Enhancing Multi-Sectoral Coordination and Collaboration Through the CHAIN Project

Importance of Multi-sectoral Nutrition

The 2013 nutrition series by The Lancet argued that to achieve global targets for reducing undernutrition, there must be a multi-sectoral approach that includes scaled-up, proven nutrition-specific and nutrition-sensitive interventions such as agriculture. The need for cross-sector collaboration was further outlined in the publication of the USAID 2014-2025 Multisectoral Nutrition Strategy, which states that “Multisectoral coordination along with collaborative planning and programming across sectors at national, regional, and local levels are necessary to accelerate and sustain nutrition improvements (USAID 2014).” It is therefore important to determine how implementing partners and donors can work better with each other and national governments to optimize nutritional outcomes. One country where strong efforts are being made to support multi-sectoral coordination and collaboration is Rwanda.

Nutrition Situation in Rwanda and USAID’s Response

Chronic malnutrition rates in Rwanda have remained stubbornly high, with 38 percent of children under the age of five being stunted, according to the 2015 DHS survey. These rates reach even higher levels among rural and impoverished children in Rwanda, with stunting as high as 41 and 49 percent, respectively (DHS 2015). Rwanda is a priority country under USAID’s Feed the Future initiative which provides funds to those countries around the world with the highest rates of chronic malnutrition and poverty. USAID Rwanda works in close partnership with the Government of Rwanda (GOR) to advance the objectives outlined in its vision under Feed the Future to reduce poverty and improve nutrition and economic growth.

In order to meet the dual Feed the Future objectives of “inclusive agriculture sector growth” and “improved nutritional status” several USAID Missions have been working to strengthen multi-sectoral coordination and collaboration between, among and across partners and sectors. USAID Rwanda is dedicated to finding multi-sectoral solutions to address undernutrition (USAID 2015). This commitment is illustrated in USAID Rwanda’s Country Development Cooperation Strategy (CDCS), in which two of the four Development Objectives (DO) explicitly relate to nutrition (see figure 1). The Mission and the activities it funds are currently developing strategies and implementation plans for multi-sectoral coordination for nutrition.

Figure 1. USAID Rwanda Results Framework

*Two of the DOs related to nutrition are illustrated with the green circles. Feed the Future falls under IR1.1, contributing to DO1. CHAIN falls under DO3. Together they impact USAID Rwanda’s goal of accelerating the country’s progress to middle-income status and improving its people’s quality of life through growth and poverty reduction.

The Community Health and Improved Nutrition (CHAIN) Project

The Community Health and Improved Nutrition (CHAIN) Project Appraisal Document (PAD) authorizes a suite of health and nutrition activities implemented by USAID Rwanda. With a five-year mandate (2014-2018), CHAIN’s overall goal is the same as IR 3.2: to improve the health and nutritional status of Rwandans through increased utilization of quality health services/products by target populations and communities. The implementing mechanisms within CHAIN fall under the Health, Economic Growth (Feed the Future), Education, and Democracy & Governance offices. CHAIN activities are designated as either “CHAIN-authorized” or “CHAIN-contributing.” As the name implies, CHAIN-authorized activities are implementing mechanisms authorized under the CHAIN PAD. However, as the CHAIN PAD was being developed, the Mission realized that activities that contributed to CHAIN’s overall goal had already been authorized under other PADs. These activities are considered CHAIN-contributing. See annex 1 for a list of all activities authorized by or contributing to CHAIN.

CHAIN has a project management team (PMT) comprising the Agreement Officer's Representatives/Contracting Officer's Representatives (AORs/CORs) who manage the implementing mechanisms. The CHAIN PMT ensures collaboration between the technical offices and among the activities contributing to and authorized under the CHAIN PAD. The Mission has made an effort to systematize how the CHAIN PMT will operate through a team charter and has drafted project management roles and procedures.

The GOR has a significant role in coordinating development initiatives across a range of donors, including USAID. Due to its considerable involvement, the Mission collaborates with the government to achieve CHAIN’s overall goal and to design the activities included in the CHAIN PAD. The CHAIN project provides a unique platform for documenting a range of approaches and lessons about coordination and collaboration, as both the Mission and the activities it funds are developing strategies and implementation plans that aim for this.

SPRING’s Review of CHAIN

In February 2016, SPRING staff traveled to Rwanda to help strengthen the Mission’s vision, plans, and approaches for coordination and collaboration of technical sectors, implementing partners, and other nutrition stakeholders. As part of the process, SPRING conducted a document review and semi-structured interviews with USAID Mission staff and implementing partners. SPRING interviewed staff from 15 CHAIN implementing partners, including five partners in Huye and Nyanza districts (see annex 2). SPRING also attended the first CHAIN partners meeting, sharing preliminary findings and prioritizing outcomes that the partners would like to see from CHAIN's efforts.

CHAIN’s project work plan began in October 2015. Because SPRING conducted the review during this initial implementation stage, findings were limited to the benefits and challenges that often occur during collaboration start-up phases. The district-level findings reflect what was discussed in Huye and Nyanza and therefore may not be generalizable to all of the districts where CHAIN implementing partners work.

The Rwanda findings will complement similar work conducted by SPRING in collaboration with USAID Guatemala and USAID Bangladesh. SPRING will draft a report based on the use of similar questionnaires and frameworks to analyze and compare findings across all three countries. SPRING used the Garrett conceptual model¹ for working multi-sectorally to formulate interview questionnaires and analyze responses (Garrett et al. 2011). Garrett states that successful collaboration relies on factors related to the internal and external context and on the nature of the mechanisms and structures that link organizations. The model also provides definitions differentiating coordination and collaboration, which resonated with respondents during interviews in Rwanda (see box 2).

Findings

The SPRING review process revealed a number of opportunities and challenges for CHAIN.

Opportunities

Mission staff and partners perceive that benefits of coordinating and collaboration often outweigh the costs.

• As a result of CHAIN, Mission staff work together on activity design. During the design phase of CHAIN activities, multiple offices contributed to discussions about target populations, interventions, and activity results. Many said that CHAIN allowed them to work directly with people who they might not have otherwise, which has led to more multi-sector activity designs and innovative ideas. Traditional agriculture activities, for example, are now incorporating nutrition and health components and thinking about alternative target populations due to CHAIN’s cross-sectoral design teams.
• There is general agreement that coordination has helped the USAID partners to know what others are doing and to avoid duplication of efforts. An orphans and vulnerable children (OVC) activity said that through meetings with other partners they realized that they were targeting the same households as another health and nutrition focused activity. They corrected this situation and now provide referrals across activities that have the potential to deepen the quality of services for shared target populations.
• Partners, particularly those at the field level, said that collaboration allowed them to leverage networks and resources and provides opportunities for innovation. Many partners provided examples of sharing training and other activity materials so that others can reuse or adapt them for their own purposes. Partners held a meeting to discuss a monitoring and evaluation (M&E) tool to monitor the quality of interventions. Instead of each activity reinventing tools, they created a platform to share tools developed by various activities that could be adapted. At the end of the meeting they decided to form a technical working group so they can continue sharing these materials.
• CHAIN may allow USAID Rwanda and the activities under CHAIN to talk about nutrition in one voice to gain greater credibility than they would alone. Mission staff reported that coordinating activities would provide an opportunity to discuss nutrition with a unified voice and allow them to talk more comprehensively about how USAID is improving nutrition in Rwanda. Many partners also felt strongly that CHAIN could increase their credibility as a cohesive unit and enhance their influence with the local government (more than they would individually) if they were seen as working together to achieve a common goal.

CHAIN can augment coordination platforms that are already in place at the national and district levels.

• Many partners would like CHAIN to address gaps they’ve identified in the current coordination mechanisms.
  • The National Food and Nutrition Technical Working Group (NF&NTWG) already convenes many of the activities in a regular forum. The NF&NTWG members represent a variety of technical areas and work across different geographic regions. However, there are many attendees and the current platform does not allow participants to delve into the level of detail required to facilitate learning or to identify strategic areas of collaboration.
  • The partners regularly participate in the Government of Rwanda-led Joint Action Development Forum (JADF) and meetings on the District Plan to Eliminate Malnutrition (DPEM) but want additional structures in place to facilitate collaboration.
  • The JADF has ‘open days’ that CHAIN could learn from. Similar to the NF&NTWG, which operates only at national/central level, the quarterly district-level JADF meetings are quite large and do not stimulate cross-activity learning because they focus primarily on providing updates to district officials. However, many partners mentioned the open days, which provide a platform for all development partners to discuss interventions. This lets partners learn about innovations that they could incorporate or adapt for use in their own programs. Several partners stated that CHAIN could establish a similar structure, focusing on lessons learned and sharing across activities.

Challenges

Turning the CHAIN PAD into a management tool requires additional thinking on management and operational strategies.

Operationalizing CHAIN

• While there is consensus on CHAIN’s overall goal, there is no clear strategy specifically for supporting coordination and collaboration. The CHAIN PMT team charter includes a work plan for the first year of implementation, with objectives and team operations specific to the PMT. It does not outline how partners are expected to coordinate or collaborate. Most partners were unfamiliar with CHAIN’s overall purpose and their role in the project, which was not particularly surprising because at the time of the review CHAIN had not officially launched. Still, it is critical that all partners gain a clear understanding of CHAIN mechanisms, goals, and approach to collaboration. This will require specific awareness-raising efforts for partners and other stakeholders. A few ideas for raising awareness and buy-in among partners may include:
  • Establishing regular meeting schedules at the various organizational levels expected for partner coordination and collaboration (e.g. district, regional national), as decided by the CHAIN PMT and partners.
  • Identify one or more communications strategies (e.g. brochures or shared talking points) for sharing the CHAIN vision so that all relevant stakeholders – at all levels of operation - have the same understanding of what CHAIN is and how it is functioning to support coordination and collaboration.
  • Establishing a short-term working group to: develop the content defining the CHAIN mechanism,/goals/approach, brainstorm who needs to understand this and why, and share this information among targeted stakeholders.
• The partners would appreciate more concrete guidance from the Mission on what the strategy and expectations are for coordinating and collaborating and how they will be held accountable. Motivation to collaborate is often tied to clear expectations, as well as a vision for where those efforts will eventually lead (Garrett 2011), and partners want USAID Rwanda to explain what it wants them to do and why. If the Mission decides to use the PAD as a management tool, it will need to orient partners to CHAIN’s overall strategy for coordination and collaboration and how they fit within it.
• There are no defined intermediate outcomes for coordination or collaboration. The current CHAIN results framework adds up the individual activities’ objectives and interventions to reach the project’s goal: to improve the health and nutritional status of Rwandans via increased use of quality health services/products by target populations and communities. However, the framework does not illustrate how coordination or collaboration will contribute to that goal. Without explicitly measuring coordination or collaboration, it will be difficult to know if activities are on track and if there is a need to revise approaches during implementation.

Accountability and recognition

• Participation in the CHAIN project management team (PMT) is not obligatory so it may be difficult to ensure accountability and recognition among those who participate. The CHAIN project manager is the only Mission staff member who has CHAIN work included in his/her job description. While PMT members have clear responsibilities associated with acting as an AOR or COR, it is not clear what one needs to (or is required to) do regarding coordinating with others in the Mission because it is not indicated in work objectives or detailed in a Mission order. The CHAIN project manager also has no supervisory authority over the PMT members, so it will be difficult for her/him to assign them tasks. If participation by CHAIN PMT members is determined as crucial, it will be important that participating members are provided clear guidance regarding their roles and responsibilities, are recognized for their contributions, and accountable for their obligations. Top level support from Mission leadership would assist in both defining these expectations and keeping them relevant to PMT members’ jobs/responsibilities.
• Partners and Mission staff alike consider coordination secondary to their work, resulting in related efforts not being prioritized. Just as PMT participation is not included in Mission staff work objectives, coordination and collaboration efforts are not written into the majority of CHAIN activity work plans. Apart from the Integrated Nutrition and Wash Activity (INWA), no other implementing mechanism’s contract or agreement explicitly states a responsibility or obligation to support coordination or to work toward common objectives with other activities. This is directly related to the lack of intermediate outcomes defined for coordination and collaboration. If partners are not mandated by their agreements or contracts to spend time and resources collaborating with others, they are unlikely to prioritize such efforts.
• AORs and CORs traditionally focus on individual activity results instead of how their activities contribute to a larger goal. Several members noted the difficulty of shifting the focus on individual activities to the bigger picture of how all the activities together improve community health and nutrition. CHAIN partners also exhibit this mindset, as several activities noted that they do not need to coordinate or collaborate to achieve their project goals. The CHAIN PMT should look at how each activity contributes to the larger picture. This would encourage activities to focus on their own strengths and leverage the expertise of other activities, instead of focusing exclusively on their own nutrition objective or outcome.
• There is no current strategy to capture the learning that may come out of CHAIN. Many Mission staff think that CHAIN has the potential to be a prototype of multi-sectoral program design and management. Learning from this effort could inform the management of future PADs, coordination efforts between USAID implementing partners, and cross-sector issue ownership. However, there isn’t a formal structure in place to systematically capture and share this learning. The Mission does have a collaborating, learning, and adapting (CLA) plan related to activity design and evaluation. It also developed a tool to determine whether or not an evaluation is necessary, and if so, how to design it. There’s also an internal evidence and data library that has links to Rwanda-specific statistical reports. While these may provide better data for both evaluation and activity design, they do not address CHAIN’s coordination and collaboration efforts. If the Mission proceeds with its plan to hire a knowledge management specialist, it would be helpful to ask that person to consider how to incorporate a CLA plan for CHAIN in addition to the work-related to activity design and evaluation.

Partners often experience communication challenges within their organizations.

• The criteria to select CHAIN-contributing activities are not well-defined. All CHAIN activities relate to community health and nutrition. However, there are activities supported by USAID Rwanda that contribute to a community health and/or nutrition objective that do not fall within CHAIN’s purview. It is important to review the criteria for what constitutes a CHAIN-authorized versus a CHAIN-contributing activity. This would help partners find opportunities for collaboration and complementarity regardless of inclusion in the CHAIN PAD.
• The relationship between the Feed the Future and CHAIN PADs is not clear across Mission offices. In Rwanda, the main objective of Feed the Future is to increase small farmers’ income and promote food security. Feed the Future-funded activities primarily aim to increase agricultural productivity, advance economic growth, improve access to more nutritious foods, and increase the use of essential nutrition actions. CHAIN focuses on both nutrition and community health. The link between the Feed the Future and CHAIN PADs therefore centers on the nutrition objective (see figure below). The association between the two PADs is well understood, but there appears to be confusion in how that link translates to the different activities and whether they are (or are not) expected to work together. Feed the Future-funded activities that are not included in CHAIN may contain a nutrition mandate. CHAIN’s strategy for coordination and collaboration across partners (both authorized and contributing) could also encompass investments under Feed the Future. Similar to clarifying which activities fall under CHAIN, detailing how activities (and AORs/CORs) across the two PADs relate could build synergies that may have otherwise been overlooked.

Recommendations

SPRING structured its recommendations on the opportunities and challenges identified in the document review and interview process. Each suggestion falls under one of the following four main recommended areas:

• Define, document, and communicate the CHAIN strategy and expectations to partners and Mission staff.
• Provide partners with guidance to coordinate and measure those efforts.
• Develop plans to address gaps between Feed the Future and CHAIN, and CHAIN-authorized and CHAINcontributing partners.
• Establish a CLA strategy for CHAIN.

Effective collaboration is integral to the success of multi-sectoral projects like CHAIN (Garrett 2011). Research suggests that effective and efficient coordination is built on a common sense of purpose (Seidman and Gilmour 1986; Alexander 1995; Bardach 1998). Many of the provided recommendations can help USAID Rwanda create a common sense of purpose across the Mission and its partners, generate a shared language for discussion, and a mutual understanding of what is expected of all CHAIN participants.

USAID Rwanda should use existing materials when acting on any of the recommendations below, as there are many Mission resources to refer to and build upon: the CHAIN PAD, CHAIN project maps, CHAIN team charter, and the associated project management roles and procedures document. Coordination and collaboration require a well-defined, well-supported approach, which takes time. For this reason, it is important to identify which areas should be undertaken immediately and which can be addressed in the long-term. SPRING has included suggestions for this phased approach, incorporating observations from the debrief with USAID Rwanda and previous experience with other Missions. Please refer to annex 3 for a complete list of challenges and corresponding recommendations.

Define, document, and communicate the CHAIN strategy and expectations to partners and Mission staff

1. Define, document, and communicate the CHAIN strategy for coordination and collaboration to partners.
   • A strategy should impose a time limit and result in a realistic outcome (so that people see concrete results of their efforts) (Garrett 2011). The CHAIN goal of improving health and nutritional status of Rwandans is critical, but defining one or more short-term attainable goal(s) could motivate CHAIN partners. Defining intermediate outcomes might also help the implementing mechanisms set priorities for what types and levels of action partners should work on and will help clarify where time and resources should be spent.
   • The CHAIN team charter already has the FY16 work plan, which could be expanded to include how CHAIN partners are expected to coordinate and collaborate over a specific time period (e.g., joint site visits and work planning, shared nutrition messages, mutual trainings) to support the intended results. The Mission should review the initial outcomes list generated by the CHAIN partners at the March 4th meeting (see annex 4) and determine which of these (or others) it would like to see as a result of the partners working together. This is important because partners may be more motivated to work on a strategy that they helped develop (Garrett 2011).
   • The strategy should reflect considerations at both central and district levels. This is important because coordination and collaboration occur primarily at the district levels and are led by those guiding the implementation of the JADF and DPEM.
   • Developing CHAIN’s strategy for coordination and collaboration will help shape many of the additional recommendations: communicating the CHAIN strategy and expectations to partners, setting realistic goals, and establishing the relationship between CHAIN and Feed the Future. For this reason, CHAIN should prioritize completing a strategy exercise this year.
2. Request regular input from partners to make sure that all voices are heard and that everyone understands how to provide feedback to the Mission.
   • As part of the quarterly review process, AORs/CORs could check in with their implementing partners to troubleshoot problems that may arise during coordination and collaboration efforts. This could also include surveys before and after CHAIN partner meetings, similar to the one circulated after March 4th.
   • Several partners are interested in providing input into CHAIN meeting agendas. Some meetings could even operate as a series of brown bags with different partners co-presenting on how their activities are working together, or a technical topic that the partners find relevant to their work.
3. Include CHAIN PMT participation in work objectives to ensure accountability and recognition among its members. Include language on accountability and performance recognition in the draft project management roles and procedures document. It is crucial that all AORs/CORs of CHAIN-authorized mechanisms participate in the CHAIN PMT. As the CHAIN project manager has proposed, the Mission may consider a more robust approach to roles and responsibilities, such as a mission order on project management. This would clarify the role of the project manager and host office and their relationship with the contributing offices specific to project management, design, and reporting.

Provide partners with guidance to coordinate and measure efforts

1. Expand mapping exercise beyond geographic coverage to include all CHAIN partners. The current CHAIN project maps include the location of the health-funded activities under CHAIN. USAID Rwanda should expand these maps to include all CHAIN activities, both authorized and contributing, regardless of which office funds them. The maps should incorporate additional information such as activity interventions and indicators to identify potential areas of collaboration among activities in the same district. Many partners would like USAID to coordinate the CHAIN collaboration effort because USAID Rwanda sees the big picture, and activity staff are not always certain where they fit. However, the Mission must map the full puzzle of activities before each implementing mechanism can see how it relates to others and how it might benefit from connecting.
2. Provide guidance to partners during coordinated annual work planning. At this time, it would be impractical for activities to develop entire work plans together. However, it might be useful to set aside time at certain CHAIN meetings or one-on-one AOR/COR meetings with partners to align work plans (e.g., to reflect specific collaboration and coordination activities in each partners’ work plan, as relevant) and include deliverables and goals for the year. This would ensure that the CHAIN coordination/collaboration strategy is reflected in CHAIN partner work plans through deliverables with discrete timeframes and budgets. This might also ease the conflict between partner contracts/cooperative agreements and the expectation to collaborate, as they would be held accountable for working together and have the collaboration detailed in their approved work plans.

Develop plans to address gaps related to Feed the Future and CHAIN, and CHAINauthorized and CHAIN-contributing partners

1. Discuss and document how CHAIN and Feed the Future will work together to achieve nutrition results. USAID Rwanda should create a detailed activity matrix that incorporates all CHAIN and Feed the Future implementing mechanisms, including information already captured by the CHAIN maps. Agriculture activities that incorporate explicit nutrition objectives are more likely to maximize positive nutrition impact and minimize harm than those that do not (FAO 2013). All Feed the Future activities that have a nutrition objective may be implementing interventions that are related to CHAIN activities in the same geographic area. If USAID Rwanda avails this information in one place, (i.e., the activity matrix), it can distinguish how activities in the two PADs may be related and identify particular areas of collaboration across them. Feed the Future activity members who do not attend the CHAIN partners meeting could participate when relevant (e.g., to provide an “agriculture 101” overview to the partners, share an example of a successful collaborative pursuit with a nutrition or community health-focused activity, or present materials used for cross-training of staff).
2. Review the list of all CHAIN activities and determine criteria for CHAIN-contributing. Similarly to what should be done for Feed the Future, USAID Rwanda should ensure that CHAIN participants (both authorized and contributing) have a nutrition or community health objective. If the division between CHAIN-authorized and CHAIN-contributing influences CHAIN participation or requirements, the Mission should clarify the distinction. This would include criteria for what constitutes each characterization and the different expectations or responsibilities for coordination and collaboration associated with each. This is especially important if USAID Rwanda plans to add or remove any CHAIN-contributing activities in the future. Due to the confusion many partners expressed on CHAIN and their relationship to it, it is important to review the list of activities and decide what types of activities may be missing.

Establish a CLA strategy for CHAIN

1. Create a plan to capture learning at the Mission level. Learning is constant, but not necessarily systematically planned or adequately supported. As a result, learning is infrequently facilitated and not typically viewed in ways that are strategic or can maximize results (USAID Learning Lab, 2014). If other PADs within the Mission intend to emulate a similar model to CHAIN, USAID Rwanda should document CHAIN’s process and disseminate knowledge about the challenges and successes to improve the process in the future. Some Missions have brought on CLA/organizational learning advisors or increased/revised the responsibilities of current M&E staff to support learning objectives (USAID Learning Lab, 2014). USAID Rwanda is considering hiring a knowledge management specialist to assist the program office. This person could be a CLA coordinator or point of contact to help the Mission establish learning processes for regularly reviewing and analyzing CHAIN’s processes (e.g., outputs from the PMT meetings and feedback from the CHAIN partner meetings, challenges facing the CHAIN Project Manager, involvement and commitment of cross-sector offices). The person could also be responsible for developing contingency plans and revising approaches as necessary, as well as disseminating these findings within USAID. Several Mission staff also prioritized creating a CLA plan for CHAIN at SPRING’s debrief.
2. Establish a process for sharing learning and knowledge between partners. The CHAIN partner meetings are an obvious forum for peer exchange. With a collectively developed format, partners could convene regularly to discuss their work and new information. This would enable the group to attain identified coordination and collaboration outcomes; conduct joint technical assistance visits, create shared tools, and identify areas for future collaboration. USAID Rwanda’s support will help the partners to have time for these discussions and prioritize communication among the implementing mechanisms. Regular discussions focused solely on learning may even decrease repetitive information gathering, such as multiple baselines or focus groups with the same beneficiaries. This might decrease survey fatigue among beneficiaries, too.
3. Require partners to report on coordination and collaboration efforts. It may be difficult to revise contract requirements to embed coordination and collaboration learning objectives. Partners might instead include vignettes or short case studies highlighting specific collaborative actions/events with other CHAIN implementing mechanisms in their quarterly reports. This should include coordination processes at the district level. It will be important to determine which staff person would be the most suited to documenting these processes from the beginning and creating a follow up system as well.

Conclusion

SPRING’s review of CHAIN revealed a number of coordination and collaboration opportunities and challenges that the Mission and its partners encounter. Many of the opportunities suggest that USAID Rwanda is in a strong position to formally incorporate a coordination and collaboration strategy to strengthen CHAIN implementation. The recommendations in this document could help the Mission mitigate the challenges. With planned and deliberate coordination and collaboration, CHAIN can harmonize its activities, serve as a model for other Missions, and reach its goal of improving the health and nutritional status of Rwandans.

To view the annex, please download the full report above.