Highlighting the Key Achievements of Transform Nutrition West Africa (TNWA)
to move forward
Transform Nutrition West Africa has worked to put stakeholders and knowledge generation at the heart of decisions about policies and programs for maternal, infant, and young child nutrition. The platform’s achievements should inspire nutrition professionals and organizations to continue investing in the mobilization of knowledge for decision-making. Scroll through for a review and reflection on the project’s achievements, the approach taken, methods applied, and results achieved. Knowledge gained from the TNWA experience can improve future efforts to move maternal, infant, and young child nutrition forward.
A regional platform to enable effective policy and programmatic action on nutrition
Recent years have witnessed growing political commitment to addressing West Africa’s high rates of maternal and child malnutrition. This commitment must be translated into appropriate policy choices and program actions to generate sustained change at scale. The Transform Nutrition West Africa project supported decisions and actions to improve maternal and child nutrition through an inclusive process of knowledge generation and mobilization throughout the region. Beginning in 2017, the project assessed and analyzed nutrition-relevant data, programs, and policies to build knowledge on optimal approaches. TNWA then mobilized this knowledge to strengthen enabling environments and inform nutrition-relevant decision-making. This work was anchored in the context of West Africa and particularly in four focal countries — Nigeria, Burkina Faso, Ghana, and Senegal.
At the regional level, TNWA’s activities were determined by a blend of supply- and demand-driven knowledge generation and mobilization embedded in the regional context, and by the priorities of key stakeholders.
The unique mix of leadership building plus knowledge generation and mobilization allowed both country and regional stakeholders to express their needs and helped TNWA tailor knowledge generation to their priorities. At the country level, TNWA activities were anchored through country leads, who played important convening roles.
TNWA adopted a holistic approach, called the 5PD Cycle (Problem, Policy, Program, People, Priorities, and Data and knowledge), to translate knowledge into action across the spectrum of malnutrition. This approach assumes that nutrition issues are the product of a cycle of interacting domains, including the nutrition problem, the related policies and programs that exist to address this problem, the key people and organizations responsible for these policies and programs, their priorities, and the data and knowledge available to inform implementation of nutrition policies and programs. To improve maternal, infant, and young child nutrition (MIYCN), we must understand all these domains; focusing on one domain alone can hamper progress.
From knowledge to action
Across these domains, TNWA used a variety of methods to generate knowledge on nutrition problems that were prioritized through stakeholder engagements (demand-driven) as well as emerging issues for the region (supply-driven). These methods included secondary data analysis, evidence synthesis approaches such as rapid reviews, a mixed-methods approach at the country level, qualitative analysis, and policy/program reviews. Applying the methods best suited for each domain ensured that the knowledge generated was both useful and used for addressing identified priorities.
MATERNAL, INFANT, AND YOUNG CHILD NUTRITION (MIYCN)
What are the relevant policies to address these nutrition problems?
What is the level of implementation of these policies?
Are there relevant programs being implemented in relation to the nutrition problem?
Who are the key people and organizations responsible for
these policies and programs?
What is the relationship between them?
How do they work together?
What are stakeholders’ perceptions regarding priorities, gaps and opportunities in relation to the nutrition problem?
Are there sufficient data and knowledge (quantity and quality) to inform the implementation of relevant policies and programs?
What are the main nutrition problems?
What is known about their causes?
Three interconnected workstreams formed the core of TNWA activities: knowledge generation and mobilization while fostering a strong enabling environment for policy and program actions. The unique mix of leadership building plus knowledge generation and mobilization
Connecting the dots
allowed country and regional stakeholders to express their needs and helped TNWA tailor knowledge generation to these needs. This multipronged approach has been crucial to achieving TNWA’s objectives of generating and mobilizing knowledge for action.
AND YOUNG CHILD
Stakeholder engagement and leadership capacity strengthening
Stakeholder engagement and leadership capacity strengthening
Long-term engagements helped to build a regional network and key partnerships. TNWA had 12 long-term engagements across 4 countries and the region and developed 7 key strategic institutional partnerships. Engagement took a variety of forms, ranging from consultations to identification of synergistic opportunities to simply linking to ongoing work in countries in the Stories of Change program and to regional platforms and bringing stakeholders together. Formal and informal engagements occurred at national, regional, and global levels. TNWA also helped to build in-country capacity and leadership for the implementation and uptake of nutrition policy and programs through two complementary short courses, offered in French and English — one focused on leadership skills needed to lead change in nutrition and one focused on the evidence for nutrition policy and programming, essential to leading that change. Building leadership and capacity has improved understanding and responsiveness to key knowledge needs for decision-making that is fit for purpose within the local context.
Engaging stakeholders and strengthening leadership and capacity to improve nutrition-relevant policy and programming.
Topics were identified and prioritized through stakeholder engagements and key partnerships in the region; these included WAHO, DataDENT, UNICEF, ACF, A&T, Countdown 2030, and the RNWG (which brings together key nutrition players in the region). Key insights into regional priorities were developed using various methodologies. For example, we used rapid review approaches to map the research landscape on World Health Assembly targets, on adolescent nutrition, and on synthesized programs and interventions that address childhood wasting and breastfeeding practices in the region. We also assessed the extent of actionable nutrition data available in West African countries for key nutrition outcomes and coverage indicators (see TNWA country data profiles), and policies and programs (see TNWA policy notes). In Burkina Faso, Ghana, and Nigeria, we also applied the mixed-methods studies of Stories of Change in nutrition. To advance the use of knowledge products to inform decision-making in the region, TNWA outputs are all available free online, along with tools and frameworks, databases, search syntaxes, and a rapid review resource bank developed through the project.
The generation and synthesis of knowledge on trends, drivers, intervention programs, policies, and enabling environments for nutrition.
As a regional platform, TNWA mobilized knowledge and convened national, regional, and global partners around knowledge products to strengthen the enabling environment and inform and improve nutrition-relevant policy and programming. Knowledge mobilization and uptake was facilitated through key events, blogs, webinars, and shared learnings from external events from partners on social media (Twitter, Facebook, LinkedIn) and TNWA’s bilingual platform. A quarterly newsletter tracked and summarized recent evidence and highlighted emerging issues in the region.
Mobilize knowledge to strengthen enabling environments and inform and improve nutrition-relevant policy and programming.
TNWA by the numbers
Knowledge products designed for decision-makers and made freely available: 35 blogs, 10 evidence notes, 3 country briefs, 32 country data profiles, 16 policy notes, 3 peer-reviewed research papers, 12 databases (with 2 visualisations), 4 evidence synthesis protocols and search syntaxes, 1 rapid review resource bank, and 1 policy report.
Key regional events organized to engage with stakeholders around key priorities for nutrition policy and programming.
Unique website users, 2,362 Twitter followers, 741 Facebook followers, and 63 presentations posted to Slideshare with 928 views.
Newsletters providing research digests of recent nutrition-relevant evidence, 4 highlighting a special topic, distributed in both French and English to 615 subscribers.
West African nutrition professionals, 53 women and 58 men, participated in 4 short courses (2 in French, 2 in English) to strengthen their capacity and leadership skills.
Engagements established at the country and regional levels, including 7 strategic institutional partnerships and 12 long-term engagements.
West African decision-makers reached directly through events, webinars, and short courses and sensitized to use knowledge to inform decision-making.
By placing and using knowledge at the heart of engagements and making stakeholders part of this process, TNWA ensured that any research or knowledge generated was fit for purpose. TNWA informed regional priorities through rapid reviews, protocols, search syntaxes, methodological tools, and publications, including peer reviewed papers. Explore snapshots of some key achievements.
World Health Assembly Targets
Rapid Review Resource Bank
Country Data Profiles
Stories of Change
Together For Nutrition: West African Data Forum
Stories of Change studies carried out in three focal countries — Burkina Faso, Ghana, and Nigeria — increased understanding of successful multisector approaches addressing nutrition problems in the region and globally. Mixed methods were used in these studies to examine how and why improvements in stunting outcomes occurred, and what challenges remain to accelerating progress in malnutrition reduction. Trends in data were analyzed, changes in policy and programs over time documented, and experiential learning from those doing nutrition-relevant work in-country or in the region was captured. Each country team completed a manuscript (to be published in a dedicated series in the journal Food Security), as well as a country brief and a slide deck highlighting the study's key findings. A cross-country slide deck presents the Stories of Change rationale, study design, and findings across the three countries.
The Burkina Faso study, led by TNWA and carried out in collaboration with SNV and the Institut Supérieur des Sciences de la Population (ISSP) in Ouagadougou, focused on changes in nutrition and food security in Burkina Faso since the early 1990s, with empirical research conducted at national, provincial, and community levels. The Ghana study, led by the University of Ghana, focused on the drivers of stunting reduction over the last decade and the reasons for the more limited improvements in anemia among young children. The Nigeria study, led by Ibadan University, looked at the drivers of change in nutrition outcomes both at national and sub-national levels.
Stories of change
In West Africa, progress on the six World Health Assembly (WHA) targets has been insufficient. To inform policy-relevant decision-making to accelerate progress, TNWA reviewed the existing landscape of peer-reviewed evidence on the WHA targets in the region through a systematic mapping review. This identified gaps in evidence and in the capacity and leadership available to deliver this research. The review produced 2 journal manuscripts, 5 country slide decks, 2 online searchable databases accompanied by online search syntaxes and technical notes, and 1 evidence note.
World Health Assembly Targets
To inform policy and program decision-making, TNWA produced high-quality evidence notes on topics relevant to partner priorities and current challenges and evidence gaps in the region. Evidence was synthesized using a rapid review methodology. The templates developed for these reviews are useful tools to aid researchers and decision-makers in producing quality evidence rapidly in low- and middle-income settings. The procedures to follow, the templates, and the relevant resources are compiled in a resource bank.
Review topics included wasting, adolescent nutrition, and breastfeeding practices.
Rapid Review Resource Bank
To guide to inform future programming decisions and guidelines to address wasting, TNWA performed a rapid review of both the quantity and effectiveness of existing interventions and programs to address wasting. An evidence note summarizes the findings on what works and identifies research gaps along the continuum of care for wasting.
A systematic mapping review of evidence generated on adolescent nutrition (1999–2019) was conducted to inform the West African Health Organization and other decision-makers at the 16th ECOWAS Nutrition Forum. Outputs include a database of all the studies retrieved, an evidence note and a poster summarizing the findings, and a technical note describing the methodology. The final Addendum of the ECOWAS recommendations resulting from this Forum, for which TNWA led the development, is also available.
Stakeholders specifically identified the need for contextualization and evidence on implementation of interventions to promote breastfeeding. TNWA assessed the highest quality evidence available on interventions to promote early initiation of breastfeeding and/or exclusive breastfeeding within the West African context, and identified the implementation approaches that contribute most to intervention success so that these can be scaled up. Results are reported in an evidence note.
High-quality, timely, and reliable data is key to monitoring and tracking progress toward global and country targets. To make progress, we must translate data into action. TNWA assessed the extent of actionable nutrition data available in West Africa, including data on key nutrition outcomes and coverage indicators of nutrition interventions across the region. For each West African country, two country profiles have been produced — one on data availability for key nutrition outcomes, and the other on data availability for indicators on the coverage of key nutrition interventions.
Country Data Profiles
The policy review explored and summarized the current landscape of nutrition-relevant policy for each West African country as well as at the regional level. It highlighted strengths, weaknesses, and gaps in nutrition-relevant policy and assessed coherence within and across policies. Outputs include recommended actions and considerations for improving the development of nutrition-relevant policies in the West African region, as well as uptake of the resulting database to inform the Nutrition Observatory which is being developed by the WAHO. Results are presented in country policy notes, and synthesized across the region in a report and in a best practice note. Validation meetings at the country level will be held.
An important knowledge gap was filled through analysis of the spatial dynamics of various multiple malnutrition burdens among children under five years and women of reproductive age in TNWA focal countries — Burkina Faso, Nigeria, Ghana, and Senegal. Outputs include a slide deck and an evidence note presenting the methodology and summarizing the findings.
TNWA demonstrated its ability as a convener by bringing key stakeholders together at the Together for Nutrition: West Africa Data Forum, which was led by TNWA and co-sponsored by 9 key institutions and programs active along the data chain for nutrition. The resulting Call to Action was endorsed by the West African Health Organization, and has been used in regional data initiatives to improve alignment across the region and stimulate collaboration and learning for improving all aspects of nutrition data.
Together For Nutrition: West African Data Forum
Rainer Schwenzfeier / Save the Children
Transform Nutrition West Africa convened key nutrition stakeholders in West Africa and globally to highlight recent achievements in generating and mobilizing nutrition knowledge and strengthening the enabling environment for improving MIYCN in West Africa. In addition to sharing TNWA’s accomplishments, the event
began to envision a new agenda for strengthening intersectoral partnerships and networks and the use of knowledge to accelerate policy and program actions to improve nutrition in the region. We provide an overview of priorities for country and regional institutions, as well as West African policymakers to whom we pass on the baton.
Imagining a new agenda: building on the momentum
Nutrition data and knowledge for policy and programs: new horizons
The demand and supply-driven approach for data and knowledge, as applied by TNWA, is key to facilitating engagement as it allows for responding to contextual needs, and can serve as a model. The region should continue putting data and knowledge at the heart of engagement and raise and sustain country voices to achieve good nutrition for national development. Furthermore, the generated knowledge by TNWA should be passed on, and used to support national and regional initiatives.
Investing in tomorrow's nutrition leaders
Future initiatives should invest in and nurture credible leadership among many to bring about change for nutrition. With apparent unmet demand for nutrition leadership training in the region, there is strong desire for future courses. Options could be explored to make TNWA’s courses available online and to tap into existing opportunities for leadership strengthening through, for example, the development of a regional capacity strengthening roadmap.
Building a regional network for nutrition: connecting the dots
In providing the opportunity to convene nutrition experts with diverse backgrounds from different countries around a common nutrition interest, TNWA built a nutrition network in the region. Investment should be made to nurture and extend this network. Having a network that can propel synergies will be extremely useful to achieve and accelerate progress on nutrition.
Harnessing collaboration and engagement for action around nutrition
TWNA showcased the impact of having a convening mandate, which facilitated stakeholder engagement, and thus helped advance the agenda to build momentum for nutrition. There is a clear need for organizations and governments to allow their staff to be able to engage with stakeholders as part of their daily job. Strategic and synergistic partnerships are needed to reinforce the mobilizing and advocating for action around nutrition.
Country data profiles
Academic institutions are key in any future capacity strengthening for knowledge generation, leadership, and strategic engagement.
I liked the perspective on the importance of networking combined with data! Something that we should be doing more intentionally.
Need for organizations to create an enabling environment for their staff to lead engagements and play a convening role.
Recordings and presentations
Decision-makers testify to the impact that TNWA’s engagement and support have had in their countries and institutions and at the regional level. In their view, integrative thinking and the emphasis that TNWA gave to inclusivity, collaboration, and listening are the core priorities that made the partnership unique.
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Photo credit: USAID Feed the Future / Herve Irankunda
Transform Nutrition West Africa is a regional platform to enable effective policy and programmatic action on nutrition.
It is funded by the Bill & Melinda Gates Foundation from 2017–2021 and is led by the International Food Policy Research Institute.