Table 1

Five forms of political commitment

[1] Rhetorical commitmentStatements made by members of the executive and legislative branches of government, and/or those outside of government with whom they are closely associated (eg, donors, civil society leaders) recognising malnutrition as a serious problem, and that concerted action is both needed and forthcoming.7 15 20 24 51 A rhetorical commitment may be a ‘symbolic gesture’ only, especially when the political costs of inaction are low. Or, when genuine, such commitments may reach a government’s ‘decision-agenda’ and be converted into [2] via directives for governmental and societal action.
[2] Institutional commitmentThe conversion of [1] into substantive policy infrastructure including institutions responsible for coordinating actions, the adoption of enabling legislation, policies and policy instruments commensurate with the severity of the problem,24 51 and the commitment of mid-level bureaucrats responsible for coordinating action.7 24 73 Institutions and policies can, however, be underpowered, inadequately resourced and have limited impact. This can trap nutrition in a ‘low-priority cycle' as ‘lack of commitment breeds lack of impact breeds lack of commitment’.8,p7
[3] Operational commitmentThe conversion of [1] + [2] into on-the-ground actions including the sustained allocation of human, technical and financial resources, the effective coordination of all actors involved along national to subnational implementation pathways and the commitment of street-level managers and implementation teams.24 51 52 Limited operational commitment can lead to implementation failure, thereby undermining sustained commitment and further trapping nutrition in a low-priority cycle.7
[4] Embedded commitmentWhen commitment to address issues indirectly related to nutrition (eg, economic development, social protection, hunger reduction initiatives) inadvertently achieves positive nutrition outcomes, referred to as ‘nutrition success without nutrition-specific action’.53p26 This can create opportunities for nutrition actors when they are capable of sensitising or positioning nutrition within these broader or related policy agendas, thus further catalysing the commitment-building process and forms.1–3 52 53
[5] System-wide commitmentThe achievement of [1]+[2]+[3]+[4] involving all actors operating within a nutrition system including communities, families and individual citizens.7 15 When achieved, system-wide commitment can create a powerful reinforcing feedback-loop that institutionalises and sustains long-term policy and programme responses. To be effective, efforts must be sustained and recalibrated in response to emerging opposition and demands, changing conditions and implementation challenges.7 13 15