9 December 2013

Africa: Nutrition for Growth - Will a U.S. $4.15 Billion Landmark Pledge Lead to Landmark Changes?


Big challenges remain to ensure the biggest ever pledge for nutrition specific interventions is not a wasted opportunity.

This June, the G8 Nutrition for Growth Summit pledged a landmark $4.15 billion to combat malnutrition in the developing world. This is the largest sum ever pledged to support nutrition, and could help save millions of lives.

Around the world, there are estimated to be 55 million people currently suffering from severe acute malnutrition, and every year 3.1 million children die from lack of food - that's an average of nearly 8,500 deaths every day.

Meanwhile, 165 million children are affected stunted growth, 19 million under-5s are experiencing severe wasting, and insufficient nutrition amongst pregnant mothers contributes to 800,000 neonatal deaths each year.

The goals for $4.15 billion pledged include ensuring that 500 million pregnant women and children are sufficiently nourished, preventing 20 million children from being stunted, and saving at least 1.7 million lives by 2020 through effective nutrition interventions.

But while these funds could prove crucial in the struggle against malnutrition, a number of hurdles remain.

The pledge remains a pledge, rather than secured funds, for now. There are concerns that a demand for results will privilege quick-fire outcomes over sustainable structural change.

And making a global fund relevant to myriad diverse and specific problems in a variety of different cultural contexts presents some major challenges.

Delivering on the pledges

At a specifically convened G8 event to address the issue of nutrition, several NGOs and governments pledged to significantly increase their funding towards nutrition interventions.

The UK government, for example, committed to triple its current investment in nutritional programmes as well as come up with a further £280 million ($378 million) between 2013 and 2020; the EU pledged €410 million ($533 million) for nutrition-specific programmes and another €3.1 billion ($4.18 billion) for nutrition sensitive interventions between 2014-2020; and the Child Investment Fund Foundation (CIFF) agreed to contribute $700 million.

Overall, $4.15 billion was committed for 'nutrition specific' interventions - such as vitamin supplementation schemes and programmes ensuring young children are well-nourished - while $19 billion was pledged to be spent on 'nutrition sensitive' initiatives - such as sanitation programmes, educational schemes, and other efforts that contribute to nutrition in an indirect way. Both funds are committed up to 2020.

The $4.15 billion sum is the largest amount ever pledged for nutrition specific interventions, but for activists this is just a start.

As Kat Pittore, Nutrition Advocacy Officer at Results UK, explains, "The Lancet estimates a total of $9.6 billion per annum is needed to scale up the proven nutrition interventions. $4.15 billion is great, but is still nowhere near the amount that globally has been estimated that it is going to cost."

Pittore and others are nevertheless encouraged by the pledge and well aware of the impact it could potentially make.

However, they also recognise that the first step for them is simply to ensure the committed funds are realised.

"We don't have a tracking mechanism to see if governments who made commitments are really keeping to those commitments," explains Rufaro Madzima, development consultant and former head of Zimbabwe's Nutrition Unit.

"As with any commitment that people make, it is essential to make sure that it is kept. Will we be able to get the money that was committed?"

These concerns are particularly pressing given that around $1.25 billion of the $4.15 pledged relies on matched funding.

That's to say that $1.25 billion of the pledge comes from a number of donors agreeing to contribute the same particular sum; the reason this is somewhat precarious is that if one donor fails to keep this promise, the remaining groups are no longer obligated to keep theirs.

This means that in fact only $2.9 billion of the pledge is secured core funding, and, as Pittore explains, "Many activists have actually started using the $2.9 billion figure instead of $4.15 billion, because much of it comes from very unclear funding."

Sharing the right goals and targets

Along with ensuring the money committed is actually raised, many nutrition activists are also concerned over how the money will be spent.

In particular, some are worried that interventions will be overly simplistic and short-term, and that donors will fail to recognise that malnutrition is not just a problem in of itself, but also the symptom of a set of much deeper challenges.

As Elizabeth Hull, a nutrition specialist and anthropology lecturer at the School of Oriental and African Studies, notes, the funding compact contains "a strong emphasis on private-sector principles such as value for money and so on ... The approach promoted seems to be very 'outcomes' focused."

Indeed, a number of the donors are in fact private companies with fairly straightforward and surface-level goals: Britannia Industries, for instance, has vowed to increase the reach of its iron-fortified biscuits from 300,000 to 1 million children; one of GlaxoSmithKline's commitments is to donate 400 million intestinal worm treatments; while Unilever has announced a programme which aims to improve hand-washing amongst birth attendants.

These programmes could of course prove valuable, but Hull explains that this "technicist" attitude is not a route to alleviating malnutrition in a sustainable and long-term manner, and is concerned that this outcomes-led mindset has been adopted by the donor community more widely.

"The problem is that this approach fails to address the underlying social and economic causes and consequences of malnutrition," she says. "This makes it a politically safe option, but ultimately limited."

Hull traces the technicist approach to nutrition back to the 1991 Ending Hidden Hunger conference in Montreal.

That event, she says, "marked a shift from national level solutions to donor-driven, global approaches that focused specifically on alleviating micro-nutrient deficiencies.

This led to a focus on developing scientific and technical solutions such as fortification, crop science and so on, which was essentially a way of bypassing the more messy questions of institutional capacity, governance and politics at national levels."

According to an article in the Lancet, this reluctance to address these more messy questions is also bolstered by political concerns and the fact that tackling malnutrition is a long-term goal while electoral cycles are based on short-term achievements: "Undernutrition has a complex set of political, social, and economic causes, none of which are amenable to easy solutions that fit within the timeframe of a single political cycle," it notes.

The result of this is that donors and governments can tend to fixate on immediate outcomes rather than capacity-building and structural solutions.

After all, training health workers, building health infrastructure, and educating communities can take a much longer time to reveal clearly-visible benefits than simply shipping across millions of food parcels and medicines. Initiatives to tackle both short-term and long-term problems are needed.

Relevant programmes

A final and related issue over how the billions committed are spent concerns the need for context-specific interventions.

Another problem with a technicist approach is that it can fail to recognise important differences in the challenges facing different communities.

After all, the dynamics underlying malnutrition can differ markedly from one place to the next, meaning the types of intervention needed are very different.

Madzima explained, for example, how the success of 'orange sweet potatoes', a special strain of the tuber fortified with vitamin A, in Uganda and Mozambique came down to its careful targeting.

Sweet potatoes were known to be a local staple, and through talking to men, women and children, researchers believed that the orange variety stood a chance of being adopted and integrated into people's diets.

Vitamin A deficiency in children was a serious problem, and with the introduction of the orange sweet potato alongside an accompanying education campaign, many locals - including children who liked the taste and appearance of the crop - were happy to eat it.

Pittore meanwhile described a similarly culturally-sensitive and relevant scheme in Bangladesh whereby imams were persuaded to tell men either to buy more nutritious foods or to allow women to go to the market to buy supplies.

In this case, an understanding of underlying issues was again crucial, and coming up with a context-specific solution was key.

Recognising that malnutrition is inextricably tied into all other kinds of local social, cultural and economic dynamics - dynamics which vary from community to community let alone country to country - will be central to making the nutrition funds count.

At the moment, frameworks for accountability are being drafted by the UK's Department for International Development (DfID) to monitor the outcomes of the initiatives paid for by the funds, the World Health Organisation (WHO) is investigating data collection possibilities, and the EU and Canada are addressing critical data gaps.

The sum pledged is already a historical landmark for its sheer size, and though much more is needed, the figure provides hope that nutrition is starting to be taken more seriously.

However, if used intelligently to address structural issues and fund locally-sensitive initiatives as well as tackling more urgent concerns, the G8 summit fund could go down in history for more than just its size - it could also prove to be a real turning point.

James Bullock is a freelance journalist and researcher with a particular focus on sub-Saharan political development, post-colonial literature and West African music.

He had been published in the Financial Times and Monocle magazine. You can contact him via his twitter.

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