Reaching Global Nutrition Targets: Improving Commitments and Accountability in the African Context
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Lawrence Haddad, Executive Director, Global Alliance for Nutrition (GAIN)
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Reaching Global Nutrition Targets: Improving Commitments and Accountability in the African Context
- 1. From Promise to Impact ATOR, Accra, October 18, 2016
- 2. The Global Nutrition Report • Independent • Global • All Forms of Nutrition • Data Driven • Encourages Accountability
- 3. Outline • Key Findings • Calls to Action • Takeaways • What you can do
- 4. Key Findings
- 5. 1. Malnutrition creates ripples of individual and societal challenges & opportunities
- 6. Akin Adesina President of the African Development Bank 2016 “We need to invest in gray matter infrastructure.” “Neuronal infrastructure is quite possibly going to be the most important infrastructure.” Jim Kim President, World Bank 2016 We couldn’t have said it better ourselves..
- 7. 16.5 11.5 10.3 7.7 6.3 5.6 3.1 Ethiopia Rwanda Malawi Burkina Faso Ghana Uganda Swaziland (% of GDP) Annual cost of undernutrition in 7 African countries AUC/WFP Cost of Hunger Studies
- 8. 2. Africa is off track to reach global targets— but there is hope.
- 9. 9 Stunting children under 5 Wasting children under 5 Overweight children under 5 Anemia women aged 15-49 years Exclusive Breastfeeding, <6 months Adult Overweight + Obesity (BMI≥ 25) Adult Obesity (BMI≥ 30) Adult Diabetes (Raised blood glucose) 3465 3 7 1 16 17 23 1 23 34 987 52 312 54 54 53 1 Global Target Missing data Off course, little/no progress Off course, some progress On courseOn course, at risk Number of African countries at various stages of progress against global targets on nutrition
- 10. 3. Nutrition is central to the SDGs
- 11. Nutrition feeds into 12 of the 17 SDGs — and dozens of the indicators used to track the SDGs 1 1 2 2 3 3 3 3 7 7 12 12 Goal 12: Sustainable cons &… Goal 17: Global Partnerships Goal 8: Growth & Employment Goal 16: Peace and Justice Goal 4: Education Goal 6: WASH Goal 10: Reduce Inequality Goal 11: Cities Goal 1: Poverty Goal 2: Hunger and Nutrition Goal 3: Healthy Lives Goal 5: Gender Equality Number of indicators highly relevant to nutrition Number of indicators not highly relelvant to nutrition
- 12. 4. There is a gap between current commitments and need
- 13. There are not enough SMART targets in African nutrition country plans 75 73 55 45 35 10 Stunting Exclusive breastfeeding Wasting Anaemia in women Low birth weight Under 5 overweight Percent of 40 African Nutrition Plans with SMART Targets for…
- 14. Few African Countries have Targets for Diet Related NCDs Source: Unpublished self-reported data from the NCD Country Capacity Survey, provided by the WHO Surveillance and Population-based Prevention Unit, Department for Prevention of NCDs. Printed with permission. % Percent of 40 countries with targets for… 40 35 15 Obesity Diabetes Salt Reduction
- 15. 5. SMART Commitments and Targets Matter
- 16. Commitment and Impact go hand in hand • Countries: Nutrition targets & rate of stunting reduction • Companies: Targets & performance • Donors: Public commitment & spending on nutrition Commitment and Impact go hand in hand
- 17. 6. We must move beyond talk to action
- 18. Coverage of nutrition-specific interventions remains highly variable across African countries 0 10 20 30 40 50 60 70 80 90 100 Exclusive breastfeeding <6 months Minimum dietary diversity (6-23 months) Zinc treatment for diarrhoea (U5) Iron-Folic acid suppl. 90+ days (pregnant women) Iron suppl. (U5) Vitamin A suppl. (U5) Salt iodization (household)
- 19. 7. Today’s nutrition data are not sufficient to maximize investment
- 20. Stunting prevalence by region within 34 African countries 0 10 20 30 40 50 60 70 80 Stunting(%) Lowest stunting region Highest stunting region
- 21. Map of stunting rates in Cambodia
- 22. Calls to Action
- 23. 1. Make the political choice to end all forms of malnutrition
- 24. Reject current trends continuation of current trends WHA goal 15% by 2025 15% by 2084 Anemia in Women
- 25. The ingredients for success are well known… ...and can lead to rapid improvement s in nutrition.Political leadership & SMART commitment Brazil Ethiopia Maharashtra Nutrition- oriented development Bangladesh Colombia Ghana Tanzania Data Systems Guatemala Indonesia Peru Strong implementation Argentina Burkina Faso Chile
- 26. 2. Invest more and allocate better
- 27. To meet WHA targets by 2025 nutrition specific funding will have to multiply Governments x 2 Donors x 3.5 Total x 3 Funding gaps: Substantial but bridgeable
- 28. Source: OPM and SUN SMS More general government expenditure could be directed towards nutrition- sensitive actions Budget allocations to nutrition sensitive actions in these countries are relatively low 4.8 2.1 1.5 1.4 1.2 1.2 1.1 1 0.8 0.6 0.6 0.5 0.1 %ofGeneralGovernmentExpenditures
- 29. 3. Invest in proven solutions & find new ones
- 30. agriculture and food systems social protection women’s empowerment WASH education There are many ways to support nutrition
- 31. Look outside nutrition to affect nutrition status, e.g. mothers’ age at birth 0 10 20 30 40 50 60 Stunting(%) Mothers aged <18 at the time of the birth ≥18
- 32. 4. Tackle malnutrition in all its forms 25%A quarter of all African countries have serious levels of undernutrition and adult overweight/obesity
- 33. Under 5 Stunting Women’s Anemia Adult Overweight (BMI ≥ 25)Ethiopia, Rwanda Ghana, Senegal Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Comoros, Congo (Republic of The), Côte d’Ivoire, Democratic Republic of the Congo, Djibouti, Eritrea, Gambia, Guinea, Guinea-Bissau, Kenya, Liberia, Madagascar, Malawi, Mali, Mauritania, Mozambique, Niger, Nigeria, Sao Tome and Principe, Sierra Leone, Somalia, Sudan, Togo, Uganda, Tanzania, Zambia, Zimbabwe Algeria, Gabon, Morocco, Seychelles, Tunisia Botswana, Egypt, Equatorial Guinea, Lesotho, Libya, Namibia, South Africa, Swaziland Countries with Multiple Burdens of Malnutrition
- 34. • Develop political strategies for an enabling environment for nutrition improvement • Build food environments for diverse diets • Implement interventions before and during first 1000 days Find “Double Duty” Actions to address multiple forms of malnutrition
- 35. Malnutrition is not destiny. Ending it is a political choice—supported by SMART commitments for accountability. Many countries are on course to meet targets. Many more are on the verge of doing so. Coexistence of multiple forms of malnutrition is the new normal. Nutrition stakeholders need to unite and then grow the nutrition constituency. Three takeaways
- 36. Three things you can do • Challenge decision makers with evidence on the slow pace of malnutrition reduction • Make those essential but challenging alliances for nutrition with those outside your immediate circle • Make SMART commitments for nutrition and ask others to do the same
- 37. Thank you
Editor's Notes
- This is the third GNR Produced by an independent expert group It covers all countries it covers all forms of nutrition It is data driven The GNR was called for at the N4G summit in London in 2013 to strengthen accountability of nutrition stakeholders to citizens. The first one was in 2014.
- This is the outline of the talk
- Malnutrition leads to: Human suffering, obviously Health related consequences. e.g. the 45% of under 5 mortality linked to malnutrition But also economic consequences
- Here are Two quotes from leaders of development banks—quite extraordinary—is this the beginning of a sea change in the way financial institutions think about nutrition? YES
- globally we are off course to meet the targets set by the World health Assembly, but there is hope because many countries are actually on track...
- We are now in the SDG era. The SDGs are great for malnutrition reduction because they challenge us to end malnutrition, by 2030 cover all forms of malnutrition stress that we should leave no one behind highlight the indivisibility of SDGs
- There are gaps between current commitments and need These commitments are of a political, technical & financial nature
- Setting SMART (specific, measurable, relevant, achievable and time-bound) targets is one indicator of commitment This analysis is from the WHO team. Unfortunately looking at 122 country nutrition plans, less than half have set SMART targets for the 6 WHA maternal and child nutrition indicators. Stunting and EBF fare the best. Wasting, perhaps surprisingly, is given lower priority when it comes to setting SMART targets. KB: Analysis of plans from 40 of 54 African countries.
- On the NCD side of things, less than a third of 174 countries surveys by WHO had targets (SMART or not) for obesity, diabetes and reduction of salt intake
- Why are we worried about SMART targets? Because they lend themselves to stronger accountability but also 2. they go hand in hand with performance (see next slide)
- In the report we give lots of qualitative examples of how commitment improved performance in reducing malnutrition But we also provide some suggestive quantitative evidence countries that set nutrition targets have higher rates of stunting reduction companies that set targets for key aspects of their performance, tend to perform better on those aspects (ATNI data) donors that make lots of public declarations about nutrition in their various documents tend to spend more on nutrition as a % of their overall spending Causality is difficult to establish here. Determined stakeholders make commitments and back them up. But the qualitative work in the report suggests that the making of commitments makes it harder to back out of action.
- We can’t have results without good implementation.
- This slide shows that when it comes to nutrition specific interventions there is a wide range of coverage achieved by different countries. This is good and bad news. Bad news because we want more countries with high coverage. Good news in the sense that some countries have achieved high coverage but they are not obviously wealthier than the countries that have not. We need to understand more about why some countries are near the top of the lines and some are near the bottom
- We need more data to guide action and promote accountability, especially at the subnational level.
- Here are some DHS data and we show stunting rates for the administrative units with the highest and lowest stunting rates (ordered by gap). There are wide disparities. At more disaggregated levels these may be equally large. But we don’t have very disaggregated pictures of nutrition outcomes (or coverage rates of programmes) Any solutions? (next slide)
- One contribution could be from small area estimation maps. They combine survey and census data to give highly disaggregated nutrition maps. They are common in poverty analyses and programming, less so in nutrition. WFP is a leader in this area and we recommend more of these maps now be produced.
- We have outlined the 7 key findings Now we do the same for the 5 calls to action.
- First of all, make nutrition more of a political issue. Technical issues are of course vital, but so too is political action.
- Don’t accept current situation. For example, look at this very simple extrapolation. For women’s anemia if we continue the current rate of progress as reported in Stevens 2013 Lancet paper, we will reach the Anemia target for women (prevalence of 15%) in 2084, not 2025. Clearly this is unacceptable, but this is a potentially powerful political message that is not being made strongly enough.
- And political leadership is vital for progress in nutrition In the past 3 GNRs we have highlighted several countries experiences on moving nutrition indicators. They are listed. Many factors are responsible and we have listed 4 sets. Central to these is political commitment. Remember: Ghana & Maharashtra halved their stunting rates 12 years. When forces are aligned properly rapid change can happen.
- Implementation takes financial resources. Some of it needs to be new. Some of it needs to be allocated differently.
- But its not just about more money. Its also about making existing allocations to food and agriculture, health, education, social protection, WASH and women’s empowerment more effective in reducing malnutrition The graph shows the percent of government expenditures going to nutrition sensitive programmes (using the SUN donor network definition). The countries on the right of the graph allocated much less of their budgets to nutrition sensitive programmes than other countries—the potential to increase is clear.
- To really make development work for nutrition, nutrition champions have to grow the circle of commitment for nutrition This means getting out of our comfort zones and forging alliances with other sectors.
- We need to find partners in these other sectors. Some of the changes in them (to make them more nutrition oriented) might be very powerful for nutrition.
- For example, the data we present shows a strong association between age of mother at birth and stunting rates of her children. (countries on left of graph) How important for nutrition status might be a law that sets a floor for the minimum age of marriage that is consistent with health outcomes for the mother and child? We don’t know, but we should find out.
- 44% of all countries are facing multiple forms of under nutrition and NCD related nutrition outcomes this % is likely to grow -- the latter are increasing faster than the former are declining
- what are these so called double duty interventions we mentioned earlier? Examples building the enabling environment for malnutrition reduction food environments that promote diverse diets interventions prior to (adolescents) and during 1000 day window; e.g. Barker hypothesis Education in schools—setting norms about healthy diets at an early age We need to do much more to find them
- There is a lot of detail in the report and the slides. But really there are 3 overarching messages that we would like you to leave with politics matters. Malnutrition is not destiny. We can choose to end it. even though the world is off track to meet WHA targets, many countries are on course to meet these targets and many others are close to being so. There are many successes out there. Nutrition champions need to come together to raise nutrition on the political agenda
- But nutrition is not just about what governments and donors and businesses and CSOs can do, it is about what each of us in this room can do Here are three things you can do