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Stuart Gillespie (IFPRI)• 2018 IFPRI Egypt Seminar: “High quality evidence is critical for high quality nutrition policy”

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as part of the IFPRI-Egypt Seminar Series- funded by the United States Agency for International Development (USAID) project called “Evaluating Impact and Building Capacity” (EIBC) that is implemented by IFPRI.

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Stuart Gillespie (IFPRI)• 2018 IFPRI Egypt Seminar: “High quality evidence is critical for high quality nutrition policy”

  1. 1. Driving change in nutrition: policy and practice Egypt Seminar Series Stuart Gillespie, IFPRI 25 September 2018 1
  2. 2. Content • Nutrition situation • Conceptualizing the drivers of nutrition • What is an “enabling environment” for nutrition? 1. Knowledge and evidence 2. Politics, policy and governance 3. Capacity and leadership • Stories of change in nutrition • Key lessons learnt 2
  3. 3. Malnutrition rates remain alarming: stunting is declining too slowly while wasting still impacts the lives of far too many young children Prevalence – Global Overview Percentage of stunted, wasting, overweight children under 5, by UN sub-region Source: UNICEF, WHO, World Bank Group Joint Child Malnutrition Estimates, 2018 edition. See Notes on the Data section on why only one time point is presented for wasting on the graphs above. 3
  4. 4. Malnutrition rates remain alarming: stunting is declining too slowly while wasting still impacts the lives of far too many young children Numbers Affected – Global Overview Number (millions) of stunted, wasting, overweight children under 5, by UN sub-region Source: UNICEF, WHO, World Bank Group Joint Child Malnutrition Estimates, 2018 edition. See Notes on the Data section on why only one time point is presented for wasting on the graphs above. 4
  5. 5. Stunting refers to a child who is too short for his or her age. These children can suffer severe irreversible physical and cognitive damage that accompanies stunted growth. The devastating effects of stunting can last a lifetime and even affect the next generation. Stunting refers to a child who is too short for his or her age. These children can suffer severe irreversible physical and cognitive damage that accompanies stunted growth. The devastating effects of stunting can last a lifetime and even affect the next generation. 5
  6. 6. Stunting Numbers Affected – Region Level (UNICEF regions), 2017 Number (millions) of stunted children under 5, by UN sub-region Source: UNICEF, WHO, World Bank Group Joint Child Malnutrition Estimates, 2018 edition. Note: *Eastern Europe and Central Asia region does not include Russian Federation due to missing data; consecutive low population coverage for the 2017 estimate (interpret with caution). There is no estimate available for the Europe and Central Asia region or the Western Europe sub-region. **North America regional average based on United States data only. 6
  7. 7. Stunting Prevalence – Country Level, 2017 Percentage of stunted children, under 5 Source: UNICEF, WHO, World Bank Group Joint Child Malnutrition Estimates, 2018 edition. Note: Country data are the most recent available estimate between 2011 and 2017; exceptions where older data (2005-2010) are shown are denoted with an asterisk(*) and where only data prior to 2005 are available the dark grey color denoting no recent data is used. 1.Eastern Europe and Central Asia region does not include Russian Federation due to missing data; consecutive low population coverage for the 2017 estimate (interpret with caution). 7
  8. 8. Overweight refers to a child who is too heavy for his or her height. This form of malnutrition results from energy intakes from food and beverages that exceed children’s energy requirements. Overweight increases the risk of diet-related noncommunicable diseases later in life. Overweight refers to a child who is too heavy for his or her height. This form of malnutrition results from energy intakes from food and beverages that exceed children’s energy requirements. Overweight increases the risk of diet-related noncommunicable diseases later in life. 8
  9. 9. Overweight Numbers Affected – Region Level (UNICEF regions), 2017 Number (millions) of overweight children under 5, by UNICEF regions Source: UNICEF, WHO, World Bank Group Joint Child Malnutrition Estimates, 2018 edition. Note:*Eastern Europe and Central Asia region does not include Russian Federation due to missing data; consecutive low population coverage for the 2017 estimate (interpret with caution). There is no estimate available for the Europe and Central Asia region or the Western Europe sub-region.. †represents regions/subregions where the change has been statistically significant; see page 12 for the 95% confidence intervals for graphed estimates. 9
  10. 10. Overweight Prevalence – Country Level, 2017 Percentage of overweight children under 5 Source: UNICEF, WHO, World Bank Group Joint Child Malnutrition Estimates, 2018 edition. Note: Country data are the most recent available estimate between 2011 and 2017; exceptions where older data (2005-2010) are shown are denoted with an asterisk(*) and where only data prior to 2005 are available the dark grey color denoting no recent data is used. 1.Eastern Europe and Central Asia region does not include Russian Federation due to missing data; consecutive low population coverage for the 2017 estimate (interpret with caution). 10
  11. 11. ROOTED IN Poverty Disempowerment of women Political & Cultural Environment Insufficient access to affordable, nutritious FOOD throughout the year Lack of good CARE for mothers & children & support for parents on appropriate child feeding practices Inadequate access to HEALTH sanitation & clean water services The causes of malnutrition are interconnected Environmental Degradation 11
  12. 12. Lancet 2013 conceptual framework 12
  13. 13. 13 Smith & Haddad. "Reducing Child Undernutrition: Past Drivers and Priorities for the Post-MDG Era." World Development 68 (2015): 180-204. What drives progress in nutrition? Contributions to reductions in stunting in developing countries, 1970-2010 (%)
  14. 14. Major shift in the nutrition landscape 2008 • Stewardship of the nutrition system dysfunctional and deeply fragmented • New evidence base introduced in the 2008 Lancet Series, identified critical 1,000 day window • Pinpointed a package of highly effective interventions for reducing undernutrition • Proposed a group of “high burden” countries as priorities for increased investment 2018 • Nutrition significantly elevated on the global agenda • Launch of the Scaling Up Nutrition (SUN) Movement in 2010: a major step toward improved stewardship of nutrition architecture • Nearly every major development agency has published a policy document on nutrition • Donors have increased ODA to basic nutrition significantly, amidst a very difficult fiscal climate • Nutrition is very prominent on the agendas of the United Nations, the G7 and supporting civil society • Agenda 2030 (SDGs) • Decade of Action on Nutrition14
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  16. 16. What does an enabling environment look like? Three vital factors for creating momentum and converting it to impact: Framing, knowledge and evidence Politics and governance Capacity and financial resources Impact 16
  17. 17. Global Nutrition Report 2015 17
  18. 18. Creating and sustaining momentum for undernutrition reduction Converting momentum to impact on nutrition status Framing, generating and communicating knowledge and evidence • Framing and narratives • What works? • How well do nutrition interventions work relative to other interventions? • Evidence/data on outcomes and benefits • Advocacy to increase priority (civil society) • Evidence on coverage and scale • Implementation research (what works,why and how) • Monitoring coverage • Programme evaluation (impact pathways) • Generating demand for evidence of impact • Learning during crisis Political economy of actors, ideas and interests • Incentivising and delivering horizontal coherence (multisectoral coordination) • Building up accountability to citizens • Civil society: galvanizing commitment • Enabling and incentivizing positive contributions from the private sector • Delivering horizontal and vertical coherence • The role of civil society in delivery & impact • The role of private sector Capacity (individual, organizational, systemic) and financial resources • Leadership/championing • Systemic capacity to sustain commitment • Understanding financing and making the case for additional resource mobilisation • Prioritisation and sequencing of nutrition action • Capacity for Implementation and scaling up • New forms of resource mobilisation 18
  19. 19. Knowledge = Evidence + Experience Major challenges relate to “how” not “what” We need to learn from the real world! 19
  20. 20. • To foster an experiential learning process based on real-time documentation of change, and sharing ideas across national boundaries. • Bangladesh, India, Nepal, Senegal, Zambia, Ethiopia (2015-17) • Many more countries now…. (2018-2020) • Inform…..and inspire! 20
  21. 21. Core findings on how change has been driven in 6 countries via the contributions and interactions of: 1. Commitment 2. Coherence 3. Accountability 4. Data, evidence 5. Capacity 6. Leadership 7. Financing 21
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  24. 24. Key lessons • Multisectoral nature of nutrition now well understood…. ..…….but operationalizing such knowledge is more challenging! • Food, health and care are all key – and synergies are possible in addressing all drivers • Nutrition-specific interventions can make inroads if designed, targeted and implemented in contextually appropriate ways, but addressing structural and underlying drivers is paramount in long term. • Enabling environments need to be created, sustained and they need to relate to the double burden of malnutrition. • Commitment needs to be translated into action through focus on data, accountability, leadership (at all levels), capacity and sustained financing. 24
  25. 25. Thank you! 25

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