Dateline and Location: May 2015 – November 2016, in 5 counties in Kenya: Marsabit, Turkana, Kwale, Wajir and Baringo.
This was a consultancy project, commissioned by the Nutrition Sector and funded by United Nations Children’s Fund (UNICEF) and Department for International Development (DFID). It had two crosscutting objectives: a learning-focused consultative process to identify facilitators and barriers to integrating nutrition within the health system and; to develop a real-time learning approach for improved performance in health system strengthening (HSS) interventions.
The consultative process highlighted that the nutrition sector has made considerable progress in nutrition integration since 2011. The service delivery integration successes have also led to significant, mostly, positive impacts on HSS for service delivery. However, generally, there has been a tendency for the external support to County Health Systems to concentrate on integrating and strengthening technical functions of service delivery with less emphasis on management, leadership and governance of health systems. Subsequently, a distinction between activities for integration of nutrition into the Health System and activities for HSS was noted with the former summed up as a phase that focused more on “who is doing the activity” and less on “who is managing the system” for nutrition and health services. It was recommended that for the sector to fully transition to HSS, there was need to establish a common agreement detailing nutrition objectives with regards to HSS as well as a change pathway.
A real-time learning approach for nutrition was developed in collaboration with the County health and nutrition stakeholders. Learning cycles incorporating reflection on HSS issues identified and action on adaptation plans developed were implemented. Although, nutrition and health stakeholders were receptive and underscored the significance of “pause and reflect sessions” in promoting adaptive learning; competing priorities, limited flexibility in program plans and perception of learning as a daunting concept were observed as some of the barriers to integrating learning within programming. Therefore, it was recommended that facilitators and barriers to establishing a sustainable learning process should be explored at the inception phase. Similarly, to demonstrate change, a multi-faceted monitoring system that captures both tacit and explicit evidence should be put in place. A detailed description of the learning cycles can be found in the accompanying “How to Note”.
The Centre for Humanitarian Change (CHC) was founded in 2014 in response to growing need new thinking to address some of the challenges facing the humanitarian system in East and Horn of Africa, especially around delivery, impact and efficiency. CHC aims to provide a platform for ‘rethinking’ and focus attention on what works in both humanitarian and development aid.