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Table 1 Overview of findings

From: Changes in the policy environment for infant and young child feeding in Vietnam, Bangladesh, and Ethiopia, and the role of targeted advocacy

  Vietnam Bangladesh Ethiopia
Changes in policy and legislation
Policy changes • Revision of the formula advertising law
• Revision of the maternity leave policy
• National Nutrition Strategy
• IYCF Action Plan
◦ Technical completeness but practical under-stipulation
• Replacement of the NNP with the NNS
• Revision of legislation on breastmilk substitutes
◦ Not succeeded in translation to action in all cases; challenges remain in rollout
• Revision of the NNP
◦ Strong content, but dissemination to local levels is not moving quickly
◦ Other key actions still lacking, such as BFHI and ratification of the Code
Agenda setting and commitment: Why did it change?
Political context • National Institute of Nutrition, under MOH, hosts the secretariat for the National Nutrition Strategy
• Nutrition Cluster Group engages non-government actors
• Vietnam’s nutrition programming is executed through a decentralization process
• National Nutrition Coordination Body is largely inactive; Nutrition Working Group and SUN-related bodies liaise with government
• National IYCF alliance group was initiated during the time-frame of A&T
• National Nutrition Coordination Body sits within MOH
• Nutrition Development Partner Group engages non-government actors
Issue characteristics • Low breastfeeding rates with limited change over time offers advocacy opportunities
• Improvements in stunting and complementary feeding make it difficult to position nutrition as a priority
• Breastfeeding, complementary feeding, and stunting are significant challenges presenting key advocacy opportunities • Low rates of appropriate complementary feeding and high stunting levels, meant that advocacy focused primarily on these issues; breastfeeding rates are high
Ideas and issue framing • Opinions on what should be addressed are not harmonized: Formula marketing and maternal employment and leave continue to be large issues
• Stunting and IYCF are generally thought of as a chosen issue, not immediately pressing politically; the international community have chosen these issues
• It is unclear how far new attention to stunting and IYCF extends beyond international actors and their immediate contacts in the national policy community, to the rest of government or to the population
• Integration of ideas on nutrition-specific and nutrition-sensitive initiatives is embedded
• The importance of accounting for geographical differentiations within Bangladesh is highlighted
• Natural disaster rates mean emergency nutrition continues to require attention
• It is unclear how ideas related to IYCF are presented to actors outside of the nutrition policy community
• Pronounced change in the nutrition discourse within the policy community, to encompass stunting, though both stunting and wasting remain priority issues
• Government priority setting has been slow to move in line with international stunting and IYCF agendas
• It is unclear whether this broader understanding of nutrition is reaching to those working in nutrition beyond the policy community; on the ground, the focus remains on programs to address wasting and food insecurity
Actor networks and power • Actor networks are more complex in 2014
• MOH continues to be regarded as influential, while NIN appears to be regarded as less central
• UNICEF and formula companies are clear hubs in the international map, while government institutions remain central in the domestic map
• Key players driving for pro-IYCF change remained the international community; There has not been strategic leadership from within national government
• Perceived increase not only in activity level but also in the number of actors
• Government, individual leaders and media were reflected centrally; MoHFW is the most influential player
• Formula companies are a powerful group of actors, with effective media campaigns as well as elite alliances, with little change since 2010
• Individual leadership remains lacking
• Little has changed over the past five years in terms of actors and their power in Ethiopia
• FMOH is still the hub, because of their mandate, and government has convening power
• Civil society and donors are numerous and active in Ethiopia, but are weak in influence due to restricting regulations
Government commitment • High-level government attention has been paid, and written policy changed
• Lack of clear implementation and enforcement plans
• Lack of government-allocated funding
• Major shift towards government leadership on nutrition policy and implementation
• Most financial support for nutrition policy still comes from international sources
• Government attention to nutrition is sporadic, and limited to certain sectors
• The government funding situation for nutrition is poor; funding for nutrition is mainly through international donors
Role of Alive & Thrive
  • A&T along with UNICEF was often cited as being among the most influential and active policy actors
• In general, those involved in IYCF policy advocacy in Vietnam recognized A&T’s role as pivotal
• A&T is credited with successful media campaigns, which recognized and supported the central role of the government
• Challenges include sustainability (particularly of funding) and integration of related issues into nutrition programming
• A&T’s contributions in BCC and media campaigns, IYCF messages and materials, and input to the NNP were widely recognized, contributing in the shift of policy and programs to a stunting reduction focus
• The project was perceived as taking on too much and achieving too little in terms of actual implementation