Exploring stakeholder commitment and capacity to address infant and young child nutrition in the capital of the Breede Valley, Western Cape Province, South Africa

Du Plessis, Lisanne Monica (2015-12)

Thesis (PhD)--Stellenbosch University, 2018.

Thesis

ENGLISH SUMMARY: There is experience with - and documented evidence on multi-stakeholder processes (MSPs) on a global - and national level and on how to build and assess commitment and capacity to address infant and young child nutrition (IYCN) at these levels. Little experience and documented evidence, however, exist for such processes at local level. In countries with a decentralised government system, part of the lack of experience and evidence on MSPs lies in the challenge of building commitment and capacity at various political and bureaucratic levels. There is, thus, a need to build an evidence-base of how to engage stakeholders at implementation level and to assess and advance their commitment and capacity to implement responses to address IYCN. There is also a call to better define enabling environments for successful action in this field. In this research, a qualitative study design and selected participatory research methods were used to explore a diversity of perceptions, willingness, abilities, relationships and powers of key stakeholders to address IYCN at sub-district level in the Breede Valley, Western Cape Province, South Africa. The study built on baseline research in the Community-based Nutrition Security Project (CNSP), which provided insight into maternal and child nutrition challenges in the Breede Valley. Stakeholders were identified and categorised during a focus group discussion (FGD) with individuals who knew the sub-district well. Subsequently, the researcher conducted semi-structured interviews with twenty seven key stakeholders to explore their perspectives, commitment and capacity concerning IYCN. Hereafter, they were invited to participate in a workshop to map stakeholder relationships and power related to IYCN governance. Lastly, FGDs were held to reflect on the research process and to explore elements of an enabling environment conducive to action on IYCN at implementation level. Main themes from the overall research findings include: the value of local knowledge and information; the appeal of the 1000 days message and its link to development; the urgent need for IYCN advocacy; the value of stakeholder engagement and seeing the broad IYCN stakeholder landscape; the need for multi-sectoral work, while recognising the difficulty in functioning across sectors; realising the capacity inherent in “people” as a resource, the need for a “whole of society approach” in advancing the IYCN agenda and the importance of strategic capacity in local forums, combined with national legislation, to advance action for IYCN. The study provides insight into the elusive concepts of commitment and capacity in relation to IYCN governance at local level. The personal and professional perspectives of key stakeholders involved at this level offered distinct information about the unique challenges they experienced as well as practical responses required to ensure action. The barriers to multi-sectoral work at the sub-district level hinged on narrow sector-specific focus areas, mandates and budgets leading to poor integration around the social determinants of health, lack of resources and lack of targeted advocacy. The core conclusion of the study is that a detailed exploration of initial stages of an MSP is a valuable practice - and research model to create awareness of IYCN as a development issue of crosscutting importance at implementation level. This process, though time and resource intensive, has supported the development of commitment and revealed collective capacity that could be unlocked to address IYCN at the sub-district level in the Breede Valley. Such an approach, appropriately adapted to local conditions, could be helpful in scaling-up efforts to improve IYCN at sub-district level elsewhere in the country. The next phase of the CNSP should involve joint planning and concrete action to improve IYCN in the Breede Valley. The proposed expansion of the definition of the enabling environment and adaptation of the nutrition governance framework could be introduced into international debates and agendas for continued deliberation, research and action to improve IYCN as a global, national and local priority.

AFRIKAANSE OPSOMMING: Daar is ondervinding in - en gedokumenteerde bewyse van multi-rolspeler prosesse (MRP) op ‘n globale en nasionale vlak asook hoe om toewyding en kapasiteit te bou en te ondersoek om baba-en-jong-kind voeding (BJKV) aan te spreek op hierdie vlakke. Daar is egter min ondervinding en gedokumenteerde bewyse vir sulke prosesse op ‘n plaaslike vlak. Die uitdaging om toewyding en kapasiteit op verskeie politieke en burokratiese vlakke te bou, dra by tot die gebrek aan ondervinding en bewyse oor MRP in lande met ‘n gedesentraliseerde regering-sisteem. Daar is dus ‘n behoefte om ‘n bewys-basis te bou oor hoe om rolspelers te betrek op implementeringsvlak en om hul toewyding en kapasiteit te bou en te bevorder om oplossings te implementeer om BJKV aan te spreek. Daar is ook ‘n versoek om bemagtigende omgewings vir suksesvolle aksie in die veld beter te definieer. ‘n Kwalitatiewe studie-ontwerp en geselekteerde deelnemende navorsingsmetodes was in hierdie navorsing gebruik om ‘n verskeidenheid van perspektiewe, gewilligheid, vermoëns, verhoudinge en mag van sleutelrolspelers te ondersoek om BJKV op sub-distrikvlak in die Breede Vallei, Wes-Kaap Provinsie, Suid-Afrika aan te spreek. Die studie het voortgebou op navorsing van die “Community-based Nutrition Security Project” (CNSP), wat insae verleen het in die moeder-en-kind voedinguitdagings in die Breede Vallei. Tydens ‘n fokusgroepbespreking (FGB) met individue, wat wel bekend was met die sub-distrik, was rolspelers geïndentifiseer en gekategoriseer. Gevolglik het die navorser semi gestruktureerde onderhoude gevoer met sewe en twintig sleutelrolspelers om hul persepsies, toewyding en kapasiteit ten opsigte van BJKV te ondersoek. Hierna was hul genooi om deel te neem aan ‘n werkswinkel om verhoudinge en mag tussen rolspelers, ten opsigte van BJKV-bestuur op sub-distriksvlak, uit te plot. Laastens was FGB gehou om oor die navorsingsproses te reflekteer en om gunstige elemente vir ‘n ondersteunende omgewing vir BJKV aksies op implementeringsvlak, te ondersoek. Hooftemas uit die oorkoepelende navorsingsbevindinge sluit in: die waarde van plaaslike kennis en inligting; die aantreklikheid van die 1000 dae boodskap en die verband met ontwikkeling; die dringende behoefte aan voorspraak vir BJKV; die waarde van skakeling tussen rolspelers en om ‘n breë perspektief van die BJKV rolspelerlandskap te sien; die behoefte aan multi-sektorale werk, maar ook die besef dat dit moeilik is om oor sektorgrense te funksioneer; die besef van die inherente kapasiteit van “mense” as hulpbron; die behoefte aan ‘n “omvattende gemeenskapsbenadering” om die BJKV agenda te bevorder; die belang van strategiese kapasiteit in plaaslike forums en nasionale wetgewing om aksie vir BJKV te bevorder. Die studie verskaf insig in die vae begrippe van toewyding en kapasiteit van BJKV-bestuur op plaaslike vlak. Die persoonlike en professionele perspektiewe van sleutelrolspelers betrokke by hierdie bestuursvlak, het spesifieke inligting verskaf rondom die unieke uitdagings wat hul ervaar en die praktiese response wat benodig word vir aksie. Die struikelblokke vir multi sektorale werk op sub-distriksvlak het gewentel om eng sektor-spesifieke fokusareas, mandate en begrotings wat lei to swak integrasie rondom die maatskaplike bepalings van gesondheid, tekorte aan hulpbronne en ‘n tekort aan geteikende voorspraak. Die kern gevolgtrekking van die studie is dat ‘n gedetailleerde ondersoek na aanvanklike stappe in ‘n multi-rolspeler proses, ‘n waardevolle praktyk- en navorsingsmodel is om bewustheid van BJKV as ‘n deursnit ontwikkelingskwessie op implementeringsvlak te skep. Die proses, alhoewel tyd - en hulpbron intensief, het die ontwikkeling van toewyding en kapasiteit ondersteun en gesamentlike kapasiteit blootgelê wat bevorder en ontsluit kan word om BJKV op sub-distriksvlak in die Breede Vallei aan te spreek. So ‘n aanslag, toepaslik aangepas vir plaaslike toestande, kan behulpsaam wees om die skaal van pogings te vergroot om BJKV op sub-distriksvlak elders in die land te bevorder. Die volgende fase van die CNSP behoort gesamentlike beplanning en konkrete aksies in te sluit om BJKV in die Breede Vallei te verbeter. Die moontlike uitbreiding van die definisie van die “ondersteunende omgewing” en die “voedingsbestuursraamwerk” kan voorgestel word aan die internasionale debatte en agendas vir voortgesette oorweging, navorsing en aksie vir die verbetering van BJKV as ‘n globale, nasionale en plaaslike prioriteit.

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