Stories of change in nutrition in Burkina Faso 1992-2018: a macro-level perspective

Abstract

Looking back at the development of successful enabling environments for nutrition may inform policymakers on how to accelerate progress to end all forms of malnutrition by 2030. As under-five stunting declined substantially in Burkina Faso, from a peak at 45% in 1998/99 to 25% in 2018, we analyzed through a stories of change approach the actors, ideas, initiatives, policies and capacities which enabled wide-scale nutrition progress. We triangulated findings from policy analysis, stakeholder mapping, and national-level semi-structured interviews (n = 20). We found that since 2002, nutrition has been anchored in the Ministry of Health, where leadership advocated for the creation of coordination bodies, enabling a coherent defining of nutrition and laying groundwork for better integration of nutrition into and prioritization of nutrition by the health and tangential ministries. Under the leadership of the Ministry of Health and its partners, horizontal and vertical coherence in nutrition action increased, through effective cooperation between nutrition actors; increasing intersectoral collaboration, particularly with the influential agriculture sector; and increasing funding to support nutrition-sensitive programming and build the capacity of nutrition staff. Nevertheless, sustainably organizing funding and human resources at the decentralized level remained challenging, in a context of emerging threats such as climate change and insecurity. Burkina Faso's health sector's success in creating an enabling environment for nutrition may have contributed to improvements in child nutrition alongside other sectoral improvements. Enhancing accountability of the Health, Agriculture, WASH, Education and Social Protection sectors and empowering decentralized bodies to take nutrition-relevant decisions may help accelerating progress in nutrition.

Keywords: Burkina Faso; Enabling environment; Leadership; Nutrition; Policy; Stories of change.

Fig. 1

Nutrition stakeholders influence mapping. Types of institutions a represented by symbols: star, government; circle, NGO; pentagon, United Nations; square, funder; diamond, CSO; triangle, private sector; flag, other. Larger, intermediate and lower influence are represented by large, medium and small size of symbol. Types of links are represented by colors: black, advocacy; red, financial; blue, information; green, technical. NGO1 group includes ACF, Alive & Thrive, CRS, GRET, HKI, NI, SCI, SNV, TDH; NGO2 group includes IFCR, HELP, SOS SAHEL; NGO3 group includes ALIMA, Ammie, ChristianAID, LVIA, MDM, Medicus Mundi, MLAL, TinTua, OCADES, Plan Internation, S.E.M.U.S. Acronyms used: ACF, Action Contre la Faim; AFDB, African Development Bank; ALIMA, Alliance for International Medical Action; AMMIE, Appui Moral, Matériel et Intellectuel à l’Enfant; BM, Banque Mondiale (World Bank); BMGF, Bill and Melinda Gates Foundation; CNCN, Conseil National de Concertation en Nutrition; CNSA, Conseil National de la Sécurité Alimentaire; CNRST, Centre National de la Recherche Scientifique et Technologique; CRS, Catholic Relief Services; CSO, Civil Society Organizations; DN, Directorate of Nutrition; ECOWAS, Economic Community of West African States; FAO, Food and Agriculture Organization; GRET, Groupe de Recherche et d'Echanges Technologiques; HKI, Helen Keller International; IFCR, Interational Federation of the Red Cross INERA, Institut de l'Environnement et Recherches Agricoles; IRSS, Institut de Recherche en Sciences de la Santé; MDM, Médecins du Monde; MENA, Ministère de l’Education Nationale et de l’Alphabétisation; MFSNF, Ministère de la Femme, de la Solidarité Nationale et de la Famille; MINEFID, Ministère de l’Economie, des Finances et du Développement; MLAL, Progetto Mondo -Lay Movement in Latin America; LVIA, Lay Volunteers International Association,; NI, Nutrition International; NGO, Non governmental Organizations; OCADES, Organisation Catholique pour le Développement et la Solidarité; OMS, Organisation Mondiale de la Santé (World Health Organization); PAM, Programme Alimentaire Mondial (World Food Programme); PTF-Nut, Groupe des Partenaires Techniques et Financiers en Nutrition (group of nutrition technical and financial partners); RAPNUT, Réseau des Acteurs Privés pour la Nutrition; REACH, Renewed Efforts Against Child Hunger; REPASEN, Réseau des parlementaires en sécurité nutritionnelle; WAHO, West-African Health Organization; SCI, Save the Children International; S.E.M.U.S., Solidarité et Entraide Mutuelle au Sahel; SNV, Netherlands Development Organization; SP-CPSA, Secrétariat Permanent de Coordination des Politiques Sectorielles Agricoles; STAN, Secrétariat Technique pour l’alimentation et la nutrition; SUN, Scaling Up Nutrition; TDH, Terre des Hommes; UE,Union Européenne; UNICEF, United Nations Children’s Fund

Fig. 2

Timeline of sectoral policy documents including an objective, an indicator and/or a budget for nutrition in Burkina Faso, 1992–2025

Fig. 3

A timeline of pivotal events, Burkina Faso 1992 – 2018