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CROSS-SECTORAL COORDINATION IN THE PUBLIC SECTOR 151


the national level; at more local levels, civil servants may have limited control over sector resource allocations, so the stakes between sectors are lower. However, the ability of state agencies to work collaboratively, even in assisting


communities, will vary widely. In Ghana and Uganda, government decentraliza- tion has progressed further than in most countries, but even in those countries district-level agriculturalists stated that local concerns were not necessarily more important than sectoral concerns in guiding their actions (Benson 2008). These agriculturalists were still subordinate to sectoral superiors, they operated with limited resources, and many of the incentives for individual effort served to ham- per cross-sectoral action to assist communities. Thus, while community-directed development may promote increased attention from agriculturalists to local health and nutrition problems, it is not guaranteed.


Conclusion The institutional barriers faced by public sector agriculturalists trying to improve health and nutrition are durable and strong. Consequently, an opportunistic approach may be more effective in practice than strong, programmatic action by the sector or even by several sectors. An opportunistic strategy would piggyback on existing individual activities in the agricultural sector or other sectors in an instrumental way, to address important context-specific determinants of ill-health and malnutrition. Working in this incremental manner appears more likely to be successful than mounting a large-scale, cross-sectoral implementation effort that is a poor fit within the institutional framework of government. Such a task- or problem- oriented approach would start small, achieve short-term goals, and build on these successes iteratively to address larger problems. Individual sectoral responses will often be the best that can be realistically expected. Consequently, one should be cautious of launching any health or nutrition


program that depends on intersectoral coordination. The risk is too great that such coordination will not happen. However, an important first step is simply to ensure that the agriculture sector (or any other relevant sector) takes seriously its potential role in improving health and nutrition. Cross-sectoral coordination emerges as a practical issue once the problems of health and nutrition are treated as politically important, stimulating leadership for action on the problems in various sectors. Coordinated efforts should follow, once such commitments are clear. Health and nutrition can be improved through agricultural means. There


are many good reasons for providing incentives to agriculturalists to address these problems in a dedicated manner. By itself, increased agricultural production is an unsatisfactory and unsustainable goal, if that increased production does not address ill-health and malnutrition. Advocacy can focus attention on specific health and


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