Abstract
Background
The Nutrition Governance Indicator (NGI) defines a first standardized approach to quantifying the ‘quality of governance’ in relation to national plans of action to accelerate improvements in nutrition. It was created in response to growing demand for evidence-based measures that reveal opportunities and challenges as nutrition-related policies on paper are translated into outcomes on the ground. Past efforts to measure ‘governance’, most notably the WHO’s Nutrition Governance Indicator and Hunger and Nutrition Commitment Index (HANCI) lack granularity below the national level, and failure to capture pinch points relating to necessary cross-sectoral actions.
The NGI addresses these caveats. This paper introduces the approach that underpins the NGI, discusses its methodology and demonstrates its application in the context of Nepal.
Methods
The NGI was developed using principal components analysis techniques. The resulting score was standardized to a more intuitive scale ranging from 0 to 100, and categorized into quintiles. Cronbach’s alpha was used to test for reliability in addition to testing for goodness of fit using confirmatory factor analysis methods. The data used to derive the index were obtained from 520 participants in the Policy and Science for Health, Agriculture and Nutrition (PoSHAN) study, a prospective and nationally representative longitudinal survey conducted across 21 districts and three agro-ecological zones of Nepal.
Results
The NGI passed validity tests with the exception of two fit indices. Two of the six domains passed the reliability test (Understanding nutrition and Collaboration), the Financial resources domain marginally passed at 0.70 criteria of Nunally, while the remaining domains need re-assessment to improve their reliability. The Nepal Health sector showed the most improvement in mean NGI score over a two-year period followed by the Agricultural sector. About half of all health sector representatives were more likely to have a high score compared to other sectors (OR 0.52, 95% CI 0.36 – 0.74).
Conclusion
Using two panels of data collected in Nepal, this paper has shown that policy-to-action translation can be quantified and applied to sub-national institutions. These findings underscore the practical utility of the index and its importance to the nutrition policy realm.