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158 ROBERT K. N. MWADIME


and Zimbabwe—have moved toward a multisectoral response to malnutrition that involves most government ministries, the private sector, and nongovernmental organizations. To sustain this multisectoral response, some countries have estab- lished interministerial coordinating agencies for nutrition to promote the mobili- zation of resources, coordinate multisectoral planning, and undertake monitoring and research. The direct and indirect activities required for effective implementation of


nutrition policies are diagrammed in Figure 1, which demonstrates that continuous advocacy, bottom-up pressure, and donor engagement are all important components in achieving implementation of national programs. Through continuous advocacy, policymakers are enlightened on the magnitude


of malnutrition problems, their consequences, and the benefits of urgently address- ing them. Unfortunately, there is often a disconnect: policymakers may not respect the advocates, who (as technical people) are their juniors in the administrative and political hierarchy. Policy champions, partnerships, and the media can cut across such barriers. Advocacy requires multiple approaches, applied consistently and repeatedly,


to communicate how the interests of different groups will be met by the nutrition policy, and it must demonstrate the real impact of action to address malnutrition. Success stories, as well as field visits to demonstrate the real suffering from malnutri- tion, can be very powerful tools to prompt immediate action. Improved nutrition is a fundamental element of human well-being and should be a central objective of social and economic development. Bottom-up or grassroots pressure has been generally missing from the nutrition


policymaking process. Unlike food insecurity and hunger, malnutrition is not generally identified as a priority problem by African households; communities have little understanding of the significant burden that malnutrition imposes on their well-being. Consequently, malnutrition does not create a liability for politicians. Community and civil society organizations need to mobilize people to demand services and conditions to improve their nutrition and that of their children. The grassroots communities represent a generally untapped political force that can transform the government’s approach to addressing malnourishment in the region. Donor engagement and funding have generally dictated the commitment and


motivation of eastern African governments to nutrition activities. However, this means that there is no assurance of long-term local support for nutrition action. Policy implementation that depends on donor resources may instead be shut down once donor resources are exhausted, putting at great risk existing nutrition actions in eastern Africa.


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