agriculture. These committees can facilitate joint planning, implementation, and evaluation of activities that link agriculture to nutrition, including maternal health interventions.

3. Improve supportive supervision: Increase the provision of supportive supervision to ensure that activities are being implemented effectively and to address any challenges that arise. This can help identify gaps in implementation and provide guidance and support to improve the quality of maternal health services.

4. Enhance reporting systems: Address the issues with the reporting system by developing a more efficient and effective system for collecting and analyzing data related to maternal health. This can help track progress, identify areas for improvement, and inform decision-making.

5. Promote multi-sectoral collaboration: Encourage collaboration and coordination between different sectors, including health, agriculture, and nutrition, to ensure a holistic approach to improving maternal health. This can involve joint planning, resource sharing, and the integration of nutrition-sensitive interventions into existing maternal health programs.

6. Conduct further research: Conduct additional studies to assess the long-term impact of routine monitoring and surveillance in nutrition-sensitive multi-sectoral activities on maternal health outcomes. This can help identify best practices and inform future interventions.

By implementing these recommendations, it is possible to develop innovative approaches that improve access to maternal health by addressing the barriers identified in the study.

AI Innovations Methodology

Based on the provided description, it seems that you are looking for innovations to improve access to maternal health. Unfortunately, the description does not provide specific information about maternal health or any challenges related to it. However, I can provide a general methodology to simulate the impact of recommendations on improving access to maternal health.

Methodology to simulate the impact of recommendations on improving access to maternal health:

1. Define the recommendations: Identify the specific recommendations that are intended to improve access to maternal health. These recommendations could include interventions, policies, or strategies aimed at increasing access to maternal health services.

2. Identify key indicators: Determine the key indicators that will be used to measure the impact of the recommendations on improving access to maternal health. These indicators could include metrics such as the number of women accessing prenatal care, the percentage of women receiving skilled birth attendance, or the reduction in maternal mortality rates.

3. Collect baseline data: Gather baseline data on the current status of maternal health access in the target population. This data will serve as a reference point for comparison after the implementation of the recommendations.

4. Develop a simulation model: Create a simulation model that incorporates the recommendations and their potential impact on improving access to maternal health. This model should consider factors such as population demographics, healthcare infrastructure, and resource availability.

5. Input data into the simulation model: Input the baseline data and other relevant information into the simulation model. This includes data on the target population, healthcare facilities, and the implementation of the recommendations.

6. Run simulations: Run multiple simulations using the model to assess the potential impact of the recommendations on improving access to maternal health. Vary the parameters and assumptions within the model to explore different scenarios and potential outcomes.

7. Analyze results: Analyze the results of the simulations to determine the potential impact of the recommendations on improving access to maternal health. Compare the outcomes of the simulations to the baseline data to assess the effectiveness of the recommendations.

8. Refine recommendations: Based on the analysis of the simulation results, refine the recommendations as necessary. Identify areas where the recommendations are most effective and areas where further improvements are needed.

9. Implement recommendations: Implement the refined recommendations in the target population. Monitor and evaluate the implementation process to ensure that the recommendations are being effectively implemented.

10. Monitor and evaluate impact: Continuously monitor and evaluate the impact of the recommendations on improving access to maternal health. Use the same key indicators identified in step 2 to measure progress and make any necessary adjustments to the recommendations.

By following this methodology, you can simulate the potential impact of recommendations on improving access to maternal health and make informed decisions on how to best address the challenges in this area.

Autor

Dima Health

Identifiers:

DOI: 10.1186/s40066-022-00400-6

Research Areas:

Community Interventions, Food Security, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants

Study Countries:

Ethiopia

Study Design:

Cohort Study, Cross Sectional Study, Exploratory Study, Grounded Theory

Study Approach:

Qualitative

Partilhar isto: