What drives policy reform? A cross-country review of micronutrient policy change in Malawi, South Africa, and Zambia.

Abstract

Abstract There is increased interest and awareness in country and among donors of the importance of evidence-based policy change in achieving the Sustainable Development Goals. While much is known about the technical and programmatic elements necessary to end hunger and undernutrition (including micronutrient deficiencies), far less is known about how to initiate policy discussion and overcome the political and implementation constraints necessary for policy change and impact in this domain. Despite universal and targeted programs to combat micronutrient deficiencies in sub-Saharan Africa, achieving results has proven more challenging than expected, except in the case of iodine deficiency reductions. This paper reviews the three in-depth country case studies of micronutrient policy change in Malawi, South Africa, and Zambia. Using the Kaleidoscope Model of policy change, data collected from the construction of policy chronologies and engagement with a range of stakeholders in the countries, the review highlights what drives and constrains policy change. The cases show that credible evidence and knowledge are crucial to all elements of the policy cycle. International attention to nutrition, focusing events and guidelines on best practice were found to be essential in initiating policy reform. However, sustaining the momentum seems dependent on donor support and the coordination of a wide range of stakeholders and implementing partners, including the private sector. The Kaleidoscope Model offers a tool to guide governments, researchers, and international agencies regarding the entry points for policy change and an insight into the key considerations to move the process through the policy stages and to initiate ongoing cycles of change.