Background: Malnutrition remains a significant public health issue in Kenya. Multisectoral Nutrition Governance (MNG) is increasingly being acknowledged as a catalyst for enhancing nutrition programming and outcomes. Effective MNG establishes policies, systems, and mechanisms that enable coordinated, adequately funded, and sustainable nutrition actions across sectors; however, its understanding and progress assessment remain inadequate. Objective: This study aimed to qualitatively assess the status of MNG and propose strategies to strengthen MNG mechanisms for improved nutrition actions and outcomes in Kenya. We hypothesized that effective performance across the MNG domains is associated with effective multisectoral nutrition actions and improved nutrition outcomes. Design: This study used a qualitative design to assess the MNG status over the past 10 years (2012–2023). Nineteen program managers and officers from government and non-governmental institutions implementing nutrition at the national level were included. Data collection was conducted between January and March 2024 through key informant interviews (KIIs). Thematic analysis, guided by both inductive and deductive coding, was carried out using MAXQDA (Maximizing Qualitative Data Analysis) software. Results: The findings indicate progress in strengthening MNG in the previous decade, though gaps persist. The progress was driven by improved political awareness and commitment, the adoption of nutrition policy and planning frameworks, and improved coordination. Constraints that impede MNG progress include inadequate financing and over-reliance on donor funding, limited translation of commitments to actions, lack of unified monitoring and evaluation (M&E) systems and fragmented policies. Conclusions: Strengthening multisectoral M&E systems that allow timely collection and utilization of data, ensuring sustainable financing for nutrition, enhancing accountability mechanisms and improving coherence across sectors are important for further improvement of MNG.

Ethiopia has demonstrated a commitment to tackling the high burden of Food and Nutrition Security (FNS) challenges by developing and implementing various policies, strategies, and programs. Despite the efforts, the current FNS situation is of significant public health concern observed by various nutrition indices. The narrative review aimed to appraise multisectoral policy, strategic and programmatic initiatives aimed at addressing FNS challenges and identify entry points for enhancing coherent and integrated FNS approaches. The review involved broad literature research using Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. A total of 1,086 articles and grey literature were identified. Out of this, 47 full-text articles and documents met the selection criteria and were included in this review. Evidence was synthesized in themes to characterize the successes and challenges of key FNS policies, strategies, and programs and identify potential areas of improvement to enhance multisectoral actions and address FNS challenges. Overall, Ethiopia has made considerable progress in enhancing FNS through the implementation of a range of FNS policies, strategies, and programs such as the National Nutrition Program (NNP), Productive Safety Net Program (PSNP), and Agricultural Growth Program (AGP) among others. These efforts have resulted in notable achievements, such as the reduction of the prevalence of undernourishment from 47.0% in 2000 to 24.9% in 2020 and the reduction of stunting among children under five years from 57.4% to 35.2% over the same period. Nonetheless, the pace of progress has been hindered by various contextual and programmatic challenges such as climatic shocks, poverty, high inflation, political instability, limited access to production resources, inadequate coverage of FNS interventions, inadequate financing, and inadequate multisectoral coherence and integration. A comprehensive and integrated multisectoral FNS approach focusing on enhancing commitment, planning, coordination, financing, capacity building, and accountability across sectors and levels is imperative. Strengthening coherence across various sectors, alongside the operationalization of robust multisectoral monitoring and evaluation systems highlighted in the National Food and Nutrition Strategy, constitutes the most suitable entry points for ensuring sustainable advancement in mitigating the prevailing FNS challenges in Ethiopia. Key words: Food and nutrition security, policy and program, multisectoral approaches, Integration, Ethiopia

Objective: Multisectoral nutrition governance (MNG) is a vital enabling determinant of improved nutrition outcomes. Despite this, it remains to be a complex phenomenon that lacks adequate understanding, especially in developing countries like Kenya. This narrative review aims to discuss the evolution of MNG, the current state of MNG, barriers and challenges, and based on these identify entry points for improvement within the complex governance structure in Kenya. Design: The Peer Review of Electronic Search Strategies (PRESS) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to ensure rigorous and transparent identification of literature and interpretation. Setting: Kenya and developing countries with similar contexts. Participants: The review included forty-five documents (peer-reviewed articles and grey literature) that reported on MNG in developing countries. Results: We acknowledge that MNG is a complex and evolving determinant of better nutrition outcomes. The paper highlights challenges Kenya and other developing countries face such as inadequate leadership, inadequate coordination, insufficient capacity, inadequate monitoring and evaluation systems, and limited financial resources, among others. For Kenya in particular, there is inadequate understanding of what MNG is and how it can be effectively operationalised and tracked. Conclusions: To enhance understanding of MNG in Kenya, a country-specific assessment of MNG processes and impact outcomes using standard tools and defined metrics is vital. Such assessment will generate evidence of progress, successes, and challenges that will compel the government and stakeholders to invest more in multisectoral nutrition approaches to achieve its nutrition goals.

Background: Kenya has shown progress in social, economic, and health indicators over the past 2 decades. Yet, malnutrition remains a critical public health issue. Effective Multisectoral Nutrition Governance (MNG) is an enabling determinant of nutrition ensures that nutrition policies are well-coordinated, adequately funded, and effectively implemented, leading to better nutrition outcomes. Objective: Our study assessed the status, evolution, and factors associated with MNG in Kenya using a cross-sectional design at 2 distinct time points (2012 and 2023). The 2 distinct time points provided valuable comparative perspectives allowing for the assessment of progress and trends in MNG allowing further analysis. Methods: The study targeted 96 government and nongovernmental staff from eligible ministries at the national level. It used a structured closed-ended questionnaire adapted from a validated Nutrition Governance Index. Results: Our findings reveal an improvement in MNG status, from 58.4% in 2012 to 71.1% in 2023 ( P < .01). The 6 MNG domains demonstrated varying performance levels, with mean scores ranging from 3.1 to 4.0 (out of 5). Despite the performance variation, the domains contributed equally to the MNG status. A positive relationship was found between the MNG score and respondent affiliation with the Ministry of Health and the level of prioritization of nutrition in a ministry ( P < .05). Conclusions: Further efforts are needed to strengthen specific MNG domains, particularly nutrition financing, transparency, accountability, and capacity, to ensure progress in tackling malnutrition in Kenya. These findings can inform efforts to enhance MNG strategies to improve nutrition outcomes sustainably in Kenya.

Effective Multisectoral Nutrition Governance (MNG) is critical for addressing the complex determinants of malnutrition. However, evidence on how key governance functions influence governance outcomes over time remains limited, particularly in low- and middle-income countries. This study assessed the status, evolution, and drivers of MNG in Kenya from 2012 to 2023. It examined how commitment, capacity, and mechanisms for action explain current MNG status and perceived improvements over time. A retrospective cross-sectional study was conducted using a validated MNG assessment tool. Respondents assessed current governance conditions in 2023 and retrospectively for 2012. Quantitative data were collected from 112 respondents across government and nongovernmental sectors. Descriptive statistics were used to assess governance trends. Wilcoxon Signed-Rank Tests and multiple linear regression were used to examine changes in MNG over time and identify factors associated with MNG outcomes. Relative importance analysis quantified the contribution of each governance theme. A total of 96 out of 112 respondents completed the survey. MNG status improved significantly from 58.4% in 2012 to 71.1% in 2023 (P < 0.01). Significant improvements were also observed across MNG themes; commitment (r _b = 0.68), capacity (r _b = 0.61), and mechanisms for action (r _b = 0.67). Relative importance analysis indicated that capacity accounted for the largest share of explained variance (35.5%), followed by mechanisms for action (33.2%) and commitment (31.2%). However, the overlapping confidence intervals indicated that all 3 themes were comparably associated with variations in MNG status and improvement over time. Kenya has made significant progress in strengthening MNG over the past decade. Although commitment and mechanisms for action remain essential, the capacity theme reflects the operational conditions through which governance improvements are implemented. Continued investments in institutional and operational capacity, including predictable and sustainable financing, are therefore important for sustaining and consolidating governance gains.