Operational Issues

This is the old United Nations University website. Visit the new site at http://unu.edu

Problems of Field Co-ordination

Many contributions of the international nutrition community are made at the headquarters level, e.g., setting scientific standards, synthesis of experience, production of guidelines. But the activity at the country level most determines the effect of efforts to alleviate malnutrition. Many of the operational problems encountered in nutrition are endemic to the international assistance system as a whole and have been studied repeatedly in recurrent efforts of the UN system to improve the efficiency of its operational activities.

There are things that might be done to increase the efficiency of nutrition assistance activities without questioning basic legislation or functional arrangements. Before considering some of these options, it will be helpful to run down the main endemic problems encountered:

Country planning exercises are important for learning about future programme content and facilitating collaboration. The fact that agency exercises frequently are not in phase with the country's planning frame, or each others' planning frames, works against medium-term co-ordination.
The "restructuring" effort of 1978 (the most recent UN system attack on problems of operational efficiency) called for the use of the UNDP Country Programme exercise as a general framework for encouraging greater exchange and "coherence," without the Country Programme's assuming any formal role in the programming of other agencies that remained undisturbed from their previous legislative and jurisdictional status. In very few countries has this taken place.
Co-ordination is hampered because agencies do not have uniform practices for representation or the degree of authority given to field staff. This has delayed or frustrated efforts to develop joint programme activity, when the resident person from one or more agencies could serve only as transmitter to the regional or headquarters level.
The decision referral process is more difficult in some regions where different agencies group different countries together for servicing by their regional levels, especially where the regional offices are in different countries even though their regions overlap.
Variation in agency procedures and documentation creates time-consuming paperwork burdens for officials of developing countries. The variation in complexity, project documentation, and local authority is even greater among the bilaterals.
There is a striking lack of uniformity (call it bureaucratic discipline) in the UN system. In the same framework of General Assembly resolutions, in repeated efforts to bring about more co-operation in field activities and within the policies of individual agencies, one finds scope for the widest variation in people's actions from one country to another with respect to inter-agency working.
Some funding agencies take an active stance, programming jointly with government but within definite objectives and guidelines set by their headquarters and governing bodies. Other agencies are more passive, willing to programme according to whatever priorities are put to them by governments, with few restrictions as to substance.
Among some SCN agencies there are different relationships at headquarters level, reflected in two- or three-party memoranda of understanding, formal relationships between some governing bodies but not others, special joint programmes, and other formal and informal relations. This pattern of more and less close headquarters relationships is reflected at the field level.

Nutrition shares the endemic co-ordination problems of the system. We have come across assertions of agency people not bothering to attend programming sessions of other agencies when invited; co-ordination mechanisms falling into desuetude because no person from other agencies took active leadership to continue the process when the initiator withdrew for a period; personal relationships too poor, or attitudes too disrespectful, to form the basis for anything more than superficial information exchange; donors too concerned with maintaining their operational (feeding} programmes to subordinate that interest to a joint effort to establish local structures that would enable them to withdraw; varying interest of the same bilaterals to co-ordinate with UN agencies, from one country to another; changes in co-ordination when an individual representative is followed by another (in normal course of job rotation) with an opposite view on interagency relations.

To some extent the problems of field co-ordination are circumvented through co-ordination at the headquarters level based on cordial and informal relationships among unit heads who have funds available for central (rather than country) programming. In these cases the SCN network has helped build working relations at organizational levels that appear less constrained by the inter-agency structural problems "above" them, or by the field difficulties at the peripheries of their bureaucratic systems.

Finally, there is the important factor of government attitude on co-ordination of external agencies. Some prefer to assign co-ordination to a government unit. Others oppose formal arrangements among the aid agencies. Government ability to orchestrate the activities of aid agencies is also a factor.

One often hears the view that it is a puzzle how such a system works at all. In fact, there are many examples where the system is working effectively (more so at the project than the programme level}, as one would expect in a system that allows so much latitude to individual personality. The criticisms must be seen in the context of a record of over two decades of international activity in training, advocacy, institution-building, research, etc., helping to bring about a coming of age of a subject considered peripheral and "merely" welfare a relatively short time ago. To get a true fix on the most prevalent state of field relations would require an effort beyond our scope. One can observe the full range, from hostility through isolation or mere information exchange, to occasional collaboration or smooth co-ordination and full joint programming. The cases at either end are apparently few, while the average appears less than satisfactory.

Areas for Strengthening Co-ordination

The ingredients for effective working relations appear to be: a government that does not discourage agency coordination, preferably one that encourages or acts as co-ordinator itself; an agency representative willing to play an active "lead" role; willingness of agency representatives to form a co-ordinating group; a country policy framework in which the group can define an integrated role that encourages the emergence of the system's potential for professionalism and enthusiasm that can overcome the inherent obstacles to harmonization; enough resources to cross a threshold level perceived on the ground as a level of effort below which the external system is irrelevant.

Most agencies have limited points of contact with government, reflecting the specific character of the agency. For example, UNICEF works largely with ministries of health, education, social affairs, and community development, hardly ever with finance. These contacts are natural, based on UNICEF's record for activities focusing on children and mothers and its interest in shifting attention down towards provincial if not local levels. On the other hand, the agency's current interest in "food entitlement" would require links with ministries of finance to get a meaningful hearing. Each agency faces similar constraints, most more narrow. Where governments are ready for a multidimensional attack on malnutrition or where domestic nutrition authorities are trying to negotiate a broad strategy with the planning and finance authorities, a joint array of the external agencies can play a useful role by joining in a dialogue integrated in concept and ministerial involvement. If a food and nutrition focal point or institution exists, the dialogue should be easy and natural. If not, the external agencies may help bring about recognition of the need for such arrangements.

In such situations, the UNICEF/WHO/FAD/WFP group, with Unesco or others, depending on circumstances, would be strengthened by association with IBRD or the regional banks, with their normal liaison points being finance and planning. Unfortunately, policy dialogue by the multilateral banks normally is carried on episodically in connection with project missions. Advocacy, resources, and local knowledge and contacts are closely related, suggesting actions along the following lines:

The SCN should assist the banks to increase the number of countries and projects putting resources into nutrition. A recent IBRD report noted that poverty alleviation projects usually have high technical assistance requirements and that in some cases it might be appropriate to post resident staff "oriented towards implementation." Such persons could also serve in the representation/advocacy role envisaged here for the agency groupings, rounding out the ministerial access discussed above. The SCN could encourage IBRD to follow up on this staff suggestion.
Repeating the point made earlier, the SCN should arrange a workshop to review the nutrition experience of IBRD. The workshop could also examine whether conditions might be ripe now to establish nutrition project development facilities, perhaps in one of the countries that has reached technical self-sufficiency in nutrition.
In some countries, special agency co-ordination arrangements have developed, focusing on some mix of food/ nutrition/health. The SCN should enourage and assist the setting up of co-ordinating groups in selected countries. The structure cannot be built in advance. Several options are possible, including general co-ordination being exercised under the good offices of the UN Resident Co-ordinator.
The UNICEF/WHO programme could play a significant role in co-ordination. New funds not tied closely to preexisting allocation or programming systems offer wider options than "regular" funds. The programme is a unique opportunity for the two agencies to buttress the range of activities being planned, by linking the programme development processes in the countries to specially formed, interagency groupings.
The SCN could recommend practical steps to facilitate co-ordination. Ongoing project information in a country could be put into a single brief document, easily updated, to serve as ready reference for government and agency personnel, NGOs and others working in the field, and new arrivals. Sets of agency policy guidelines regarding nutrition could be prepared so that all worked from the same information basis. A roster of expected visitors, programme exploration teams, and forthcoming meetings and planning exercises could be issued regularly. This would alert people to events of joint interest and eliminate irritation over being "ignored." An annual informal retreat could be held where participants could sit back and take stock of where the government is heading in nutrition, what role the external agencies should play, and areas for improving effectiveness and co-ordination. Finally, officials in developing countries have long complained about lack of uniformity in donor project documentation and the burden this imposes on the project process. If the nutrition agencies could agree to use a single format when several are working jointly on related activities, this would remove another obstacle to assistance co-ordination.

REFERENCES

1. Task force of the World Bank, "Focus on Poverty" (World Bank, Washington, D.C., 1982).

2. "Accelerated Development in Sub-Saharan Africa" (World Bank, Washington, D.C., 19811.

3. Annual Report of the Executive Director on the Development of the Programme: 1981 (World Food Programme, 1982).

4. D. Gwatkin, J. Wilcox, and J. D. Wray, "Can Health and Nutrition Interventions Make a Different?" (Overseas Development Council, New York, 1980).

5. J. Pines, "National Nutrition Planning: The Lessons of Experience, " Food Policy, Nov. 1982.

6. "Operational Activities for Development" (A/36/478; United Nations, 1981).

7. Food and Nutrition Board, National Academy of Sciences National Research Council, "Nutritional Analysis of Public Law 480 Title II Commodities" (NAS/NRC, Washington, D.C., 1982).

Additional Bibliography

Agriculture: Toward 2000, ch. 2. FAO, Rome, 1980.

Ahluwalia, M. S. "Rural Poverty in India: 1956-57 to 1973-74." IBRD, Washington, D.C., 1982.

Berg, A. "Malnourished People: A Policy View." Poverty and Basic Needs Series. IBRD, Washington, D.C., 1981.

Carvalho da Silva, A. "Food and Nutrition Policies in Brazil." 1981. "Case Studies and Country Papers, Asia and Pacific Regional Work shop on Developing Primary Health Care." Chiang Mai, Thailand, Feb. 1981. Government of Thailand. "Current Views on Nutrition Strategies." UNICEF, New York, 1983.

Development Support Bureau, Office of Nutrition, USAID. Annual Budget Submission, FY 1983. USAID, Washington, D.C., 1981.

"Food and Nutrition in National Development: An Evaluation of the Tanzania Food and Nutrition Centre (TFNC)." SIDA/TFNC, 1979.

"Formulation of Nutrition Strategies in the Framework of Primary Health Care." Report of a consultation meeting, Oct. 1981. SEA/Nut/82. WHO, SEA Region, 1982.

Gish, O., and P. Berman. Comments on above in Soc. Sci. Med, 16: 1049 (1982), and responses.

Golladay, F., and B. Liese. "Health Problems and Policies in the Developing Countries." World Bank Staff Working Paper No. 412. IBRD, Washington, D.C., 1980.

Horwitz, A. "Increasing the Capacity of the International Agencies for Policy Formulation and Programme or Project Preparation in Nutrition," Food and Nutr. Bull., 1 (4): 11 (1979).

Kent, M. M. "Breast-feeding in the Developing World: Current Patterns and Implications for Future Trends." Population Reference Bureau, New York, 1981.

"Managerial Process for National Health Development." WHO, Geneva, 1981.

Murphy, J. "Agriculture Research and Development," AID Evaluation Working Paper No. 45. USAID, Washington, D.C. 1982.

"Nutrition." AID Policy Paper. USAID, Washington, D.C. 1982.

"Nutritional Status of the Rural Population of the Sahel." IDRC- 160e. International Development Research Centre, Ottawa, 1981.

"Nutrition and Socio-economic Development of Latin America." Inter-American Development Bank, Washington, D.C, 1979.

"Operational Activities for Development: Comprehensive Policy Review of Operational Activities of the UN System." Note by the Secretary-General. A/35/324. United Nations, 1980.

Pines, J. "Nutritional Consequences of Agricultural Projects: Evidence and Response." 1982.

Population, Health and Nutrition Division, IBRD. "Toward an Operational Work Programme for Nutrition." IBRD, Washington, D.C., 1980.

"Poverty and/or Ignorance: A Socio-economic Study of Nutritional Problems in Thailand and the Philippines." FAO, Bangkok, 1982.

"Programme Cooperation at Intermediate and Local Levels." E/ICEF/L. 1439. UNICEF, 1982.

"Progress with National Food Strategies and Resource Mobilization." WFC/1982/2. World Food Council, 1982.

Report of the Executive Board, UN Children's Fund. ECOSOC Official Records, suppl. no. 8. 1981.

Report of the Executive Director. E/CEF/690. UNICEF, 1982.

"Report of the Workshop on Food and Nutrition Planning, Programming, Implementation and Evaluation." Colombo, Sri Lanka, July 1979. UN/ACC-SCN.

"Report on Research and Development." Overseas Development Administration, New York, 1980.

Rural Employment Policies Branch, World Employment Programme, ILO. "The Challenge of Rural Poverty." ILO, 1981.

"Support for the Improvement of Nutrition, 1982-86." E/ICEF/L. 1441. UNICEF, 1982.

The United Nations University: The fifth Year, 1979-1980. UNU, Tokyo, 1981.

"UN Capital Development Fund, Annual Report of the Administrator for 1981." DP/1982/38. UNDP, 1982.

Walsh, J., and K. Warrent. "Selective Primary Health Care: An Interim Strategy for Disease Control in Developing Countries." New Engl. J Med, 301: 967 (1979).

Contents - Previous - Next