Risks for Scaling Up Nutrition in Senegal

Senegal has one of the most effective and comprehensive nutrition service delivery systemsin Africa. Between 1991–92 and 2012–13, chronic malnutrition dropped from 34.4 percent to lessthan 20 percent. However, this progress has not led to stepped up nutrition-sensitive interventions in relevant sectors such as agriculture, education, water and sanitation, social protection, or health. This absence of nutrition-sensitive interventions, combined with aseries of external shocks (economic crises, increased food prices, and irregular rainfall), has resulted in a persistent fragmentation of approaches, discourse,and interventions. As a result, there is no comprehensive framework guiding nutrition investments in Senegal.


Acronyms
List of Tables

Objective
The objectives of this report are to identify potential risks associated with the implementation of the PSMN by category; their probability of occurrence; the effects they may have on Senegal's capacity to achieve the strategic nutrition goals; and to propose measures to mitigate the impact of these risks.

Methodological Approach
The risk analysis was based on reports of the series, (1) one-on-one interviews, (2) a survey questionnaire administered to sectoral ministries, and (3) benchmarks derived from several sources.

PSMN Implementation Context
The circumstances listed below are key aspects of the PSMN implementation context: ® Integrated multisectoral approach to nutrition poses challenges for governance: Implementation of the PSMN poses a major challenge with regard to the successful integration of all sectors relevant to nutrition policy and to the expansion of coverage. The organization and resources of individual ministries will need to be strengthened, and the institutional framework will need to be consolidated and endowed with sufficient authority to coordinate actions at sectoral and local levels.  ® Impact of this risk (Imp): What would be the severity of the impact if the risk appears?
The level of criticality is rated on a scale of 1 to 9 by the formula:

Cri = Exp × Imp
Summary and Classification of Risks

Methodological Approach
Literature review: The analysis of risks was based on: the reports of the series; the PSMN; documentation related to Senegal's strategic planning; and the evolution of public finance procedures, institutional organizations, and administrative reforms. The experiences of international organizations in the field of nutrition policy-and those of other countries that have adopted multisector nutrition strategies-were also used to inform the analysis.

Reference:
The methodology used for risk analysis and management is based on the ISO's ISO 31000:2009 Standard (ISO 2009). The risk for an organization is defined by the ISO and for the purposes of this report as "the effect of uncertainty on the achievement of objectives." The risk is symmetrically assessed by comparing negative variations (falling short of targets) with positive variations (opportunities to exceed targets). Although most of the analyses lead to an assessment of risks in negative terms, the missed opportunities will also be taken into account in this report.
As described in the risk management process recommended by the ISO 31000 standard (ISO 2009), the first step consists of analyzing the context in which the PSMN will be implemented to identify the most relevant factors that may influence its success. Establishing the context will facilitate the assessment of opportunities or threats and their strengths and constraints in the short and medium term; this information will be used to identify the types of risks and provide evidence of their significance.
The second step of the risk assessment comprises the following three activities: ® Identifying the various categories of risk by mapping and providing a precise definition of each risk ® An analysis of each risk to weigh its likelihood of occurrence and the magnitude of its potential impact ® An overall risk rating to prioritize and define mechanisms for handling them The third step of the risk assessment concerns the handling of the identified risks through defining measures to mitigate their impacts.
This approach involves ongoing communication and consultation with stakeholders to gather the information and guidance required for the assessments, and to involve them in the risk management process. It also requires an organization for regular risk monitoring and enhanced responsiveness to the changing context and sources of risk.

Information gathering:
In addition to the analyses and recommendations from the reports in the series, the following three sources were used to gather information: ® Face-to-face interviews with representatives of CLM; Bureau Exécutif National (National Executive Bureau) (BEN); Bureau d'Appui à Section

Limitations:
Risk analysis is an iterative process that deserves a comprehensive review-in collaboration with stakeholders-to reach a common understanding of the principles and assessments. The innovation of incorporating risk analysis into strategic planning further justifies taking advantage of the opportunity to bring stakeholders together for a thorough review. Their evolution will be critical in the risk analysis both for the identification of the principal sources of risk and for the assessment of their impact.

Strengthened International Commitment to Nutrition
The international context is very favorable to nutrition policy. Aware of the considerable social and economic damage caused by malnutrition, the international community has raised nutrition as a development priority.
The Sustainable Development Goals (SDGs)-particularly Goal 2 to "End hunger, achieve food security and improved nutrition and promote sustainable agriculture"-following the Millennium Development Goals

Growing Need for Nutrition Resources
The total expenditure for nutrition reached US$195 million for the period from 2012 to 2015, that is, about US$49 million per year (Offosse N. 2018). More than half (58 percent) of this funding comes from nutrition-sensitive sectors (Offosse N. 2018). In order to fund the PSMN from 2017 through 2021, budgetary needs for nutrition will increase substantially, reflecting the increase in scope of mainstreaming nutrition activities in the sectors, as well as the national scale-up of a set of nutritional activities to achieve the 80 percent population coverage target. Table 1 shows costs estimated by each sector during planning workshops for their respective nutrition action.
In addition to the financial needs, effective implementation of the PSMN will require greater availability of human resources specializing in nutrition, both for nutrition-specific and nutrition-sensitive activities.
Despite the existence of opportunities for higher education, there is still a shortage of skilled personnel; the lack of human resources specializing in nutrition is a problem that affects all sectors both at the central and decentralized levels. Training capacity and facilities will need to be adapted to provide the required personnel to all nutrition activities and the most specialized higher qualifications to the support staff and technicians (Deussom et al. 2018).

Public Reforms that Affect Nutrition Governance
Senegal was the first country in the UEMOA to enact the six 2009 regional directives on public finance. After the effective implementation of reforms and establishment of IFIS, the CLM and ministries will have a multiannual planning framework for their spending, better visibility of budgeted actions, and an information system that facilitates their coordination, monitoring and accounting of activities.

Risk Mapping and Assessment Principles
Risk classification and the detailed analyses are presented according to the process shown in figure 1:

Principles of Risk Assessment
Each risk to the PSMN is assessed according to its level of criticality (Cri), which is a combination of two factors: ® The degree of exposure to the risk (Exp): What is the likelihood of occurrence of this risk during the PSMN's implementation phase?

Risk Classification
The implementation of the PSMN entails the coordinated management of activities, projects, and programs within a multisectoral framework in order to achieve the defined strategic objectives. Risk management is important for the success of the implementation process. It is based on a proactive approach, which anticipates implementation constraints by identifying situations and events likely to affect or even jeopardize the achievement of the targeted objectives.
The identified risks to the PSMN are based on a process cycle, beginning with the conditions for preparation of development strategies and quality of implementation planning ( ing it possible to capitalize on lessons learned. Figure   1 outlines the process.

3
® Impact of the risk (Imp): What would be the level of severity of the impact if the risk occurs?
The degree of exposure of the PSMN to the risks-and the consequences in the event of occurrence-are assessed as follows:

Assessment (score) Characteristics
High (3) High likelihood of occurrence Average (2) Likely to occur Low (1) Remote likelihood of occurrence

Assessment (score) Characteristics
High ( The choice of a three-level scale-both for the assessment of exposure to risks and the impact of risks-is due to the lack of well-documented risk bases for similar cases, the qualitative nature of the assessments, and the need to focus on major risk classifications. The use of four-to five-level classification systems would increase the number of risk situations without providing additional clarity to the analyses and or their conclusions.
The level of criticality is rated on a scale of 1 to 9 by the formula: The risks were classified into four categories, according to their level of criticality: ® very high risks, whose probability and expected impact could potentially cause the PSMN to fail (level of criticality 9 in

Principles of Risk Management
Actions to mitigate risk include the following four options: ® avoiding them by eliminating the source of the identified risk (ruled out because the implementation of the PSMN is considered in its entirety) ® reducing them through measures to mitigate their likelihood and impact ® sharing them by transferring them partly or entirely to third parties through, for example, comanagement or insurance ® tolerating them, particularly when their impact is limited or the cost to avoid them is high compared to the expected gains Ultimately, selection of risk mitigating measures will depend on several factors including the initial level of criticality of the risk, and the feasibility and effectiveness of the recommended measure. Feasibility is rated on a three-tier scale according to complexity and the political, legal, financial, and administrative constraints to implementation, with level 1 being the most difficult to implement and level 3 being the most feasible (table 3).    Senegal's SDG commitments for its impact on the levers of emergence (such as human capital, competitiveness, and productivity) and overall economic growth; and (3) build effective coalitions among key stakeholders to promote the cause of nutrition.
These recommended mitigating measures involve nutrition stakeholders with no major financial or political constraints; they are easily feasible (3) and would reduce the level of criticality from very high (9) to high (6).
Poor alignment of the PSMN with economic and social priorities  ® Exposure of the PSMN: low (1) The commitment of TFPs to the planning of nutrition policies has, for a long time, been very strong.
Nutrition is high on the agenda of bilateral and mul- ® Impact: high (3) Although it is necessary to eventually reduce dependence on international donors, their contributions in the early phases of implementation of the PSMN will be crucial, and a decline in their commitments constitutes a major risk for the success of the PSMN.
® Recommended mitigating measures: The establishment of (1) a common results framework, including alignment of partner investments with the PSMN; and (2) a framework for regular consultation with TFPs to coordinate interventions and monitor commitments and achievements.
These actions, which are included in the SUN Movement commitments, are feasible (3) and would reduce the level of criticality from moderate (3) to low (2).  (2), but their implementation would significantly reduce the level of criticality from high (4) to low (2).

Risks Related to the Mobilization of Financial Resources
The      (3) promote investment opportunities in the production of healthy and nutritious foods and public-private partnership projects, in partnership with institutions that support the private sector (such as APIX, ADEPME, and ANIDA). 7 These recommended mitigating measures are easily feasible (3) and will reduce the level of criticality from very high (9) to high (6).

Risks Related to the Mobilization of Human Resources
The quality of human resources is crucial in the performance of any organization. The risks to human resource mobilization are related to the ability of government and partners to meet the need for capacity building and recruitment, provide the means for competitive wages to retain or renew human resources, and facilitate the availability of needed skills in the market.
Three risks related to the mobilization of human resources were identified (  (2) BEN has a multidisciplinary staff with diversified expertise. The positions are filled through transparent calls for applications and rigorous procedures. However, the staff specialized in nutrition is insufficient, and the regional offices are understaffed. Their status limits career prospects and the ability to attract and retain talent. This issue will be addressed in the development of an optimal institutional framework for the PSMN. CLM's BEN (or the body that will take over) will be a shared competence center serving all sectors and stakeholders, and will need a stable pool of qualified human resources. The feasibility of these recommended mitigating measures is average (2). The level of criticality would remain high, although reduced from (6) to (4).  The level of criticality remains high (6).   Weak capacity for mobilizing nonfinancial support of communities and private partners potential is yet to be fully tapped.     (3) give CLM's BEN the role of project manager for critical projects during the first phase of the PSMN. The feasibility of these recommended mitigating measures is average (2). The level of criticality would remain high, although reduced from (6) to (4).

Risks Related to the Mobilization of Other Resources
Poor management of public procurement and expenditure procedures ® Impact: average (2) The public resources allocated to nutrition are limit- The level of criticality would remain high (4). It is more relevant for sectoral entities given their increased responsibility in the transfer of operational management. Capacity building with regard to donor procedures would be opportune. CLM's BEN will have to strengthen its capacity as the cornerstone of the PSMN, providing advice and expertise that covers the entire "value chain." This role will be closer to that of an agency than that of a unit, yet with the same high level of institutional anchoring as today.

Poor Management of TFP procedures
® Impact: high (3) Owing to the importance of the contribution of TFPs to nutrition policy, management of their procedures is critical to avoid the risks of delay or interruption in the provision of funds. Beyond the immediate financial constraints, the credibility of the PSMN and, consequently, its subsequent financial support could be affected. ® Impact: high (3) The impact of this risk is high, at least at the beginning of the PSMN's implementation, due to the significant responsibility vested in the sectors for proper management of SAPs.
® Recommended mitigating measures: The recommended mitigating measures are: (1) establish intrasectoral nutrition committees to coordinate actions among the departments 8 ; and (2) encourage intrasectoral collaboration on nutrition, using CLM focal points as promoters (Deussom et al. 2018). These recommended mitigating measures are easily feasible (3). The level of criticality would remain high, although reduced from (6) to (4). Poor coordination at the regional and local levels ® Description: Poor coordination among stakeholders at the regional and local levels, reducing benefits and impact of nutrition interventions.

Insufficient intersectoral coordination
® Exposure of the PSMN: average (2) Sectoral interventions are carried out by decentralized services whose efficiency depends on the availability of human, logistical, and material resources. On the whole, the workload exceeds capacity. Coordination is carried out by administrative authorities (such as CLs, departments, and regions) under a framework that is not conducive to close collaboration between sectors. For BEN, the management of interventions at the local level is delegated to partners (the sectors, Agences d'Execution Communautaire (Community Executing Agencies), or the private sector). Coordination is satisfactory at the regional level, but there are inadequate human resources, expertise in nutrition-related issues, and coverage of decentralized services at the local level.
Constraints on the management of activities at the local level are also related to poor appropriation by local stakeholders and elected officials and to a disconnect between national nutrition policy and local priorities. There is a need for better information about the nutrition strategy for local stakeholders, more regular consultation on local priorities, and better integration of local priorities into SAPs.
® Impact: high (3) Coordination at the local level is crucial to ensuring effective service delivery to beneficiaries. The local setting is also dependent on the quality of sectoral coordination. Poor coordination at the local level can have a significant impact on implementation of the PSMN.
® Recommended mitigating measures: The key mitigating measure recommended by Deussom et al. (2018) is to strengthen multisectoral coordination at the regional and local levels under the leadership of the Bureaux Exécutifs Régional (Regional Executive Bureaus), and through consultation with the administrative authorities, decentralized bodies, and CLs. The feasibility of this mitigating measure is average (2). The level of criticality would remain high, although reduced from (6) to (4).

Risks Related to Monitoring, Evaluation, and Control
The monitoring, review, evaluation, Two risks related to monitoring, evaluation, and control were identified (table A.6): Inadequate system for the monitoring and evaluation of sectoral activities and the PSMN overall

Risks Related to Communication and Change Management
The management of plans and programs often impos-   This measure is easily feasible (3). The level of criticality would remain high (4).

Exceptional Risks
The context in which the PSMN is implemented will have a crucial impact on the ability of stakeholders to achieve its strategic objectives, even if financial and human resources are sufficient.
The following exceptional risk has been identified (