USAID Multi Sectoral Nutrition Strategy 2nd Periodic Assessment

Abstract Information: The United States Agency for International Development’s (USAID) Multi-Sectoral Nutrition Strategy (MSNS) (2014–2025) was developed to guide and inform the agency’s nutrition policies and programs in humanitarian and development contexts, with the goal of improving economic productivity, resilience, and overall nutritional status to save lives. At the request of USAID, Data for Impact (D4I) conducted the second assessment of the MSNS to assess the progress in using the MSNS globally by focusing on five case study countries—Bangladesh, Mali, Nepal, Rwanda, and Uganda—and addressing the causes of malnutrition through multisectoral nutrition (MSN) program approaches. D4I used a mixed-methods approach, including a review of documents and USAID nutrition projects, an online survey of USAID Mission staff, and qualitative key informant interviews and focus group discussions with USAID staff, implementing partners, and external partners. The assessment found that the five countries have made excellent progress in reducing malnutrition, as measured by stunting and wasting in children under five. There continue to be challenges in reducing anemia in children 6-59 months and women of reproductive age and in improving infant and young child feeding indicators. Participants responded favorably to the national commitment to the MSN programming approach but provided several recommendations for translating national multisectoral nutrition plans into action, including increased capacity support for designing and implementing interventions and better monitoring of the uptake of optimal practices during implementation. Participants provided evidence about the importance of the quality and reach of nutrition programs to address remaining structural barriers at the country level.

Relevance Statement: From 2006-2013, global nutrition development partners disseminated key analyses to promote interventions to reduce malnutrition, which included a discussion of a multisectoral nutrition approach. Our assessment was designed to evaluate the current progress of multisectoral nutrition programming in five focus countries. The main objective was to understand how countries used USAID's MSNS to design, implement, and monitor nutrition interventions, and to gather lessons learned around MSNS implementation. The assessment also looked at how partners have influenced MSN programming and how nutrition programming has evolved at USAID missions. We used a mixed-methods approach to 1) evaluate how countries have progressed in reducing malnutrition, 2) identify specific lessons learned for developing policies and implementing programs, 3) understand how USAID's MSNS has contributed to country progress, and 4) provide recommendations for the next iteration of the MSNS. We selected five focus countries, two in Asia and three in Africa, with a range of environmental, economic, and cultural contexts to weave a story of MSN programming, and what the country-specific experiences and challenges can tell us about the broader MSN narrative. We began with a review of nutrition indicators and the Global Nutrition Targets for each country, analyzing additional socioeconomic indicators to inform the differences in context between the countries. We connected with country missions to share nutrition flagship program documents, which were synthesized in a document review to illustrate how specific program approaches aligned with the MSNS. Next, we used three approaches to glean insights on each country's journey in nutrition programming. An online survey was sent to mission teams in countries outside the five focus countries to provide a broader picture of how the MSNS is being used. We conducted key informant interviews with USAID Mission staff in the focus countries, implementing partners, and external development partners. These discussions resulted in program-specific nutrition wins, candid challenges, and robust recommendations for future MSN programming. Lastly, we held focus group discussions with USAID/Washington bureau staff who worked in nutrition programming. This process resulted in an abundance of data that we categorized into themes and used compelling quotes from to draft a final report that tells a story of MSN programming across the five countries. This is a story of progress, adaptation, and coordination, met with internal and external challenges, all meant to shape future recommendations for MSN programs. Overall, the assessment found that there is significant support for MSN programming through USAID funding in the five countries. The MSNS has played a key role in influencing the design of USAID-funded projects and, in some countries, informed the development of National MSN plans. Respondents reported that integrating nutrition-specific and -sensitive interventions, complemented by activities in social and behavior change, gender, social inclusion, and local governance, improves nutrition outcomes. Recommendations for future programming focus on strengthening the enabling environment for MSN programming at mission, national, and local levels, and across health, agricultures/economic growth, and humanitarian assistance sectors.