Improving Nutritional Outcomes in India

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Guest blog written by Saachi Bhalla

When I applied for the IPP online course, I was hoping to help strengthen my understanding and capacity for policy analysis and to spend dedicated time in identifying ways of making progress on complex public policy issues. I was particularly interested in engaging with ways of identify formal and informal power relationships and processes which can lead to strong policy implementation and action by policy makers.

In particular, I was keen to explore how to build on the capability-accountability of state and non-state actors and how to shape processes for convergent action across ministries to impact nutrition outcomes in India. 

The course’s approach of teaching theory combined with the space to work on applying theory to one’s own implementation challenge is what was particularly attractive. 

My biggest learnings from the course include:

  • Understand the problem: define, redefine, and unpack the problem. The approach of constructing and deconstructing the problem, drilling down till you are really identifying the root causes and what are the smaller pieces that constitute the root causes. Asking the five whys and drawing up the fishbone has been such an enriching process. I find that I am using the fishbone diagram as an approach in much of my work now, beyond the policy challenge I have been working on through this course. 
  • Understand the change space: related to the learnings from constructing and deconstructing the problem and drawing up a fishbone, I find that understanding the change space is critical. The 3 As – acceptance, authority, and ability – helped in understanding what is critical to be able to act on policy challenges, but even more importantly, it helped me in identifying where to start. This has possibly been the most important learning for me from the course. I’ve learnt from colleagues at work about the concept of relentless incrementalism but have always questioned about where to start. This framework and analysis of change space has helped me with a tool to be able to answer the question. 
  • Practice leadership: this course has provided some rich resources and the reflective questions within modules have helped me think about myself as a leader, reflect on what constitutes leadership, and how to practice those skills. The multi agent leadership model made me think about how the same person could play the role of a leader and a follower simultaneously. Being cognizant of what role you play where, who are the others involved, and what role could they be playing, can help in building allies and recognizing when more efforts may be required to bring critical stakeholders along.
  • Learning as critical to success: the idea of short feedback loops and actively learning what, how, and why has been at the back of my mind for long. This course has helped me in articulating it better and defining a process through which this can be practiced. 
  • Importance of a collective voice: aligning on vision, engaging with legitimate sources of knowledge, understanding what we are projecting are important for success. Having a collective voice helps in building traction for a narrative and support for the aspects of the policy challenge we are trying to address. 

My implementation challenge relates to improving nutrition outcomes in India. My problem definition was that Malnutrition remains a rampant problem in India despite evidence- based policies to address it. The major causes to this relate to poor multi sectoral governance, program design not allowing attention to be paid to address the causes of malnutrition, public finance management systems which limit effective spending on nutrition, and information asymmetry and social/gender norms impacting both govt leadership as well as community behaviours. 

I think the most significant progress that I have made is in my understanding of the public policy challenge and how to engage with various stakeholders to be able to make a change. Specifically, in terms of progress on the policy challenge:

  • Organized a successful ‘renewing a commitment to action’ to address malnutrition in India with the participation of government, senior political leadership, civil society, researchers, and media. A 7-day campaign is ongoing, and we plan to organize state level events as well with the participation of a wide range of actors from frontline workers to Chief Ministers of states
  • Publications of reports and op-eds
  • Setting up a multi-agent team to be able to work on different parts of the fishbone diagram and at different levels (state / national)
  • Formal partnerships with government and citizens groups to make progress on different parts of the problem
  • A month-long campaign for nutrition where we provided support for the creatives and roll out of the campaign 
  • Work in progress : institutionalizing courses at the premier institute for training civil services officers for nutrition and building a course on nutrition financing which will bring together knowledge and work by different partners across costing, budgetting, and utilization of resources for nutrition to be delivered to District Magistrates (the highest administrative authority at the district level).

My fishbone diagram did not go through much change through the course but the process of creating it and then using it to understand my change space helped a great deal. It has also become a way of rallying team members and building agreement about where to focus efforts. 

My motivation came from the response I got from people I trust and then over the course of the efforts, from the progress we saw possible. As mentioned before, I have come to believe in the concept of relentless incrementalism as being the only way to effect change, but have struggled with an approach to identify where to start or initiate efforts. This course has provided me with many tools to be able to identify where to start and to continue making progress. 

I am using it everyday! In the work that I lead on gender and nutrition policy but also in my interactions with colleagues and senior government officials. I also find myself trying to apply my learnings when reading about the latest issues in the world including the concerns being raised by farmers against the newly formed agriculture reform laws in India. 

This is tough work, but we are dealing with tough, complex problems, and a ‘solution’ can not be simple. The PDIA provides us with the tools to be able to navigate this complex space, iterate our understanding and approaches, and continue building allies along the way. The key component of the approach, iteration, is only possible through consultation and dialogue. Building trust and mobilizing more folks is an important part of this process. These efforts build faith in policy makers and authorizers that progress is possible, creating more space for us to continue working on these complex problems.  

This is a blog series written by the alumni of the Implementing Public Policy Executive Education Program at the Harvard Kennedy School. Participants successfully completed this 6-month online learning course in December 2020. These are their learning journey stories.

Learn more about the Implementing Public Policy (IPP) Community of Practice and visit the course website to apply.

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