Abstract
Adolescent health is being increasingly featured in global policy discourse on sustainable development. Despite global calls for more joined up working across relevant sectors, there is less known on how to effectively co-opt other sectors for programming of globally recommended adolescent health measures.
This paper aimed to assess multisector programming of nutrition versus tobacco control interventions for adolescents in Pakistan from a political economy lens. Both nutrition programming and tobacco control rely on multi-sectoral programming and are one of the foremost areas for adolescent health needs in Pakistan. Data was drawn from 84 key informant interviews across government stakeholders, development partners, civil society organizations, experts and youth groups, review of policy and programming resources and published literature. The study scope was confined to exploring the pathway of programming and early implementation does not extend to evaluation of implementations. Existing frameworks of multi-sector governance were adapted and progress was assessed against i) issue framing, ii) stakeholder coalitions, iii) resourcing and iv) coordination platforms, to understand challenges and opportunities for an effective multi-sector response.
Our analysis found important commonalities as well as differences across both nutrition and tobacco control programming in Pakistan. First, adolescents had a weak constituency within nutrition efforts confined to under-nutrition interventions for reproductive health and a gendered nuancing overlooking needs of boys but have featured historically in national Tobacco control frameworks. Second, lack of framing of social-behavioural perspectives in national response was commonly seen for both adolescent Nutrition as well as Tobacco Control constraining coalitions with new stakeholder groups such as youth initiatives, local government, sports, education, and entertainment that are necessary for lifestyle changes in adolescents. Third, Nutrition had opportune multi-sector platforms of the SUN networks available for programming whereas Tobacco Control situated within the health ministry struggled with mandate to steer multi-sector programming and unlock resources held by other sectors. Fourth, we found that horizontal coordination across sectors itself requires dedicated resourcing and capacity which was overlooked.
The Pakistan case study adds to contextual insights on success and failure of multisector governance for nutrition providing an analytical contrast with a similar multi-sector issue of tobacco control. We conclude that the process of how multi-sector programming for adolescent nutrition is brought about within countries is equally important as the prescriptive content of globally advocated interventions. We also identified key elements of a pathway to more effective programming that include attention to i) inclusive framing for its domino effect on coalition building, ii) ensuring diversity within core coalitions; iii) an organisational home outside the health sector for programming across sectors; iv) dedicated resourcing for impactful coordination and oversight of multi-sector programming.