Collaborating to solve society’s big issues – a new case study on tackling undernutrition in Ethiopia

"There is almost nothing worth doing that you can do just within your organisation, with resources that you have direct authority over", Professor Chris Stone said to a room full of senior Brazilian government officials.

"Leaders that try that tend to pick really narrow goals. In contrast, building coalitions across institutions and across structures that you don’t control allows public leaders to consider how to solve the big challenges society face".

For Chris, this was one of the key lessons from a new case study from the Case Centre on Public Leadership that looks at how a cross-sectoral approach to tackling undernutrition in Ethiopia contributed to lasting change. The case was used as a touchstone for conversation among around 50 Brazilian senior leaders from across the political spectrum who gathered at the Blavatnik School for the Lemann Foundation Programme’s Brazilian Leadership Forum. The case discussion was just one of the sessions where Brazilian public leaders had a chance to consider how to make change happen to achieve common goals over the coming years.

The case study, ‘Tackling undernutrition in Ethiopia through the Seqota Declaration’, focuses on the work of former Ethiopian Minister of Health Kesetebirhan (Kesete) Admasu in the mid-2010s as he tried to accelerate nutrition gains in his country. While Ethiopia had made significant progress in nutrition in the years prior to Kesete’s appointment in 2012, many challenges endured. Undernutrition indicators, notably stunting (a condition caused by chronic undernutrition), were still well above the African median, and poor nutrition was a significant cause of death among Ethiopian children, in addition to hampering the nation’s economic development. Meanwhile, the country’s existing nutrition programme was failing to deliver on promises of collaboration across the various federal ministries and local-government levels involved, and different sectors sometimes even worked at cross purposes.

But Kesete knew that the health sector alone could not effect change. Undernutrition had myriad causes, from food insecurity to lack of clean water. Kesete believed that other sectors, such as Agriculture and Water, needed to be at the centre of a new system of multisectoral, multilevel cooperation on nutrition that, unlike previous attempts, would work in practice and not just appear on paper.

His answer, in 2015, was the Seqota Declaration – a high-level political commitment to end stunting in Ethiopian children under the age of two by 2030. Six ministers, ranging from the women’s minister to the water minister, agreed to implement the declaration’s activities, while coordination would be conducted by new Programme Delivery Units (PDUs) at both federal and regional levels, comprised of technical experts from each sector. The federal PDU would then report back to ministers from the implementing sectors at fortnightly meetings, thus combining technical and political leadership.

Securing the support of the other sectors had not always been straightforward, though, and at one point, Kesete came to an impasse: he was struggling to get a fellow minister to attend the fortnightly meetings. This challenge became the focal point for the Brazilian delegation in the case discussion. In the classroom, participants considered and shared ways to get peers to collaborate on important innovations in the face of competing priorities. The strategies were varied, from offering to expand the activities to a region where the minister has a political interest to strategically using press conferences to highlight the minister’s absence, demonstrating the range of options available in lieu of formal authority over a fellow minister (although participants recognised that the different strategies may come with different costs).

Despite these early challenges with collaboration, the declaration proved to be remarkably successful. From 2016, Ethiopia saw considerable turnover in ministers – Kesete himself left his post that October – and the country faced a civil war, with conflict in areas the Seqota Declaration had targeted. And yet, the government still made progress on undernutrition. A 2021 study by Johns Hopkins University found a 15-19% decrease in stunting in targeted areas, with over 100,000 cases of stunting prevented and an estimated 1,000 child deaths prevented. For Kesete, the success came from continuity despite the leadership turnover. He commented, "When I left office, my immediate successor did not like the program. He was not opposed to it, but he was not taking initiative. Instead, the other sectors stepped up and then, when he left, the state minister who had been a part of writing the declaration took up the ministership and drove the program again".

For Dr Anna Petherick, the director of the Lemann Foundation Programme, the case study was a valuable addition to the Leadership Forum: "Generating coordination among decision-makers working in different departments of the central government, as well as in different levels of government, is one of the key characteristics of the case that made it a relevant and inspiring discussion for the participants. And despite these complications, over time, the Seqota Declaration successfully sustained policy progress in an area of acute human need".

If you would like to learn more about the case method, join our workshop in June. For more information, you can email the Case Centre at casecentre@bsg.ox.ac.uk