Multisector governance for nutrition and early childhood development: Overlapping agendas and differing progress in Pakistan

Shehla Zaidi, Zulfiqar Bhutta, Syed Shahzad Hussain, Kumanan Rasanathan

Research output: Contribution to journalArticlepeer-review

19 Citations (Scopus)


This paper compares the policy trajectories of Nutrition and Early Childhood Development (ECD) in Pakistan, identifying enablers that led to better multisector progress for Nutrition over ECD. Specifically, it deliberates on (1) multisector policy adoption in terms of instigation, construct and stakeholder coalitions; and (2) horizontal coordination in terms of capacity, incentives and structures. The analysis builds on existing work of the authors, supplementing this with further document review and expert insights. Nutrition and ECD initiatives in Pakistan, while overlapping agendas, differed in terms of buy-in and structural grounding. A favourable policy window for Nutrition was successfully managed through coordinated advocacy, programmatic support and investment in networks, while capture of policy opportunities was not seen in case of ECD. A vague construct for ECD confined its activities narrowly to the education sector while a Nutrition discourse specifying roles for other sectors resulted in a broader coalition and expanded activities. Both Nutrition and ECD faced powerful disincentives to coordination, but Nutrition overcame this through cofinancing of different sectors and creation of structural platform in supraplanning ministries. Both Nutrition and ECD share common capacity constraints for horizontal coordination, raising concerns for effective implementation. We conclude that multisector action for child well-being requires deliberative action and investment to unlock opportunities. The analysis from Pakistan highlights four governance areas for progressing multisector action: (1) opportune management of policy windows; (2) a clear and inclusive menu of actions for stakeholder coalitions; (3) availability of cofinancing and structural platforms for catalysing coordination; and (4) investment in horizontally placed human resource and integrated tracking systems.

Original languageEnglish
Article numbere000678
JournalBMJ Global Health
Publication statusPublished - Oct 2018


Dive into the research topics of 'Multisector governance for nutrition and early childhood development: Overlapping agendas and differing progress in Pakistan'. Together they form a unique fingerprint.

Cite this