Utilize the Right Actors

Addressing malnutrition requires a multisectoral response. Many participants agreed that the entire government must be involved and that each government body has a distinct,

specialized role to play.

Different ministries can be involved, depending on the type of intervention. If we do a complementary feeding intervention, we should work together with the WASH program. And join with a livelihood program to promote the food security, and with MAFF for home gardening to make food available and to MIME and Ministry of Commerce (MoC) for the fortified food. We also need Ministry of Information for mass media to make people aware and know how to change their behavior so together we can reduce stunting.

– Civil Society

The majority of participants said that the MoH, MAFF, and MRD were critical for an effective, multisectoral response. These three ministries, along with MoP, have been recognized in policy frameworks, such as the National Strategy for Food Security and Nutrition, 2014-2018, as being the core ministries for addressing nutrition in Cambodia. The second most important ministries were said to be: Ministry of Information (MIF), MOWA, and MEYS. According to a couple of participants, parliament also needed to be engaged.

MoH: For many participants, particularly those working in the health sector, MoH was seen as having primary responsibility for nutrition. According to one non-health sector government official, MoH plays a critical role in nutrition improvement: “…like Sub-decree 133 [which regulates the advertising and marketing of IYCF products]. And they have the breastfeeding program, and the counseling program, and the health center level.” MoH’s purview was said to entail both the health system and community service delivery through the VHSGs. Further, given MoH’s mandate, including those of individual departments, such as Health Promotion, MoH was considered to be responsible for preventive and curative nutrition services, and health

information and education.

MAFF: MAFF was said to be responsible for the first of the three objectives of the National Strategy for Food Security and Nutrition, 2014-2018: Food-insecure households increase

availability and access to food through more productive and diversified agriculture and livestock production, sustainable fisheries and forestry, and from non-agricultural employment and

income opportunities (31). According to a MAFF official, the ministry aims to achieve food security through agricultural productivity, diversification, and commercialization.

According to one health-sector government official, MAFF is responsible for ensuring children have quality foods, while MoH is responsible for ensuring these foods are eaten: “They

say from farm to fork. Farm is MAFF, and when you come to fork it is MoH.”

MRD: Participants identified MRD as the key government body responsible for implementing their number one identified priority action at scale—water and sanitation. One government official clarified that safe water is the role of MRD, and not MoH, while another official from MRD explained the ministry’s responsibilities, in comparison to MoH, in greater detail:

We are responsible for the rural water supply, hygiene and

sanitation. Anything on prevention, hand washing, safe drinking, and clean environment. But not treatment because treatment is under health. We provide education and behavior change to the people.

– RGC

MoP: Only a few participants—only funders and civil society, identified MoP as having a specific role in nutrition. MoP’s responsibility for nutrition was said to be related to food fortification. A few civil society actors mentioned having worked closely with MoP on salt iodization, and the fortification of fish sauce, as examples.

MIF: Because SBCC was one of the prioritized actions for implementation at scale, multiple respondents from all organization groups considered MIF’s support critical. MIF was said to be able to help people recognize the importance of addressing stunting by disseminating messages to the general public.

Mass media is important. We need support from the government [because it is] very expensive. They could talk to the owner of each channel, for example CTN [Cambodia Television Network]; the popular ones.

– Civil Society

MOWA: MOWA is not officially a member of the TWG-SP&FSN and does not participate in the NWG, but was cited by select members of all participant groups as an important ministry to engage. This was because of their focus on women and children and their local structures, such as their Women and Child Committees, which could be tapped for service delivery. A

government official cited MOWA as being able to engage women in home gardening, which would support household food security and diet diversity.

MEYS: According to participants, MEYS could be utilized in a few ways, such as by integrating nutrition topics into the school curriculum to increase awareness and improve knowledge. MEYS could also reach girls before they start childbearing:

At 15 or 16 years of age, the girl may drop out of school due to family issue. But when she finds a job or gets vocational training for a job she will already know: ‘I have to improve my health or my situation to contribute to my child.’

– RGC

As illustrated by one participant, others saw school campuses as a venue for teaching children skills that could benefit them at home.

Thailand teaches school gardening and we see their malnutrition rates are quite different. There are many factors, of course, but this is one thing they have been doing. Our education manager worked in Pakistan and he said the mothers would come to the school to learn gardening and the kids would go to school, so they targeted both at the same time and that worked really well.…Another thing that should be done more is

interlinking with WASH. Our programs do hand washing promotion with school children because children are like vehicles for change. They go home and say: ‘We did this.’

– Civil Society Another participant suggested that school campuses could be used as a venue for promoting healthy eating and hygiene practices by placing restrictions on the kinds of food available on school campuses.

Food vendors are allowed onto school grounds to sell food to children. So what are you feeding them? Is it a nutritious meal or not? Do you get the children to wash hands or not before eating?

– Civil Society

Parliament: A few participants from all participant groups cited parliament as a critical actor in the response. A government official suggested that parliament has the power to persuade the MoEF to allocate sufficient resources to nutrition, but that for this to happen, parliament must understand and accept the idea that investing in nutrition is critical for the country’s economic and human resource development. A funder concurred, stating that parliament can put pressure on the government:

…a champion at the parliament asking results, asking what the ministries are doing. Then maybe we will have the government spending more money on these issues. Like what's happening on HIV. A parliamentarian is asking about what is happening and asking for results. Policy makers are moving more now because they're getting pressure from upstairs.

– Funder

The framing of the issue most relevant to parliamentarians related to the economy.

You have to show them the intervention can have a good impact on the economy because they all look at the economy. They want their country to grow, to show people their lives are getting better. They don't want to hear public health results. You will have less stunting. What does that mean for them?

– Funder

One civil society actor cited the experience of effectively using parliament in other countries, such as Vietnam. But key would be to find the right parliamentarian committee, such as that for health.