Article Text
Abstract
This paper compares the policy trajectories of Nutrition and Early Childhood Development (ECD) in Pakistan, identifying enablers that led to better multisector progress for Nutrition over ECD. Specifically, it deliberates on (1) multisector policy adoption in terms of instigation, construct and stakeholder coalitions; and (2) horizontal coordination in terms of capacity, incentives and structures. The analysis builds on existing work of the authors, supplementing this with further document review and expert insights. Nutrition and ECD initiatives in Pakistan, while overlapping agendas, differed in terms of buy-in and structural grounding. A favourable policy window for Nutrition was successfully managed through coordinated advocacy, programmatic support and investment in networks, while capture of policy opportunities was not seen in case of ECD. A vague construct for ECD confined its activities narrowly to the education sector while a Nutrition discourse specifying roles for other sectors resulted in a broader coalition and expanded activities. Both Nutrition and ECD faced powerful disincentives to coordination, but Nutrition overcame this through cofinancing of different sectors and creation of structural platform in supraplanning ministries. Both Nutrition and ECD share common capacity constraints for horizontal coordination, raising concerns for effective implementation. We conclude that multisector action for child well-being requires deliberative action and investment to unlock opportunities. The analysis from Pakistan highlights four governance areas for progressing multisector action: (1) opportune management of policy windows; (2) a clear and inclusive menu of actions for stakeholder coalitions; (3) availability of cofinancing and structural platforms for catalysing coordination; and (4) investment in horizontally placed human resource and integrated tracking systems.
- nutrition
- child health
- health policies and all other topics
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Footnotes
Handling editor Seye Abimbola
Contributors SAZ and KR conceptualised the framing of the paper. SAZ and ZB undertook the analysis assisted by SSH. SAZ wrote the paper, while review and inputs were made by ZB, SSH and KR. SAZ and ZB respectively led the PEA and PUTMI works, SSH assisted with additional documentary review and stakeholder discussions, SAZ and KR conceptualised the paper with review by ZB.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.