The role of evidence in nutrition policy-making in Ethiopia: Institutional structures and issue framing

Malnutrition is the single greatest contributor to the global burden of morbidity and mortality, with most cases arising in low- and middle-income countries. However, the multi-sectoral nature of nutrition policy-making adds considerable complexity to the implementation of effective programmes. This raises questions about why or how relevant policy change can come about within different country settings. This article examines multi-sectoral nutrition policy-making from the health sector perspective, specifically focusing on different sectoral perspectives and the role and use of evidence within this. Ethiopia provides a unique example of the challenging nature of multi-sectoral nutrition policy-making, even with a strong co-ordinating infrastructure. In December 2014 we undertook 23 in-depth semi-structured interviews with stakeholders from key health sector organizations, along with a related documentary analysis. Participants represented a diverse range of perspectives, including government representatives, policy stakeholders, aid providers from multi-lateral organizations and academic researchers. Our respondents described how nutrition framing in Ethiopia is changing, with greater consideration of overweight, obesity and non-communicable diseases, as well as undernutrition and micronutrient deficiencies. However, overweight- and obesity-related concerns are still less evident in key documents. Some health actors described the challenge of enacting structural policy changes when doing so requires engagement from the agriculture sector. While multi-sectoral plans and infrastructure to address malnutrition are in place, respondents suggested that the mandate for addressing nutrition resting with the health sector was reinforced by the nature of evidence collected. This study of nutrition policy-making in Ethiopia highlights the complex interaction of evidence within different conceptualisations of policy problems and responses. Despite Ethiopia's strategic framework and its progress in achieving terms of nutrition targets, it shares the challenge of countries elsewhere in addressing nutrition as a multi-sectoral issue.