From efficacy research to large-scale impact on undernutrition: the role of organizational cultures.

Undernutrition in low-income countries is receiving unprecedented attention at global and national levels due to the convergence of many forces, including strong evidence concerning its magnitude, consequences, and potential solutions and effective advocacy by many organizations. The translation of this attention into large-scale reductions in undernutrition at the country level requires the alignment and support of many organizations in the development and implementation of a coherent policy agenda for nutrition, including the strengthening of operational and strategic capacities and a supportive research agenda. However, many countries experience difficulties achieving such alignment. This article uses the concept of organizational culture to better understand some of the reasons for these difficulties. This concept is applied to the constellation of organizations that make up the "National Nutrition Network" in a given country and some of the individual organizations within that network, including academic institutions that conduct research on undernutrition. We illustrate this concept through a case study involving a middle-income country. We conclude that efforts to align organizations in support of coherent nutrition agendas should do the following: 1) make intentional and sustained efforts to foster common understanding, shared learning, and socialization of new members and other elements of a shared culture among partners; 2) seek a way to frame problems and solutions in a fashion that enables individual organizations to secure some of their particular interests by joining the effort; and 3) not only advocate on the importance of nutrition but also insist that high-level officials hold organizations accountable for aligning in support of common-interest solutions (through some elements of a common culture) that can be effective and appropriate in the national context. We further conclude that a culture change is needed within academic departments if the discipline of nutrition is to play a central role in translating the findings from efficacy trials into large-scale reductions in undernutrition.