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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.
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