BackgroundIn response to high rates of undernutrition, Uganda began rolling out the multisectoral Uganda Nutrition Action Plan (UNAP) in 2011, followed by Phase II (UNAP II) in 2020. Uganda has since progressed toward several nutrition targets; however, limitations in nutrition coordination and financing call for continued strengthening of the UNAP II.ObjectivesGiven that monitoring of the UNAP II does not consistently capture district-level outcomes and relies upon quantitative nutrition indicators, this study aims to qualitatively assess nutrition stakeholder and community perspectives at the district level.MethodsFrom June to August in 2022, under an umbrella study utilizing community-based participatory research methods to train youth from Lira District in research, in partnership with the University of Southern California (USC) and community organization Children's Chance International-Uganda, these youth helped carry out an explanatory qualitative assessment consisting of 10 key informant interviews. Responses were compiled, transcribed, and analyzed using the Atlas TI software to code responses for thematic insights.ResultsParticipants highlighted several challenges with the UNAP II implementation at the local level. Mechanisms intended to promote multisectoral collaboration, such as district nutrition coordination committees, have been on hiatus due to limited funding; local governments experience funding disbursement delays and a lack of nutrition prioritization; and nutrition surveillance is limited by tools, training, and human resources.ConclusionsObtaining community perspectives revealed several gaps in local UNAP II implementation and demonstrates the importance of creating mechanisms for communities to continuously provide feedback for national policies like the UNAP II.
Keywords: CBPR; UNAP; Uganda nutrition action plan; community-based participatory research; malnutrition; nutrition policy; undernutrition.
Uganda implemented its first multisectoral nutrition strategy, called the Uganda Nutrition Action Plan, in 2011, followed by Phase II in 2020. The Uganda Nutrition Action Plan does not currently have its own mechanism of monitoring and evaluation. Instead, it relies on quantitative data from national health surveys to track levels of undernutrition. These data are not specific to each district and provide a helpful but incomplete picture of nutrition progress in the country. In order to gather local stakeholder perspectives of the Uganda Nutrition Action Plan, our research team facilitated interviews with key nutrition stakeholders in Lira District between June and August, 2022. We sought to understand how the Uganda Nutrition Action Plan's implementation has fared in 3 ways: multisectoral collaboration, funding, and surveillance of nutrition.Overall, participants described the Uganda Nutrition Action Plan's limited success at the district level. Mechanisms intended to promote multisectoral collaboration, such as district nutrition coordination committees, have been on hiatus due to limited funding. Furthermore, the local government frequently does not have enough nutrition funding due to disbursement delays and the nutrition budget being integrated into the budgets of other sectors. Finally, the district struggles to produce accurate and consistent nutrition monitoring due to inadequate surveillance tools, training, and human resources. Local perspectives in Lira District have uncovered several gaps in the implementation of the Uganda Nutrition Action Plan, and they highlight key recommendations moving forward. This study demonstrates the value of community-level insights on the implementation of national policies like the Uganda Nutrition Action Plan to promote measures that are effective, relevant, and made in partnership with the community.