Making progress on nutrition

SUNA new report was launched last week in the Houses of Parliament which lays out progress made in tackling nutrition in several counties, as well as the challenges still ahead. “What works for nutrition? Stories of success from Vietnam, Uganda and Kenya”, a joint publication from RESULTS UK, Concern Worldwide and the University of Westminster, discusses these countries success in the context of global nutrition targets and concludes with key recommendations for government and civil society to build on this success and learn from their experiences.

Despite considerable progress in reducing hunger and the physical signs of malnutrition (the number of hungry people has been reduced by 200 million since 1990 and stunting in children under age five by 40%), malnutrition still places a heavy burden on survival and overall development. Some two billion people, for example, are estimated to suffer from micronutrient deficiencies (about 27% of the global population), which can have wide ranging long-term and irreversible consequences for their health and livelihoods. Undernutrition can reduce GDP and an individual’s earnings by as much as 10%. Progress in tackling malnutrition has also been uneven and inequitable: children in rural areas, for example, as twice as likely to be stunted as those in urban areas. But global initiatives are improving awareness of global malnutrition, and in 2012, the World Health Association (WHA) endorsed six targets on nutrition to be achieved by 2025.

  1. Achieve a 40% reduction in the number of children under-5 who are stunted;
  2. Achieve a 50% reduction of anaemia in women of reproductive age;
  3. Achieve a 30% reduction in low birth weight;
  4. Ensure that there is no increase in childhood overweight;
  5. Increase the rate of exclusive breastfeeding in the first 6 months up to at least 50%;
  6. Reduce and maintain childhood wasting to less than 5%.

Financing for nutrition has been growing recently, although evidence indicates donors need to quadruple their financial pledges and governments need to at least double the amount allocated to nutrition in order to meet the WHA target on stunting in 37 high burden countries. And nutrition is a good investment: every dollar invested in nutrition yields more than 16 in return.

Although progress so far has generally been slow, amongst those countries making headway are Vietnam, Uganda and Kenya. Vietnam, for example, has raised agricultural production by over 60% since the 1990s, reduced the incidence of stunting in children under five years by almost 60% between 1985 and 2013, reduced Infant and under-five mortality by around 50% between 1990 and 2013, and maternal mortality by over 60% in the same period, largely due to targeted programmes on health and nutrition. Kenya has also reduced under-five deaths by over 40% between 1989 and 2014, increased the rate of exclusive breastfeeding by 30% and reduced anaemia in women by nearly 50% between 1999 and 2011. More recently Uganda have made progress in reducing the prevalence of stunting, by 11% between 2000 and 2012.

The report, based on interviews and focus group discussions with government ministries, international and local development partners, and civil society, discusses the factors that have contributed to these countries’ achievements. In Vietnam, for example, the reasons behind their successes include:

  • Their prioritisation of nutrition in the national agenda:
    • Setting up the National Institute of Nutrition (NIN) in 1980 under the Ministry of Health;
    • The NIN’s campaigning for improving exclusive breastfeeding rates, which resulted in two legislative changes: extending paid maternity leave and banning the marketing of breast milk substitutes for children under the age of 24 months.
  • The creation of targeted national policies and programmes such as:
    • The National Plan of Action for Nutrition (1995-2000);
    • National Nutrition Strategies (2001-2010) and (2011-2020).
  • The generation of evidence for nutrition:
    • The set-up of a Nutrition National Surveillance System in the early 1980s;
    • Annual surveillance, by NIN, on nutrition indicators;
    • Nationwide General Nutrition Surveys every 10 years.
  • Their multi-dimension approach to tackling undernutrition:
    • The set-up of a Nutrition Cluster Partnership Group (NCPG) in 2009, comprised of government and development partners who meet every four to six weeks to discuss nutrition issues, share information and work collaboratively.
  • Their commitment to global initiatives such as:
  • Their investment in research, development and innovation:
    • Development of a local Ready-To-Use Therapeutic Food (RUTF) called “Hebi” in 2009;
    • Scaling up to Integrated Management of Acute Malnutrition programme, with donor help;
    • Development of a Multi-Micronutrient Powder (MNP) for home-based food fortification, known as “Bibomax”.
  • Utilisation of the media to promote nutrition awareness, campaigns and practices.

Alongside the successes, Vietnam also faces many challenges, for example progress has been uneven, with some regions and ethnic groups still experiencing significant malnutrition. This is linked to other development outcomes such as income, health and education, which also lag behind in these areas and for these groups. Better funding and tracking of nutrition data as well as better efforts to tackle other dimensions of nutrition such as obesity and micronutrient deficiencies are also needed.

The report concluded with some general drivers of success for nutrition:

  • Nutrition needs to be on the national agenda, requiring an enabling policy, infrastructure and legislative environment;
  • Local, sub-national and national capacities for planning for nutrition and allocating budget to initiatives must be strengthened;
  • Countries must be committed to global nutrition initiatives;
  • Governments must focus nutrition interventions in the areas with the greatest burden of malnutrition;
  • Policies and interventions need to be backed by secure and long-term funding;
  • Transparent tracking of nutrition funding and spending aids accountability and measurement of progress towards targets;
  • Surveillance of progress on nutrition outcomes can accelerate and guide efforts to tackle malnutrition;
  • Multi-stakeholder partnerships need official recognition;
  • Nutrition interventions must be brought into the essential healthcare package;
  • Research, information sharing and cross learning should be fostered in-county;
  • Advocacy efforts should be coordinated and supported by government and other nutrition stakeholders.

The report, by showcasing individual country’s efforts, goes a long way to explaining how malnutrition can be successfully tackled at levels of government, donor and civil society governance. While efforts and progress is largely approached from a top-down view, it is clear that successful initiatives and programmes have had benefit for at least some people on the ground. Based on a balanced and practical analysis of progress on nutrition, this report is both realistic and optimistic, and gives both idealistic recommendations as well as concrete examples of how these might work in practice.

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