Race is on to implement nutrition initiative

 A UN initiative will push countries to design nutrition policies based on new studies that show good quality food for mothers and children in the first 1,000 days, including pregnancy, would not only save millions of lives but raise literacy and economic growth rates.



The initiative - designed with input from UN agencies, NGOs, academics and think-tanks - known by its acronym SUN (Scaling Up Nutrition) and led by David Nabarro, head of the UN High-Level Task Force on the Global Food Security Crisis, is only likely to come together in 2011.



But already questions are being raised about the lack of consultation, and time and resources needed to see it through.



In 2009 the World Bank calculated it would cost at least US$12 billion a year to implement nutrition-specific interventions, including an investment in agriculture in the 36 countries which account for 90 percent of the global under-nutrition statistics. That amount of funding is not available at present, so SUN will look to public-private-civil society partnerships.



At least 29 countries still have levels of hunger that are “extremely alarming”, according to the 2010 Global Hunger Index (GHI) produced by the International Food Policy Research Institute (IFPRI). These include countries such as Burundi, Chad, the Democratic Republic of Congo and Eritrea.



SUN spells out a two-pronged approach to reduce nutrition – directly by providing good quality food and indirectly by ensuring there are nutrition-related programmes in all government sectors, such as agriculture, education and social welfare.



It focuses on overhauling nutrition strategies and implementing low-cost nutrition interventions such as eating well-balanced meals fortified by micronutrients, and breastfeeding until a child is two years old. Studies published in The Lancet in 2008 showed that these interventions not only reduce infant and maternal mortality but boost economic growth in developing countries.



Scepticism



However, time is a concern. Purnima Menon, a research fellow with IFPRI, cited India as an example where building consensus around the focus on children’s first 1,000 days and related interventions as recommended by the 2008 Lancet studies took a year. India has 42 percent of the world’s underweight children, according to the GHI.



“There are now state-level nutrition strategies that incorporate the focus on under-twos and the interventions… but are not operationalized yet,” Menon said. “Getting country buy-in is still only the first step at the country level. Work on SUN has helped bring the global community together on this issue but the real implementation challenges lie in districts, towns and villages in the different countries, where the core interventions must be implemented.”



In the past weeks, Nabarro has been meeting country representatives and experts in the nutrition sector.



But, said Mamady Daffe, head of the nutrition unit at the Guinea Health Ministry: “They’ll never find the real solutions there because they didn’t ask the specialists who are on the ground.”



The initiative is “not a bad thing”, Daffe said, but “…if such things are not based on the realities on the ground they will always fail”.



The plan



Some countries, such as Ghana and Malawi, are already designing their nutrition policies based on The Lancet findings - the “window of opportunity” in the first 1,000 days of a child’s life.



A nutrition programme in agriculture could help farmers diversify their crops and grow vegetables and fruit, besides starch-rich staples such as maize and wheat, which would make sure people have access to a wide variety of nutrients.



The initiative does not provide details of interventions, but says it will depend on new evidence-based studies and encourages countries to develop and design their own policies.



SUN says the implementation of low-cost interventions can save the lives of a million children every year and increase the economic wealth of poor countries by 2-3 percent. Getting the nutrition right will not only help achieve the Millennium Development Goal to halve hunger and poverty, but other targets on education, gender equality, and child and maternal mortality.



Nabarro said the roadmap to implement SUN called for providing resources to at least 25 countries to initiate three steps - stock-take, build capacity and scale up action by the end of 2015. But since they are unlikely to obtain the required funds, he hoped that at least eight countries would start to receive “intensive support” for scaling up by the end of 2011.



SUN is open to all countries with an undernourished population. The initiative allows countries to pick and choose their own strategies, which could include micronutrient fortification initiatives, and nutrition objectives in agriculture, such as encouraging the production of diverse crops, including fruit and vegetables.



The third step involves scaling up programmes with local and international funding.



Menon said: “Each of these steps is important but can take a substantial amount of time and resources.”



Stéphane Doyon, leader of the Médecins Sans Frontières nutrition team, said that while the initiative is a good plug for nutrition, it probably requires more consultation and a rigorous engagement at the grassroots.



Milla McLachlan, a nutrition consultant with the UN Children’s Fund (UNICEF), said: “I think at the moment there still is a lot of work to be done to get country buy-in and to make sure that countries feel equal partners in the SUN process and not just ‘Johnnies-come-lately’. So how to do that? How to work with the regional structures to facilitate? That is going to be really important.”



Nabarro said meetings and events at regional level have been planned over the next few weeks. A joint transition team - to be set up with the help of the policy-making UN Systems Standing Committee on Nutrition - will begin to work out how efforts will be coordinated. The regional meetings will be followed by global consultations over the next two months.



Africa in the lead



The African Union, through its New Partnership for African Development (NEPAD), has this year begun pushing to incorporate nutrition in agriculture and other sectors. Malawi, which has one of the world’s highest ratios of chronically malnourished children, has a nutrition head in 10 of its ministries. The 2010 GHI rates Ghana as one of the 10 best performers - along with Iran, Saudi Arabia and Malaysia - in getting the numbers of hungry down since 1990.



The new focus on nutrition follows the global food price crisis in 2007-2008, which saw the number of undernourished shoot past a billion. But the GHI pointed out that political instability, conflicts and the high prevalence of HIV/AIDS have also “severely undermined” food security even where incomes have grown substantially.



Nabarro said he sees SUN as a “good opportunity for investing in food security, poverty reduction and societal empowerment”. But countries also need to fund-raise and ensure interventions are implemented effectively and in an accountable way, he said.



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