From Awareness To Action On The Nutrition And Epidemiologic Transition In Nigeria: The Role Of Policy Actor Perspectives And Strategic Capacity
Nigeria, like other low/middle income countries, is undergoing a nutrition and epidemiologic transition. An increasing burden of overnutrition and noncommunicable diseases (NCDs) now coexists with traditional problems of undernutrition and infectious diseases. The result is that overall morbidity and mortality in Nigeria is high, and there are greatly increased health care costs. The WHO and other global health authorities strongly advocate for a multisectoral government policy to address NCDs. Nigerian policy actors are aware of the need for this policy, and a public policy unit for NCDs has existed since 1989; still, there is no formal policy on NCDs. There are four components of policymaking - the actors, process, context and content. This dissertation assessed these four components in relation to NCDs in Nigeria. A Q-study was used to assess the perspectives of policy actors concerning NCDs, and semi -structured interviews were used to understand aspects of the policy process as well as the context of policymaking (strategic capacity). Furthermore, a descriptive epidemiological analysis of undernutrition and overnutrition in Nigeria was conducted to determine which subpopulations are at most risk for NCDs, and to identify important considerations for the content of a NCD policy. It was found that all policy actors appeared to consider NCDs as an important issue that must be addressed, but they seemed to disagree on how to address the issue. Yet, the policymaking context was not conducive for brokering conflict and building consensus. Also, the epidemiologic analyses revealed that groups that are highly vulnerable to undernutrition also have a significant prevalence of overweight; thus developing the policy content to address NCDs will be a complex undertaking. In contrast, the policy actors appeared to perceive the issue in a simplistic manner. Similar to these findings, the factors which were reported by policy actors to be contributory to the stagnation in the policy process were related to deficiencies of the actors and context, and the low awareness of the issue. For successful policymaking and action for NCDs in Nigeria, there is an urgent need to build strategic capacity and resolve the intricacies associated with the content for a NCDs policy.
Noncommunicable diseases; Nutrition policy; Strategic capacity
Pelletier, David Louis
Stoltzfus, Rebecca Joyce; Pinstrup-Andersen, Per; Devine, Carol M
Ph.D. of Nutrition
Doctor of Philosophy
dissertation or thesis