76921 H N P D i s c u s s i o n P a p e R POLITICAL ECONOMY ANALYSIS FOR FOOD AND NUTRITION SECURITY Michael R. Reich and Yarlini Balarajan December 2012 POLITICAL ECONOMY ANALYSIS FOR FOOD AND NUTRITION SECURITY Michael R. Reich and Yarlini Balarajan December 2012 Health, Nutrition and Population (HNP) Discussion Paper This series is produced by the Health, Nutrition, and Population Family (HNP) of the World Bank's Human Development Network (HDN). The papers in this series aim to provide a vehicle for publishing preliminary and unpolished results on HNP topics to encourage discussion and debate. The findings, interpretations, and conclusions expressed in this paper are entirely those of the author(s) and should not be attributed in any manner to the World Bank, to its affiliated organizations or to members of its Board of Executive Directors or the countries they represent. Citation and the use of material presented in this series should take into account this provisional character. 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For information regarding the HNP Discussion Paper Series, please contact Martin Lutalo at mlutalo@worldbank.org or 202-522-3234 (fax). © 2011 The International Bank for Reconstruction and Development / The World Bank 1818 H Street, NW Washington, DC 20433 All rights reserved. ii Health, Nutrition and Population (HNP) Discussion Paper Political Economy Analysis for Food and Nutrition Security Michael R. Reicha and Yarlini Balarajan,b with contributions from Ashley M. Foxc a Takemi Professor of International Health Policy, Department of Global Health & Population, Harvard School of Public Health, Boston, MA, USA b Department of Global Health & Population, Harvard School of Public Health, Boston, MA, USA c Assistant Professor, Department of Health Evidence and Policy, Mt. Sinai School of Medicine, New York, NY This work was commissioned by staff of the World Bank for the South Asia Food and Nutrition Security Initiative (SAFANSI). SAFANSI is supported by the Australian Agency for International Development (AusAID) and the UK Department for International Development (DfID); however, the views expressed do not necessarily reflect these departments’ official policies. Abstract: The overall goal of this paper is to promote the use of political economy analysis in advancing more effective food and nutrition policies. The paper reviews the field of applied political economy for the food and nutrition sector, and offers practical guidance on how to conduct political economy analysis to better navigate the policy reform process. The paper is presented in three parts. Part I reviews the literature on political economy analysis (PEA) and its application in the food and nutrition fields, focusing on the applied literature in development. Three kinds of PEA are discussed: In-depth, Stakeholder, and Rapid Assessment PEA, which serve different purposes. The paper then introduces a structured qualitative method for conducting an in-depth PEA, based on four stages of the policy cycle: agenda-setting, policy design, policy adoption, and implementation. Part II provides an illustrative case study of an in-depth PEA for a specific food and nutrition- related policy of India, the Integrated Child Development Services scheme. The analysis explains how the agenda was set and its consequences. Part III presents a newly developed tool to conduct a rapid assessment PEA for food and nutrition policy. This tool uses a questionnaire approach to evaluate the level of political commitment for food and nutrition security and opportunities for change, and can be used to monitor change in political commitment over time. This paper is intended to assist the South Asia Food and Nutrition Security Initiative (SAFANSI), along with national governments and development partners, to develop more politically feasible strategies for policy reform. The paper proposes that investing in PEA and developing capacity to conduct such analyses can help improve the effectiveness of iii the policy reform process and achieve better outcomes in the food and nutrition sector in the South Asia region and beyond. Keywords: Food and nutrition security, India, Integrated Child Development Services (ICDS), policy cycle, policy reform, political economy. Disclaimer: The findings, interpretations and conclusions expressed in the paper are entirely those of the authors, and do not represent the views of the World Bank, its Executive Directors, or the countries they represent. Correspondence Details: Michael R. Reich, Department of Global Health & Population, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA; Telephone: 617-432-0687; Fax: 617-432-1251; E-mail: michael_reich@harvard.edu; Website: http://www.hsph.harvard.edu/michael-reich/ iv Table of Contents ACKNOWLEDGMENTS ............................................................................................. viii PREFACE ......................................................................................................................... ix PART I – A REVIEW OF POLITICAL ECONOMY ANALYSIS FOR FOOD AND NUTRITION SECURITY ................................................................................................ 1 By Michael R. Reich and Yarlini Balarajan EXECUTIVE SUMMARY ............................................................................................. 1 1. INTRODUCTION.......................................................................................................... 2 2. HISTORY AND CONTEXT OF POLITICAL ECONOMY ANALYSIS ................................... 4 2.1 Exploring the Growth of Political Economy Analysis ...................................... 5 2.2 Promoting Applied Political Economy in Practice: DFID and the World Bank ......................................................................................................................... 6 2.3 Seeking Practical Methods for Political Economy Analysis ............................ 9 3. POLITICAL ECONOMY ANALYSIS FOR FOOD AND NUTRITION SECURITY ................. 11 3.1 Emerging Themes from the Political Economy Literature in Food and Nutrition Security ............................................................................................ 11 3.2 Applied Political Economy of Nutrition: Recent Studies ................................ 12 4. A METHOD FOR CONDUCTING AN IN-DEPTH POLITICAL ECONOMY ANALYSIS ........ 14 PART II: AN ILLUSTRATIVE CASE STUDY: A POLITICAL ECONOMY ANALYSIS OF INDIA’S INTEGRATED CHILD DEVELOPMENT SERVICES SCHEME ......................................................................................................................... 20 By Yarlini Balarajan and Michael R. Reich EXECUTIVE SUMMARY ........................................................................................... 20 1. INTRODUCTION........................................................................................................ 22 2. CONDUCTING A POLITICAL ECONOMY ANALYSIS.................................................... 23 2.1 Step 1: Describe the Study Objectives and Policy Context ............................. 23 2.2 Step 2: Select Stage of the Policy Cycle for Analysis ..................................... 27 2.3 Step 3: Analyze Political Dynamics to Assess Political Feasibility ............... 28 2.4 Step 4: Assess Political Strategies .................................................................. 44 3. DISCUSSION ............................................................................................................ 47 3.1 Is Nutrition on the Agenda in India? .............................................................. 47 3.2 What Strategies could have Promoted more Effective Convergence of the Streams?.......................................................................................................... 48 4. CONCLUSIONS ......................................................................................................... 50 4.1 Key Findings about Agenda-Setting for ICDS Reform and Child Undernutrition in India ................................................................................... 51 PART III –A RAPID POLITICAL ECONOMY ASSESSMENT TOOL FOR MEASURING COMMITMENT AND OPPORTUNITY TO ADVANCE FOOD AND NUTRITION SECURITY POLICIES ................................................................ 67 By Ashley M. Fox, Michael R. Reich and Yarlini Balarajan v EXECUTIVE SUMMARY ........................................................................................... 67 1. INTRODUCTION........................................................................................................ 68 2. HOW THE TOOL WORKS .......................................................................................... 69 REFERENCES ................................................................................................................ 78 APPENDIX 1: REVIEW OF PAST POLITICAL ECONOMY ANALYSES FOR FOOD AND NUTRITION SECURITY........................................................................ 90 APPENDIX 2: A RAPID ASSESSMENT TOOL FOR FOOD & NUTRITION POLICY: POLITICAL PRIORITIZATION AND AGENDA-SETTING ................ 98 1. POLITICAL COMMITMENT AND PRIORITY OF FOOD & NUTRITION............................ 98 2. AGENDA SETTING: POLICY WINDOW OF OPPORTUNITY ........................................ 102 3. STAKEHOLDER AND INSTITUTIONAL ANALYSIS ..................................................... 109 List of Tables Table 1: Political Commitment and Opportunity Survey Item Summary......................... 73 Table 2: Political Commitment and Opportunity Survey Score Sheet ............................. 74 Table 1-A: Eight Narratives on Nutrition and Development ............................................ 97 List of Figures Figure 1: Spectrum of Political Economy Analysis .......................................................... 18 Figure 2: Four Steps for Conducting a Political Economy Analysis ................................ 19 Figure 3: Method for Conducting an In-Depth Political Economy Analysis .................... 54 Figure 4: Timeline of ICDS .............................................................................................. 55 Figure 5: Components of the ICDS................................................................................... 56 Figure 6: Stages of the Policy Reform Cycle and Examples of Research Questions ....... 57 Figure 7: Factors Operating in the Problem, Policy and Politics Streams that Shape Agenda-Setting................................................................................................... 58 Figure 8: Key Factors in the Problem, Policy and Politics Streams Affecting the Policy Process for Child Undernutrition and ICDS in India Prior to 2010 ................... 59 Figure 9: PolicyMaker Screenshot: Player Table: The ICDS Stakeholders and their Positions and Power ........................................................................................... 60 Figure 10: PolicyMaker Screenshot: Main Menu: ............................................................ 61 Figure 11: PolicyMaker Screenshot: Strategies to Enhance the Political Feasibility of Reform ............................................................................................................... 62 Figure 12: Strategies that were Successfully Used by the Planning Commission (PC) to Improve Political Feasibility of Agenda-Setting for ICDS and Child Nutrition 63 Figure 13: Strategies that Could Have Been Used by the Planning Commission to Improve Political Feasibility of Agenda-Setting for ICDS and Child Nutrition 65 vi Figure 14: Agenda Setting Framework ............................................................................. 72 vii ACKNOWLEDGMENTS The authors appreciate the helpful comments on previous drafts of this report received from many readers in the World Bank and the UK Department for International Development. At the World Bank, our special thanks go to Julie McLaughlin (Sector Manager, SASHN) for her support and interest in this work. We thank the following people for their written comments in the review process: Marie Chantal Messier (Senior Nutrition Specialist, SASHN), Menno Mulder-Sibanda (Senior Nutrition Specialist, AFTHW), and Marcela Alejandra Natalicchio (Consultant, AFTOS). We appreciate the discussion from participants at a review meeting on this report, including people at the World Bank offices in Washington DC and in the South Asia region. We also appreciate comments received from the following World Bank staff: Janneke Hartvig Blomberg (Nutrition Specialist, AFTHE), Verena Maria Fritz (Senior Governance Specialist, PRMPS), Blair Edward Lapres (Operations Analyst, SASDA), Jonathan Rose (Consultant, SASGP), Meera Shekar (Lead Health Specialist, AFTHW), and Tony Verheijen (Sector Manager, SASGP). At DFID, we are grateful for the support from Lizzie Smith (Senior Regional Health Advisor, Asia) and for her assistance in collecting comments from colleagues at DFID. We also thank Peter Berman and the doctoral students at the Harvard School of Public Health, James Levinson at Tufts University, and Shehla Zaidi at Aga Khan University, who took the time to read and comment on the paper. For Part II, we thank Sujatha Rao and K.R. Venugopal IAS (Retd.), for their detailed and thoughtful comments on the case study. We are, in addition, grateful to the many stakeholders in India who generously agreed to participate in this study and share their experiences and thoughts in interviews. Our deep thanks go to Animesh Shrivastava (Lead Agriculture Economist, SASDA), and Project Manager of the South Asia Food and Nutrition Security Initiative (SAFANSI), for his continuing support of this project. Finally, we are grateful to Ramesh Govindaraj, the Team Task Leader, for his unwavering encouragement and enthusiasm for this effort, and the support of his team. As the scope and direction of the project evolved, we are grateful to all for their guidance and commitment that helped us to complete this report. Parts I and II of this report were prepared with support from the World Bank and SAFANSI, the South Asia Food and Nutrition Security Initiative. Part III was prepared with separate funding. The authors are grateful to the World Bank for publishing this report as an HNP Discussion Paper. viii PART I – A REVIEW OF POLITICAL ECONOMY ANALYSIS FOR FOOD AND NUTRITION SECURITY EXECUTIVE SUMMARY This paper (Part I) provides a review of the existing political economy literature with a focus on applications in development, health and nutrition policy. The goal is to create a useful framework that can help to explain both obstacles and progress in food and nutrition policies and to provide guidance in making decisions that address obstacles to improving nutrition. The paper describes three kinds of applied political economy analysis (PEA): In-depth PEA, Stakeholder PEA, and Rapid Assessment PEA (Figure 1). An example of an applied in-depth PEA that examines agenda-setting for the India Integrated Child Development Scheme is presented in Part II; and a tool for conducting a rapid assessment PEA to gauge the level of political commitment for food and nutrition policies and opportunity for policy reform is presented in Part III. Recent attention to political economy issues for food and nutrition security has coincided with rising concern about political economy of development more generally. Two development agencies, the U.K. Department for International Development (DFID) and the World Bank, have devoted significant resources to promoting political economy analysis. Part I briefly reviews the strengths and weaknesses of their approaches to PEA. In general, there is increasing agreement that development cannot be understood, analyzed, or managed without explicit recognition of the roles of politics and institutions in shaping what happens. This agreement is often summarized by the phrase “political economy.� We next identify four political economy themes that emerge from the literature on the political economy of food and nutrition policies. First, the nutrition system is fragmented and uncoordinated, from the global level to the community level. Second, nutrition does not have a natural home, and is often institutionally “homeless� in government. Third, the multiplicity of owners for nutrition creates a multiplicity of narratives about nutrition. And fourth, there is a continuing limited capacity of “nutritionists� to manage the broader political dynamics of creating nutritional policy. Appendix 1 provides a more detailed review of key writings in the field of food and nutrition policies, from 1975 to 2011, including a discussion of recent developments in the global nutrition system. The last section presents a method for conducting an in-depth political economy analysis (see Figure 2). This method provides a guide to help policy analysts identify the steps needed to perform a political economy analysis for a given policy issue. 1 1. INTRODUCTION The South Asia Food and Nutrition Security Initiative (SAFANSI), established in 2008, sets out to promote innovation and reform of food and nutrition-related policies, with the goal of improving food and nutrition security (FNS) in the region. This initiative, supported by the World Bank and DFID, covers activities in Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. SAFANSI places particular attention on the political economy of FNS in South Asia, with an objective of increasing “the commitment of government and development partners to more effective and integrated food and nutrition-related policies and investments (programs)� (SAFANSI 2010). This emphasis results from the intersection of two trends: the growing attention to political economy in development, and the growing concern with food and nutrition security in South Asia. This paper has three main objectives: (1) to review the literature on applied political economy (PE), particularly as it relates to food and nutrition security; (2) to define different types of political economy analysis (PEA), present a method for conducting an in-depth PEA for food and nutrition-related policies, and provide an example of an in-depth PEA; and (3) to present a tool for conducting a rapid assessment PEA of political commitment for food and nutrition security. The paper confronts two major challenges. First is the lack of clarity about what constitutes political economy analysis, including what its main objectives are, how it is conducted and used in practice, and who should be using it. The concept of political economy has rich historical roots but also distinctly different current interpretations. It covers both economic and political forms of analysis, includes both quantitative and qualitative approaches, and does not have a single consensus definition in theory or practice. Second is the lack of clarity about what food and nutrition security is, and what kinds of policies are needed to achieve this goal. This is pertinent, given the increasing global attention to this issue, as illustrated by the Scaling Up Nutrition movement. The field of food and nutrition security involves different disciplines, different policy communities, and different perspectives on both the problems and the solutions. A major obstacle in this policy arena is effectively bringing together diverse intellectual communities and bureaucratic agencies, especially in seeking to create a common cause between the agriculture and health arenas in pursuing nutrition objectives. Combining these two contested areas in a single paper is not easy. Our goal in this paper is to use the existing political economy literature to create a useful framework that can help to explain both obstacles and progress in the evolution of food and nutrition policies and to provide guidance in making decisions that address obstacles to improving nutrition. Our study builds on the insights and results of the existing literature and seeks to move forward in ways that have both academic validity and practical utility. The paper is aimed primarily at policy analysts working in the area of food and nutrition policy, especially those who seek to give guidance to policymakers and development partners. The paper discusses three different types of applied political economy analysis (outlined below), based on different needs, purposes, and resources (especially time, money, and expertise). It should be noted, however, that there is some overlap among these three kinds of analysis, and 2 that all three are based on similar principles and theories of political economy. This spectrum of political economy analysis is illustrated in Figure 1. The three kinds of applied political economy analysis are the following: (1) In-depth PEA: The first type of political economy analysis is conducted primarily for background or academic purposes, and does not necessarily lead to specific actions or decisions. Such analyses apply theories of political economy to better understand specific events, and are mainly conducted by researchers with knowledge of the PE literature and training in associated methods. This type of analysis can provide broader contextual and background information to assist policy analysts seeking practical solutions, and help to identify political strategies. An in- depth PEA would usually include both an extensive review of the published and non-published documents as well as interviews with key stakeholders involved in the policy. In this study, we propose a method for conducting an in-depth political economy analysis and provide an example in Part II. (2) Stakeholder PEA: The second type of political economy analysis is more focused and aims to assist in decision-making and negotiations on a specific policy. This type of analysis can apply a number of methods, such as stakeholder analysis and political strategy assessment, to generate political strategies that can enhance the political feasibility of policy alternatives. This method does not necessarily require academic training in the PE literature and related methodologies. This type of analysis may require some training in political economy analysis, but can generally be conducted by a policy analyst with some additional guidance or instruction. (3) Rapid Assessment PEA: The third type of political economy analysis provides a rapid assessment that can be used to measure political commitment for FNS and identify specific opportunities for policy reform. The rapid assessment method proposed in Part III of this paper uses a questionnaire that covers key analytical themes. This rapid analysis can be carried out by an informed policy analyst, without special training. These three types of analysis demonstrate to policy analysts the broad choices of analysis available, reflecting different kinds of political economy methods that can be used to inform policymaking for FNS (Figure 1). In this way, the paper seeks to assist policymakers in their own institutions (at both the national and sub-national levels) by promoting greater awareness and application of political economy analysis. This can support policymakers to devise politically feasible strategies for policy reform in food and nutrition security, and to assist development partners in their roles to promote effective policies and programs in food and nutrition security. We hope that the paper helps SAFANSI move forward in its efforts to use political economy analysis in advancing the commitment of governments to consider, design, and adopt more effective food and nutrition policies in the South Asian region. Part I of this paper is divided into four sections. The first section provides a general introduction to the paper and its objectives, and how it fits into the overall study. Section 2 reviews the history and context of the practice of political economy analysis, considering recent approaches and experiences at DFID and the World Bank. Section 3 presents key themes emanating from the political economy literature related to FNS, with a review of recent applied PEA by the World Bank and DFID for food and nutrition. (Appendix 1 provides a more detailed 3 review of the history of political economy analysis for FNS, as well as recent developments in the global nutrition system.) These more academic sections place this paper in the broader literature on PEA and its practice. Section 4 introduces a method for conducting an in-depth political economy analysis related to food and nutrition policies. We use theory from political economy to divide the policy cycle into four stages: agenda-setting, policy design, policy adoption, and implementation, in order to consider how the political dynamics at each stage differ. Our method of PEA involves a structured, qualitative approach that combines stakeholder analysis and political strategy development. This section is intended to assist policy analysts in conducting an in-depth political economy analysis. 2. HISTORY AND CONTEXT OF POLITICAL ECONOMY ANALYSIS The global food crisis of 2008 renewed widespread frustration with ineffective government policies for food and nutrition security. This frustration, in turn, has re-focused attention on the political economy dimensions of food and nutrition policy. There is growing recognition that limited capacity to achieve social objectives of food and nutrition security is due at least in part—perhaps even large part—to political economy. Economists have become increasingly sensitive to the point that good policies do not necessarily produce good results. The attention to political economy, in turn, reflects growing recognition about problems with both governments and markets. Two decades ago, Charles Wolf, Jr. (1988) called this the challenge of “choosing between the imperfect alternatives of markets or governments� for all sorts of public policies. The choice, he argued, is not between perfect markets and imperfect governments, or between imperfect markets and perfect governments. “Instead, it is a choice between imperfect markets and imperfect governments, as well as imperfect combinations between them� (Wolf 1988, xi). This reality of multiple imperfections pervades the policy choices to assure food and nutrition security (as well as other areas of social development). Peter Timmer reflected on this challenge in a commentary on the 2008 global food crisis (Timmer 2010, 227S): “When politics is in command, which seems to be the normal state of affairs for most developing countries, how do efficiency issues stay on the agenda? When markets are in command, which seems to be the main policy advice from the donor community to poor countries, how do distributional and welfare issues stay on the agenda?� Per Pinstrup-Andersen recognized the importance of political economy for food and nutrition policies in a book published two decades ago (Pinstrup-Andersen 1993). He wrote, “A government’s inability to design and implement cost-effective policies and programs to deal with the nutrition problem is often attributed to ‘politics’, which many see as irrational and unpredictable� (1993, xiii). Yet, “virtually no research has been conducted to understand the goals and behavior of the various agents and institutions within and outside government, which in the final analysis would determine whether the planning efforts would succeed� (1993, xiii). The failure to consider political economy had been identified as a major source of failure for nutrition planning and policies. Pinstrup-Andersen’s book sought therefore to “peek inside the black box of the political economy of food and nutrition� (1993, xiv). The volume made progress in presenting case studies and in highlighting the importance of political economy factors, 4 especially the power, interests and interactions of key actors. But the book also emphasized the need to develop political economy methods that could produce analysis that would be used by policymakers (1993, 234). Pinstrup-Andersen’s call to develop these political economy methods, however, has not been adequately addressed to date, and the need for applied methods remains relevant today. Recent attention to political economy issues for food and nutrition security has coincided with rising concern about political economy of development more generally, especially from two development agencies: the U.K. Department for International Development (DFID) and the World Bank. These two organizations, more than other development agencies, have devoted significant resources to trying to understand the political economy and its implications for development work. Political economy has not, however, become “mainstreamed� by being integrated into standard operations in ways that are widely accepted, commonly practiced, and affecting decisions. But these two organizations (along with others) increasingly recognize the need for political economy analysis as a core part of the development agenda. 2.1 Exploring the Growth of Political Economy Analysis The past decade witnessed growing interest in political economy analysis related to development, with direct attention to the political and institutional factors that shape the impact of public policy. This growing interest reflects an expansion of academic research on the political economy dimensions of development plus increasing recognition from several development agencies of its importance. The common theme uniting this recent attention is agreement that development cannot be understood, analyzed, or managed without explicit recognition of the roles of politics and institutions in shaping what happens. This agreement is often summarized by the phrase “political economy� even if there is no consensus on its definition. Publications in this field often offer a definition of the phrase, sometimes providing it in a location removed from the main text, for example, in an endnote—perhaps reflecting the ambiguity of the term. For instance, Anne-Mieke van Breukelen, in her perceptive review of DFID’s activities in this area, provided her definition in endnote number 2 (van Breukelen 2007, 46): Political economy refers to a variety of approaches for studying economic and political behaviour, and the understanding of how political institutions, social and political power relations, and the political and economic environment influence each other. A recent review of political economy analysis placed its definition of PEA in the report’s first footnote and cited the OECD Development Assistance Committee (Boak 2011, 6) as follows: the interaction of political and economic processes in a society: the distribution of power and wealth between different groups and individuals, and the processes that create, sustain and transform these relationships over time. A recent publication from the World Bank on how to do a political economy assessment started with its own definition as follows (Poole 2011, 1): 5 Political economy (PE) is the study of both politics and economics, and specifically the interactions between them. It focuses on power and resources, how they are distributed and contested in different country and sector contexts, and the resulting implications for development outcomes. While broad, these statements capture a common theme in development studies at the start of the twenty-first century. There is a need for more explicit recognition of the role of politics and political analysis in development, and to use that knowledge in improving the effectiveness of the development process. At the same time, it is important to note that there is a substantial (and growing) academic literature on the political economy of development. The quantitative political economy literature includes studies, for example, on the political economy of development aid, such as the paper by Alesina and Dollar (2000) on “Who Gives Foreign Aid to Whom and Why?� and the paper by Dreher et al (2011) on whether the behavior of new donors differs from that of the existing major OECD donors. The qualitative political economy literature includes studies such as the analysis by Bates (1981) of the political determinants of agricultural policies and food supply in African countries as well as the work by Immergut (1992) on the political institutional determinants of health reform in Western Europe, and by Nunn (2008) using historical institutionalism to explain AIDS treatment policies in Brazil. Given the focus and space limitations of the current paper, it is not possible (or desirable) to review the academic literature on political economy. For one review of different strands of this literature, interested readers can consult the essay by Adam and Dercon (2009) on the political economy of economic development and the related papers in a special issue of the Oxford Review of Economic Policy. As they note (Adam and Dercon 2009, 174), political economy has moved to the “centre of all branches of economics�: This revolution has had a profound impact on how economists approach their subject nowadays: by bringing to the fore political choices and the role of institutional forms in shaping societal decisions, the study of political economy has forced economists to engage much more closely with disciplines such as economic history, politics and political science, decision theory, geography, and, increasingly, psychology (while at the same time it has brought some of the theoretical and empirical rigour of economics to these fields). In this paper, we refer primarily to the political economy literature associated with the policy reform process. A classic work in this field is the book by John Kingdon (1995) on Agendas, Alternatives, and Public Policies, originally published in 1984. We explain and draw on his ideas below in our analysis of agenda-setting processes. These theories are focused on the policy reform process, to help explain how issues get on a policy agenda, how policies are designed and adopted, and how implementation occurs. We develop this approach in more detail below and in Part II of this study. 2.2 Promoting Applied Political Economy in Practice: DFID and the World Bank A number of development agencies have been actively supporting the application of political economy in practice. Many of these experiences, together with tools and case studies are available in the Topic Guide on Political Economy Analysis from the Governance and Social Development Resource Centre (Mclaughlin 2012). DFID has supported major efforts in political 6 economy through its program on “Drivers of Change,� with a series of over 20 country studies as well as general overview papers (DFID 2009). According to a recent review of political economy methods by Erika Boak (2011, 9), DFID was the first donor to “develop a framework for analyzing political economy at the country level.� The World Bank has made significant investments in “Institutional and Governance Reviews� (Fritz et al. 2009). The Swedish International Development Agency (SIDA) has supported the development of what it calls “Power Analysis� (Bjuremalm 2006). The Dutch Ministry of Foreign Affairs has supported the development of the Framework for Governance and Corruption Analysis, to assess the determinants of governance within a specific country (Unsworth and CRU 2007). The Australian Agency for International Development (AusAID) has also supported political economy studies of development, illustrated by an analysis of policy-making processes in Indonesia (Datta et al. 2011). We briefly review several of these efforts, to help locate the problem of food and nutrition security within a political economy context. DFID began its Drivers of Change (DoC) efforts in 2001, and over the next several years supported the analysis of various development policy problems in individual countries (DFID 2009). Many DFID-supported DoC studies for 18 countries can be found on-line at the “Governance and Social Development Resource Centre� website, with a special section on examples of political economy analysis (GSDRC n.d.). The same website, under “political economy analysis,� provides copies of academic papers (many supported by DFID) on how to do political analysis (see, for example: Leftwich 2006). These papers provide both the theoretical basis and practical guidance for conducting a DoC study on development issues. As van Breukelen (2007) points out in her review of the DFID project, the DoC approach has a number of limitations. Perhaps the most important is that the project did not develop a specific method, leaving each team to design and devise its own analysis. The general approach was to identify structural features, institutional dimensions, and agents that promote or obstruct change. But as van Breukelen notes, this lack of a clearly defined analytical method makes the DoC approach difficult to use and the resulting studies impossible to compare. Even basic terms (such as structures, institutions, and agents) are not consistently defined or applied. As a result, it is difficult to know how to do a DoC analysis, where to start, and how to proceed. As van Breukelen concludes in her review (2007, 43), “The DoC approach has great potential… However, a lot of work must be done to make the DoC approach more effective and the findings more useful for informing policy.� A different review of DFID’s Drivers of Change (and SIDA’s Power Analysis efforts), conducted with support from the OECD, reached a similar conclusion of mixed results (Dahl-Østergaard et al. 2005). In short, DFID made significant progress in promoting academic and applied research on the political economy of development, in making many existing studies publicly and easily available on-line, and in creating greater global attention to the critical role of political economy. But the effort also left many theoretical and practical questions unanswered. In 2012, DFID devoted new resources and energy to political economy and development in ways that promise to answer some of these questions. Over the past decade, the World Bank has also given growing attention to the critical role of political economy for all sectors of development. For example, a “community of practice� has been formed within the Bank to promote political economy knowledge and analysis. One recent publication on The Political Economy of Policy Reform (World Bank 2008) provides a general 7 introduction to political economy analysis and how it can be made operationally relevant. In its introduction, the report (2008, i) stresses some basic points on the policy process and political economy: Policy design and implementation is a complex, multi-directional, fragmented and unpredictable process. A political economy lens broadens operational considerations beyond technical solutions to include an emphasis on stakeholders, institutions and processes by which policy reform is negotiated and played out in the policy arena. The study emphasizes three key messages (World Bank 2008, ii), presented in bold in the original text: 1. The importance of good political economy analysis, applied early in the process, to effective donor engagement in sector policy reforms and operations. 2. The significance of a sustainable process of building coalitions for change that involves dialogue with a broad range of stakeholders, including client governments, donors, other development partners, and the public. 3. The importance of promoting transformative processes of institutional change, including empowering forms of bottom-up accountability. This 2008 report from the World Bank frames political economy analysis with three dimensions: the reform context, the reform arena, and the reform process. Some progress in integrating these ideas into the operations of the World Bank is reflected in the World Bank’s User’s Guide to Poverty and Social Impact Analysis (World Bank 2003) and the subsequent compendium of Tools for Institutional, Political and Social Analysis for Poverty and Social Impact Analysis (Holland 2007). This paper does not provide a full review or evaluation of how political economy methods have been adopted by the World Bank or their impact. But it is important to note one of the underlying motivations for this attention, as reflected in this statement (World Bank 2008, 24): The Bank has experienced many frustrations with effecting change in the agriculture sector when the benefits of the proposed reforms, in terms of growth and poverty reduction, often seemed so apparent to Bank task managers. In short, one of the major motivations for attention to political economy analysis in the World Bank has been the resistance of countries to Bank-proposed solutions. To the extent that political economy analysis is seen as a way to improve the acceptance of policies proposed by the Bank, rather than to change the nature of how the Bank works, it is not likely to help improve the development process (although it may help improve the adoption and implementation of World Bank policies). The same publication, for example, calls for a “sea change� in the Bank’s role (2008, 37): “to be seen as a useful catalyst in the reform process rather than resisted as an outside player imposing an external blueprint solution.� How these lessons will be integrated into Bank practices remains to be seen. The report also calls for more “policy ethnographies,� to document how the reform process unfolds in practice in different sectors and 8 countries. There remains, however, some persistent ambiguity in the methods for conducting political economy analysis, how they will be adopted by the World Bank, and the impact they produce in countries. A World Bank publication in 2009 (Fritz et al. 2009) sought to give greater coherence to methods of political economy analysis, drawing on relevant political science literature. The report aims to present a “menu of options rather than to offer or prescribe one particular way of doing things� (Fritz et al. 2009, viii). The focus is on diagnostics, “complemented by a brief discussion� on how analysis can be translated into action (p. viii). The report emphasizes “problem-driven analysis� for political economy, to provide “political intelligence for agreement on what is feasible within teams and with management� (p. x). It also stresses the importance of seeking “good enough governance� and “feasible options� for reform, rather than some perfect plan. The report presents many kinds of political economy analysis that can be done, depending on the “level� of analysis: “the country level, the sector-focused or thematic level, or individual policy level� (p. 70)—each with different challenges, methods, and pay-offs. While the report offers a number of “good practice� guidelines on how to do a political economy analysis, it still gives more attention to diagnostics than to action. A more recent report examines World Bank experiences with political economy analysis in Zambia and reaches a number of relevant conclusions (Beuran et al. 2011). The report includes several sectoral analyses mostly focused on the challenges of implementation—why good policies do not achieve their expected potential. The authors identify instances where analysis helped achieve better development results and instances where it did not. The report also illustrated some of the challenges of political economy analysis. For example, some studies were more academic exercises than practical analyses, while some analyses raised questions deemed too sensitive for public dissemination but still important for development strategies. Overall, the report provides an excellent assessment on how political economy analysis can be conducted and used to improve the development process within a World Bank context. 2.3 Seeking Practical Methods for Political Economy Analysis One key challenge for political economy proponents is to provide a robust method of analysis that is also easily learned and applied in a consistent manner. In March 2011, the World Bank published a brief document of “how-to notes� for conducting a political economy analysis (Poole 2011). The document provides a useful guide for World Bank staff on different kinds of PE analyses that can be considered, including a range of time frames, methods, clients, and costs (including a desk-based note, a project or sector assessment, an in-depth field analysis, and an implementation review). The document also provides a step-by-step guide on how to develop a PE analysis. One important conclusion is that a PE assessment can involve different analytical tools, such as institutional review, historical analysis, and stakeholder analysis. Another key lesson is the importance of defining the purpose of the PE assessment and the policy problem that is to be explored. This “how-to notes� provides an introduction to the WB’s Political Economy Community of Practice (with over 200 members), which is prepared to assist in supporting PE assessment within the World Bank. We have used this document to guide our analysis in this report. We also present a range of different types of PEA that can be conducted which serve different purposes. 9 Another group within the World Bank is promoting an “Agent-Based Stakeholder Model� (Nunberg et al. 2010) as a practical political economy tool. This approach argues that PE assessment needs to move “beyond traditional approaches to political analysis.� They point out that traditional approaches have tended to rely on qualitative forms of stakeholder analysis (2010, 2) and: tend to be subjective and static, and they are inevitably overwhelmed by highly complex reform environments with large numbers of relevant stakeholders. These conventional instruments are easy to use but they do not exploit the rigor of cutting-edge political science methods now available to analyze how coalition dynamics affect the political prospects of specific interventions. To improve the quality of political analysis, Nunberg et al. used a proprietary computer software program that simulates bargaining among stakeholders “and provides an empirical assessment of the likely extent of reform and degree of shareholder support for this outcome� (Nunberg et al. 2010, 2). The paper analyzed three development case studies using the Senturia Software developed by Sentia Group (http://sentiagroup.com). While the paper explains some assumptions of the method, the software is not easily available and public information is limited on the method, its use, and its costs. The main published paper on this “predictive political simulation technology� is a report from the US National Defense University (Abdollahian et al. 2006) that assesses several case studies of complex political-military situations. One World Bank discussion of the Senturia software commented, “A key issue to consider is the relatively high cost of using this tool due to the program license and specific training required for using the tool effectively� (Fritz et al. 2009, 47). An alternative software package for applied political analysis is PolicyMaker 4.0 (Reich and Cooper 2010), developed by one coauthor of this paper. This approach combines stakeholder analysis with political strategy development in a Windows-based software (Reich 1996). The approach has been used in health policy analysis in many countries around the world, including the following published articles: • health reform in the Dominican Republic (Glassman et al. 1999); • national emergency health policy in Nigeria (Aliyu 2002); • cesarean section policy in Lebanon (Kabakian-Khasholian et al. 2007); • national health financing in Poland (Krajewski-Siuda et al. 2008); • dengue control program in Mexico (González Fernández et al. 2010); • health financing reform in Taiwan (Lin et al. 2010); and • family planning policy in Nicaragua (Drake et al. 2011). In addition, a version of the software has been adopted agency-wide by the UNFPA (under the name of “Interest Group Analysis�) for use by UNFPA country offices to support policy analysis at the national level (O’Brien et al. 2007). The publications listed above, and the adoption of PolicyMaker as an agency-wide approach by the UNFPA, suggest that the software program is useful to policy analysts both in assessing the political situation around specific 10 decisions and in designing political strategies for change. A formal evaluation of the software, however, has not been conducted. PolicyMaker guides the user in a stakeholder PEA that provides a systematic assessment of the policy content, relevant stakeholders, and key institutions involved in a policy reform, and provides support for generating political strategies that can improve the feasibility of a reform. The most recent version of PolicyMaker is downloadable for free on the Internet (at www.polimap.com). This approach is focused on a specific policy reform and generates both a systematic stakeholder analysis and a series of strategies for action. As such, the analysis can be conducted by someone with relatively limited training in political economy. PolicyMaker can also be used as a tool to assist with parts of the stakeholder analysis and political strategy assessment which is required as part of the in-depth PEA. 3. POLITICAL ECONOMY ANALYSIS FOR FOOD AND NUTRITION SECURITY Attention to political economy analysis for food and nutrition policies has grown over the past several decades, especially in the past ten years. Here we would like to highlight four common political economy themes that emerge from this literature, and review recent efforts from development partners to promote the practice of PEA in the FNS sector. A more detailed review of key writings in the field of food and nutrition policies, from 1975 to 2011, is provided in Appendix 1, including a discussion of recent developments in the global nutrition system. 3.1 Emerging Themes from the Political Economy Literature in Food and Nutrition Security Four main political economy themes emanate from the FNS literature, based on our review of the literature over the past several decades. First, the nutrition system is fragmented and uncoordinated, from the global level to the community level. As the final paper of the Lancet Series on Maternal and Child Undernutrition bluntly stated in its key messages, “The international nutrition system—made up of international and donor organisations, academia, civil society, and the private sector—is fragmented and dysfunctional.� (Morris et al. 2008, 608). There is fragmentation in the “nutrition community,� as multiple sub-groups compete to get their view of nutrition accepted by others (Pinstrup- Andersen 1993). Those sub-groups include households and communities, different government agencies, and many private sector organizations, including for-profit companies, as well as advocacy groups. One particularly strong disconnect is between agriculture and health, and their contrasting views on nutrition. Another major controversy focuses on the role and extent of private sector involvement in addressing undernutrition. Building coalitions across these fragmented multisectoral groups, with their own perspectives and interests, is a time-consuming and challenging process for nutrition policy. Second, nutrition does not have a natural home; it is often institutionally “homeless� in government (Pinstrup-Andersen 1993; Levinson 2003). In many cases, it does not fit cleanly into a single government agency. As a result, there is often a lack of strong leadership for nutrition, a lack of strong ownership and accountability, and a lack of strong advocacy for nutrition. The fuzzy roles and responsibilities about where nutrition belongs create obstacles to policy 11 innovation and adoption and to policy implementation. At the global level as well nutrition is claimed by several international agencies, including UNICEF, the World Health Organization, the Food and Agriculture Organization, and the World Bank. Third, the multiplicity of owners for nutrition creates a multiplicity of narratives about nutrition (Rogers 2002). Different players in the nutrition field have sharply different perspectives on what the problem is and what the solution is. Jonsson identified seven historical periods in the development of applied nutrition, with each period promoting a single dominant paradigm of how to address problems of malnutrition (Jonsson 2010). For example, some groups focus on inadequate consumption of food as the core problem and on food supplementation programs as the main policy solution. Other groups focus on poverty as the core problem for malnutrition and on poverty alleviation as the main solution. Yet another group focuses on food as a human right as the core problem and on government obligations to fulfill that right as the solution. These different “narratives� about malnutrition, which in part stem from the complex and multilevel determinants of nutritional status, become embodied in different framing efforts that cut across, bring together, or divide the multiple stakeholders involved and also affect the capacity to change behavior at the household and individual levels. A survey of over 500 nutritionists revealed that “infighting of nutrition community and absence of consensus on priorities� was the most commonly cited disappointment among these practitioners, which may have constrained collective efforts to advance nutrition policy and maintain credibility (Berg et al. 2008, 48). A fourth common theme in the political economy of nutrition literature is the limited capacity of “nutritionists� to manage the broader political dynamics of creating nutritional policy. Even though this characteristic was recognized in 1975 (Field and Levinson 1975), a recent publication still lamented the limited training that nutritionists have in managing the politics of the nutrition policy cycle (Natalicchio et al. 2009). Nutrition experts, at least according to some reviews, are more interested in the science of nutrition than in the messy business of shaping, promoting, and implementing effective nutrition policy (Leroy and Menon 2008). This reflects Alan Berg’s earlier diagnosis of the nutrition community’s negligence in “preparing people to work operationally in nutrition� (Berg 1993, 5). These four political economy themes reflect significant obstacles to moving nutrition policy forward at the global and national levels. How these themes become embodied as particular challenges will differ country by country. That is precisely why political economy analysis is necessary at the national and sub-national levels—and to identify political strategies that can help overcome these barriers to progress on food and nutrition security. 3.2 Applied Political Economy of Nutrition: Recent Studies Several recent studies on the political economy of FNS are of particular relevance for this paper, and are briefly summarized below. First is a World Bank Discussion Working Paper on the political economy of nutrition policy reforms in Africa, under the title of Carrots and Sticks (Natalicchio et al. 2009). This project brought together academics and practitioners in learning about the challenges of nutrition 12 policy reforms. The report’s preface explains, “Institutional and political challenges, rather than technical knowledge, are the primary constraints to greater impact of policies and programs on nutrition� (Natalicchio et al. 2009, xi). The report is based on a two-day workshop on the political economy of nutrition policies that included a discussion of methods, a comparative review of country case studies in Africa, and lessons about how to move forward from several “pilot experiences.� The analysis is focused at the national level—how to address the political economy obstacles of nutrition interventions in countries and how to move forward effectively. The report presents a series of different analytical frameworks and approaches, and then a series of country case studies (with positive and negative factors, and a few lessons per case). Marcela Natalicchio brings the different approaches of the report together in a final chapter “towards an analytical framework.� She begins by defining the problem for nutrition policy as being caught in a “low priority cycle� (Natalicchio, 2009, 41–2). Reform is needed, she states, in order to change the political feasibility of nutrition as an issue. She attributes the lack of political feasibility to four factors, including the role of losers in reform, the difficulty in organizing a constituency, the lack of an institutional home, and the lack of administrative capacity to implement reform. She recommends a series of actions for putting nutrition on the policy agenda, and for promoting adoption, implementation, and sustainability. As a follow-up to this report, the World Bank launched a comparative study in Africa on the political economy of national nutrition policy. The report on this study (including eight African countries, four Francophone and four Anglophone) concludes that “elements of power, nature of the problem, institutional placement, donor behavior, and poor results have combined over time� to trap nutrition in a low-priority cycle that reinforces its low governmental priority (Natalicchio and Mulder-Sibanda 2010, 33). A second important report is the Mainstreaming Nutrition Initiative, which compares the policy process experiences of five countries (Bangladesh, Bolivia, Guatemala, Peru and Vietnam) (Pelletier et al. 2011). This World Bank-supported study examines four policy processes in each country: 1) national commitment, 2) agenda-setting, 3) policy formulation, and 4) implementation, using a participant-observer method over a one to two year period. An article on the study’s results (Pelletier et al. 2011) examines the determinants of success for each phase of the policy process. Here “success� was defined as high national commitment, placement on the national policy agenda, formulation of a nutrition policy, and implementation of that policy. The study found marked variation in the country experiences, but also identified commonalities: policy disagreements were often related to “questions of institutional leadership, expertise, and agenda control� (2011, 9). The paper identifies a common theme across all four processes: the importance of strengthening “strategic capacity� within the nutrition community, particularly the “capacity to broker agreements, resolve conflicts, build relationships, respond to recurring challenges and opportunities, and undertake strategic communications� (2011, 11). In addition to these two studies, researchers at the Institute of Development Studies, UK are currently engaged in a DFID-funded study to examine the “political, institutional and governance aspects of delivering a national multisectoral response to reduce maternal and child malnutrition� (IDS 2011). This study aims to identify the “political challenges and opportunities in the adoption, implementation, and scaling up of nutrition policies� and includes a comparative analysis of six country case studies. The results of this initiative have now been released. 13 4. A METHOD FOR CONDUCTING AN IN-DEPTH POLITICAL ECONOMY ANALYSIS In this section we present a method for conducting an in-depth PEA (Figure 2). This method provides a guide to help policy analysts identify the steps needed to perform a PEA for a given policy issue. Although we offer this approach for use in the FNS sphere, the process can be adapted to other policy contexts and issues. While this is certainly not the only approach that could be used to conduct a PEA, we have sought to provide a theory-based method and thus to address one of the problems of the Drivers of Change approach, which did not propose a specific method. This approach to PEA requires substantial investment of knowledge and time, and for this reason requires policy analysts who are trained in political economy and have sufficient time to carry out an in-depth analysis. They in turn can advise interested parties (policymakers, development partners or practitioners) with appropriate strategies for improving the political feasibility of reform efforts. We envisage that most users will already be familiar with the context, major stakeholders and institutions for the policy under analysis. We also propose using the PolicyMaker software for certain steps in the PEA process, especially for stakeholder analysis, political feasibility assessment, and strategy design. A major question in conducting PEA is: Analysis of what? When examining the political economy of policy reform, it is necessary to specify the stage in the policy cycle. There are many different versions of the policy cycle (see, for example, Kaufman and Nelson 2004; and Roberts et al. 2004). For the purposes of this paper, we consider four phases: (1) agenda-setting, when an issue is placed on the policy agenda; (2) design, when a reform proposal is put together; (3) adoption, when a reform bill is considered and passed by the legislature or accepted by an executive agency; and (4) implementation, when an adopted policy is put into practice (and evaluated). The same framework was recently used in an analysis of the political economy of health financing reform (Fox and Reich, in press): Different elements of political economy come into play at these four stages in the reform process, and different theories of political economy help explain what happens and why some proposals go forward while others founder. This point also applies for the political economy of food and nutrition security. The political economy processes differ depending on where the issue is located in the policy cycle. In addition, interactions occur among the four phases. For example, how a reform proposal is designed and what elements are included in the policy affect the chances of its adoption. Moreover the process of adoption can involve negotiations and compromises on the policy that change its substance in order to get agreement from specific groups. The political economy challenges (and strategies) of getting an issue onto the national policy agenda diverge from the challenges (and strategies) of designing a policy, securing its adoption, or improving its implementation. We present all four stages of the policy cycle in order to consider potential interactions between the different stages. Since analyzing all stages of the policy process is demanding, a policy analyst may decide to focus on one specific stage of the policy cycle for assessment—for 14 example, the stage under debate in a country at a particular time. (In our illustrative example of analysis presented in Part II, for example, we focus on the agenda-setting stage.) The approach can be used both retrospectively, to understand the political dynamics around a policy issue (and produce a diagnosis of problems or success), as well as prospectively, to help foresee potential obstacles facing a policy proposal and develop strategies for action that could improve political feasibility. Figure 2 presents four steps in conducting an in-depth political economy analysis for food and nutrition–related policies. Step 1: The first step is to identify the key goals and expectations for the political economy analysis. Is the analysis going to be retrospective or prospective? In other words, is the analysis intended to explain some specific policy decisions or effects in the past, or designed to analyze the current situation and propose specific strategies for action that could improve the political feasibility of a policy under consideration? As part of this step, the analysis should describe the broad landscape in food and nutrition security and assess major trends in the political economy context. For example, does the country (or state, depending on the government unit under analysis) have existing policies in food and nutrition security, and have those policies achieved their objectives? Has the country experienced any recent crises in food and nutrition security (such as a famine, or drought, or price escalations)? Recent trends in the political economy context should include upcoming or recent elections, competition among political parties, the level of political stability in the country, and political activities of major interest groups in the food and nutrition domain (such as agricultural workers, government agencies, and civil society organizations). This first step specifies the terms of the analysis and places it within the food and nutrition context and the national political economy. This first step could also become a substantive analytical essay in itself, as illustrated in the analysis in Part II. Step 2: The second step is to identify the stage in the policy cycle and the research question on which the analysis will focus. As noted above, the four stages are: agenda-setting, policy design, policy adoption, and implementation (including evaluation). Each stage involves different kinds of research questions, which relate to different theories in political economy. Considering the example of India’s Integrated Child Development Services (ICDS), which we pursue in Part II, the following questions could be considered: 1) For agenda-setting: How and why did reform of the ICDS get on the Prime Minister’s agenda in 2010?; 2) For design: Why did the technical design of the ICDS reform not introduce major changes in the existing program?; 3) For adoption: Whose assent is required to adopt the ICDS policy reform, and what is the process of selection?; and, 4) For implementation: What problems may occur in implementation of the new ICDS reform? In Part II of this paper, we examine question 1 in detail. The second step thus requires specifying both the stage in the policy cycle for analysis and the specific research question to be examined. The policy analyst can strengthen the analysis by referring to the relevant political economy literature related to the research question under consideration. Step 3: The third step is to collect data and analyze the political dynamics in order to answer the research question. This step requires attention to policy content (what is actually contained in the policy?), issue framing (how is the issue defined and positioned in the local 15 political economy?), political context (are there political transitions such as upcoming elections?), external or global influences (are there events in the global nutrition system or changes to the agendas or resources available from development partners?), and policy entrepreneurs (who is the main champion for the policy, and what kinds of political skills and political resources does the champion have access to?). The third step also requires an analysis of stakeholders, those individuals, groups, and organizations that are potentially affected by the policy both positively and negatively. How much power does each stakeholder possess? What position does the stakeholder take on the policy? What kinds of coalitions exist or could be constructed among different stakeholders? This analysis of stakeholders should include an assessment of institutions related to the policy, including their access to financial resources and their potential to use incentives to persuade other stakeholders to take specific positions. The analysis should also consider perceptions of both the policy problem and potential solutions, including how the mass media might influence broader public opinion as well as the views of the elite on the policy under consideration. Based on these assessments, the analysis should draw some conclusions about the political feasibility of the policy. For a retrospective study, the analysis would identify the main determinants of the policy’s feasibility (for example, what were the main factors that explain why the policy was not adopted?). For a prospective study, the analysis would identify the main supportive factors and the main obstructive factors that would probably shape the policy’s future feasibility. Step 4: The fourth step for a retrospective study is to identify and assess political strategies that were used to promote a past policy reform at one stage in the policy cycle; and for a prospective study, to propose political strategies that could be used to shape the political feasibility of a new policy reform. This step would also consider interactions between different stages of the policy cycle. For example, the compromises used to assure adoption of a policy (such as compensation for a powerful interest group opposed to the reform) could create barriers to implementation or even undermine the intended effects of the policy. Or the decision to exclude certain groups from participation in the design of the policy (in order to reduce conflict over the content of the policy by limiting the scope of participation) could increase opposition from the excluded groups during the process of policy adoption. A retrospective study would examine the effectiveness of different political strategies in seeking to assure policy adoption. A prospective study, on the other hand, would identify different options for action and the likely consequences of different strategies on a reform’s political feasibility. The fourth step would also include monitoring the effects of different political strategies on the intended goals and expectations of the reform. The PolicyMaker software program provides suggested political strategies that can be adapted to different circumstances in order to improve the political feasibility of a policy reform. This kind of political economy analysis generates several products and results. First, it generates some specific knowledge products, including a stakeholder map, a definition of the policy content and its components, and an assessment of political feasibility. Second, it raises awareness among policymakers about the political landscape and its consequences and the implications for the policy reform under consideration. Third, the analysis focuses attention on the role of political strategies in shaping the feasibility of a policy reform and the importance of politically managing the change process in order to achieve the desired policy impact. Finally, the analysis underlines the importance of viewing the entire policy cycle, including the interactions 16 of different stages, when seeking to design, adopt, and implement a new policy. The approach stresses the iterative nature of the policy cycle, and the role of political economy factors throughout. This approach to political economy has a number of limitations. First, the analysis uses qualitative methods of data collection and it can be influenced by the persons conducting the study. To reduce potential bias, the methods require careful attention to data collection and interpretation. In addition, the research questions need to be articulated in ways that reflect the theoretical literature and can be answered within a reasonable time frame using direct interviews and document reviews. Second, this approach is only one possible way to conduct a political economy analysis. As noted above, a number of development agencies have proposed alternative methods of analysis, with varying degrees of standardization. Finally, the main objective of this paper is to propose a method of political economy analysis with strong grounding in the academic literature but also with sufficiently routine methods that allow its use as an input into the policy process by practitioners. Finding the right balance between academic validity and practical application may result in some trade-offs in quality. We hope that those trade-offs are justified by the utility of the analysis. In Part II of this paper we illustrate both the strengths and the limitations of this form of political economy analysis through the case study of food and nutrition security in India. 17 Figure 1: Spectrum of Political Economy Analysis Source: Authors Each type of PEA serves different purpose and requires different resources (expertise, time and money), with some overlap and complementarity between the types. 18 Figure 2: Four Steps for Conducting an In-depth Political Economy Analysis Step 1: Describe the study objectives and policy context Identify key goals and expectations for the political economy analysis Analyze food and nutrition security landscape in Country/State X Analyze political economy context in Country/State X Step 2: Select stage of the policy cycle for analysis Stage 1: Agenda-setting Stage 2: Policy design Stage 3: Policy adoption Stage 4: Implementation Identify key research Identify key research Identify key research Identify key research question/issues question/issues question/issues question/issues Step 3: Analyze political dynamics to assess political feasibility a) Establish b) Analyze stakeholders: c) Assess political feasibility • Key issue/problem and its • Power • Based on stakeholder framing • Position on the problem analysis, plus role of • Policy content • Number institutions and • Political context • Coalitions perceptions • External/global influences • Policy entrepreneurs Retrospective Step 4: Assess or design political strategies Prospective • Identify strategies used Consider interactions • Propose strategies for action and their consequences between different stages of and potential consequences • Assess effectiveness of the policy cycle • (Identify potential obstacles strategies on political and opportunities ) feasibility • Monitor outcomes against goals and expectations Source: Authors 19 PART II: AN ILLUSTRATIVE CASE STUDY: A POLITICAL ECONOMY ANALYSIS OF INDIA’S INTEGRATED CHILD DEVELOPMENT SERVICES SCHEME EXECUTIVE SUMMARY Part II applies the structured qualitative method for conducting an in-depth political economy analysis (as presented in Part I) to a case study in India. The case study analyzes India’s Integrated Child Development Services (ICDS) scheme, and focuses on the agenda-setting stage of the policy-cycle. This case study explores why and how the issue of policy reform of ICDS and child undernutrition got onto India’s national policy agenda in 2010, and the consequences that followed. In this illustrative example, we follow each step in conducting a political economy analysis. In Step 1, the key goals and expectations for the political economy analysis are defined and background information on India’s nutrition landscape and ICDS are presented. In Step 2, the research question is identified, which in this instance focuses on a retrospective analysis in the agenda-setting stage. In Step 3, the political dynamics are evaluated to assess the political feasibility of reform. This analysis used published and unpublished documents along with data gathered from semi-structured interviews with key stakeholders. In Step 4, the political strategies that were used in setting the agenda for ICDS are assessed. We also discuss missed opportunities and potential strategies that could have been used to improve the feasibility of reform of ICDS at this particular time. The analysis also draws on the academic literature in political economy to improve our understanding of how and why events occurred in the policy process. The analysis of this case study shows a number of missed political opportunities in the policy process for child malnutrition in India. Some key findings were: 1) the lack of a policy entrepreneur to capitalize on favorable factors and events in the ICDS reform process; 2) the inability of technocrats to develop politically feasible policy solutions and respond to policymakers’ requests to prioritize and simplify their recommendations; 3) the fixed and entrenched views of select stakeholders who have considerable influence on the framing of the problem and solutions; 4) the existence of powerful interest groups, whose support was important for policy change to happen; 5) the historical weakness of the lead Ministry for ICDS, which constrained its capacity to influence and manage policy reform. We find that the event of the PM’s Council on India’s Nutrition Challenges represented a significant level of stated and institutional political commitment, yet this Council was not designed in a way to produce political action on reform. In sum, the political strategies that achieved agenda-setting on India’s malnutrition problem at the same time served to slow down action in the policy reform process. 20 This case study also illustrates the strengths and limitations of this analytic method. The major strengths are its flexibility, so that time and effort can be directed on the most critical question at a specific point in the policy cycle; and its practicality, so that practical strategies are generated to navigate the policy process. These two strengths would be of interest to users conducting prospective analyses and designing political strategies for change. The major limitations are the time needed to carry out the analysis, and concerns about the quality of the output, which are dependent on the process of research (as with many qualitative and quantitative tools). While this approach is resource intensive, it can yield rich contextual understanding of the policy process and specific reform issues, especially if supported by drawing on the relevant theoretical literature. 21 1. INTRODUCTION In this section, we apply the method presented in Part I to conduct an in-depth political economy analysis of the food and nutrition security sector in India. We illustrate this method using a case study of India’s Integrated Child Development Services (ICDS) program. This example was selected because it continues to be the main intervention to address childhood undernutrition in India. In fact, ICDS is the world’s largest early child development program, delivering integrated interventions for nutrition, health, and education through a network of anganwadi (village) centers (GOI 2011b). This government-led initiative, involving both central and state governments, has a long history of implementation in India since it was established in the 1970s. The program’s history provides an opportunity to explore the political economy of efforts to reform existing policies. This reflects the challenges of nutrition policies and programs in many SAFANSI countries where the reform of existing policy responses to nutrition confronts significant political economy problems. In this case study, we focus on the first stage of the policy-cycle: agenda-setting; and we analyze the political economy of ICDS at the national level. This fits with SAFANSI’s objective to better understand the factors affecting the commitment of national governments to food and nutrition-related policies. Our main objective here is to explore why and how the issue of policy reform of ICDS and child undernutrition got onto the national policy agenda in 2010, and the consequences that followed. We follow each of the steps described in Figure A and recommend that readers refer to Figure A as a guide. In Step 1, we define the key goals and expectations for the political economy analysis (PEA) and describe the policy context, with a brief introduction to India’s nutrition puzzle and ICDS. In Step 2, we analyze the policy cycle and identify the research question, as a retrospective analysis of the first stage of the policy cycle: agenda-setting. In Step 3, we analyze the political dynamics to assess political feasibility. We draw on a theory of agenda-setting to strengthen our analysis of the policy process. Also, we supplement this analytical step with qualitative data gathered from semi-structured interviews with key stakeholders. In Step 4, we assess the political strategies that were used in setting the agenda for ICDS and child undernutrition, approaching this strategic analysis from the perspective of the Planning Commission. In the Discussion, we draw on theories of agenda-setting to help understand the analysis and consider strategies that could have been employed to improve the political feasibility of ICDS reform. In the Conclusion, we discuss the strengths and limitations of this method of PEA and the key findings related to agenda-setting for ICDS and child nutrition in India. A key objective of this case study is to illustrate to potential users how to conduct an in-depth political economy analysis using our proposed approach. Potential users of this approach will require training in this method, as well as knowledge of political economy literature. 22 2. CONDUCTING A POLITICAL ECONOMY ANALYSIS 2.1 Step 1: Describe the Study Objectives and Policy Context In Step 1, we define the key goals and expectations for the political economy analysis and describe the policy context. Study objectives The objectives of this study are to understand how the policy reform of ICDS got on to the national agenda in 2010. The expectations are to better understand specific past policy events related to ICDS and identify political strategies that were used for agenda- setting, and how additional strategies could have improved the political feasibility of efforts to reform ICDS and put undernutrition onto the government agenda. This illustrative analysis shows how political economy can be used to assess and influence the political commitment of national governments for nutrition-related policies. (The focus was at the national-level and did not extend to state-level political economy factors, which although important given India’s federal structure, were deemed beyond the scope of this study). The policy context: India’s nutrition puzzle, ICDS and the political economy context India’s nutrition puzzle 1 The “South Asian enigma� has puzzled public health researchers for decades (Ramalingaswami, Jonsson, and Rohde 1996). Despite impressive economic growth, particularly in India, there has been limited progress in improving nutritional status in the region. Solving this enigma has proved difficult, partly because of the complex multifactoral drivers of nutritional status at the individual and population levels, and partly because of data constraints that have limited empirical enquiry and the “analytical disconnect� between empirical studies that tend to fall into either agriculture and economics or nutrition and health domains (Headey, Chiu, and Kadiyala 2012). The Indian experience demonstrates that economic growth alone, both at the macro and the micro levels, is not sufficient to improve nutrition; this finding is supported by cross-national studies (Haddad et al. 2003; Milman et al. 2005) and national studies (Headey, Chiu, and Kadiyala 2012; Subramanyam et al. 2011). Although national data from the FAO shows small increases in calorie and protein intake at the national level (Headey, Chiu, and Kadiyala 2012), Deaton and Drèze point out that national surveys in India 2 show a decrease in per capita calorie consumption and a decrease in cereal and pulse intakes over the last few decades, in the context of increasing per capita incomes (Deaton and Drèze 2009). Surprisingly, the decrease in calorie consumption has been greater among the rich. It is unlikely that the declines are attributable to an increase in the relative price of food compared to other goods, since the relative price of food has actually decreased over time (from 1983 to 2004–5). One explanation offered is that 1 Please see Deaton and Dreze for an excellent analysis and discussion of India’s nutrition situation. 2 National Sample Surveys and National Nutritional Monitoring Bureau (NNMB) surveys 23 calorie requirements have declined in response to improved health status and reduced exposure to disease, and lower physical activity over time. Indeed, as only 2 percent of India’s population report that they do not get enough food every day, it seems that most Indians do not feel hungry despite the state of the nutritional indicators (Deaton and Drèze 2009). However, impaired appetite can result from environmental enteropathy, inflammation, psychosocial stress, and other factors. The lack of dietary diversity, especially among poorer groups, appears to be a strong determinant of nutritional status (Headey, Chiu, and Kadiyala 2012). Cross- national studies of spending by the poor in India and other countries have also revealed interesting findings (Duflo and Banerjee 2011; Banerjee and Duflo 2007). A study in Udaipur showed that poor households have the ability to spend up to 30 percent more on food but choose not to, preferentially spending money on festivals, alcohol, and tobacco. Additionally, as incomes increase, the poor prefer to buy more expensive, but not necessarily more nutritious, food. For instance, 10 percent of the food budget is spent on sugar, salt, and processed foods (Banerjee and Duflo 2007). Changing preferences towards non-food items and necessities, such as transport, may also be a factor explaining the lack of expenditures on food. Other factors also contribute to India’s child nutrition problems, including: inadequate sanitation and hygiene and care practices; suboptimal infant and young child feeding practices (which should include early and exclusive breastfeeding and age-appropriate complementary feeding); limited progress in improving maternal health and nutritional status; and failure to adequately address the underlying causes of undernutrition (poverty, low education, low status of women and children). In an attempt to address the nutrition problem, the Government of India has implemented several food-based schemes to improve access to food, especially among vulnerable groups, seeking thereby to improve nutritional status. These schemes include the Public Distribution System (PDS), the Antyodaya Anna Yojana (AAY), the “mid-day meal scheme� (MDM) or National Programme of Nutritional Support to Primary Education, and the ICDS. These nutrition-related policies complement other nutrition- sensitive policies in other sectors, such as water and sanitation, health, education and agriculture. Disconnects within and between these multiple sectors are probably driving India’s nutrition puzzle (Headey, Chiu, and Kadiyala 2012). 3 Political economy analysis may help understand some of these disconnects and assist in proposing possible solutions to resolve them. ICDS and the dominance of supplementary nutrition In 1974, India made a major national commitment—through the National Policy for Children—to provide services to children to ensure their physical, mental and social development. In response to this policy, the government launched ICDS in October 1975 as an experiment to coordinate and integrate services for children under six years of age, 3 It is important to note for children, nutritional status is strongly determined during pregnancy and the first two years of life. Therefore maternal factors, such as nutrition, health and education which affect care and feeding practices, are important in determining child nutrition status. The links between economic growth, with increased household income and increased availability to diverse diets, may therefore be less dominant in determining child nutritional status. 24 and for pregnant and lactating mothers (Tandon 1983) (Figure B). The initial success of the ICDS experiment in improving the nutritional status of children in 33 blocks 4 led to its expansion to cover 150 blocks by 1980 (Tandon 1983). Since this time, ICDS has expanded greatly: from 37.5 million beneficiaries in 2002 to 56.8 million beneficiaries in 2006 (Hawkes and Ruel 2006). Today, ICDS has evolved to cover over 70 million children and 16 million pregnant and lactating mothers (GOI 2011b). 5 The ICDS program was designed to deliver a comprehensive package of services relating to nutrition, health and education (Figure C). Six main services were included: supplementary nutrition, immunization, health check-ups, health and nutrition education, referral services, and non-formal pre-school education. 6 Although ICDS is an early child development program, the nutrition component has dominated the program and is the main intervention to address child undernutrition. The nutrition component includes supplementary nutrition (SNP), growth monitoring and promotion, treatment and referral of severely malnourished children, and nutrition and health education. Services are coordinated at the village level through anganwadi centers (AWCs) by local female village workers (anganwadi workers) (AWWs) trained for this program. The ICDS is overseen by the central government through the Ministry of Women and Child Development. At the state level, the program is implemented through the Women and Child Development Department or related departments. Typically around 100 AWCs are designated as “projects,� which are managed by Child Development Project Officers (CDPO) and assisted by “Supervisors.� The project officers oversee the AWCs and the work of the AWWs and their helpers. The population size served by AWCs differs by rural, tribal, and urban projects, depending on need and the catchment size. For example, typically there is one AWC per 500-1000 population in rural areas, and one AWC per 150-500 population in tribal areas (Hawkes and Ruel 2006). More detailed descriptions of the ICDS program and its operations are presented elsewhere (GOI 2011b; Gragnolati et al. 2006b; Lokshin et al. 2005; Gragnolati et al. 2006a). Disbursements towards ICDS have increased substantially over time from Rs 10392 crore ($2.2 billion) for the 10th Five Year Plan (2002-2007) to Rs 44400 crore ($9.45 billion) for the latest 11th Five Year Plan (2007-2012) (Adhikari and Bredenkamp 2009). The budget for ICDS from the most recent Union Budget for 2012-13 was Rs 15850 crore compared to Rs 4761 crore for the financial year 2007-08 (GOI 2012a). Funding for the supplementary nutrition program (SNP) has increased relatively more over time (Gragnolati et al. 2006a). The funding structure for SNP varies: since 2009-10, the funding for SNP in most states is shared equally between central and state 4 India had a total of 5011 rural and tribal blocks at this time, and selection for ICDS was based on those considered backward or underprivileged based on national criteria (Tandon 1983). Each block covers about 100,000 people. 5 ICDS also has been supported by development partners, including the World Bank, UNICEF, CARE, World Food Programme, USAID. As discussed later, the World Bank has a long complex history of assistance to ICDS and the Tamil Nadu Integration Project. Interested readers are directed to the extensive literature related to the World Bank’s experience with ICDS and TINP, as the history and politics are relevant to this analysis. 6 Nutrition: Supplementary nutrition (SNP), growth monitoring and promotion, treatment of severely malnourished children, nutrition and health education; Health: immunization, health services (health checkups, treatment of minor illnesses, antenatal and postnatal services, referral services; and preschool education). 25 governments, but in the Northeastern states the central government funds 90 pecent of the SNP (GOI 2011b). For other components of ICDS, central government funds 90 percent of activities (GOI 2012b). This shared responsibility has faced difficulties at both central and state levels; there is evidence of failure to spend allocated funds due to central government delays in releasing funds and lack of capacity to absorb and utilize them (World Bank 2004). This shift in funding is intended to increase state control over the ICDS, leading to more flexibility and local adaptation, with increased success at implementation. However, expenditures per child are regressive at the state level, and previously state governments have not succeeded in matching the grants given by the central government. The individual level costs for ICDS are Rs 4 for children (6-72 months), Rs 6 for severely malnourished children (6-72 months), and Rs 5 for pregnant and lactating women, per beneficiary per day (GOI 2012b). Both quantitative and qualitative evaluations of ICDS have highlighted its lack of effectiveness, with major shortcomings in its design, implementation, and coverage (Adhikari and Bredenkamp 2009; Gragnolati et al. 2006a; Gragnolati et al. 2006b; NIPCCD 2006). The poor performance of ICDS, however, has not resulted in significant changes in policy design. There has been minimal change to the original model since 1975, with few changes to the technical design of packages. 7 Instead, the emphasis has been on improving the coverage of ICDS and improving the implementation of the program, together with a shift in the emphasis to 0-3 years and pregnant and lactating mothers. The shift in target groups away from children 3-6 years reflects global evidence of the greater efficacy and effectiveness of interventions in the critical window of child development between 0-2 years (Bhutta et al. 2008). Increasing effort has been made to improve the implementation and targeting of the program, especially since the landmark Supreme Court decision in 2001 when the government was instructed to universalize ICDS and provide an AWC in every settlement. The ICDS is currently in the midst of a major reform effort seeking to achieve “universalization with quality� (Right To Food Campaign 2011). As the Planning Commission’s latest ‘Approach to the 12th Five Year Plan’ states: “The programme needs to be radically restructured to focus on reaching pregnant and lactating mothers, and also the more vulnerable children in the 0-3 age group. Restructuring should promote decentralisation of administration, and lay stress not only on expansion, but also on quality. Other proposals include ensuring greater flexibility in implementation, capacity development, ensuring greater community ownership with participation of women’s/mothers groups, management reform and strengthening of convergence with related flagship and other programmes� (GOI 2011c). As a result, a Working Group was commissioned to come up with a proposal for strengthening ICDS. The Ministry of Women and Child Development’s strategic plan for 2011-2016 also offers a number of reforms to strengthen ICDS, citing the need for ICDS to be 7 An example being a change in calorific norms for supplementary food for children under 6 years, and pregnant and lactating mothers. 26 implemented in “mission mode� in order to achieve its goals (GOI 2011a, 65). This requires “convergence and coordination� especially with the health sector at the implementation level through schemes such as the National Rural Health Mission (GOI 2011a, 217). In January 2012, the proposals for ICDS reform were under review, with interested parties eagerly awaiting the outcome. The latest Union Budget speech revealed that there will be a roll out of a “Multi-sectoral Nutrition Augmentation Programme� in 200 high burden districts to focus on maternal and child malnutrition (GOI 2012a). Through these ICDS reforms, the government seeks to improve the implementation and quality of ICDS services nationally and expand the coverage and effectiveness of ICDS in districts with high undernutrition. The ultimate objective is to reduce the level of malnutrition in India and resolve the Indian nutrition puzzle. Whether these reforms will achieve their objectives requires a consideration of the problems affecting the policy cycle related to ICDS, and the political economy sources of those problems. 2.2 Step 2: Select Stage of the Policy Cycle for Analysis Step 2 of the PEA requires the analyst to choose which stage of the policy cycle to study, and identify the research question or issue for analysis. Figure D shows examples of research questions relating to ICDS for each stage of the policy cycle. In this case study, we focus on a research question related to agenda-setting. In a retrospective analysis of agenda-setting, we examine how and why the issues of undernutrition and ICDS got onto the Prime Minister’s agenda in late 2010. PEA of Policy Reform Stage 1: Agenda-setting: Child nutrition and ICDS on the national policy agenda In November 2010, India’s Prime Minister, Dr Manmohan Singh, chaired the first meeting of the Council on India’s Nutrition Challenges 8 (GOI 2010). The meeting was attended by key stakeholders on nutrition in India at the highest level, including the Minister of State for Women and Child Development, the Minister of Agriculture, Consumer Affairs, Food & Public Distribution, and the Deputy Chairman of the Planning Commission. Convening the meeting signaled a high level of commitment to nutrition, and the attendance reflected the importance of food and nutrition security as an issue of national priority. The meeting placed India’s reform of the Integrated Child Development Services high on the government’s policy agenda. The Prime Minister stated the “need to take a hard look at the ICDS to improve the programme� (GOI 2010). ICDS policies and programs needed “strengthening and restructuring� in order to better address undernutrition. The Ministry of Women and Child Development and the Planning 8 The Prime Minister emphasized three key points relating to the issue of nutrition: 1) the complexity of malnutrition: its multifactoral etiology and the necessary intersectoral response and institutional mechanisms to effect change across Ministries, and at all levels (central, state, district, block and Gram Panchayat); 2) the absolute magnitude of India’s undernutrition burden, with far-reaching consequences for health, development and the economy; and 3) the unacceptably slow improvement in the country’s nutrition status over time, despite economic growth. 27 Commission were charged with monitoring the implementation of the Council’s recommendations. How and why did reform of the ICDS and child undernutrition get onto the national policy agenda in 2010? What political economy factors affected the decision to convene the Council on India’s Nutrition Challenges? Why was there a delay of two years between constituting the Council and its first meeting? With intense competition among public programs for priority attention, what factors brought ICDS reform to the attention of policymakers? 2.3 Step 3: Analyze Political Dynamics to Assess Political Feasibility Step 3 of a political economy assessment is an intensive data gathering and analytical exercise. In Step 3, we considered factors related to the issue, the policy solutions, and the contextual factors. We also conducted a stakeholder analysis, examining the relative power, position, coalitions, and perceptions of each stakeholder. The existence of policy entrepreneurs or advocates was assessed. Based on these factors, the political feasibility of the policy reform was considered. For this analysis of ICDS, the key questions to consider are: How was the problem of child nutrition and ICDS defined, and how was it framed by different stakeholders? What factors shaped policy solutions and its content? What was the political context surrounding ICDS and its policy reform? What external factors shaped how the problem of undernutrition was viewed, and the policy solutions? Who were the stakeholders and what were their respective powers, positions, and perceptions of the issue? Were there policy entrepreneurs and advocates for the issue of nutrition? Based on the issue framing, context and stakeholders, what was the political feasibility of proposed reforms? For this case study, we gathered data from semi-structured interviews with key stakeholders. We use the qualitative data from interviews to supplement the documentary analysis. We briefly describe our methods and data sources for the PEA here. Interviews with relevant stakeholders were conducted in Delhi in January 2012, except for two that were conducted by telephone/skype from the United States. Potential participants were identified through several different sources: 1) literature relating to nutrition and health in India to identify the range of key individuals and institutions; 2) input from key informants working in nutrition and health in India; 3) and snowball sampling, whereby participants were asked whether they could recommend others who may be relevant to the study. More than 30 potential participants were identified and approached by email, telephone, and/or in person. In total 20 national-level stakeholders 28 were interviewed either in person or by telephone (7 stakeholders from government, 6 from NGOs/civil society, 4 from international organizations, 2 from academia/research, and 1 from the private sector). These interviews were guided by a prepared instrument developed exclusively for this study, although stakeholders were encouraged to freely discuss the issue and some preferred to talk generally about the issue. Interviews were recorded when permitted, and contemporaneous notes were taken which were then immediately written up following the interview. Informed consent was obtained verbally at the time of the interview. Each of the recorded interviews was transcribed, and the interview transcripts and notes were examined and content analysis performed to identify relevant themes relating to the research question. This qualitative work was supplemented by information and data from government policy documents, national surveys, donor reports, and published research relating to nutrition. This study was approved by the Institutional Review Board of Harvard School of Public Health. Results of the analysis Here, we present the results of the PEA by introducing a theory of agenda-setting to frame the analysis which provides a broad context for understanding the policy process. Applying theory in this way requires more detailed knowledge of the literature and qualitative methodology, and therefore requires that the policy analyst have prior experience with political economy. Alternatively, an informed policy analyst could use this paper and follow the steps described herein to conduct a PEA similar to the one presented below. We illustrate the analytic steps and findings using figures to provide guidance on the structure and logic of the PEA presented in this paper. Political theory: Kingdon’s theory of agenda-setting Political science theories of agenda-setting can be useful to examine the political economy processes whereby an issue gains the attention of policymakers. In this analysis, we draw on Kingdon’s theory of agenda-setting. We chose to apply Kingdon’s theory because it helps to explain why issues gain political attention and make it onto the governmental agenda, and has been widely applied in the literature. It provides a method for understanding how and why events occurring in disparate streams can converge in a policy window to produce change in the agenda-setting stage of the policy cycle. Kingdon argues that for an issue to gain political priority on the government agenda, three independent streams need to converge: the problem stream, where an issue becomes perceived as a problem that needs to be and can be addressed; the policy stream, where a set of alternative policy solutions are proposed to address the problem; and the politics stream, where political events create a window of opportunity, such as national elections or international political events (Kingdon 1995). Policy entrepreneurs have an important role in facilitating and promoting the convergence of the three streams, and using a political window so that an opportunity for change can be translated into policy reform. These are all political processes. 29 This theory, which emanates from the public policy literature, has been adapted to examine priorities for global health issues (Reich 1995) and to explain why some global health initiatives receive more attention than others (Shiffman and Smith 2007), and factors that shaped national agenda-setting for maternal health in five countries (Shiffman 2003). The framework has also been used to examine national agenda-setting of nutrition policies (Pelletier et al. 2012, Lapping et al. 2012). We have combined Shiffman’s framework with Kingdon’s model, and slightly adapted the factors to include external/global influences that can affect the domestic agenda, to produce the framework shown in Figure E. In the next section we discuss the main factors related to the ICDS operating in each of Kingdon’s three streams (Figure E). For each stream, we briefly define the factors, explain the role of the factors in the agenda-setting process for ICDS reform, and summarize the key findings in each stream. The key findings of the analysis are presented in Figure F. This qualitative analysis helps explain how the issue of food and nutrition security reached the national agenda in India in November 2010. Problem Stream The analysis of the problem stream for malnutrition in India requires an assessment of credible indicators, focusing events, and issue framing. Credible indicators refer to metrics that can clearly and credibly quantify the magnitude and severity of a problem. Indicators that are easy to understand, especially by non-technical communities, may have greater traction in conveying the nature of a problem, the changes over time, or the impacts for different groups. Focusing events describe social phenomena that draw attention to an issue or problem. These can be external incidents such as disasters, famines, political or financial crises, or more predictable and manageable proceedings such as strategic planning cycles, public meetings, or the release of reports or budgets. Issue framing refers to efforts that shape how different stakeholders perceive or understand an issue. There can be a disconnect between the internal frame (how the policy community perceives the problem) and the external frame (how the public perceives the problem). Framing also influences how stakeholders view the proposed policy solutions. Credible Indicators: In September 2007, the findings of India’s third National Family Health Survey (NFHS-3), 2005-06, reported the magnitude and persistence of India’s undernutrition problem (International Institute for Population Sciences 2007). This survey uses well established and internationally recognized credible indicators to measure undernutrition. The nationally representative survey showed that an estimated 43 percent of children under 5 years were underweight, 48 percent were stunted, 20 percent were wasted; and 70 percent were anemic. The prevalence of child undernutrition was alarming. The prevalence of underweight children in India was higher than in many countries of Sub-Saharan Africa—for example, Niger had 39 percent of children underweight in 2006, and Ethiopia had 33 percent underweight in 2005 (Kothari and 30 Abderrahim 2010). 9 The national aggregate statistics also masked serious socioeconomic inequalities within India in undernutrition which had widened during the 1990s (Gragnolati et al. 2006b). Trend analysis over time also showed problems. Comparisons with NFHS-2, conducted seven years earlier in 1998-99, showed a disturbing lack of progress towards alleviating the undernutrition burden (International Institute for Population Sciences 2007). Even within the context of economic growth, the decline in undernutrition lagged behind other countries with similar economic growth rates (Gragnolati et al. 2006b). For example, while the prevalence of child underweight in China declined at an annual rate of more than 8 percent, in India the decline was only 1.5 percent (Gragnolati et al. 2006b). India was characterized as an “economic powerhouse and nutritional weakling� (Haddad 2009). The data made it clear that economic growth alone was not sufficient to reduce undernutrition. Focusing Events: A series of focusing events that helped make the issue of nutrition noticeable to policymakers and other stakeholders were the Prime Minister’s Independence Day Addresses in 2007, 2008, and 2009, pushing the problem of child undernutrition into the public domain. As India’s Prime Minister stated in his Independence Day Address in 2007, “The problem of malnutrition is a matter of national shame... I appeal to the nation to resolve and work hard to eradicate malnutrition within five years� (Singh 2007). One respondent also commented on the special influence of Amartya Sen, particularly his annual meetings with the Prime Minister and Chair of the Planning Commission, along with his press statements, all of which directed national attention to India’s persistent malnutrition and other welfare issues. There was also a focusing event with the development and publication of the midterm appraisal of the 11th Five Year Plan. There was concern that the results were not encouraging and the results were not coming through—it [ICDS] required serious thought. (I-3) The midterm appraisal states: ICDS has been in existence for about 34 years and today covers the entire country, but it has not been able to achieve the outcomes expected… This is clearly time for a detailed comprehensive appraisal of the programme in its entirety, going beyond the usual periodic evaluations. The proposed appraisal/review should examine the need and desirability of continuing with ICDS in its present shape and form. Currently the scheme is treated as a panacea for all child related activities, which it cannot be… (GOI 2011d, 237) The findings of the midterm report card of ICDS raised a number of questions in the high levels of government and triggered dialogue between the Planning Commission and the lead Ministry. The MWCD was asked to explain the midterm appraisal’s findings and justify its level of performance (I-4). Following this, the MWCD initiated internal 9 On the other hand, the prevalence of stunting in the Africa region continues to be higher than in Asia (Mason, Orleans, and Shrimpton 2010). 31 activities to identify gaps and come up with recommendations to improve the performance of ICDS, which became the basis of several key documents. Also, prior to this in December 2009, the Planning Commission asked the MWCD and MOHFW to come up with a joint strategy document, which was later submitted to the Planning Commission (I-20). These focusing events, which coincided with the strategic planning cycle and the planning for the next 12th Five Year Plan, helped push the issue of ICDS reform onto the national agenda. Issue Framing: External framing of the issue of undernutrition by the media was successful in commanding the attention of high-level leaders—they were quick to take up the poor status of child nutrition and push the issue into the spotlight in a way that resonated and shocked external audiences. Undernutrition was also framed as a rights issue by the ‘Right to Food’ Campaign, and ensuring access to ICDS was seen as upholding such entitlements. (The role of this coalition is discussed further below.) For the Government of India (GOI), the severity of the undernutrition problem was a major cause for concern, indicating that economic growth and poverty alleviation were not resolving this problem. More importantly, however, India’s persistent malnutrition became a source of national embarrassment, especially when the issue appeared in foreign media: What pricked their [GOI] pride was when people put it together that it was worse than sub- Saharan Africa. Thanks to the all the media campaigns…—people think that Africa is the worst on earth—so when they said India’s malnutrition rate is worse than Africa, people reacted. (I-12) The government only takes notice when it’s [child malnutrition] in the New York Times, otherwise they don’t care. (I-16) This analysis shows that several favorable factors for agenda-setting existed in the problem stream. Credible indicators quantified the severity of stagnation of India’s undernutrition burden, and facilitated stark comparisons with other countries. Powerful external framing by the media and other groups portrayed the results in a way that was shocking and cogent to external audiences. This external framing commanded the attention of high-level national leaders and contributed to declarations of expressed commitment to address this issue. The cycle of national strategic planning, with its midterm appraisal and planning for the next five year phase, provided a forum for policymakers and technocrats to discuss the problem, and an opportunity to consider potential new policy solutions to address the problem. Policy Stream The policy stream provides alternative policy solutions to address national problems, and this stream is often driven by policy communities and technocrats who share interests in a given issue. We analyze the policy stream by assessing policy community cohesion, guiding (policy) institutions, viable policy solutions, and policy entrepreneurs. Policy community cohesion refers to the level of cohesiveness or alignment among the key stakeholders for a given issue. A guiding (policy) institution relates to an institution or initiative that effectively takes on the leadership for a given issue. A viable policy alternative is a politically feasible and credible policy solution that 32 can be presented to decision-makers and is likely to be viewed as acceptable. Policy entrepreneurs are ‘hidden’ stakeholders who influence the policy stream and work towards achieving alignment between stakeholders and generating politically feasible policy solutions. Policy Community Cohesion: In case of malnutrition in India, a high degree of policy community cohesion exists in the relatively small nutrition community. Many have been working in the field for decades and have developed longstanding relationships with deep understanding of each other’s viewpoints and perceptions. On a value level, the policy community shares certain socialist beliefs and is committed to improving the welfare of disadvantaged groups and solving India’s nutrition puzzle. Also, most technocrats in India’s nutrition community have biomedical backgrounds and share the same thinking on the complex multifactorial etiology of child undernutrition, with deep understanding of the technical issues. While there is some difference of opinion about the role and design of ICDS as the main intervention to tackle undernutrition, the Indian policy community is united in its opinion that ICDS has failed: In part, the nutrition problem is seen as government failure, but it has also been a social failure—it is a collective social failure—that is why ICDS has failed. (I-4) The core group of nutrition technocrats is generally well respected by policymakers, and tends to include academics or technocrats who are unlikely to raise controversial issues or question the decisions of policymakers. As one stakeholder commented: Sensible bureaucrats listen to us, but we shake them up. Some may not like it, so they don’t invite us to the next meeting… It’s out of our passions for the correctness, or the country, that we keep going… Different or lone voices get drowned out. (I-18) At the same time, however, India’s nutrition community is not oriented toward or adept at managing the political process, preferring more academically inclined theoretical solutions for government interventions. Guiding Policy Institution: In the late 2000s, certain focusing events helped to bring the nutrition policy community together to form a coalition under the leadership of the eminent agricultural scientist, Prof. M.S. Swaminathan. In August 2007, the National Nutrition Conclave, sponsored by the M.S. Swaminathan Research Foundation, Indian Council of Medical Research and USAID/India, put forward the Chennai Declaration. They described themselves as “a group of people who are passionate about achieving a nutrition-secure India, representing Central and State Governments, non-governmental organizations, civil society, corporate leaders, bilateral and multilateral development agencies, nutrition experts, activists and academia.� They were unified in their call for “nutrition to be a priority on the national agenda� (National Nutrition Conclave 2007). The National Nutrition Conclave also called for a “National Nutrition Authority� and a Parliamentary committee to bring together the concerned ministries and stakeholders. This group evolved into the Coalition for Sustainable Nutrition Security in 33 India (CSNSI), chaired by Prof. Swaminathan. This is an example of a guiding policy institution that stepped up to assume a leadership role for nutrition security—they even put forward a “Leadership Agenda.� As part of the coalition’s advocacy work, there was a “Meeting on Political Mapping to Develop a Nutrition Advocacy Plan� 10 facilitated by DFID in 2009, which identified specific groups and individuals to target and influence in order to move the nutrition agenda forward. Working together, the Coalition sought to find technical alignment on solutions to different aspects of the problem, adopting a holistic vision of nutrition, encompassing the economic, environmental, agricultural, cultural, health, and political determinants of malnutrition. They also sought solutions that went beyond the public sector and included the private sector. This cross-sectoral approach generated conflict as some parties expressed strong skepticism of private sector involvement in solutions to undernutrition. Viable Policy Alternatives: Despite the cohesion of the policy community and its commitment to addressing the problem, a major challenge arose in developing politically feasible and viable policy alternatives. This is because of disagreement about the policy solutions and the role of ICDS as part of the solution. In this case, it is important to distinguish between a theoretical ‘ideal on paper’ policy solution and a practical, implementable, politically feasible one. On one level, some stakeholders believe that the original comprehensive design of ICDS with its holistic approach to early child development is appropriate. However, some technical experts question whether ICDS, even if implemented well, would have any impact on poor nutrition outcomes, as illustrated by this respondent: ICDS to my mind is a crude surrogate intervention that we are giving; we cannot expect magic out of it. It was primarily used for counseling; now it is being used for food distribution. You need to be clear of the objective. If the outcome is to address other issues then it is okay, but for undernutrition, 0.2 standard deviations [referring to the changes in child anthropometric outcomes] is the best you can achieve. (I-18) For others, specific aspects of the design of ICDS raised concerns. Overwhelmingly, the most controversial aspect has been the role of the supplementary nutrition program (SNP) which has dominated the debate. Opinions vary about what form SNP should take, who should prepare and procure it, and concerns exist about conflicts of interest related to commercial foods and corruption. The emphasis on SNP is interesting, as the technical design of the policy was based more on the assumption that supplying more food would lead to an increase in nutritional status, rather than evidence of this effect: there have been no randomized control trials of complementary feeding strategies conducted in children older than 18 months (Bhutta et al. 2008), who were the main beneficiaries of ICDS over this time. Also, it is clear that the critical time for intervention is between 0 and 2 years, which is not the key target group for SNP. Yet, debates over SNP have been more than a technical issue, but also a normative issue of whether this should be a ‘supplement’ or a ‘substitute.’ Ultimately, however, it is a political issue with many potential winners and losers with stakes to claim, especially as food-related 10 http://www.nutritioncoalition.in/pdf/Nutrition-Coalition_DFID-Meeting-Minutes-August-12-2009.pdf 34 activities are more likely to bring in more votes than other less visible interventions. (I- 20) Specific pieces of the policy solution that involve the private sector are highly contentious, primarily because of concerns over corruption. It is important to place this discussion in the context of the recent debate on whether ICDS should serve cooked food or processed ready-to-eat food, and the underlying dominance of the supplementary nutrition program in ICDS. In 2008, the then-Minister of MWCD, Renuka Chowdhury, proposed a centralized system of processed pre-packed food, which was proposed in part because of the lack of adequate supporting structures at AWCs to serve hot cooked meals. But the influence of corporate interests raised concerns, and civil society activists and academics challenged the proposal (Baru et al. 2008), as the ‘biscuit lobby’ had been active in lobbying MPs and writing directly to the Ministry for Human Resource Development and the MWCD. Amartya Sen also entered the debate, with a letter to the Prime Minister advising against serving biscuits and other packaged foods in ICDS. The proposal was then “shot down� by the Planning Commission, due to concerns that it would be difficult to manage contractors and monitor procurement to prevent leakage and corruption (Indian Express 2008). Their view was that the choice of food should not be imposed centrally, but decided locally and adapted to the needs and food habits of local beneficiaries. Several nutrition experts and other stakeholders also voiced a preference for nutritious cooked meals rather than dried ready-to-eat options. States were then given the choice of providing cooked meals or ready-to-eat food, under a policy design that allows for local adaptation. The political economy of the supply of SNP, with the potential winners and losers and the large sums of monies involved, clearly affects political dynamics and exchanges. Needless to say, clientelism, rent seeking, and pork-barreling with their varying scope and directness varies, especially at the state and local levels and are likely important factors in this puzzle. Yet, these factors did not dominate the discussion of stakeholders interviewed at the national-level; these would have been raised perhaps in a state-level political economy analysis which extends beyond the scope of this current study. These debates about SNP and the different thinking of technocrats and bureaucrats and politicians have made it difficult to define viable policy alternatives. While several policy solutions were presented by the Coalition, which were in line with global recommendations from the 2008 Lancet Series on Maternal and Child Undernutrition, they were considered too complex to adopt and implement: It [CSNSI] was an excellent exercise, but it hasn’t been able to change anything inside because it was too ambitious and included almost everything… It is just repacking what has been done. We have not been able to prioritise and say, ‘Let the government focus on these three things over the next three years, etc.� So it became almost everything. At the table, with 20 people representing different things, it was necessary to include everybody’s viewpoint… There was no priority list… It is very attractive for the donor agencies, but it doesn’t change government action. (I-12) In preparations for the meeting of the PM’s Council in November 2010, the policy alternatives raised concerns that the comprehensive recommendations being presented by technocrats would face difficulty when trying to translate them into policy: 35 There was demand from politicians to have a few interventions. They were asking, which of these should we focus on? But this issue was not addressed by the technical community. All the technical stakeholders wanted “their� issue to be a recommendation, therefore this was over-comprehensive. (I- 10) This analysis shows the emergence in the policy stream of a favorable guiding institution, led by an eminent policy advocate for nutrition. Still, the technical policy community was unable to come up with a viable policy alternative so that the issue could be placed on the government’s policy agenda (Kingdon 1995, 142). CSNSI and the technocratic community were limited in their success, in part because of discordance in internal framing relating to the policy solutions, and in part because of lack of response to the need for politically feasible policy alternatives. Debates about SNP also continued to enter policy discussions (despite consensus that the critical age group for interventions is 0 to 2 years). The policy community was searching for comprehensive technical solutions, rather than trying to propose prioritized, practical, and easily implementable ones. Importantly, there was no policy entrepreneur, a person who was able to successfully push the issue in the policy stream and “soften up� the technical community to deliver a more appropriate technical design (Kingdon 1995, 205). “Policy entrepreneurs anticipate political constraints as they develop proposals� (Kingdon 1995, 229). This does not appear to have effectively taken place in the Indian context for nutrition policy in 2010. Politics stream The political stream involves a diverse set of factors, including electoral, partisan, and interest group factors, which affect the government agenda and also create a potential political window of opportunity for policy reform. We consider the following factors for the political stream around ICDS reform in India: political transitions, policy advocates, interest group mobilization, and external influences. Political transitions refer to changes in government, administration or leadership, which can rapidly shift the political climate, the attention to issues, and national mood. Policy advocates are individuals or groups of individuals with a vested interest in a particular issue and who openly promote external attention to their issue or proposal. Interest group mobilization refers to the rallying of specific groups that share common interest in a given issue. Such organized groups can adapt items to fit with their agenda, block potential proposals that do not fit with their agenda, and sometimes initiate or set their own agendas. External or global influences describe the influence of non-domestic factors that can shape domestic agendas through “norm promotion� and “resource provision� (Shiffman 2007) 11. These are often driven by global policy developments and the specific agendas of international agencies. 11 Shiffman (2007) describes “norm promotion� and “resource provision� as examples of “transnational influences� which describe the role of international agencies in shaping domestic agendas. We, however, do not favor the use of the ‘transnational’ in describing such activities as they do not inherently incorporate the interconnectedness or two-way flow of exchange implied by most definitions of transnationalism, but rather suggest a more ‘external’ imposition of the norms and agendas of international agencies. 36 Political Transitions: Following India’s 2004 general election, the United Progressive Alliance (UPA), a coalition party led by the Congress Party, assumed national political leadership. This center-left alliance was supportive of social welfare programs and sought to support and universalize many government schemes, such as the National Rural Health Mission in 2005, the Mid-Day Meal scheme in 2006/7, and later ICDS. There was a political transition with the general election and political continuity was assured when PM Manmohan Singh was reelected in the 2009 general election. Although the following government (referred to as the “UPA 2 coalition�) was less left- leaning, the investment in social welfare programs continued. Following liberalization reforms in the 1990s, India began a period of rapid economic growth. While economic resources may not be necessary or sufficient in driving issues onto the policy agenda (Fox and Reich in press), economic progress can change the “political calculus of leaders� by giving them more resources available to address social and welfare issues. India’s stronger economic position created a more supportive political environment for attention to social welfare issues and contributed to pressure from within the central government, especially from the Planning Commission, to support greater attention to nutrition problems (Biswas and Verma 2009). This pressure was reflected in increased disbursements for investing in nutrition. For example, the budgetary allocation to ICDS was increasing by 30-40 percent in the early 2000s (Biswas and Verma 2009). There was a sense that the Indian government not only could spend more on nutrition but should spend more on nutrition to bolster its new international role as an emerging economic power. Yet, with competing priorities for the Prime Minister’s attention, the PM and Planning Commission were more interested in fiscal policy, despite the underlying and fundamental belief that basic entitlements should be secured. As one respondent put it, The PM doesn’t have time for this [nutrition]. They have time for economics, but not for nutrition. (I-18) Policy Advocates: Sonia Gandhi, chairperson of UPA, is a key political individual and strong supporter of social welfare programs. The National Advisory Council, which Sonia Gandhi chairs, provides “policy and legislative inputs to Government with special focus on social policy and the rights of disadvantaged groups.� 12 This Council has had a strong commitment to nutrition and food security, which was chosen as a focus area at a meeting on 10 June 2010. Also several members of the appointed National Advisory Council (NAC) had strong interests on nutrition (for example, Prof M S Swaminathan and Prof Jean Drèze). The NAC was active in making recommendations for, and drafting, the National Food Security Bill (NFSB) in 2010. NAC members Harsh Mander and Dr. NC Saxena were also the Special Commissioners to the Supreme Court charged with monitoring the implementation of the Supreme Court Order of 2001, which ordered states to fully implement ICDS (see below). This group has strong and direct access to the highest political authorities of the national government and of the UPA. 12 http://nac.nic.in/images/recommendations_oct.pdf 37 Interest Group Mobilization: A major factor operating in the political stream for malnutrition was interest group mobilization. Increasingly strong civil society activism has changed the political equilibrium relating to the food and nutrition security debate. India’s Right to Food campaign, an “informal network of organisations and individuals committed to the realization of the right to food,� has been successful in promoting the argument of rights and entitlements for food. 13 This lobby has been active in communicating its demands through various platforms, and in holding the government accountable for delivering entitlements through legislative action, democratic processes, and changing public perceptions (Drèze 2004; Kent 2006). In 2001, the Right to Food campaign filed a Supreme Court case that resulted in a landmark decision demanding government action to protect the right to food. 14 The decision makes specific reference to Article 21 of the Indian Constitution that concerns the right to life and personal liberty. State negligence in the response to drought-affected areas and the inadequacy of the Public Distribution System were the main foci of the initial petitions. Following this decision, several interim Supreme Court hearings have been held and many orders issued. These include orders focusing on the government’s eight food-related schemes, including ICDS. 15 The Supreme Court decision institutionalized the process of universalizing ICDS as a critical part of ensuring food security for infants and children and realizing the Children’s Right to Food agenda (Kent 2006). On 28 November 2001, the Supreme Court directed State Governments and Union Territories to fully implement ICDS, ensuring that each AWC provide specific calorie and protein requirements for children aged 0-6 years, adolescent girls, pregnant and lactating mothers and malnourished children, together with an ICDS disbursement center in every settlement. Since then, several detailed Supreme Court orders have been issued relating to ICDS. On 7 October 2004, the government was directed to universalize ICDS, including specific targets for numbers and placements of AWCs, and allocation of funds. This was followed by the order of 13 December 2006, which specified additional time-bound targets and further details of the State allocation and spending for each group of beneficiaries. 16 As part of this process, two Commissioners (Harsh Mander and Dr NC Saxena) were appointed by the Government of India since 2002 to monitor and assess the implementation of the orders, and to ensure accountability. 17 13 http://www.righttofoodindia.org/campaign/campaign.html 14 People’s Union for Civil Liberties (PUCL, Rajasthan) vs Union of India and others, Writ Petition [Civil] 196 of 2001) 15 (1) the Public Distribution System (PDS); (2) Antyodaya Anna Yojana (AAY); (3) the National Programme of Nutritional Support to Primary Education, also known as “mid-day meal scheme�; (4) the Integrated Child Development Services (ICDS); (5) Annapurna; (6) the National Old Age Pension Scheme (NOAPS); (7) the National Maternity Benefit Scheme (NMBS); and (8) the National Family Benefit Scheme (NFBS). 16 http://www.righttofoodindia.org/icds/icds_orders.html 17 Supreme Court Commissioners: http://www.sccommissioners.org/ 38 These court decisions radically changed the policy context for ICDS and the power dynamics relating to the key policy advocates, which was disconcerting to some technocrats. It is a real tragedy that of all the other people [stakeholders in nutrition] that it was a court order that made this [universalization of ICDS] law. It was not from the public health community, not from the political community, not from the state, it actually came from this. (I-16) As a result of strong interest group mobilization, the rights discourse entered into official policy documents with an external frame that resonates with politicians. For example, the 10th Five Year Plan (2002-2007) acknowledges its commitment “to adopt a Rights-based approach to the development of children� with the obligation this brings to the Government to “ensure their survival, protection and development� (GOI 2002). In addition, the Right to Food campaign has continued to lobby and to exert pressure for a comprehensive Food Security Act. 18 External Influences: For the case of malnutrition in India, it appears that external or global influences have played a restricted role in the national agenda-setting process, which has been largely domestically driven. Despite many global activities in nutrition, such as the Lancet Series on Maternal and Child Undernutrition 19 and the SUN movement (India is not a SUN country), our analysis shows that these global activities, from the perspective of domestic stakeholders, exerted only limited influence on the national nutrition policy process in India (contrary to our initial expectations). As one stakeholder in India noted on the Lancet Series on Maternal and Child Undernutrition, What did they say that was not common sense understanding of the last 20 to 30 years? The Lancet series did not have an impact on policy making here!... The Lancet musicalizes the problem and doesn’t get to the real issues! (I-16) Stakeholders’ opinions on the impact of other events on policymaking, such as the IFPRI 2020 conference on ‘Leveraging Agriculture for Improving Nutrition and Health,’ which was held in Delhi in February 2011, varied. 20 As one stakeholder noted, this event was useful for bringing people together, and there have been lots of spin-offs (I-10), but the distinct presence of the private sector put off some people (I-9, I-12, I-13). Some stakeholders are deeply skeptical of “BINGOs� (Business Interest Group Organizations) and view any private sector initiatives, including public-private partnerships, with profound skepticism. Commercial influences are at work also—it’s a commercialization of poverty and undernutrition. It is viewed as an opportunity. In India a lot of money is coming in, so malnutrition means enticing with products, which may not really be a sustainable scenario. (I-18) 18 http://www.righttofoodindia.org/data/national_food_security_act_primer.pdf 19 http://www.who.int/nutrition/topics/Lancetseries_MediaAdvisory_UK.pdf 20 http://2020conference.ifpri.info/ 39 Other stakeholders, on the other hand, saw the IFPRI conference as a lost opportunity: It is unfortunate as everyone uses the private sector in so many ways. But when it comes to the poor and food aid, they say that they should not be used at all. It is extreme to say that the private sector should not come in at all. (I-12) Development partners, such as the World Bank with its latest ICDS Systems Support and Nutrition Improvement Project (ISSNIP), and DFID with its changing response to nutrition (Amery and Philpott 2009), have been sympathetic to the nutrition agenda in India. In particular, the World Bank has a long history of assistance with projects to support ICDS since the late 1970s and has supported the well-known and widely cited Tamil Nadu Integration Project. Furthermore, “The World Bank has studied the ICDS to the last T� (I-20), having supported several evaluations and research to learn from these experiences. The latest ISSNIP project is currently awaiting approval and includes implementing select ICDS reforms in specific states and specific districts, a broader multisectoral nutrition component, and technical assistance and support for monitoring and evaluation. Yet, domestic stakeholders remain deeply skeptical of non-domestic input from development agencies: They [international agencies] don’t have an understanding [of what happens domestically]. For them the solution is only food, that is how the equation is working at the moment— if not only food, primarily or predominantly food. This is not going to solve the problem. (I-18) Such perspectives were not shared by all stakeholders, although most agree with the diminishing influence of international agencies in India. Some respondents, for example, cited earlier times when UNICEF representatives would frequently meet with the Prime Minister and high-level officials, which is no longer the case. However, UNICEF in particular has maintained some influence over the nutrition policy debate through its longstanding relationships with key individuals who also sit on the National Advisory Council. The World Bank, perhaps in part because of its extensive history with ICDS and the Tamil Nadu Integration Project, continues to show interest in supporting the nutrition agenda and reforms of ICDS. Our analysis of the politics stream shows again several favorable factors to promote the agenda-setting process for malnutrition. Political continuity assured some level of sustained attention to social welfare issues, and economic prosperity created an enabling environment for ICDS reform. Powerful proponents for nutrition existed at the highest levels of government. Yet, it is strong civil society activism that has dominated the politics stream. Strong interest group mobilization has been critical to changing the debate around nutrition and the right to food. Although the success of the Right to Food movement in the judicial system occurred several years before convening the PM’s Council, these events have radically changed the political environment around ICDS. In this first part of Step 3, we have systematically considered factors occurring in the problem, policy and politics streams that help to explain the process leading up to the convening of the PM’s Council in 2010. We revisit these streams in the Discussion to 40 assess their convergence and the consequences (whether or not ICDS reform and undernutrition made it onto the agenda and why). Step 3 Continued: Stakeholder Analysis The previous sections introduced many of the key stakeholders involved in ICDS reform. In this Step, we perform a stakeholder analysis (using PolicyMaker software) to identify and map the key players, the positions they take on the issue, and their power and coalitions. The results of the stakeholder analysis for major players on ICDS using PolicyMaker is shown in Figure G, and not listed in the text here. The analysis (based on findings from interviews) identified three powerful stakeholders who have played a crticial role in influencing the policy agenda and public perceptions of child undernutrition in India. These are the Breast Feeding Promotion Network of India (BPNI), the Right to Food group, and the Special Commissioners to the Supreme Court. For different reasons, these stakeholders have managed to command great influence on the nutrition agenda. One respondent described two key non- governmental groups as follows: They have a lot in common—both are totally anti-industry, anti-international agencies and anti- western influence. They think that they have a solution for the problem and that nothing else is needed and if what they say is implemented the problem will be solved… There is a good milieu for organizations like Right to Food to be in the center stage and write the agenda, and what they sincerely believe is right—you can’t question their commitment and passion—but they are not open to anything else. They think they have the solution for everything; the latest fad for them is the Food Security Bill. They are a very powerful group, [partly] because there is nobody else; no one is interested in this area. No one even has a view on it. (I-12) The third key stakeholder, the Special Commissioners to the Supreme Court, are also on the National Advisory Council (NAC): [After the Supreme Court ruling] two Special Commissioners were appointed... they have become technical advisers and justice deciders. They are the ones deciding what SNP should be, what age group should get treated, and who gets what. So it all stays in the same set of people. How are they so powerful? Because the common thing among these people is that they are all anti-industry— they think that the private sector should not be involved in anything in anyway. (I-12) Understanding the role of these individuals and the complexities of the relationships between these powerful stakeholders and other stakeholders is central to understanding 41 interactions of the players, and the differences in their perspectives and approaches to the policy reform process. In this step we sought to identify policy entrepreneurs among the stakeholders. These are key individuals or groups who are able to help devise politically viable policy solutions and to exploit policy windows to bring the streams together and drive an issue onto the government agenda. From interviews with stakeholders, there was mention of champions within the Planning Commission advocating for nutrition. However, in the case of ICDS, we found no clear policy entrepreneurs, ‘hidden’ politically adept individuals working behind the scenes to influence the policy stream, who were continuously and successfully championing to place nutrition on the government’s policy agenda. There is a lacuna [in the area of nutrition policy]. There needs to be someone to look into this with authority with the PM. (I-9) The stakeholder analysis we conducted provided a picture of the varied players involved, with their differential power, positions, and perceptions on ICDS reform. There were many supporters for reform, with several policy advocates openly canvassing for the issues, creating a potentially supportive political environment. One striking finding of this analysis is that there were no opponents to the idea of placing ICDS and child undernutrition on the government’s agenda (although there were opponents to specific pieces of the policy reform). There were some players who were not yet well-mobilized. In addition, other players were becoming increasingly mobilized, such as anganwadi workers with increasing unionization were becoming more powerful in their demands (I- 20). Based on this analysis, we moved on to assess the political feasibility of the agenda- setting process. Step 3 Continued: Assess Political Feasibility According to Kingdon, viable policy alternatives are those that “meet such standards as technical feasibility, value acceptability, public acquiescence, politicians’ receptivity, and budgetary stringency� (Kingdon 1995, 206). Assessing political feasibility thus requires placing policy alternatives in the broader political and institutional context. We therefore considered the feasibility of different solutions, given the results of the stakeholder analysis, along with an assessment of institutional roles and perceptions. In this section, we focus on the role and perceptions related to the lead institution for ICDS, the Ministry of Women and Child Development. 42 Pierson states, “In politics, institutional constraints are ubiquitous. Politics involves struggles over the authority to establish, enforce, and change the rules governing social action in a particular territory. In short, much of politics is based on authority rather than exchange� (Pierson 2000, 259). In the case of the ICDS, the lead ministry’s limited authority has curtailed its ability to influence policy priority for malnutrition and manage the coordination with other ministries and institutions to deliver on child nutrition. The Department of Women and Child Development was established in 1985 within the Ministry of Human Resource Development and was intended to draw together other sectors and ministries on issues concerning women and children. In 2006, this Department was upgraded to a Ministry and given higher status but no additional power. 21 As a small and less powerful institution within the overall governmental bureaucracy, the MWCD has faced great challenges in coordinating the nutrition response across different agencies and through the phases of the policy cycle. If you look at the structure [of MWCD] and you see the organogram you can see the weakness—it is so small. There are not enough people to manage ICDS. So, their job is to get the money and suballocate it, and they make a report and that’s it. (I-12) According to our respondents, there are no powerful champions currently in MWCD at the ministerial level able to push for ICDS reform, or for the broader agenda of improving the status of India’s women and children. Also, the MWCD has been criticized for not performing effectively in its role of intersectoral coordination (Saxena and Srivastava 2009). But this shortcoming applies beyond MWCD, as “state capability to organize cross-government actions to tackle undernutrition is weak� (Biswas and Verma 2009). To address this constraint, the MWCD’s latest strategic plan recommends setting up a Department of Nutrition within the Ministry to strengthen coordination (GOI 2011a, 121). Whether this will work remains an open question. As noted in Part I of this report, the “institutional homelessness� of nutrition within the government bureaucracy is a structural constraint on nutrition policy found in many countries. India is no exception. A proposal of creating a new institutional arrangement for nutrition was raised in November 2010 at the Prime Minister’s Council meeting (GOI 2010), by the Planning Commission, the NAC (NAC 2011), and others: What is needed at the country level is a national level body—if anything it would be to keep nutrition on the agenda and help to monitor progress of the government’s commitments. (I-10) The idea is that this new institutional entity would be charged with overseeing the national response to nutrition and coordinating the inter-ministerial response, together with technical experts and members of civil society. 22 It was suggested that this executive 21 http://wcd.nic.in/ Smt. Krishna Tirath appointed Minister in 2009 22 Examples of similar national nutrition agencies attached to the Prime Minister’s office include Cellule de Lutte contre la Malnutrition (CLM) in Senegal, National Nutrition Agency (NANA) in The Gambia, and Office National de Nutrition (ONN) in Madagascar. These have been able to maintain advocacy for nutrition, and assist with implementation of national nutrition programs. There is limited knowledge of the effectiveness of such institutions to improve nutrition (Natalicchio & Mulder- Sibanda, 2012). 43 authority would sit under the Prime Minister’s National Council and would replace the National Nutrition Mission of 2003. At the state level, there are examples of states that have created Nutrition Missions involving high-level state bureaucrats, but it is not clear whether this institutional approach would achieve better results at the national level. In our interviews, respondents held mixed views about the need for such a national institution, and about whether it would actually produce better results. The costs of creating new institutional arrangements are high, and path dependency suggests that existing arrangements are often favored over hypothetical ones. In many countries, the persistence of existing institutional arrangements makes coordination for public policy hard (Pierson 2000, 259); this is a persistent problem of public administration. While other ministries have been asked to “bring strong nutrition focus to their programme� (GOI 2010), there have been minimal attempts to create appropriate incentives or capacities to promote such collaboration, making it hard to reverse existing arrangements and the power asymmetries. For example, the Ministry of Agriculture could play a more dominant role in addressing undernutrition, but this more powerful ministry has little incentive to change its position. In the Council on India’s Nutrition Challenges meeting, the Ministry of Agriculture made the statement that “the Government was making efforts to invest in agriculture to increase food production and to streamline public distribution system so as to increase both availability and access to food� (GOI 2010). Similarly, the tension between the MWCD and MOHFW is compounded by limited incentives to encourage coordination. Lack of convergence between the two Ministries and “the current fashion where they either pass the buck or blame each other� limit synergistic action (Gupta and Khaira 2008, 19). This assessment of the political feasibility of ICDS reform indicates that the institutional weakness of the MWCD has limited the ability for potential policy solutions to gain leverage among more powerful stakeholders and institutions. The widespread perception of the weakness of the lead ministry makes it challenging for this institution to promote intersectoral coordination for nutrition; this institutional weakness has probably contributed to calls for a new nutrition body to carry out coordination and promotion of nutrition policy at the central government. Path dependency suggests that this current existing and unsatisfying arrangement, which limits the feasibility of any potential policy solution, is likely to persist unless there is radical and concerted effort to change the status quo. 2.4 Step 4: Assess Political Strategies 44 In Step 4 of this political economy analysis, we assess the political strategies that were used in setting the agenda for ICDS and child undernutrition, using PolicyMaker software as a support (Figure H & I). This step requires identifying the key actor for whom the political strategies were designed. In this retrospective (and illustrative) analysis, we assess the strategies that were used by the Planning Commission (PC) for setting the agenda around ICDS reform (Figure J). We selected the Planning Commission because of its key strategic role in setting the policy agenda for nutrition (and other issues) in India. Below, in the Discussion, we assess missed opportunities and strategies that could have been employed by the Planning Commission to improve the political feasibility of ICDS reform (Figure K). It is important to note that we did not have access to some pertinent information and were not able to substantiate certain findings with the Planning Commission, which would be necessary to make strategic recommendations in this case. We recommend that in practice this analysis be done in collaboration with, or by, the relevant national body that has the authority to implement the resulting strategies. In our analysis, we consider four kinds of political strategies related to power, position, players, and perceptions. These four kinds of strategies can be used to affect the political feasibility of a reform proposal. Power strategies, for example, relate to increasing the power of supporters through increased access to resources (technical knowledge, financial), the creation of coalitions, and increased access to politicians. Position strategies relate to persuading supporters to strengthen their position, and persuading non-mobilized groups to take up or strengthen their position. Player strategies seek to change the number of players mobilized for or against an issue, through incentives and sanctions of different sorts, often through negotiations. Finally, perception strategies seek to change the external frame to resonate with politicians, supporters, and the public, and align the internal frame to provide clearer understanding of the problems and solutions. Here we briefly discuss eight strategies used by the Planning Commission to shape the agenda for malnutrition. 1. Meet directly with supporting stakeholders (Power): The PC met with various interest groups to discuss ICDS and child undernutrition and to identify areas of agreement. Several groups, such as the BPNI and fortification groups, lobbied government officials in 2010 to press for their issue to be included in the agenda for the PM Council’s meeting (I-9). Other groups from the private sector, including international and domestic food manufacturers, were trying to push for ready-to-eat foods to be part of ICDS, which would give them an expanded market (I-17, I-19). In meeting with these groups, the PC gained better understanding of the issues and facilitated discussion and access to political leaders. They were also able to gain legitimacy for key stakeholders, and assist them with navigating the political and legal context and gaining access to political leaders. 2. Support a coalition of supporting groups (Power): The Planning Commission participated in the CSNSI, which brought together many of the key stakeholders in nutrition, and agreed with the CSNSI’s efforts to provide technical support and leadership for nutrition policy. The PC’s involvement signalled the support of the 45 government. This allowed for early involvement in the discussions to achieve technical alignment on nutrition policy, and also conferred some power to this coalition. By supporting the CSNSI, the PC supported an eminent leader to work with technocrats to find policy solutions. 3. Persuade supporters to work together (Position): Following the focusing events in the problem stream, and the strategic planning cycle, the PC requested the MWCD and MOHFW to work together to come up with a policy paper to address child nutrition and ICDS. This strategy sought to persuade key government “supporters� to strengthen their position either by changing the policy to remove contested goals and mechanisms or by adding desired goals and mechanisms to the policy. 4. Facilitate multistakeholder dialogues as a way to stress common goals (Position): In the run up to the meeting of the PM’s Council, the PC facilitated multistakeholder dialogues that brought together all stakeholders to seek common goals or values with mobilized and non-mobilized stakeholders. This was also important in bringing together stakeholders from different parts of the policy cycle. Following this consultation, the PC created a policy document that was used to guide the position of the different groups at the PM’s Council. 5. Make the decision-making process open and inclusive (Player): The PC convened multistakeholder consultations to expand the number of supporters and devise a more politically feasible solution. This consultative process sought to change the nature of decision-making. 6. Create a new institutional body (Player): The PC proposed the creation of a new national institutional body under the Prime Minister’s National Council with executive authority to lead on nutrition issues, as a way to expand the number of mobilized players engaged on nutrition policy. This strategy, however, was not implemented. 7. Align the internal framing among different groups (Perception): The PC used the multistakeholder consultations in attempts to align the internal framing of the problems and solutions among different stakeholder groups. These perceptions were captured in the policy document that formed the basis of the recommendations to the PM’s Council. 8. Use media to increase public visibility (Perception): The PC supported the recommendation for a national communication campaign to increase awareness of India’s problem with child undernutrition with active involvement of civil society and media. This strategy aimed to increase public visibility of the issue and expand public acceptance of an external framing that found leverage with many supporters. 46 This assessment of the strategies employed by the Planning Commission shows how agenda-setting for nutrition was championed and facilitated prior to the meeting of the PM’s Council. Much of the groundwork was achieved through the organization of multistakeholder consultations. This served many purposes, with multiple strategies seeking to enhance the positions, players, and perceptions of key stakeholders in support of nutrition policy, and create support for the PM’s Council meeting. However, many opportunities were lost. Figure K presents strategies that could have been pursued and that might have maintained the momentum to use open policy windows and generate more politically feasible policy solutions. In the next section, we consider the lessons of this political economy analysis for two critical questions: Is nutrition on the policy agenda in India? What strategies could have promoted more effective convergence of the three streams? Then in the paper’s conclusions, we present some reflections about this method of political economy analysis, and six key findings about agenda-setting for ICDS reform and child undernutrition in India. 3. DISCUSSION 3.1 Is Nutrition on the Agenda in India? The convergence of problem, policy, and political streams creates opportunities for policy entrepreneurs to use open policy windows and push an issue high onto the government’s agenda and keep it there. Despite favorable conditions for this to occur for child undernutrition policy in India, and a number of focusing events that changed the food and nutrition security landscape (Figure B), our political economy analysis suggests that the full potential of these opportunities were not harnessed in late 2010 in India (Figure K). Our analysis shows that convergence of the three streams was weak and protracted. Moreover, even though the PM’s Council on India’s Nutrition Challenges met in November 2010 and placed ICDS reform high on the government’s agenda, the policy process was not managed in a way that allowed the issue to move forward; thus the momentum for policy change was lost. As a result, the significance of the PM’s Council became unclear and its impact is difficult to assess. While the meeting of the PM’s Council was a strong signal that the issue of nutrition commanded the attention of the highest government leaders, several factors suggest that the attention was not lasting. First, there was a substantial delay before the Prime Minister’s meeting took place. Second, the Council only met once, its initial meeting. Third, there is continuing ambiguity today about what the Council will do and its role for nutrition and food security in India. As one stakeholder commented, There have been so many councils [relating to nutrition]. Some of them never met, not even once. They were ornamental; that’s not the right word, but you know what I mean. (I-18) Does the meeting of the PM’s Council in November 2010 signify that nutrition was high on the agenda, or was it merely “ornamental�? Our stakeholder interviews found 47 divergent views on whether child undernutrition is really on the government’s policy agenda, and divergent views on the Council’s contribution to the policy process concerning ICDS and undernutrition. As one respondent put it, I’m not really convinced that nutrition is on the agenda. I don’t think that the PM/Planning Commission really care about nutrition. Economic growth is impressive, and the nutrition problem does not seem to be a big issue that limits economic productivity, so there’s no urgency to address it at all. (I-10) Nutrition has always been on the agenda for the last 10 years, but there has been slow movement… There is so much inertia because of the bureaucracy… Decision making takes time and government takes energy to make decisions. Despite slow progress, much has happened since this meeting. (I-9) Some respondents directly raised concerns about the Council’s potentially counterproductive impact on the policy process: I’m not sure that putting [the issue before] the PM Council has been a very good move. At some point, the PM is too busy so the meetings don’t get held often enough. Because it’s the PM, nobody is able to talk about problems or get into some details, so I think this council has been a wrong move… I am telling you very seriously that it has been an impediment. I find the quality of discussion, and the frequency of discussion has been reduced. But yet it is becoming something that the government is obliged to respond to and that is important. (I-16) This body [the Council]—it’s not properly loaded with the expertise that is required. It lasts for half an hour…one hour—to decide the whole country’s fate? To make such a big decision? The PM doesn’t have time for this [nutrition]. They should have a different mechanism to feed up to the higher levels. They have time for economics, but not for nutrition. (I-18) 3.2 What Strategies could have Promoted more Effective Convergence of the Streams? This retrospective analysis has identified a number of missed political opportunities in the policy process for child malnutrition in India (Figure K). These relate to power, position, player and perception strategies that might have allowed the Planning Commission to achieve governmental adoption of ICDS reform. Three in particular are worth noting: First, a major hindrance was the lack of a policy entrepreneur to focus on the favorable factors and events in each of the three streams and bring them together. For example, if the Planning Commission had identified and supported policy entrepreneurs and advocates within the Prime Minister’s Office or Planning Commission, they could have pushed more effectively for attention to undernutrition and ICDS reform. An internal policy entrepreneur might have catalyzed the momentum following the submission of the joint strategy note from the MWCD and MOHFW to more rapidly conceive the background note from the Planning Commission that was needed prior to the PM Council meeting. By the time this background note was prepared the issue had already lost the attention of the PM (I-20). 48 Other powerful stakeholders could have also been promoted to advocate more effectively for the issue of nutrition. For example, using their special access to the PM, the National Advisory Council and its chairperson, or young parliamentarians, could have helped to maintain pressure and devise strategies to improve the political feasibility of ICDS reform. A second strategic shortcoming was the inability of technocrats to effectively respond to requests from policymakers to prioritize the recommendations, resulting in overly complex policy solutions. There seems to be a disconnect between the technical search for evidence-based solutions and the political need for simple policy decisions. Technocrats focused on designing a comprehensive package of interventions (or seeking to accept the proposals of different stakeholders to assure their support) that were not comprehensible in the view of policymakers; the result was solutions that cannot be adopted or implemented. As two respondents explained, The real problem is that we have never gone with a set of solutions that can be implemented well. (I- 16) Many of us, when we make recommendations, we don’t see how those can be implemented. (I-12) Despite the existence of several highly qualified technocrats, there is limited awareness or skill among nutrition experts in managing the policy process. This group’s strength lies in in-depth technical knowledge and not in translating such ideas into action. It is difficult, therefore, for them to provide solutions that can be easily implemented. If the Planning Commission had identified and supported a policy entrepreneur to guide technocrats and “soften up� the solutions, it might have been possible to bridge the gaps between technocrats, bureaucrats, politicians, and implementers. One important strategy that the Planning Commission used in August 2010 in preparation to the PM’s Council meeting was to organize multistakeholder consultations. This brought together stakeholders from each stage of the policy cycle, including technocrats and implementers, and this process could have led to more politically feasible solutions. The extent to which this was successful remains to be seen, as the ICDS reforms are currently underway. If the Planning Commission had used the opportunity to prioritize more viable solutions, this could have led to a smaller number of more focused and politically acceptable recommendations to the PM’s Council. A third strategic shortcoming was the weakness of the lead Ministry for ICDS, the MWCD. If the Planning Commission had worked more to increase the capacity of this institution and improve its credibility with other more powerful stakeholders, this may have increased the likelihood of positive reform following the Council’s meeting. Under the current institutional arrangements, more investment is needed to improve the Ministry’s leadership capacity and human resources, and create incentives to improve institutional strength and inter-ministerial collaboration. High staff turnover and the inability to maintain the most able and motivated staff currently constrains its operational capacity. Importantly, the Ministry’s latest Five Year Strategic Plan for 2011-2016 included a Stakeholder Analysis and SWOT analysis (GOI 2011a). This could provide the 49 basis for strengthening the MWCD’s capacity to influence and manage the policy process around ICDS reform. 4. CONCLUSIONS This political economy analysis has focused on the process of agenda-setting for ICDS reform and child nutrition in India. We analyzed a central question relating to the policy cycle, guided by the agenda-setting literature, and then carried out a stakeholder analysis and assessed political strategies related to policy reform. This national-level analysis did not cover state-level politics, which is relevant in this context but beyond the scope of this paper. There are several strengths of this method. First, it gives policy analysts the flexibility to focus on a specific issue occurring at a specific point in the policy cycle. This approach is necessary because the political economy differs at each stage of the policy cycle, and there are interactions between the different stages. This flexibility also means that efforts and time can be focused on the most critical question at hand. For most users, this method will be used for a prospective analysis, likely involving the implementation stage of the policy process where complex political economy challenges prevail. Second, this method generates practical strategies to navigate the policy process. We expect that users of this method would be policy analysts and development practitioners who are most interested in prospective analyses and designing political strategies for change. Our recommendation that this analysis be done by or in collaboration with the relevant national decision-making institution would mean that the resultant strategies are more likely to be implemented. Using PolicyMaker with this method can assist with generating several different political strategies, which can then be mapped and followed in an iterative process. Third, the method does not necessarily require detailed knowledge of the political economy literature, but it does require some understanding of this literature. Following the Steps outlined in Figure A would require the policy analyst to have basic training in using this PEA approach. In this illustrative example, we supplemented the method by drawing on the academic literature to enhance our explanation of the course of events. Applying the method in this way, therefore, would require knowledge of political economy theory and qualitative methods. There are also limitations of this method. As with any qualitative tool, the quality of the output is dependent on the process of research. Sampling, data collection, data analysis and data interpretation are important issues that require careful consideration. We note in this case study the absence of state-level stakeholders who may have added rich perspectives to this analysis. Issues such as corruption, clientelism, and rent seeking, which clearly play a role, were not dominant themes in the qualitative data collected at the national-level in Delhi. Similarly, issues such as social structures and caste were not highlighted in the data we collected. 50 Second, this structured approach, while facilitating systematic analysis, does not easily lend itself to showing the overlap and connection between the different factors and strategies. Users, therefore, will need to exercise their judgment in seeing the relationships between different factors influencing the reform process, as well as the role and importance of relationships between stakeholders and the psychology of these interactions. As this method does not prioritize strategies, users will also need to decide which identified strategies may be of particular interest or importance to pursue in moving forward with political strategies. Third, as illustrated in this case study, this method focuses more on political dynamics, but gives less emphasis to exogenous economic factors that affect the political cycle, such as changing food prices, inflation, and other shocks. The flexibility of the approach can, however, be adapted by users to give more attention to these exogenous factors, especially in Step 1. We believe that this method is strengthened by its consideration of the political economy literature, which we used to frame how we assessed the complex factors that were in play in the Indian context surrounding ICDS reform. The academic literature can help improve our understanding of how and why events occur in the policy process. We believe that the key findings of our analysis (presented below) and the political strategies that we identified (above) provide a more advanced and nuanced understanding of the issue than if we had not used the literature on agenda-setting. We note, however, that there is a fine balance between being comprehensive, as we have attempted to be in this case study, and going into sufficient depth in some issues. Some readers may feel that we have not driven deep enough into some aspects of political economy relating to this issue. Future analyses of ICDS could focus on a different stage of the policy cycle (such as implementation) and could examine other political economy dimensions. 4.1 Key Findings about Agenda-Setting for ICDS Reform and child Undernutrition in India This analysis leads to a number of key findings about agenda-setting for ICDS reform and child undernutrition in India. The findings may also help in deciding on next steps for ICDS reform to address the nutrition puzzle in India. First, the political economy of the event of the PM’s Council on India’s Nutrition Challenges represented a significant level of political commitment to the issue at that time and generated significant discussion (much of this prior to the meeting, rather than during or after the meeting). The establishment of the Council reflected some convergence of the problem, policy and politics streams in 2010. Yet, the PM Council was not designed in a way to produce action. The political strategies that achieved agenda-setting on India’s malnutrition problem at the same time served to slow down action in the policy reform process. The strategies gave political attention to the issue but did not produce political action on reform. Second, our analysis found several powerful stakeholders that have fixed and entrenched views of the problem and solutions, and those views are often mutually 51 incompatible. Each group has generated substantial power to support their own views and at the moment there are no incentives to seek a compromise agreement, and no policy entrepreneur to mediate such negotiations. The Supreme Court order in 2001 has created dramatic power shifts in the ICDS and nutrition debate, and the power afforded to the Special Commissioners has shifted institutional power as state governments are held accountable on their performance to deliver ICDS. Third, our analysis showed that technocrats did not deliver politically feasible solutions to India’s nutrition puzzle. Issues surrounding SNP have been contentious and have dominated the debate, making it difficult to have more useful discussions on policy solutions that could be implemented. Also, the design of ICDS still raises fundamental concerns among some stakeholders. Stakeholders with expert knowledge and nuanced understanding of nutrition issues have either not been able to come up with suitable policy alternatives or have been marginalized in the debate, and thus cannot introduce new ideas about potential policy solutions; the lack of a policy entrepreneur may have contributed to this impasse. Despite widespread concerns about the design of ICDS, alternative solutions have not been forthcoming; the existing framework has stubbornly resisted change. Fourth, non-governmental organizations and networks, including the Right to Food movement and other groups, have exercised enormous influence on public perception of both the problem and the solution and continue to play a dominant role in public debates. Any political calculation of reform would have to consider that change is unlikely to happen without their support. Any coalition would need to gather the support of these interest groups. This political condition places significant constraints on what can be considered for both debate and reform. Fifth, our analysis found that the lead Ministry has a number of institutional weaknesses and there has been minimal attempt to strengthen its capabilities. Formal institution change has not occurred and there are few incentives to change this set up or improve its relationships with the MOHFW and other Ministries. Although there have been calls for a new national-level nutrition institutional body, the specific purpose and institutional role have not been well defined. As a result, the costs of creating a new institutional arrangement seem high while the benefits are uncertain. Sixth, the policy process on nutrition in India has been largely domestically driven. According to our interviews, events in the global nutrition system (such as publications and conferences) have had limited influence on India’s domestic policy making. However, development partners have had some role in setting the agendas, but their influence has diminished over time, although in some cases influence persists through relationships with key individuals. For some stakeholders, the input and influence of development partners, has been unwelcome. On another note, external framing of the problem to global audiences has been powerful: the portrayal of India’s undernutrition problem in international media became a powerful focusing event that triggered political attention to the issue, but it was not sufficient to generate sustained attention or politically viable solutions. 52 These six findings may not be surprising or controversial to stakeholders intimately involved in the policy process for nutrition and food security in India. This analysis does, however, provide some new insight on the key players and the strategies employed by the Planning Commission to shape the policy agenda on nutrition, and strategies that could have been employed to lead to better policy outcomes. Despite the missed opportunities, in January 2012, more than a year after the PM’s Council meeting, and several years after the initial idea arose to convene the Council, ICDS was undergoing reform. The latest Union Budget for 2012-13 revealed a budget increase for ICDS to Rs 15,850 crore ($3.2 billion), signaling increased budgetary commitment to ICDS pointing to some level of success in the agenda-setting stage. This case study has attempted to demonstrate how to carry out an in-depth PEA using a structured approach and the types of results this can yield. Looking forward, this method can be applied to different research questions at different stages of the policy cycle, and strategies generated through this method can be used to more successfully navigate the policy process for ICDS reform. We envisage that state-level analyses and issues relating to the implementation stage of the policy cycle may yield important insights for future attempts to reform ICDS. The key findings and insights generated through this in-depth analysis, along with more politically feasible strategies to effect change, can also be used to guide future efforts for reform , and ultimately reduce child undernutrition in this setting. 53 Figure 3: Method for Conducting an In-Depth Political Economy Analysis Step 1: Describe the policy context and study objectives Identify key goals and expectations for the political economy analysis Analyze food and nutrition security landscape in Country/State X Analyze political economy context in Country/State X Step 2: Select stage of the policy cycle for analysis Stage 1: Agenda-setting Stage 2: Policy design Stage 3: Policy adoption Stage 4: Implementation Identify key research Identify key research Identify key research Identify key research question/issues: question/issues: question/issues: question/issues: e.g. How and why did ICDS reform e.g. Why did the technical e.g. Who is required to adopt the e.g. What problems may occur get on the PM’s Agenda in 2010? design of ICDS reform not ICDS policy reform, and what is the in implementation of the new change radically? process? ICDS reform? Step 3: Analyze political dynamics to assess political feasibility a) Establish b) Analyze stakeholders: c) Assess political feasibility • Key issue/problem and its • Power • Based on stakeholder framing • Position on the problem analysis, plus role of • Policy content • Number institutions and • Political context • Coalitions perceptions • External/global influences • Policy entrepreneurs Retrospective Step 4: Assess or design political strategies Prospective • Identify strategies used Consider interactions • Propose strategies for action and their consequences between different stages of and potential consequences • Assess effectiveness of the policy cycle • (Identify potential obstacles strategies on political and opportunities ) feasibility • Monitor outcomes against goals and expectations 54 Figure 4: Timeline of ICDS Notes: RTF Right to Food, WB World Bank, AWC Anganwadi center ICDS Disbursements (Adhikari and Bredenkamp 2009) ICDS Expenditures estimates for Financial Years, exclude Northeastern states: Source Budget Briefs: Integrated Child Development Services, GOI 2011-12, Vol 3 Issue 3 available at: http://www.accountabilityindia.in/sites/default/files/bb_icds_goi_2010-112.pdf (Accessed 28th May 2012) 55 Figure 5: Components of the ICDS Notes: Size of doughnut proportional to funds release by central government for General and SNP services, (2010-2011). Central government provides 90% of funds for general ICDS services, and 50% for SNP in most states and 90% of SNP in the north eastern states. State government contributions to ICDS and SNP varies. Data source: MWCD, http://wcd.nic.in/icdsimg/icds(snp)31032011.pdf. Accessed 12 March 2012. 56 Figure 6: Stages of the Policy Reform Cycle and Examples of Research Questions Policy Reform Stage I II III IV * Agenda-setting Policy design Policy adoption Implementation Examples of How and why did ICDS reform Why has the technical What is the process of Why has the Research Questions and child undernutrition get on design of ICDS reform not policy adoption and who is implementation of ICDS the Prime Minister’s Agenda in change radically? Why required to adopt the failed? What is the political 2010? does SNP continue to proposed changes to ICDS economy of interstate and dominate ICDS? reform? intrastate program What strategies could be adopted placement and targeting? to increase the attention afforded What can be done to What strategies can be to child nutrition and ICDS? increase the political adopted to increase the What are the potential feasibility of ICDS policy likelihood of policy problems facing design? adoption for ICDS? implementation of the new ICDS reforms? What strategies for improved implementation could be adopted by the MWCD? Dependent variable Attention to ICDS reform Design of ICDS reform Adoption of ICDS reform Implementation of ICDS reform Examples of Kingdon’s theory of agenda-setting Pierson’s theory of path Immergut’s concept of veto Potter and Brough’s Theories and (1995) dependency (2000) points (1992) framework of capacities Frameworks that (2004) can be used to better Shiffman and Smith’s framework explain why policy of agenda-setting (2007) proposals are successful or not Heaver’s Framework of commitment (2005) * Policy Reform Stage is not one sequential process, but overlapping with different theories, factors and strategies 57 Figure 7: Factors Operating in the Problem, Policy and Politics Streams that Shape Agenda-Setting POLICY STREAM POLITICS STREAM PROBLEM STREAM Credible Indicators Policy Community Cohesion Political Transitions Focusing Events Guiding Policy Institution Policy Advocates Issue Framing Viable Policy Alternatives Interest Group Mobilization Policy Entrepreneur External/Global Influences 58 Figure 8: Key Factors in the Problem, Policy and Politics Streams Affecting the Policy Process for Child Undernutrition and ICDS in India Prior to 2010 POLICY STREAM POLITICS STREAM PROBLEM STREAM Credible indicators (+) Policy community cohesion (+) Political transitions (+) • Internationally recommended indicators • Small number of technocrats, mostly biomedical • Political continuity as PM Manmohan Singh capture severity, persistent and magnitude of experts, with aligned interests, sharing welfarist reelected in 2009, and United Progressive child undernutrition in India from nationally- attitudes and general skepticism of private sector. Alliance’s support for welfare programs representative National Family Health Survey continues. India’s improved economic prosperity 2005/6 [and more recently the release of the Guiding institution (+) creates an enabling environment for policy Hungama report in 2012 for select districts]. • Coalition for Sustainable Nutrition Security in reform. Strategic planning cycle highlights poor India (CSNSI) forms under leadership of MS performance of ICDS. Focusing events (+) Swaminathan, to find technical alignment on • Comparison of India’s nutrition problem with solutions. Coalition puts forward Leadership Policy advocates (+) other countries brings attention to Agenda. • Several key advocates for nutrition, including undernutrition. PM’s Independence Day Sonia Gandhi (chairperson of UPA and National addresses highlight the issue of undernutrition. Viable policy alternatives (-) Advisory Council); National Advisory Council; • 11th FYP midterm appraisal questions • Broad complex solutions put forward to address ‘Right to food’ movement. Commitment to food persistent undernutrition and poor performance the multisectoral nature of undernutrition; no security and nutrition (strong involvement with of ICDS. consensus reached on the priorities of issues to recommendations for the National Food Security give coherent politically feasible policy Bill). Issue framing (+) alternatives. • External frame resonates with politicians and • Divergent views on the technical design of ICDS, Interest group mobilization (+) the public, with effective uptake of issue by its potential impact, the role of SNP (type of • Strong civil society activism, particularly the media and civil society groups. supplement, procurement). Concerns about private well-organised ‘Right to Food’ campaign. • ‘Right to Food’ movement frames the issue of sector involvement and corruption add to debate. Previous landmark successes in using the judicial undernutrition in terms of rights and system through Supreme Court Orders to hold entitlements. Policy entrepreneur (-) government accountable for upholding the right • No policy entrepreneur to “soften up� the technical to food and the universalization of ICDS. community to deliver a more appropriate politically feasible technical design. External/global influences (-) • Domestically driven policy process with limited global influence of technical or financial support from global organizations and events. KEY: (+) factor present; (-) factor absent 59 Figure 9: PolicyMaker Screenshot: Player Table: The ICDS Stakeholders and their Positions and Power 60 Figure 10: PolicyMaker Screenshot: Main Menu 61 Figure 11: PolicyMaker Screenshot: Strategies to Enhance the Political Feasibility of Reform 62 Figure 12: Strategies that were Successfully Used by the Planning Commission (PC) to Improve Political Feasibility of Agenda- Setting for ICDS and Child Nutrition Power Strategies What was actually done: Meet directly with stakeholders to increase their power to support the PC agreed to meet with NGOs, the Right to Food campaign, and other issue. stakeholders, to listen to their framing of the issues and solutions, and to give more attention to the issue of undernutrition. Support a coalition of supporting groups or players, with a PC supported and participated in the CSNSI, which brought together recognizable name and sufficient resources. many of the key stakeholders in nutrition. This conferred more attention to the issue and increased the power of the coalition. Position Strategies What was actually done: Persuade supporters to strengthen their position and focus on PC requested MWCD and MOHFW to work together to come up with a devising a strategy for undernutrition and ICDS strategy paper to address child nutrition and ICDS. Seek common goals among different groups, by supporting PC supported CSNSI’s leader, MSS, a powerful and well respected technocrats to design policy solutions scientist, to lead a coalition to help achieve some technical alignment on a national nutrition strategy. Seek common goals among different groups, to persuade them to take PC facilitated multistakeholder consultations, encouraging dialogues a public position of support between all stakeholders involved in ICDS and undernutrition, supporting them to take a position in finding policy solutions Seek new groups to take a public position of support PC included the Ministry of Agriculture in multistakeholder dialogues and PM’s Council in order to expand the group of supporters. Player Strategies What was actually done: Create a new organization of existing organizations and individuals. PC recommended the creation of a new national institutional body under the Prime Minister’s National Council with executive authority to lead on nutrition issues. Change the decision-making processes, in order to expand the PC brought together all stakeholders, from politicians to implementers, number of supporters. in a consultative process to reach consensus on the problems and solutions, prior to the meeting of the PM’s Council. Persuade political officials to adopt the issue, through personal PC made concerted effort to draw attention to the issue of nutrition at meetings, position papers, or political incentives. the PM’s Office, by organizing multistakeholder consultations, compiling background note, pushing MWCD and MOHFW to work together, giving recommendations to the PM’s Council. 63 Perception Strategies What was actually done: Seek to unify perceptions among different groups through various PC drew up a strategy document following multistakeholder mechanisms (internal framing) consultations, and designed recommendations for the PM’s Council meeting. Use the media to increase public visibility of the issue and change PC supported the recommendation for a national communication perception of problem and solution (external framing) campaign to increase awareness of nutrition, with the active involvement of civil society and media. Source: Authors 64 Figure 13: Strategies that Could Have Been Used by the Planning Commission to Improve Political Feasibility of Agenda- Setting for ICDS and Child Nutrition Power strategies What could have been done: Increase access of supporters to political leaders, by organizing a PC could have further used the special access to the PM, and lobbying campaign. championed access through other channels (NAC/Sonia Gandhi), to sustain momentum for the PM’s Council and capitalize on the potential policy window. Increase the organizational strength of supporters. PC could have supported the MWCD as lead ICDS Ministry more to improve its institutional strength, and ability to manage other stakeholders. Position strategies What could have been done: Persuade supporters to strengthen their position. PC could have better guided CSNSI/technocrats to devise politically feasible recommendations, by specifically asking for prioritized recommendations and simple policy solutions. Persuade non-mobilized to take a position of support. PC could have invested more in information and education initiatives to persuade potential beneficiaries (mother and children) of their entitlements, and increase demand for ICDS. Meet with opponents to seek common goals or mechanisms, and PC could have engaged in more dialogue with the private sector, to seek thereby reduce the intensity of their opposition. support. [However, because of entrenched views of some stakeholders this could be a high-risk strategy]. Player strategies What could have been done: Identify policy advocate and equip with resources to promote issue Could have further promoted champions with the PMO or PC to push for nutrition on the agenda, and for the PC to take a stronger leadership role. This may have minimized the substantial time delays which resulted in a loss of momentum between the call to convene the PM’s Council and its meeting. Create a new organization or partnership of existing organizations and Could have further explored the creation of a national nutrition body to individuals, to involve non-mobilized promote agenda-setting, to monitor GOI’s commitment to nutrition, and mitigate weakness of lead Ministry. Create a new organization or partnership of existing organizations and Could have fostered young parliamentarians to unite earlier across party 65 individuals. lines on nutrition and increased their power to push for nutrition/ICDS. Threaten legal action against an opponent, raising the costs of Could have created clear strategy to minimise leakage/corruption in opposition and persuading the player to cease its opposition. ICDS, with structures and incentives, including legal action. Perception strategies What could have been done: Persuade supporters to take a more public stand on the policy. Could have persuaded policy advocates (Right to Food movement/NAC/Sonia Gandhi) to maintain attention to nutrition/ICDS. Use symbols to increase public support of the policy, by organizing a Could have mobilized celebrities and media earlier in campaign to media campaign support nutrition and ICDS. Use the media to increase public visibility of the issue and change Could have increased coverage in international media to pressurize perception of problem and solution government to sustain attention to undernutrition. Source: Authors 66 PART III – A RAPID POLITICAL ECONOMY ASSESSMENT TOOL FOR MEASURING COMMITMENT AND OPPORTUNITY TO ADVANCE FOOD AND NUTRITION SECURITY POLICIES EXECUTIVE SUMMARY Part III presents a newly developed tool that can be used to conduct a rapid assessment PEA for food and nutrition policy. The Rapid Assessment Tool (RAT) for Measuring Commitment and Opportunity to Advance Food and Nutrition Security Policies is a theoretically driven close-ended survey that assesses the level of political commitment to food and nutrition security and opportunities to advance food and nutrition related policies. The tool is unique in that it combines stakeholder analysis with metrics of political commitment and reform opportunity. If implemented at different time points, the analysis can serve benchmarking and accountability functions, to measure a country’s progress in advancing food and nutrition security on the policy agenda. This Rapid Assessment Tool has three main purposes: 1. To gauge the current level of political commitment accorded to food and nutrition policy and measure recent changes in level of priority. 2. To identify moments when a policy window is open to advance food and nutrition policy, based on the multiple streams approach. 3. To assist in developing strategies to advance food and nutrition policy in a given political context, through stakeholder and institutional analysis. The tool is intended to serve as a complement to more in-depth analysis to assessing national commitment and prioritization processes. The tool is based on a questionnaire that provides a theoretically driven analysis of the political factors that shape food and nutrition security. This rapid analysis can be carried out by an informed policy analyst without special training, and does not require detailed knowledge of the theoretical basis which has been used to design the survey. The stakeholder and institutional analysis provided by this tool can be used to assess current political circumstances and help generate political strategies to advance policies for food and nutrition security. 67 1. INTRODUCTION Part III presents a rapid assessment tool that that can be used as a complement to the in-depth method of political economy analysis discussed in Parts I and II. The Rapid Assessment Tool (RAT) is a theoretically driven close-ended survey, which collects information from informed respondents to capture the current level of commitment to food and nutrition security and opportunities to advance food and nutrition related policies. This tool can be deployed by decision makers and development partners to assess the level of political commitment to food and nutrition-related policies within countries at a given moment and to identify windows of opportunity for policy advancement. Also, if implemented at different time points, this framework can serve benchmarking and accountability functions in the area of food and nutrition, to measure a country’s progress in advancing food and nutrition security on the policy agenda. The tool is unique in that it combines stakeholder analysis with metrics of commitment and opportunity. Theoretical Motivations. As described in Part 1, in the first stage of the policy cycle, agenda-setting, political processes can influence decision making over which issues gain priority and how to allocate resources. Agenda-setting is especially important for food and nutrition policy as this has been an issue that has consistently received low priority relative to its importance for child health outcomes (Heaver et al 2005; Morris et al, 2008). The multiple streams approach finds that when there is a convergence of three separate streams (the problem, policy, and political streams) a “window of opportunity� exists to place a problem on the government’s agenda (Kingdon 1995). Further research on agenda-setting in global health has identified twelve variables that are associated with an enhanced probability that an issue will be placed high on a policy agenda, cutting across the three streams (Shiffman 2007; see Table 1). Stakeholder analysis provides further information about constraints and opportunities to advance reform and offers strategies to improve the likelihood of advancing a policy(Reich and Cooper 2010). Existing Frameworks to Assess National Level Commitment to Food and Nutrition. Similar efforts to measure political commitment and readiness to act have been proposed previously in food and nutrition, but these efforts have relied on lengthy desk reviews and qualitative assessments that are cumbersome, time consuming, and difficult to analyze empirically. Engesveen et al (2009) and Chopra et al (2009) developed a rapid assessment framework for determining a country’s commitment, capacity, and readiness to adopt food and nutrition policy. This framework involves different activities to generate a complete Landscape Analysis: 1) development of a Nutrition Landscape Tracking System (NLTS); 2) classification of countries according to "readiness to act" through desk review; and 3) implementation of in-depth country assessments. This method is currently being reviewed and updated by a WHO team. The first activity, the Nutrition Landscape Tracking System, provides information on nutrition outcomes (Nishida et al. 2009). The second activity, the use of desk review to determine readiness to act, involves conducting a content analysis of a country’s Poverty 68 Reduction Strategies (PRSP) to assess recognition of undernutrition as a development problem, the use of nutrition information for poverty analysis, and support for appropriate nutrition policies, strategies, and programs (Engesveen et al. 2009). Finally, in-depth country assessments were conducted in several countries using field-based, qualitative rapid assessment interviews, focus group discussions, checks at the national and sub- national level, and during visits at field sites. These were designed to assess a country’s willingness to act using a variety of indicators that include measures of both commitment and capacity. The framework developed by Engesveen et al (2009) and Chopra et al (2009) is thorough and comprehensive. However, data collection using this method is also lengthy and time-consuming. The Nutrition Barometer sponsored by Save the Children and World Vision 23 as well as the Institute of Development Studies’ Hunger and Nutrition Commitment Index 24 are additional tools that analyze country commitments to food and nutrition. Both include measures of social and economic rights, government spending on health, and national policies to fight hunger and undernutrition. Economic and social rights include adoption of the right to food, membership in Scaling up Nutrition, nutrition-specific commitments to the Every Woman Every Child initiative, national nutrition policies and regular monitoring of nutrition outcomes. Public expenditure includes measures of health spending and the existence of a current costed nutrition plan. Neither of these indices includes information on relevant in-country stakeholders nor on more targeted information about the recent attention of key leadership to food and nutrition issues, both of which have been demonstrated to be critical to advancing food and nutrition policy. 2. HOW THE TOOL WORKS This Rapid Assessment Tool has three purposes: 1. To gauge the current level of political commitment accorded to food and nutrition policy and measure recent changes in level of priority. 2. Based on the multiple streams approach, to identify moments when a policy window is open to advance food and nutrition policy. 3. From the rapid stakeholder analysis, to assist in developing strategies to advance food and nutrition policy in a given political context. The tool thus serves as a complement to more in-depth analysis and more cursory approaches to assessing national commitment and prioritization processes. Contents. The Rapid Assessment Tool (RAT) consists of three major parts: 1) Assessment of current level of political commitment; 2) Assessment of opportunities to advance food and nutrition policy; and 3) Stakeholder and institutional analysis to identify obstacles to achieving desired goals. The major modules are summarized below. 23 http://reliefweb.int/sites/reliefweb.int/files/resources/Nutrition_Barometer_EO_Asia_EMBARGOED.pdf 24 http://www.hrcindex.org/2011/07/methodological-note-on-developing-country-index/ 69 A. Current level of political commitment 1. Expressed Commitment (verbal declarations of support for an issue by high level, influential political leaders); 2. Institutional Commitment (specific policies and organizational infrastructure in support of an issue); and 3. Budgetary Commitment (earmarked allocations of resources towards a specific issue relative to a particular benchmark). B. Existence of an open policy window based on the three streams approach (whether the timing is right) 1. Problem Window 2. Policy Window 3. Political Window C. Stakeholder and Institutional Analysis 1. Rapid Stakeholder Analysis 2. Political Institutions Figure 14 provides a graphic presentation of the agenda-setting framework used in this rapid assessment. Table 1 presents a summary of the constructs and questions contained in the Rapid Assessment Tool, and Table 2 provides a score sheet to assist in better understanding how the responses can be analyzed. The questionnaire for “Food and Nutrition Policy: Political Prioritization and Agenda Setting� is presented in Appendix 2. Data Collection Methods. The Political Economy Rapid Assessment Tool employs methods that will be familiar to some users including landscape and stakeholder analysis, but involves a more theoretically driven analysis of the political factors that shape food and nutrition security. This rapid analysis can be carried out by an informed policy analyst, without special training, and does not require detailed knowledge of the theoretical basis which has been used to design this tool. The tool can also be adapted to be carried out at the regional or sub-national level. There are two primary methods that can be used to complete the RAT: 1. Group Interview Session. Six to ten food and nutrition specialists per country representing diverse institutions including government, donors, and the non- governmental sector can be brought together to complete a single Rapid Assessment Tool. This approach has the advantage of allowing respondents to discuss answers and arrive at the most accurate representation of responses for a given country. The downside is that it requires greater coordination of schedules and may take longer to complete as certain questions may elicit discussion. 2. Individual Expert Assessment, Coordinated by an In-country Consultant. The rapid assessment tool can be completed, by 6-10 food and nutrition specialists per 70 country representing diverse institutions including government, donors, and the non-governmental sector, with data collection coordinated by an in-country consultant. National consultants, independent of a national nutrition program but with good knowledge of food and nutrition programs, would be charged with implementing the survey and gathering responses from the 6-10 food and nutrition specialists. Analyzing RAT Results and Assessing windows of Opportunity for Change. The rapid assessment tool comes with a spreadsheet that can assist in calculating a score with minimal effort. To assess whether a policy window of opportunity exists, the presence of at least one opening in each stream (problem, policy, and political) can be calculated. If there is an opening in all three streams, then an open policy window can be said to exist. This can be combined with information on the current level of political commitment to determine whether the current level of support and opportunity for reform coincide. Finally, the stakeholder and institutional analysis can be used to generate strategies to better target efforts to advance food and nutrition security. Strengths and Limitations. The strengths of our approach are its theoretical basis in research from the fields of political science and public policy, which captures the level of priority given to the issue as well as the political opportunities to advance food and nutrition related policies. We have specifically designed this tool using this theoretical basis to lend greater validity to its findings. Also, this tool can be rapidly administered at specified intervals, generating a measure that can be used for comparisons between countries/states, and over time. In spite of these strengths, the rapid and quantitative nature of this tool necessarily reduces a complex set of information to a summary measure, which may give a false sense of certainty about a complex and dynamic political process. In addition, a number of the proposed questions rely on the judgment of experts. Respondents in different countries may use different frames of reference in responding to certain items, which may create difficulties in comparing scores across countries. Furthermore, the results will also be sensitive to the selected respondents. Our focus is also on political factors related to agenda-setting and therefore does not explicitly capture certain variables related to policy formulation or the capacity to implement policies, which other frameworks assess. 71 Figure 14: Agenda Setting Framework Source: Authors 72 Table 1: Political Commitment and Opportunity Survey Item Summary Component Definition I. Political Commitment & Prioritization of Food and Nutrition Policy A. Stated Public pronouncements by high level officials of support for food and nutrition policy, waging of Commitment public campaigns to raise awareness about food and nutrition related issues, specific goals and targets set B. Institutional Policies and institutional structures in support of food and nutrition policy Commitment (e.g., existence of a mechanism that coordinates multisectoral food and nutrition programming; national food and nutrition policy; country has adopted a national food and nutrition plan of action; right to food enshrined in national legislation either explicitly or implicitly) C. Budgetary Earmarked allocations of resources towards a specific issue relative to a particular benchmark (e.g., Commitment overall adequacy of size of food and nutrition budget; funds are allocated towards specific initiatives) II. Policy Windows of Opportunity A. Problem Stream Credible indicators: the existence of credible indicators demonstrating a serious food and nutrition related problem or shortfall in the country Focusing Event: the occurrence of a major event that has focused attention on food and nutrition (e.g., a famine, a conference, news story, food and nutrition-related demonstration) Champion: An influential figure that is promoting food and nutrition at a high level Civil society mobilization around food and nutrition B. Policy Stream Clear policy alternatives: there exist clear, feasibly policy alternatives that are being promoted A policy “entrepreneur� (an individual with technical expertise who is advancing a particular policy solution) is promoting policy ideas Cohesiveness of the policy community around a single policy or set of policies C. Politics Stream Elections or other political transitions Changes in Cabinet or high-level positions related to food and nutrition D. Other factors: Financial and technical support country receives from international agencies to address food and External Influences nutrition problems III. Stakeholder and Institutional Analysis: Positions and Power Stakeholders and Existence of powerful opponents and proponents with a high ability to stop the advancement of food Institutions and nutrition reforms relative to proponents Ideological character of government Number of veto players. Source: Authors 73 Table 2: Political Commitment and Opportunity Survey Score Sheet Component Question # Question (points) Scoring I. Political Commitment & Prioritization of Food and Nutrition Policy A. Stated Commitment Q1-7 • Has the head of the government, and/or other high If 2+, (public pronouncements by official, spoken publicly about food and nutrition assign a 1 high level officials of problems at least twice? (1) support for food and nutrition policy) • Have public campaigns been waged in the past year to raise awareness about food and nutrition related issues? (1) • Is the overall rating of current political support of the head of government for food and nutrition programs 7 or greater? (1) B. Institutional Q8-13 • Is there a mechanism that coordinates multisectoral If 2+, Commitment (policies and food and nutrition programming? (1) assign a 1 institutional structures in support of food and nutrition • Has the country adopted a national food and policy) nutrition policy? (1) • Has the country adopted a national food and nutrition plan of action? (1) • Is a multisectoral food and nutrition program currently operational in the country? (1) • Is the national nutrition plan or strategy part of a national development plan? (1) • Are there published national dietary guidelines? (1) • Is the right to food enshrined in national legislation either explicitly or implicitly? (1) C. Budgetary Commitment Q14-17 • What is the overall rating of resources available If 2+, (earmarked allocations of for food and nutrition programs? 7+ (1) assign a 1 resources towards a specific issue relative to a particular • Is there a rating of 3 for specific food and nutrition benchmark) initiatives that the government has specifically prioritized? (1) • Is there a budget-line for nutrition in the budget? (1) Total: 74 II. Policy Windows of Opportunity: Three Streams Problem Stream Credible Indicators (the Q18-20 • Have credible indicators of food and nutrition If 1+, existence of credible status been cited in media reports on food and assign a 1 indicators in support of the nutrition in the last 12 months? (1) problem) • Have policy advocates and/or high level officials cited indicators showing the extent of food and nutrition problems to advance food and nutrition policy in the last 12 months? (1) Focusing Events & Public Q21-24 • Have there been any major events in the last year If any Attention that have drawn particular attention to food and focusing event or nutritional problems in the country? (1) 2+, assign a1 • Thinking about public attention to the topic of food and nutrition problems, how much attention would you say this topic has received in the past year in the official [state] media? (1 point if substantial) • How much attention would you say the topic of food and nutrition problems has received in the past year through other forms of public discourse (e.g., protest, social media)? (1 point if substantial) External Framing (public 25a-f How often do proponents of food and nutrition If 2+, portrayals that resonate with initiatives invoke each of the following in their assign a 1 political leaders controlling advocacy efforts? resources) • Centrality of Food and Nutrition to Poverty Reduction (1) • Cost Effectiveness of food and nutrition initiatives (1) • Unfavorable comparisons with other countries on food and nutrition progress (1) • Human rights (e.g., the right to food) (1) • Quantitative evidence highlighting the extent of the problem (1) • Qualitative experiences with the food and nutrition related health problems (e.g., vignettes and emotive pictures of starvation and diseases) (1) • Other ____________ (1) Political Advocate Q26-27 • Is there a high-level “champion� or influential 1+, individual who has taken on food and nutrition as assign a 75 a cause that he/she is currently (or within the past 1 year) promoting? (1) • Are there civil society groups that promote food and nutrition issues? (1) Cohesiveness of Advocacy Q28 • In your estimation, how cohesive would you say 1+, Community are advocates of food and nutrition in this assign a country? (Very cohesive=1) 1 Total: Policy Stream Clear Policy Alternatives Q29-33 • How would you describe the current status of policy alternatives regarding food and nutrition 1point problems in the country? (1 point if a well thought out, coherent proposal has been put forward) Policy Entrepreneur Q34 • Is there an influential individual within the policy 1 point community who has been especially influential in promoting a particular food and nutrition policy (or set of policies) in the past year? (if yes, 1 point) Policy Community Cohesion Q35 • In your estimation, how cohesive would you say 1 point Internal are proponents of solutions for these policies? (if very cohesive, assign 1 point) Internal Framing (how the Q36 • How often would you say the following is true of 1+, assign policy community views the food and nutrition policy experts in this country? a1 problem) a. Food and nutrition policy experts agree on a single framing issue to advance food and nutrition policy (e.g., women’s empowerment, stunting, food insecurity, right to food). (if yes, assign 1 point) b. Food and nutrition policy experts agree on a common set of indicators to advance the food and nutrition cause. (if yes, assign 1 point) Total: Politics Stream Political Transitions Q37-39 • When are the next major executive elections 1+, assign scheduled to be held (year)? _______ (1 point if a1 within next year) 76 • When are the next major legislative elections scheduled to be held (year)? _______ (1 point if within next year) • When is the next budget scheduled? ___________ (1 point if within next year) External Influences Q40 • How much financial and technical support has the 1+, assign country received from international agencies to a1 address food and nutrition problems? (if a lot, assign 1) Competing Priorities Q41 • If the government had an extra 5 million dollars 1 point for health initiatives, which of the following categories would it be most likely to allocate the resources to first?(If nutrition assign a 1) Total: III. Stakeholder Analysis Interest Group Mobilization Q42-43 • Thinking about the food and nutrition policy that Scored has most recently been seriously discussed in the separately country, how would you describe the likely position of each potential proponent and opponent of this food and nutrition policy? • How would you characterize the level of power you believe each group has over the level of priority accorded to food and nutrition policy? • How would you describe the ideological character Scored of the party of the current executive [vis-à-vis separately other national political parties]? • How would you describe the ideological character of the majority party of the current legislative branch [vis-à-vis other national political parties]? • For the following, please mark 1 if this actor has the ability to block the legislative passage of a bill. 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From Agriculture to Nutrition: Pathways, Synergies and Outcomes. Report No. 40196-GLB. Washington, DC: World Bank. _____. 2008. The Political Economy of Policy Reform: Issues and Implications for Policy Dialogue and Development Operations. Washington, DC: World Bank, Social Development Department. 89 APPENDIX 1: REVIEW OF PAST POLITICAL ECONOMY ANALYSES FOR FOOD AND NUTRITION SECURITY This appendix reviews past analyses that used the perspective of political economy to examine the challenges of malnutrition. We also discuss recent developments in global nutrition, especially the Scaling up Nutrition (SUN) movement that has created global partnerships to support multisectoral nutrition strategies and the global nutrition agenda. (Recent applied political economy studies commissioned by the World Bank and DFID are discussed in the main text above.) As noted in the introduction to this paper, the field of political economy for food and nutrition policies has been slow to develop. One early paper by Field and Levinson (1975) emphasized the “dynamics of political commitment� for nutrition and development, noting that “major nutrition allocation decisions will be political decisions� (1975, 81). The two authors stress that nutritionists need to understand “the relevance of politics,� in order to improve nutrition policy, nutrition planning, and nutritional status in poor countries. Many of the themes introduced in this paper appeared in more detail— nearly two decades later—in the book by Pinstrup-Andersen (1993) on the political economy of nutrition. Ten years later, a publication on the problems of “combating malnutrition,� produced jointly by the World Bank and UNICEF, examined a number of elements of political economy analysis (Gillespie et al. 2003). One chapter uses a “policy sciences framework� to explain why the nutrition agenda was encountering problems and to propose specific actions to improve the effectiveness of the nutrition community (Pelletier 2003, 48). Pelletier stresses that knowledge alone is not sufficient for policy change, and that other “sociocultural factors,� such as beliefs, interests, and power, must be taken into account. He emphasizes that because of these factors, “how problems and solutions are framed is critical in determining the social patterns of support or opposition� (2003, 44). Pelletier proposes a series of actions (2003, 50–53) based on a “policy sciences� approach and on analysis of both national cases and international institutions. He concludes that this kind of approach is needed to address the “how questions� at the “interface of policy, programs, and politics� (55). The same report identifies institutional “homelessness� as a major problem for the nutrition community, at both international and national levels. James Levinson points out that “nutrition activities are seldom situated securely in ministries or departments with clear mandates, boundaries, and divisions� (Levinson 2003, 101). He identifies three major periods in nutrition’s homelessness. The first period, during the 1970s, was dominated by multisectoral nutritional planning in planning commissions outside the ministry of health, in part in reaction to the previous trend toward free-standing nutrition institutes. Then, during the 1980s and 1990s, the field entered a period of “nutrition isolation,� in part in reaction to the dysfunctional results of the multisectoral approach, as calls arose that nutrition should be “left to the nutrition community�—without a clear idea of what that meant institutionally (2003, 104). In Levinson’s third period, he proposes that the international community is entering a new age of “goal-oriented 90 nutrition� in the early twenty-first century when there will be a new and stronger UN presence with a similar national nutrition agency that will avoid the dysfunctional multisectoralism of the first period, and will also avoid the developmental marginalization of the second period. Unfortunately, he does not provide clear indications on how to reach this (rather vague but hopeful) institutional nirvana for nutrition at either the global or the national level. Another major theme in this report is the fragmentation of the nutrition community and the multiplicity of nutrition narratives. Levinson (2003), for example, identifies five different sub-groups in the nutrition community: 1) Laboratory or Clinic- Based Nutrition Scientists; 2) Activist Nutritionists; 3) Development Economists and Planners; 4) Social Science Activists; and 5) Nutrition Practitioners. Notably, his list does not include public health nutritionists or agricultural specialists. He uses these sub-groups to help explain two of his three periods of international nutrition interventions (described above): the multisectoral nutrition planning of the 1970s, and the nutrition-alone separatism of the 1980s and 1990s. Beatrice Rogers (2002), in her background paper for the same publication, examines nutrition narratives as “simplified stories that describe cause-and-effect relationships among different factors� related to the role of nutrition in development (2002, 26). She points out that narratives “constitute a powerful force in influencing not only the way in which policy makers think about development, but also their actions related to investment and the implementation of policies and programs.� She analyzes eight narratives on the health and economic consequences of malnutrition (see Table 1-A) to illustrate how certain narratives can be “firmly entrenched� at certain historical moments, and how they have evolved over time in response to country experiences, new research, and advocacy efforts. She pays specific attention to the roles of UNICEF and the World Bank (the sponsors of the research and the publication). In her conclusion, Rogers notes that narratives “are used as political tools� and that the power of a narrative depends on “how they are used�; in addition, whether a narrative affects action on nutrition depends on whether a narrative is “in the right hands to influence policy� (Rogers 2002, 43). The paper thus raises questions about how different narratives can be used in promoting more effective actions on malnutrition. In short, different groups exist within the “nutrition community� with starkly different notions about the nature of the problem and the kinds of solutions that should be pursued. These different “framings� of the problem and solutions become even more contentious when the nutrition community is expanded to include agriculture, as shown by the proliferation of contrasting figures from the perspectives of UNICEF (Pelletier 2002), FAO, IFPRI, and food policy (Timmer et al. 1983). Our point here is not to compare and contrast these different framings (which have significant areas of overlap), but rather to stress that framing matters throughout the policy cycle and that these different perspectives persist and are stubbornly resilient in the nutrition field. Morris et al. (2008), in the Lancet Series on Maternal and Child Undernutrition, identify similar problems in their examination of the “international nutrition system.� 91 They find a plethora of actors and institutions in this system, and problems that are “long- standing and deeply embedded in organizational structures and norms� (2008, 608). They highlight, in particular, the problems of “fragmentation, lack of evidence base for prioritised action, institutional inertia, and failure to join up with promising developments in parallel sectors� (2008, 618). Their solution to this set of institutional problems is reform to create “a new international architecture for nutrition,� with a new global governance structure, a more effective UN, and less parallel organizations, among others. The overall goal, revealed in the article’s last paragraph, is to “transform the political salience of undernutrition� (2008, 619). The article points to many institutional problems in the international nutrition system but makes little use of explicit political economy analysis. As a follow-up to the Lancet Series on Undernutrition, Levine and Kuczynski (2009) conducted an institutional analysis of global agencies for nutrition. They point to the lack of an effective policy community, due to “incoherence, lack of institutional leaders, and persistent underfunding� among the agencies concerned with nutrition. Their proposed solution is two-fold: first, create a “shared set of principles� for global institutional action on nutrition, and second, introduce “nutrition security� into global actions on food security and international agriculture (2009, 1). The paper proposes better coordination at the global level plus better connection to national efforts to help “unify the community into a coherent way forward� (2009, 23). The analysis, however, does not clarify the political mechanisms for overcoming the existing barriers and does not place the institutional problems in an appropriate political economy context. Another political problem, which also appeared in the 1975 paper by Field and Levinson, is inadequate implementation as an obstacle to progress on malnutrition. Leroy and Menon (2008), for example, call for more research in nutrition on moving from “efficacy to public health impact,� especially for better understanding of the many actors that are involved in improving the delivery and use of nutrition interventions—from “policy makers, program planners and implementers, markets, and civil society and front- line providers� to “households and individuals and the support they receive from their families and communities� (2008, 628). Their article attributes the lack of research on implementation to both the lack of funding and “limited expertise and/or interest among biologically or clinically oriented scientists� (2008, 628). These problems are compounded by ambiguity about what is covered by the broad term of “food and nutrition security� and how different policy communities and institutions conceptualize and interpret this term differently. Agriculture – Nutrition – Health Disconnect Recently, efforts have emerged to create a more unified narrative on malnutrition, particularly to bring agriculture back into the fight against malnutrition. Morris et al. (2008, 611) observed, for example, “The international system provides no guidance on how agricultural policy and policies that regulate trade in food can be designed to support better nutritional outcomes.� Similarly, Von Braun et al. state, “The framework for linking agriculture and health in ways that alleviate poverty and hunger is missing, and so 92 is the set of instruments to effectively exploit the synergies between agriculture and health and to achieve joint policy formulation� (Von Braun et al. 2010, xxx). A conference organized in New Delhi in February 2011 on “Leveraging Agriculture for Improving Nutrition and Health� represented a major international effort to bring these three sectors together at the global level, in a way that might influence events and perceptions within India and other countries. The welcome note to participants from the Director-General of the International Food Policy Research Institute added that the three sectors of agriculture, nutrition, and health “are often moving along parallel paths that rarely seem to meet� and the conference was designed “to bend these paths more toward one another� (Fan 2011). Whether the IFPRI conference achieved its objective of bending parallel paths is hard to tell, but a number of points are worth noting. First, the high-level nature of this conference, with participants from multiple sectors, underlined the interactions among agriculture, health, and nutrition, and the potential to use those interactions to address nutrition problems in the world. Second, the organizers viewed this potential as a new revelation: “Only recently has the potential of agriculture to sustainably reduce undernutrition, overnutrition, and ill health been recognized� (IFPRI 2010). But certainly this potential has long been recognized by people both inside and outside the agricultural sector. The World Bank, for example, noted in From Agriculture to Nutrition (2007, 1) that the last time it examined how to incorporate nutrition effects and objectives into agricultural policies and programs was in 1981. The real question, and the third point, is how to harness this potential effectively and make intersectoral action work toward solving nutrition and health problems. Whether the conference generated new ideas, catalyzed exchanges among participants, and produced new actions remains to be seen. At least one person at the IFPRI conference raised a note of caution about the optimistic calls for intersectoral consensus, collaboration, and action. Todd Benson (2011) argues that the organizational barriers to cross-sectoral collaboration are “durable and strong� (2011, 3) due to the “rational sectoral organization that enables government to fulfill many of its duties.� He concludes that “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� (2011, 4). (Indeed, although Benson does not mention it, these calls for collaboration resemble the calls for multisectoral nutrition planning of the 1980s.) Instead of a programmatic effort to coordinate sectors, Benson recommends an “opportunistic approach� to cross-sectoral action that takes advantage of “policy champions, civil society coalitions, and community-based efforts� (2011, 3). The specific political dimensions of the actors involved, he implicitly suggests, will determine whether reaching across sectors can achieve tangible improvements in human welfare in poor countries. Benson’s approach and suggestions draw on concepts from both political economy and policy sciences. Recent Global Developments in FNS Growing interest in the political economy of nutrition has been promoted by global developments in FNS. In 2006, the World Bank report, Repositioning Nutrition as 93 Central to Development A Strategy for Large-Scale Action, put forward cogent arguments for investing in nutrition (World Bank 2006). This provided the evidence base for global and national advocacy for nutrition interventions and catalyzed many of the recent initiatives which have brought the global nutrition community together for action. Furthermore, this was also supported by the 2008 Copenhagen Consensus which identified nutrition interventions among the most cost-effective interventions to address the world’s development challenges. More recently, the World Bank conducted a cost analysis to estimate how much it would cost to scale up nutrition, focusing on the 36 countries where the burden of undernutrition is greatest. Scaling up a package of 13 select interventions to universal coverage was estimated to cost $11.8 billion per year ($10.3 billion from public sources and $1.5 billion from private households) (Horton et al. 2010). Providing this figure has also influenced interest in nutrition and the global commitment to nutrition. During 2009 and 2010, multiple stakeholders in nutrition came together to develop the Scaling Up Nutrition (SUN) Framework to address chronic undernutrition. The results of this effort were presented at a special “High-Level Nutrition Event� hosted by the World Bank, USAID, CIDA and the Government of Japan in the April 2010 meetings of the World Bank and IMF. At this event, the document, Scaling Up Nutrition: A Framework For Action, was shared with the objective of disseminating this “global public good� further (SUN 2010a). At this time, the Framework had already received endorsement from over 80 institutions. As the report of meeting states, “The SUN Framework was described by meeting participants as “historic� in the way the global nutrition community has rallied for the first time around a common agenda and solutions to the problems of malnutrition� (SUN 2010a, 4). Following this meeting, a Task Team developed “A Road Map for Scaling-Up Nutrition,� which was prepared for the United Nations High-level Plenary Meeting on the Millennium Development Goals in September 2010. 25 The Road Map outlines the process by which “country, regional and international stakeholders will work together to establish and pursue an effort to Scale Up Nutrition� (SUN 2010b, 7). It also refers to 25 Also during September 2010, the Committee on Food Security appointed a High Level Panel of Experts on Food Security and Nutrition (HLPE) to “assess and analyze the current state of food security and nutrition and its underlying causes and provide scientific and knowledge-based analysis and advice on specific policy-relevant issues.� http://www.fao.org/news/story/en/item/45086/icode/ Also in September 2010, the U.S. and Irish governments launched a joint initiative to strengthen civil society efforts to address undernutrition, called “1,000 Days: Change a Life, Change the Future. Call to Action.� This effort emphasizes the critical period of development between the 1000 days from pregnancy to age 2 years for interventions to address maternal and child undernutrition (Bread for the World Institute and Concern Worldwide 2011). This was followed by a conference in June 2011 on “Building Political Commitment� with workshops on advocacy and communications, capacity building, SUN implementation at the country level, and nutrition-sensitive intersectoral approaches. The meeting brought together civil society organizations focused on nutrition from around the world, with the goal of strengthening political commitment to address malnutrition. 94 other global initiatives that complement and promote the SUN movement. For example, REACH: Ending Child Hunger and Undernutrition Initiative, which was initiated by WFP and UNICEF and endorsed by other partners to support national level nutrition policies and programs. The SUN Road Map document also includes a list of the many different stakeholders around the world, at both national and international levels, involved in implementing the SUN framework through a “multi-stakeholder process� (SUN 2010b, 24–25). During the evolution of the SUN movement, there has been much consideration of the political and institutional dimensions of nutrition, particularly around multi- stakeholder partnerships and global agenda-setting. In “Policy Brief: Scaling Up Nutrition: A Framework for Action,� by Keith Bezanson and Paul Isenman (2010), the importance of political economy was highlighted in the editor’s introductory note: “The principle objective is to catalyze actions to move undernutrition toward the center stage of international political economy discourse� (Bezanson and Isenman 2010, 178). A major objective of this policy brief is “to support advocacy and political mobilization for addressing nutrition� (Bezanson and Isenman 2010, 185). The paper gives particular attention to the importance of civil society in “sustaining political will for government action� (184), the need for “strong political ownership� (184) to support national strategies for nutrition, and the need for effective global advocacy for the nutrition agenda. While the paper provides a “framework for action� to build political commitment on addressing malnutrition, it does not explicitly set forth the need for or the methods for systematic political analysis in scaling up of nutrition, across different levels (global and national) or across different phases of the policy cycle. SUN has recently shown significant success in the first stage of the policy cycle: agenda-setting. SUN has mobilized global support to advocate for Scaling Up Nutrition and has brought together multiple stakeholders to promote the agenda for global nutrition. This interest has been catalyzed by evidence of the effectiveness of specific nutrition interventions, consensus on the time period for the delivery of interventions, cogency of the argument to invest in nutrition, and the acceptance of the common goal to reducing hunger and undernutrition as part of the Millennium Development Goals. Recent efforts to coordinate the SUN movement have focused on strategies for issue framing and stakeholder mobilization. For example, in early 2011 the SUN Transition Team commissioned Paul Isenman, Keith Bezanson and Lola Gostelow to “examine possible stewardship options for SUN� (Isenman et al, 2011, 26). In a consultative process, the researchers conducted interviews with over 100 stakeholders using a structured questionnaire. The report, Stewardship of the SUN Movement: Taking SUN to the Next Level, analyzes the perceptions of stakeholders and presents an assessment of global partnerships so that SUN can learn from the experiences of other global multi-stakeholder initiatives. The report makes a series of recommendations on how to move from stakeholder mobilization around SUN objectives to timely implementation of the SUN Framework. 95 This report raises many questions that reflect a political economy perspective. For example, the report seeks to identify advocacy strategies and champions for the SUN movement, asks how political commitment to implementation can be strengthened, examines the kinds of organizational structures that could be adopted to support SUN within the UN system, and explores the lessons of other multi-stakeholder partnership for managing the diverse interests and agendas of the SUN partners. These are all fundamental political economy questions at the global level for Scaling Up Nutrition. In Attachment 7, on advocacy and champions, the report also cited an analysis by Jeremy Shiffman asking, “What are the drivers required to bring about serious and sustained political priority to nutrition?� (Isenman et al, 2011, 93). The report noted that Shiffman concluded that this question is “not easily answered because there has been little systematic research on the subject� (93), but that Shiffman (2005) had identified five drivers of major health interventions, including: • the mobilization of dedicated political champions, especially from national leaderships, • effective and informed NGO pressure, • policy cohesion within the professional and policy community, • community participation, • the existence and application of credible indicators, focusing events, and good management. The Stewardship report then asks how these five drivers could be used to advance the objectives of the SUN movement. In short, the Stewardship report proposes a number of recommendations that the SUN Transition Team could consider in planning its next steps and actions, and many of these recommendations have political economy implications. This suggests that a more formal and structured approach to political economy analysis, especially at the national level, could help move the SUN efforts forward. 96 Table 1-A: Eight Narratives on Nutrition and Development Consequences of Malnutrition Narratives: 1. Nutrition is a critical input into health and survival 2. Nutrition is critical to physical and cognitive functioning and thus to economic productivity 3. Nutritional status of populations is critical to economic growth Determinants of Malnutrition Narratives: 4. If the problem is malnutrition, the answer must be food 5. Economic growth will resolve nutrition problems 6. Poverty alleviation will resolve nutrition problems 7. Intra-household dynamics critically affect the impact of income on nutrition 8. Food is a human right Source: Rogers, 2002. 97 APPENDIX 2: A RAPID ASSESSMENT TOOL FOR FOOD AND NUTRITION POLICY: POLITICAL PRIORITIZATION AND AGENDA SETTING 1. POLITICAL COMMITMENT AND PRIORITY OF FOOD AND NUTRITION Stated Commitment of Key Leadership 1. In the past year, has the head of the government, and/or other high officials, spoken publicly about food and nutrition problems at least twice? 1a. Head of government __Yes __No 1b. Other high officials, specify _____ __Yes __No 1c. First Lady _____ __Yes __No 2. Have public campaigns been waged in the past year to raise awareness about food and nutrition related issues? __Yes __No 3. Which of the following issues has the head of state or other high level officials/celebrities mentioned in the past year in speeches? [check all that apply] __ undernutrition and/or malnutrition __ stunting __ obesity __ vitamin A and/or micronutrients __ fortification __ maternal nutrition and/or adolescent girls __ breastfeeding __ growth-monitoring and promotion programs __ school-feeding programs __ targeted supplementary feeding programs __ broad-based food distribution programs __ integrated delivery __ food security and agriculture __ multisectoral focus ___ Other, specify ______________ [adapt for each SAFANSI country according to specific food and nutrition programs] 98 4. Please name one food and nutrition-related policy issue that has in your estimation received the most attention from government in the past year: _______________________________ 5. Has the attention of high level officials on food and nutrition problems increased, decreased or stayed about the same in the past year? __ Increased __ Decreased __ Stayed about the same 6. Overall, how would you rate the current political support for food and nutrition programs? No support Strong support 0 1 2 3 4 5 6 7 8 9 10 7. Thinking about how food and nutrition compares with other health issues, would you say that high level officials have spoken publicly about food and nutrition problems more or less often than the following health conditions in the past year? HIV/AIDS __ More often __ Less often Water and Sanitation __ More often __ Less often Maternal mortality __ More often __ Less often Child health (e.g., vaccinations) __ More often __ Less often Other__________ __ More often __ Less often Institutional Commitment 8. Is there a mechanism that coordinates a multisectoral food and nutrition programming? __Yes, please describe _____________________________________ __No 8a. If no, has one been proposed? __Yes __No 9. Has the country adopted a national food and nutrition policy? __Yes, please describe _____________________________________ __No 9a. If no, has one been discussed? __Yes __No 9b. If yes, when did this happen? ________ Has it been updated since being adopted? __Yes __No 10. Has the country adopted a national food and nutrition plan of action? __Yes, please describe _____________________________________ __No 10a. If no, has one been proposed? __Yes __No 99 10b. If yes, when did this happen? ________ Has it been updated since being adopted? __Yes __No 11. Is there a multisectoral food and nutrition program currently operational in the country? __Yes, please describe _____________________________________ __No 11a. If no, has one been proposed? __Yes __No 12. Is the national nutrition plan or strategy part of a national development plan? __Yes __No 12a. If no, has this been proposed? __Yes __No 13. Are there published national dietary guidelines? __Yes __No 13a. If no, has this been proposed? __Yes __No Budgetary Commitment 14. Overall, how would you rate the resources available for food and nutrition programs? ___ 0 no resources ___ 1 limited resources ___ 2 substantial but insufficient resources ___ 3 adequate resources to meet needs 15. How would you rate the resources available for the following specific food and nutrition programs and problem areas? (where 0 = no resources, 1= limited resources, 2=substantial but insufficient resources, 3= adequate resources to meet needs) [to tailor specific food and nutrition programs for each SAFANSI country ] __ undernutrition and/or malnutrition __ stunting __ obesity __ vitamin A and/or micronutrients __ fortification __ maternal nutrition and/or adolescent girls __ breastfeeding __ growth-monitoring and promotion programs 100 __ school-feeding programs __ targeted supplementary feeding programs __ broad-based food distribution programs __ integrated delivery __ food security and agriculture __ multisectoral focus ___ Other, specify ______________ 16. Is there a budget-line for nutrition in the budget? __Yes __No 13a. If yes, is this part of the health budget? __Yes __No 13b. If no, has this been proposed? __Yes __No 17. Are resources allocated according to priority guidelines including considerations of need, cost-effectiveness and available infrastructure? __Yes __No 101 2. AGENDA SETTING: POLICY WINDOW OF OPPORTUNITY A. Problem Stream Credible Indicators 18. In your estimation, how available are credible indicators of the extent of food and nutrition related problems? [Credible indicators are clear measures that demonstrate the severity of the problem and that can be used to monitor progress] Very available Somewhat available Somewhat unavailable Not available at all DK Other (please specify) ________________________ 19. Have credible indicators of food and nutrition status been cited in media reports on food and nutrition in the last 12 months? Always Often Never NA- Not available DK 20. Have policy advocates and/or high level officials cited indicators showing the extent of food and nutrition problems to advance food and nutrition policy in the last 12 months? Yes, please give an example of the type of evidence invoked___________________ No DK Other (please specify) ________________________ Focusing Events & Public Attention 21. Have there been any major events in the last year that have drawn particular attention to food and nutritional problems in the country? 102 Yes, please describe (briefly) ___________________________________ No DK Other (please specify) ________________________ 22. Which of the following occurred in the past year [check all that apply]? Food-related crises Nutrition surveys Small-scale demonstrations and intervention studies on food and nutrition Positive experiences with salt iodization or vitamin A supplementation Windows via sector reform or policy dialogues National or international summits or conferences Visits by high-profile external actors Nutrition highlighted in the MDGs or other global initiatives Famine Financial crises Other, specify ________ 23. Thinking about public attention to the topic of food and nutrition problems, how much attention would you say this topic has received in the past year in the official [state] media? Very little (it is never or rarely discussed in any media outlets) Some talk and some general writing on the topic in the newspaper, on radio, and on television Substantial attention to the health conditions related to food and nutrition Other (please specify) ________________________ NA (e.g., Freedom of the press is highly constrained) DK 24. How much attention would you say the topic of food and nutrition problems has received in the past year through other forms of public discourse (e.g., protest, social media)? Very little (it is never or rarely discussed in any popular discourse) Some attention mainly from already mobilized groups Substantial criticism and popular disaffection with the current state of food and nutrition, describe ________ Other (please specify) ________________________ DK External Framing (public portrayals that resonate with political leaders controlling resources) 103 25. How often do proponents of food and nutrition initiatives invoke each of the following in their advocacy efforts: Never Rarely Some- Frequ- DK NA If Sometimes or times ently Frequently, Provide Brief Example Centrality of Food and Nutrition to Poverty Reduction 0 1 2 3 6 9 Cost Effectiveness of food and 0 1 2 3 6 9 nutrition initiatives Unfavorable comparisons with other countries on food and 0 1 2 3 6 9 nutrition progress Human rights (e.g., the right to food) 0 1 2 3 6 9 Quantitative evidence highlighting the extent of the 0 1 2 3 6 9 problem Qualitative experiences with the food and nutrition related health problems (e.g., vignettes 0 1 2 3 6 9 and emotive pictures of starvation or diseases) Other ____________ 0 1 2 3 6 9 Policy Champions & Advocacy 26. Is there a high-level advocate or influential individual who has taken on food and nutrition as a cause that he/she is currently (or within the past year) promoting? __Yes __No Who?___________ 27. Are there civil society groups that promote food and nutrition issues? __Yes __No 27a. If yes, how influential are these groups? Very influential (have the ear of high level policies makers, publicly visible) Somewhat influential Not very influential 104 Not influential at all (little public visibility, do not communicate with policymakers) DK Other (please specify) ________________________ Cohesiveness of Advocacy Community 28. In your estimation, how cohesive would you say are advocates of food and nutrition in this country? [By cohesive, we mean the degree to which the policy community agrees on the definition of, causes of and solutions to the problem] Very cohesive (all pushing for a common food and nutrition agenda) Somewhat cohesive Somewhat non-cohesive Not cohesive at all (competing advocacy messages, different areas within food and nutrition vying for attention, efforts not combined) Other (please specify) ________________________ B. Policy Stream Clear Policy Alternatives 29. Please select the option that best describes the current status of policy alternatives regarding food and nutrition problems in the country. In marking your response, think about the government’s policy agenda over the past year: A well thought out, coherent proposal has been put forward. A variety of reform options have been discussed, but no coherent proposal has been advanced. Potential policy solutions have not been discussed. DK Other/Comment/Sources (please specify) ___________________ 30. What are the three most prominent food and nutrition policy solutions that have been advanced in the past year? Policy 1 ____________ Policy 2 ____________ Policy 3 ____________ 105 31. In your estimation, how technically feasible is policy 1 to implement [technical feasibility refers to the practical feasibility given existing infrastructure, capacity and the need to coordinate across different sectors]? Very Somewhat Not at all DK 32. In you estimation how acceptable would policy 1 be to the public at large? Very Somewhat Not at all DK 33. In your estimation how financially sustainable would policy 1 be? Very Somewhat Not at all DK Policy Entrepreneur 34. Is there an influential individual within the policy community who has been especially influential in promoting a particular food and nutrition policy (or set of policies) in the past year? __Yes __No Who?___________ Cohesiveness of Policy Community 35. In your estimation, how cohesive would you say are proponents of these policy solutions? [By cohesive, we mean the degree to which the policy community agrees on the definition of, causes of and solutions to the problem] Very cohesive (all pushing for a common reform agenda) Somewhat cohesive Somewhat non-cohesive Not cohesive at all (each proponent has its own policy proposal, efforts not combined) 106 DK Other (please specify) ________________________ Internal framing: (how policy community understands the problem among themselves) 36. How often would you say the following is true of food and nutrition policy experts in this country: Never Rarely Some- Frequ- DK NA Provide Brief times ently Example Food and nutrition policy experts agree on a single framing issue to advance food and nutrition policy 0 1 2 3 6 9 (e.g., right to food, women’s empowerment, food insecurity). Food and nutrition policy experts agree on a common set of indicators to advance the food 0 1 2 3 6 9 and nutrition cause. Food and nutrition policy experts diverge in their support for multisectoral versus focused 0 1 2 3 6 9 approaches. Food and nutrition policy experts agree on the responsibilities of various ministries and organizations. Other ____________ 0 1 2 3 6 9 C. Political Stream Political Transitions & Openings 37. When are the next major executive elections scheduled to be held (year)? _______ NA (no major elections scheduled) DK 38. When are the next major legislative elections scheduled to be held (year)? _______ 107 NA (no major elections scheduled) 39. When is the next budget scheduled? ___________ NA (no major elections scheduled) DK External Influences 40. How much financial and technical support has the country received from international agencies to address food and nutrition problems? A lot Some A little None received None- received some but rejected assistance DK NA Competing Priorities 41. If the government had an extra 5 million dollars for health initiatives, which of the following categories would it be most likely to allocate the resources to first? HIV/AIDS Food and nutrition Water and Sanitation Maternal health Health system strengthening Other__________ 108 3. STAKEHOLDER AND INSTITUTIONAL ANALYSIS 42. Thinking about the food and nutrition policy that has most recently been seriously discussed in the country, please indicate the likely position of each potential proponent and opponent of this food and nutrition policy. If there are other potential opponents or proponents not listed here, please indicate the name and level of opposition. Strongly Moderately Neutral Moderately Strongly Support Support Opposed Opposed Planning Commission 2 1 0 -1 -2 2 1 0 -1 -2 Ministry of Finance 2 1 0 -1 -2 Minister of Health 2 1 0 -1 -2 Ministry of Agriculture Other Ministry, e.g. Ministry of Women 2 1 0 -1 -2 and Child Development specify___ Agricultural industry 2 1 0 -1 -2 Opposition Party 1, specify______ 2 1 0 -1 -2 Opposition Party 2, specify______ 2 1 0 -1 -2 FAO_____ 2 1 0 -1 -2 WFP_____ 2 1 0 -1 -2 WHO_____ 2 1 0 -1 -2 UNICEF_____ 2 1 0 -1 -2 Other 1, specify_____ 2 1 0 -1 -2 Other 2, specify_____ 2 1 0 -1 -2 Other 3, specify_____ 2 1 0 -1 -2 109 43. Please characterize the level of power you believe each group has over the level of priority accorded to food and nutrition policy. HIGH (Ability to block MEDIUM (Ability to LOW (Little influence policy advancement) alter, but not block over whether policy policy advancement) advances or not) Planning Commission 2 1 0 2 1 0 Ministry of Finance 2 1 0 Minister of Health 2 1 0 Ministry of Agriculture Other Ministry, e.g. Ministry of Women and Child Development 2 1 0 specify___ Agricultural Industry 2 1 0 Opposition Party 1, specify______ 2 1 0 Opposition Party 2, specify______ 2 1 0 FAO_____ 2 1 0 WHO_____ 2 1 0 WFP_____ 2 1 0 UNICEF_____ 2 1 0 Other 1, specify_____ 2 1 0 Other 2, specify_____ 2 1 0 Other 3, specify_____ 2 1 0 44. Please describe the ideological character of the party of the current executive [vis- à-vis other national political parties]? Left Left-Center Center Right-Center Right DK 110 Other, specify __________________________ 45. Please describe the ideological character of the majority party of current legislative branch [vis-à-vis other national political parties]? Left Left-Center Center 46. Depending on countries’ political institutions, there are different processes that legislation has to pass through before it becomes adopted. For the following, please mark 1 if this actor has the ability to block the legislative passage of a bill. If not applicable, write NA: ___ Executive 1 (President/Prime Minister/Monarch) ___ Executive 2 (President/Prime Minister/Monarch) ___ Lower Chamber Is a supermajority required to pass legislation? Yes No DK Other (please specify) ________________________ ___ Upper Chamber Is a supermajority required to pass legislation? Yes No DK Other (please specify) ________________________ ___ Other, explain_____________________ ___ Policy can be adopted by executive decree and doesn’t require legislative approval 111 About this series... This series is produced by the Health, Nutrition, and Population Family (HNP) of the World Bank’s Human Development Network. The papers in this series aim to provide a vehicle for publishing preliminary and unpolished results on HNP topics to encourage discussion and debate. The findings, interpretations, and conclusions expressed in this paper are entirely those of the author(s) and should not be attributed in any manner to the World Bank, to its affiliated organizations or to members of its Board of Executive Directors or the countries they represent. Citation and the use of material presented in this series should take into account this provisional character. For free copies of papers in this series please contact the individual authors whose name appears on the paper. Enquiries about the series and submissions should be made directly to the Editor Martin Lutalo (mlutalo@worldbank.org) or HNP Advisory Ser- vice (healthpop@worldbank.org, tel 202 473-2256, fax 202 522-3234). For more information, see also www.worldbank.org/hnppublications. 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