What does an enabling environment for infant and young child nutrition look like at implementation level? Perspectives from a multi-stakeholder process in the Breede Valley Sub-District, Western Cape, South Africa

BACKGROUND: Breede Valley is a sub-district of the Cape Winelands district, Western Cape Province, South Africa. The administrative capital of the district is situated in the semi-rural town Worcester. Findings of a baseline survey in Worcester revealed poor infant feeding practices and childhood under- and overnutrition, with particular concern over high levels of stunting and low dietary diversity. Maternal overweight and obesity was high. These characteristics made the site suitable to study multi-sectoral arrangements for infant and young child nutrition (IYCN). The purpose of this study was to explore elements of an enabling environment with key stakeholders aimed at improving IYCN at implementation level. METHODS: Focus group discussions and interviews were conducted with representatives from two vulnerable communities; local and district government; higher education institutions; business; and the media in the Breede Valley. Audio recordings were transcribed and data were analysed with the Atlas.TI software programme. RESULTS: The participants viewed knowledge and evidence about the first 1000 days of life as important to address IYCN. The impact of early, optimal nutrition on health and intellectual development resonated with them. The IYCN narrative in the Breede Valley could therefore be framed around nutrition’s development impact in a well-structured advocacy campaign. Participants felt that capacity and resources were constrained by many competing agendas spreading public resources thinly, leaving limited scope for promotion and prevention activities. “People” were viewed as a resource, and building partnerships and relationships, could bridge some shortfalls in capacity. Conversations about politics and governance elicited strong opinions about what should be done through direct intervention, policy formulation and legislation. A lead government agency could not be identified for taking the IYCN agenda forward, due to its complexity. Participants proposed it should be referred to a local, informal, inter-governmental body where directors and senior managers meet to address issues of cross-cutting importance. CONCLUSION: The study illustrated that knowledge and evidence; politics and governance; and capacity and resources, elements of the international definition of an enabling environment, also apply at implementation level. In addition, our findings indicated that a people-centred approach is critical in shaping the enabling environment at this level.