How Does an International Idea Play Out in National Policy and Local Implementation? The Case of Intersectoral Coordination for Nutrition in Zambia

BACKGROUND The UNICEF nutrition framework identifies key underlying determinants of child malnutrition as food, health and care. The public goods and services relating to these are normally tackled separately by different sectors, but international agencies have drawn attention to the potential of coordinating action to improve outcomes. This research traced the concept of ‘intersectoral coordination’ for nutrition from international discourse, through Zambian national policy and local implementation, to community experiences, in order to understand the impact of the idea. METHODS This qualitative research employs an explicit theory of change, and is informed by established social science frameworks. We use several sources of qualitative data, collected at different levels (international, national, district and community), and at different time points over five years. Analysis included detailed description of the contextual, policy and programmatic situation in Zambia; thematic coding that sheds light on the views of key actors and communities; and testing the theory of change by tracing the transmission of a concept through the different levels over time. FINDINGS ‘Intersectoral coordination’ has occurred as a paradigm twice in the history of international nutrition: once in largely unsuccessful attempts in the 1970s, and again more recently. This time around, the nutrition community is framing coordination differently‐ as ‘nutrition‐sensitivity’ of different sectors‐ and it appears to be finding some traction. In Zambian policy circles, a small technical elite has grasped the concept. Nevertheless, although written policies in key sectors include nutrition‐sensitive elements, broader sectoral actors still struggle to see benefits to their core interests. At local level, attempts have been made at operationalizing multi‐sectoral plans, and an externally‐facilitated pilot of coordination in one district has been successful: sectoral actors are clear on their roles and have formed strong networks around the issue of malnutrition, transmitting learning back to policy makers. This model has relied on external support in its initial stages, however, and on strong local leadership; while there has been an attempt to replicate elements of this pilot, it will take intensive effort to be effectively scaled up. At community level, coordination of activities in the field is rarely reported, but there is a sense that some interventions are complementary to one another, whether by chance or by design. CONCLUSIONS In the Zambian context, there are clear national and local manifestations of the concept of ‘intersectoral coordination’ for nutrition, but transmission of action is not as linear or streamlined as is often assumed: adaptation to context is necessary, and learning goes both ways. This work provides insight into how ideas are adopted and adapted throughout the policy cycle, and can inform how intersectoral processes might be fostered in different contexts in which malnutrition remains a persistent problem. Support or Funding Information This research is part of the Stories of Change initiative, funded by the Child Investment Fund Foundation and the Transform Nutrition consortium.