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Enhancing governance and strengthening advocacy for policy change of large Collective Impact initiatives.

ABSTRACT: Nutrition issues are increasingly being addressed through global partnerships and multi-sectoral initiatives. Ensuring effective governance of these initiatives is instrumental for achieving large-scale impact. The Collective Impact (CI) approach is an insightful framework that can be used to guide and assess the effectiveness of this governance. Despite the utility and widespread use of this approach, two gaps are identified: a limited understanding of the implications of expansion for an initiative operating under the conditions of CI and a lack of attention to advocacy for policy change in CI initiatives. In this paper, a case study was undertaken in which the CI lens was applied to the advocacy efforts of Alive & Thrive (A&T), UNICEF and partners. The initiative expanded into a regional movement and achieved meaningful policy changes in infant and young child feeding policies in seven countries in Southeast Asia. These efforts are examined in order to address the two gaps identified in the CI approach. The objectives of the paper are (a) to examine the governance of this initiative and the process of expansion from a national to a regional, multilayered initiative, with attention to challenges, adaptations, and key elements, and (b) to compare advocacy in the A&T-UNICEF initiative and in typical CI initiatives and gain insight into how the practice of advocacy for policy change can be strengthened in CI initiatives.

SUBMITTER: Michaud-Letourneau I

PROVIDER: S-EPMC6519038 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Enhancing governance and strengthening advocacy for policy change of large Collective Impact initiatives.

Michaud-Létourneau Isabelle I Gayard Marion M Mathisen Roger R Phan Linh Thi Hong LTH Weissman Amy A Pelletier David Louis DL

Maternal & child nutrition 20190201

Nutrition issues are increasingly being addressed through global partnerships and multi-sectoral initiatives. Ensuring effective governance of these initiatives is instrumental for achieving large-scale impact. The Collective Impact (CI) approach is an insightful framework that can be used to guide and assess the effectiveness of this governance. Despite the utility and widespread use of this approach, two gaps are identified: a limited understanding of the implications of expansion for an initi ...[more]

PMID: 30793547

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Project description:BackgroundThree global health initiatives (GHIs) - the US President's Emergency Plan for AIDS Relief, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Bank Multi-Country HIV/AIDS Program - finance most HIV services in Nigeria. Critics assert that GHIs burden fragile health systems in resource-poor countries and that health system limitations in these countries constrain the achievement of the objectives of GHIs. This study analyzed interactions between HIV GHIs and the Nigerian Health System and explored how the impact of the GHIs could be optimized.MethodsA country case study was conducted using qualitative methods, including: semi-structured interviews, direct observation, and archival review. Semi-structured interviews were held with key informants selected to reach a broad range of stakeholders including policymakers, program managers, service providers, representatives of donor agencies and their implementing partners; the WHO country office in Nigeria; independent consultants; and civil society organizations involved in HIV work. The fieldwork was conducted between June and August 2013.FindingsHIV GHIs have had a mixed impact on the health system. They have enhanced availability of and access to HIV services, improved quality of services, and strengthened health information systems and the role of non-state actors in health care. On the negative end, HIV donor funding has increased dependency on foreign aid, widened disparities in access to HIV services, done little to address the sustainability of the services, crowded out non-HIV health services, and led to the development of a parallel supply management system. They have also not invested significantly in the production of new health workers and have not addressed maldistribution problems, but have rather contributed to internal brain drain by luring health workers from the public sector to non-governmental organizations and have increased workload for existing health workers. There is poor policy direction, strategic planning and coordination, and regulation of externally-financed HIV programs by the government and this poses a great limitation to the optimal use of HIV-specific foreign aid in Nigeria.ConclusionsA few reforms are necessary to improve the strengthening effect of GHIs and to minimize their negative and unintended consequences. This will require stronger leadership from the Nigerian government with regards to better coordination of externally-financed health programs. Also, donors need to play a greater role in addressing the negative consequences of foreign aid. The findings highlight important unintended consequences and system-wide impacts that get little attention in traditional program evaluation.

Project description:BackgroundThe need to more collaboratively measure the impact of health research and to do so from multidimensional perspectives has been acknowledged. A scorecard was developed as part of the Collective Research Impact Framework (CRIF), to engage stakeholders in the assessment of the impacts of health research and innovations. The purpose of this study was to describe the developmental process of the MULTI-ACT Master Scorecard (MSC) and how it can be used as a workable tool for collectively assessing future responsible research and innovation measures.MethodsAn extensive review of the health research impact literature and of multistakeholder initiatives resulted in a database of 1556 impact indicators. The MSC was then cocreated by engaging key stakeholders and conducting semi-structured interviews of experts in the field.ResultsThe MSC consists of five accountability dimensions: excellence, efficacy, economic, social and patient-reported outcomes. The tool contains 125 potential indicators, classified into 53 impact measurement aspects that are considered the most relevant topics for multistakeholder research and innovation initiatives when assessing their impact on the basis of their mission and their stakeholders' interests. The scorecard allows the strategic management of multistakeholder research initiatives to demonstrate their impact on people and society. The value of the tool is that it is comprehensive, customizable and easy to use.ConclusionsThe MSC is an example of how the views of society can be taken into account when research impacts are assessed in a more sustainable and balanced way. The engagement of patients and other stakeholders is an integral part of the CRIF, facilitating collaborative decision-making in the design of policies and research agendas. In policy making, the collective approach allows the evaluation perspective to be extended to the needs of society and towards responsible research and innovation. Multidimensionality makes research and innovations more responsive to systemic challenges, and developing more equitable and sustainable health services.

Project description:Climate change is driving shifts in the abundance and distribution of marine fish and invertebrates and is having direct and indirect impacts on seafood catches and fishing communities, exacerbating the already negative effects of unsustainably high fishing pressure that exist for some stocks. Although the majority of fisheries in the world are managed at the national or local scale, most existing approaches to assessing climate impacts on fisheries have been developed on a global scale. It is often difficult to translate from the global to regional and local settings because of limited relevant data. To address the need for fisheries management entities to identify those fisheries with the greatest potential for climate change impacts, we present an approach for estimating expected climate change-driven impacts on the productivity and spatial range of fisheries at the regional scale in a data-poor context. We use a set of representative Mexican fisheries as test cases. To assess the implications of climate impacts, we compare biomass, harvest, and profit outcomes from a bioeconomic model under contrasting management policies and with and without climate change. Overall results show that climate change is estimated to negatively affect nearly every fishery in our study. However, the results indicate that overfishing is a greater threat than climate change for these fisheries, hence fixing current management challenges has a greater upside than the projected future costs of moderate levels of climate change. Additionally, this study provides meaningful first approximations of potential effects of both climate change and management reform in Mexican fisheries. Using the climate impact estimations and model outputs, we identify high priority stocks, fleets, and regions for policy reform in Mexico in the face of climate change. This approach can be applied in other data-poor circumstances to focus future research and policy reform efforts on stocks now subject to additional stress due to climate change. Considering their growing relevance as a critical source of protein and micronutrients to nourish our growing population, it is urgent for regions to develop sound fishery management policies in the short-term as they are the most important intervention to mitigate the adverse effects of climate change on marine fisheries.

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Enhancing governance and strengthening advocacy for policy change of large Collective Impact initiatives.

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Enhancing governance and strengthening advocacy for policy change of large Collective Impact initiatives.

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