Beyond paper realities: Fostering integrated nutrition governance in Uganda

Many African governments have expressed ambitions to govern nutrition in a more integrated manner as specified in the overarching integrated nutrition strategies. The strategies provide the main approach envisioned to guide actors in different sectors and government levels to jointly respond for more effective reduction of malnutrition and its impacts on health, human capital and socio-economic development.  This is expected to contribute towards realising the targets of the Sustainable Development Goal 2 on reducing hunger and all forms of malnutrition. Despite the popularity of the integrated nutrition strategies, little is known about their follow-up and ultimate success (or failure) in achieving integrated nutrition governance. This dissertation aims to assess and explain to what extent these ambitions to govern nutrition in a more integrated manner have proceeded beyond paper realities in Uganda. The aim is addressed in four research questions: (i) how has (mal)nutrition been framed by parliamentarians in Uganda over time; (ii) to what extent have nutrition concerns been integrated into cross-sectoral policy outputs over time; (iii) what policy mechanisms explain the observed nutrition policy (dis)integration patterns in Uganda; and (iv) what practices are adopted by frontline workers to enable or obstruct nutrition integration in service delivery?

The questions are investigated using four public policy theoretical concepts: policy framing, policy integration, policy mechanisms and street-level bureaucracy. Identifying the processes, interactions and practices of the different actors involved is necessary to understand shifts towards more or less integrated nutrition governance.

The overall conclusion of the dissertation is that there is progress towards increased nutrition integration in political commitments and the policies adopted in different sectors. However, these commitments were rarely followed up with actual cross-sector services on the ground. The study has provided new insights about the political interpretations, patterns of nutrition integration, the policy mechanisms and practices as well as the conditions fostering and hampering integrated nutrition governance. Donor involvement proved to be a key determinant for ensuring that the endorsed integrated nutrition strategies proceeded beyond paper realities. Efforts to foster and sustain integrated nutrition governance require that the policy makers in government and international actors become more proactive and invest in the domestic capacities at different levels. This includes; deliberate investments in integrative leadership at all government levels, facilitating frontline workers across sectors to integrate nutrition services; adjusting current nutrition monitoring systems to capture cross-sector and multilevel data; and supporting integrative policy-oriented learning. This is a long-term endeavour − not easily sustained through short-term funded projects − that necessitates going beyond tracking nutrition integration in sectoral policies and checking off performance indicators.