Well, another fun and intense week of learning, sharing, inspiration and laughing has finished. Once again the Brighton weather over performed, as did the participants.
We had about 30 participants from Africa, Asia, Europe and the Americas. We were national policymakers, programme managers, UN agencies, donors and researchers --all learning together.
One key part of the programme is for participants to break into working groups and develop an action plan for a problem they have identified in their country, state or organisation (e.g. how to increase uptake of nutrition services? How to move nutrition up the political agenda? How to get a budget line established for nutrition?)
On the final day of the course the plans were presented to a panel who gave feedback. This year we had 7 groups: Ethiopia, Odisha, Madhya Pradesh/Bihar, Malawi/Zambia, Ghana/Tanzania, Nepal/Timor Leste/Lao PDR (or NeTiLao!) and a global group.
Some reflections from me on their presentations:
1. The chicken and egg dilemma. Several of the plans noted that it takes resources to make the case for increased resources. We reflected that change usually takes sacrifice of committed people to push for change even while they already have day jobs. It helps if you can plausibly show that increased resources will lead to improved outcomes
2. Focusing on a problem does not necessarily lead to a narrow plan of action. Even the most focused problem identified by the groups required a broad range of alliances, actions and capacities to overcome. Consider the increased uptake of antenatal services: is it low demand or poor quality supply? On the demand side is it discrimination or universal norms that need changing? On the supply side is it front line worker capacity or capacity elsewhere in the system?
3. Who is going to do this? Often brilliant plans were put in place about what, when, where and how of actions. But the "who" was much more difficult. Related to point 1, who is going to go beyond their job description? Changing job descriptions is hard--it requires taking on vested interests, has resource implications and is a big change to take on for an unproven set of actions.
4. Learning from other country experiences. As usual, much of the learning was from reviewing other country experiences, especially from near neighbours. We will use more and more case studies as the course evolves.
5. Be explicit about what's in it for me? If we want multiple sectors to work on and with nutrition we have to be strategic about figuring out what is in it for them. Some of the country plans were very strategic--focusing on 2 or 3 ministries where alliances could really pay off rather than worrying about all 12 potential ministries they could work with.
6. The importance of creating "forcing moments". Some of the plans presented were focused on creating "forcing moments" where it is difficult or embarrassing to avoid making a pledge. And if you make a pledge it makes you look good--perhaps around the launch of a new policy, or a new survey or a new crisis, or a visit of an outside group.
7. Accountability is rising up the agenda. The plans focused on accountability, things like: budget transparency, community feedback, real time monitoring of outcomes. This felt different to previous years' plans. It was not enough to formulate the plans but how would we monitor implementation of them?
8. It is not all about financial resources. Often we have a knee-jerk reaction to throwing more money at the problem. These plans had some of that but were more focused on capacity gaps.
9. The capacity debate is getting more sophisticated. On capacity, there was a great deal of emphasis on building capacity to scale up implementation. Capacity audits were to be instigated and ways of upgrading skills, strengthening incentives and improving the system as a whole were highlighted.
10. Finally there was a sense that nutrition had moved on. One of the panelists who had served the same role in 2012, our first year, said that she felt the plans were very different from her previous engagement. Back then it was about getting someone to pay attention to nutrition. Now it is about delivering under their gaze. If our composed and steely participants are anything to go by I have no doubt this will happen in many places.
We will be running the course in Brighton in July 2015. Watch out for our call in January.