The governments of the UK and Brazil, and the Children's Investment Fund Foundation (CIFF), will co-host a high-level international meeting, Nutrition for Growth: Beating Hunger through Business and Science on Saturday in London.
The event will bring together business leaders, scientists, governments and civil society to make financial and political commitments to combat malnutrition worldwide. It follows the release on Thursday of a new Lancet series on maternal and child nutrition that examines the problems associated with undernutrition and successful interventions.
Undernutrition is the largest single contributor to child mortality worldwide, underlying one third of deaths amongst children under five. It is also responsible for the loss of billions of dollars in productivity.
The Scaling up Nutrition (SUN) movement has been key in securing the commitment of governments in the malnutrition fight. AllAfrica spoke with the SUN coordinator, Dr. David Nabarro, about the Nutrition for Growth event, recent successes in improving nutrition in the world's poorest countries, and what is needed to scale-up successful interventions. Nabarro is also special representative of the UN secretary-general for Food Security and Nutrition.
Can you tell us how the Scaling up Nutrition efforts tie in to this week's nutrition events in London?
Scaling up Nutrition is an effort by 40 countries to put nutrition higher on their political agenda and to get better results in terms of improvements in nutrition, especially for women and children. It recognizes that to do that you have to work across a lot of different sectors of government and also you have to engage many different stakeholders.
The Nutrition for Growth event where at least 30 governments plus development partners, civil society and business will make commitments to act in a multi-sectoral way for better nutrition. In the SUN movement, it's the countries that are completely in charge of what's happening, and this London summit will provide fantastic extra energy to support the work of the countries over the next few years.
How might political and financial commitments made in London translate into real reductions in malnutrition in countries?
The key thing about the commitments being made this weekend is that they are quantified public commitments which will be accountable. That means if a government says, 'We're going to reduce levels of chronic undernutrition or stunting over the next five years by 20 percent from the current level,' then that commitment will be very much taken on board by national and international civil society groups. There will be expectations that the efforts are made to try to fulfill the commitment, and if the commitment is not fulfilled, then there will be some kind of explanation needed of what has happened.
Within countries we're seeing several things happening. First of all, nutrition platforms being set up that bring together government, civil society, international organizations, donors, business and other groups- and these platforms become the central element of efforts to improve nutrition. There are also policies being established, legal frameworks and codes being set up, particularly for how different groups work together. Then there is an effort to align around a single set of results that equate to a government's commitment and mobilizing resources to achieve them.
It's not a simple process, but within the SUN movement that's the style of working. And I'm pleased to say that we watch very carefully how countries are working. They share their experiences with the SUN secretariat. We are seeing about 25 to 30 countries, out of the 40, showing real progress towards that work style, and I think after the London event there will be more of it.
How do you describe the difference that SUN has made?
We're always cautious about saying the movement has led to an outcome, because the movement is actually bringing everything together and giving it extra energy and focus and ensuring that it has got clearer accountability. It could well have been in many countries this effort would have happened anyway. We don't really have a good control population. But out of the 40 countries in the SUN movement, 15 of them globally are rapidly reducing the prevalence of chronic malnutrition. And this reduction has been speeding up since 2000. It's measured through intermittent surveys that are validated internationally.
Ten of these countries are in Africa. The great thing is these are countries where we've seen strong political leadership, good working across different sectors of government, a real focus on the needs of people, particularly women, engagement of the different stakeholders and attention to results. If the countries that we see doing this can demonstrate good results, then others can do the same. I expect to see most countries in Africa over the next five years using similar methods and starting to demonstrate real reductions in chronic malnutrition, in anemia during pregnancy, in acute undernutrition that is so dangerous for children, and also improvements in the capacity of communities to avoid the other side of malnutrition - obesity.
What have the successful countries done in terms of governance and nutrition, putting successful policies in place?
The most important is a commitment by the head of government to actually achieve results. Second is a particular emphasis on the empowerment of women. If we look at issues around malnutrition, fundamentally they're about women - whether women have access to cash, opportunities to get nutritious foods in local markets, time in order to be able to feed their children, whether they're also able to look after their children in a hygienic way by accessing water supplies and being able to practice good sanitation.
Third is working across the sectors. It used to be thought that the health sector should be responsible for nutrition. Now it's much more than that. It's all the sectors concerned with gender and women's issues, sectors concerned with social welfare, sectors concerned with agriculture and food, water and sanitation, employment, education and health. And I don't want to underestimate the need for the health sector to be nutritionally sensitive because if it isn't it tends to miss things.
Ethiopia, which is one of our star countries, had been moving very strongly in this direction with very powerful community-level platforms. But also Tanzania, Mali, Mauritania, Uganda, and Zimbabwe - Zimbabwe has done the multi-sectoral thing very well. Kenya has a very strong program led by the minister for health, and Ghana has also had good inter-sectoral efforts. The fact is whether we're looking at East Africa, southern Africa, Central Africa, the Sahel or Maghreb, we are very impressed by what we're seeing.
It's really exciting to see the regional organizations like the African Union focus on food security and nutrition with more energy, and also the regional economic commissions moving forward in this area. I think it's only happened because they've come to understand that malnutrition is an economic drain on society. It probably leads to a loss of about five percent of GDP each year.
Also they've recognized that the cost-effectiveness of investing in nutrition is enormous. Every dollar invested in nutrition is estimated to yield at least 30 dollars worth of benefit. As I look at some of the statements that African ministers are going to make in London on Saturday, they're very much focused around not just the moral case for improving nutrition but the economic and social case as well. And that I think is making a big difference.
What have you seen as the biggest challenges in getting governments to make nutrition a priority?
There is a big difference to having a government saying it's going to achieve results and setting up lots of processes in the capital city and then what actually happens in the districts and villages throughout the country. Even in a relatively small country like Malawi, President (Joyce) Banda has shown extraordinary leadership. They have had to work very hard to take forward their efforts, particularly linking together different sectors at the district, local authority and village level.
But that's what really matters. You can't really make a difference to nutrition if you try to do it all just at the national capital. So the real issue is a strong decentralized approach for scaling up nutrition.
Despite the availability of relatively simple and extremely cost-effective interventions to address malnutrition, very few countries effectively implement proven interventions at scale. How can this be rectified?
I think that starts with the notion of commitment, and then you've got to get the money. Quite a lot of countries are facing a financing gap.
And then it's a question of ensuring that different groups in society - civil society, different parts of government, faith groups and the rest - actually work together to implement interventions. The countries that have been successful in demonstrating really high coverage of key interventions are those countries that are involving lots of different stakeholders in the effort and are also running a regular program of monitoring and checking to see what's going on. It is very variable, and some countries still have a long way to go.
But it's not the same for all interventions. One intervention that is particularly tricky is the treatment of severe acute malnutrition. It's expensive; it's difficult. But if you look at a country like Niger, which is not a wealthy country, they've got a fantastic program of expanding and tracking the quality of care for children with acute malnutrition. What I'm seeing is that countries are learning from each other and gradually we're seeing a general upscaling in quality right across the continent.
How would you describe the role of the private sector in helping end malnutrition?
Most people get their food privately from either the market or from the shop or from some other source which is in the form of an enterprise - it might be a cooperative or something - but has not come from the state. It has come from some form of business enterprise. We always have to have that in our minds when we consider the role of the private sector. Farmers are business people, people who work in local markets, often women, are business people, people who process food close to their home or in a local mill are business people, again, often women. When people talk about the private sector I'm keen to see it in a very broad way and to recognize that actually private activity is important for the vast majority of the food that everybody procures and then eats.
That means that there is a real need for private actors to work within any effort to improve nutrition. However, they have to be operating within a framework that is established by the government as part of its own accountability to its people. And they have to operate within any rules or regulations that the government has established that work in the interests of people and ensure that they obtain food in a fair way - food that is safe and also food that has got the nutrition content that it says it has.
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Government sets the standards, government provides the regulatory framework, government ensures compliance. The private sector has a huge role in actually assuring that people can access foods, not only processed foods, but the original foods, and the combination of the public and private sector is frankly how we have to work on so many issues in development. Nutrition is no exception.
There are some who get very worried about the role of business in helping to set standards for nutrition, and that's completely understandable. That's why I'm very clear that it's the role of government and the elected representatives of the people to set the standards. It's often also important that civil society helps to make sure that those standards are properly realized.
Is there anything else you would like to add?
Some people think it's impossible to ensure good nutrition in countries that are affected by war or civil strife where perhaps government is not very strong. But some of the countries that have come into the SUN movement are countries that have experienced or continue to experience quite a lot of difficulty in terms of violent conflict. Yet we see real capacity within those countries for local organizations and for national government to continue to prioritize nutrition - both short-term issues and longer term issues like dealing with the immediate shortage of food, and longer term issues like linking together agriculture, social welfare, women's empowerment and nutrition.
We're seeing magnificent strides in Africa in all sorts of countries, countries in a very advanced state of political development, countries that are not, countries that have a long history of attempts to ensure that people realize their right to food, and countries that perhaps operate according to different ideologies. But they're all recognizing the importance of nutrition for the future of their people and also the importance of empowering women to achieve nutrition outcomes.
It's a real joy to me that we have in the SUN movement so many countries from the African region - 28 out of 40 - and I'm really pleased to see the extraordinary strength of African leadership on nutrition. There will be strong African representation in the meeting on Saturday from all different parts of Africa. That shows me that Africa is the renaissance continent in so many areas and nutrition is one of them.
