This document summarizes key information on improving nutrition over the past 50 years, including paradigms in international nutrition from the 1950s to present. It discusses lessons learned from community nutrition programming case studies in countries like Bangladesh, as well as the importance of infant and young child feeding best practices. The document also examines approaches to tackling micronutrient deficiencies through interventions like salt iodization in China and micronutrient powders in Mongolia. Finally, it outlines the community-based management of acute malnutrition model and case studies of its implementation in countries such as Malawi.
In recent years, the world has seen unprecedented attention and political commitment to addressing malnutrition. As nutrition rapidly rises on the global agenda, guidance is urgently needed on how to design, implement, and evaluate nutrition-enhancing policies and interventions. Nourishing Millions: Stories of Change in Nutrition brings together the most intriguing stories about improving nutrition from the past five decades. These stories provide insight into what works in nutrition, what does not, and the factors that contribute to success.
THE CALLS FOR strong leadership in the fight against global and national malnutrition have multiplied during the past decade. The role of nutrition champions in advocating for nutrition, formulating policies, and coordinating and implementing action in nutrition have increasingly been recognized in such countries as Peru, Brazil, Thailand, and the Indian states of Tamil Nadu and Maharashtra. Global initiatives such as the Scaling Up Nutrition (SUN) Movement, the African Nutrition Leadership Programme, and the European Nutrition Leadership Platform have invested in building up capacity for leadership among national governments, civil society, and the private sector. The World Public Health Nutrition Association’s guide on competencies needed to build up the workforce in global public health nutrition identified leadership as key. More widely, leadership within the field of public health has been highlighted as key to moving child or maternal health higher up on the global agenda and tackling critical issues such as HIV and AIDS at the national and community levels.
BY WEAVING STORIES together with analysis and description in this book, we have sought to convey the variety of experiences in tackling malnutrition in different contexts throughout the past five decades. This narrative approach is intended to help the reader translate an experience into his or her own context, showing many examples of what can be done and how success can be achieved. Our aim is not only to inform action, but to inspire.
ODISHA, A STATE of 42 million people in eastern India, is one of the poorest in the country. It has faced many development challenges over the years, including insurgent movements, large pockets of extreme deprivation among scheduled tribe communities, social disparities, and natural disasters, as well as a relatively late fiscal turnaround (in 2004–2005) in comparison with other states. Yet Odisha has made significant progress in reducing child undernutrition—less than India as a whole, but more than many other richer states. How has it achieved this progress?
This book is an attempt to meet for narratives of what has worked well by combining a review of various analyses and studies with a narrative approach to convey the drivers and pathways of success in nutrition in different contexts and at different times. It seeks to inspire as well as to inform. In recent years, there has been a growing focus on the potential of narrative and storytelling to inspire and promote change.4 Stories can turn the key in ways that help the reader intuitively grasp why change is needed, what it involves, how it happens, and—crucially—how it can be made to happen. Stories enable listeners to extrapolate from case studies and to see analogies with their own backgrounds, their own contexts, and their own fields of expertise. Research has shown that stories catalyze change because they are natural and easy to tell, they show connections between things, and they cut through complexity. They are memorable, non-adversarial, non-hierarchical
THAILAND REDUCED CHILD undernutrition by more than half within one decade—an achievement recognized by the nutrition community as one of the best examples of a successful national nutrition program. Underweight rates among children under five decreased from more than 50 percent to less than 20 percent from 1982 to 1991, and severe and moderate underweight rates were nearly eliminated. The underweight rate was further reduced to 10 percent by 1996 and to 9 percent by 2012. Maternal care interventions were also successful. Thailand improved the reach of antenatal care—coverage increased from 35 percent in 1981 to near 95 percent in 2006. And iron-deficiency anemia prevalence among pregnant women was reduced from nearly 60 percent in the 1960s to 10 percent in 2005.
FEW SECTORS HAVE clearer links to nutrition than agriculture. Most simply, of course, agriculture is a source of food. Because many poor households around the world grow food that they both consume and sell for income, agricultural interventions can have a massive effect on the lives of people in developing countries. Through the decades, and most famously in Asia’s Green Revolution, development projects have sought to boost agricultural production of staple foods as a way of improving people’s nutrition. Yet, while consuming a sufficient quantity of calories is important, especially among undernourished populations, quality matters too. Thus, the traditional focus on producing enough food to meet people’s calorie needs has evolved into a deeper understanding that to improve nutrition, we also need people to consume balanced, high-quality, and diverse diets that contain enough essential nutrients to meet their daily requirements.
REMARKABLE IMPROVEMENTS IN welfare and human development indicators in Bangladesh—including a notable reduction in the poverty headcount—have accompanied recent economic growth.1 Some aspects of nutrition have been part of this success story. For example, the percentage of underweight children declined by 1.1 percent per year and stunting rates declined by 1.3 percent per year between 1997 and 2007.2 And this trend has continued, with rates of child stunting falling to 36 percent in 2014 (Figure 12.1). Other countries may have experienced shorter, quicker reductions, but the Bangladesh story reflects “one of the fastest prolonged reductions in child underweight and stunting prevalence in recorded history.
In recent years, the world has seen unprecedented attention and political commitment to addressing malnutrition. As nutrition rapidly rises on the global agenda, guidance is urgently needed on how to design, implement, and evaluate nutrition-enhancing policies and interventions. Nourishing Millions: Stories of Change in Nutrition brings together the most intriguing stories about improving nutrition from the past five decades. These stories provide insight into what works in nutrition, what does not, and the factors that contribute to success.
THE CALLS FOR strong leadership in the fight against global and national malnutrition have multiplied during the past decade. The role of nutrition champions in advocating for nutrition, formulating policies, and coordinating and implementing action in nutrition have increasingly been recognized in such countries as Peru, Brazil, Thailand, and the Indian states of Tamil Nadu and Maharashtra. Global initiatives such as the Scaling Up Nutrition (SUN) Movement, the African Nutrition Leadership Programme, and the European Nutrition Leadership Platform have invested in building up capacity for leadership among national governments, civil society, and the private sector. The World Public Health Nutrition Association’s guide on competencies needed to build up the workforce in global public health nutrition identified leadership as key. More widely, leadership within the field of public health has been highlighted as key to moving child or maternal health higher up on the global agenda and tackling critical issues such as HIV and AIDS at the national and community levels.
BY WEAVING STORIES together with analysis and description in this book, we have sought to convey the variety of experiences in tackling malnutrition in different contexts throughout the past five decades. This narrative approach is intended to help the reader translate an experience into his or her own context, showing many examples of what can be done and how success can be achieved. Our aim is not only to inform action, but to inspire.
ODISHA, A STATE of 42 million people in eastern India, is one of the poorest in the country. It has faced many development challenges over the years, including insurgent movements, large pockets of extreme deprivation among scheduled tribe communities, social disparities, and natural disasters, as well as a relatively late fiscal turnaround (in 2004–2005) in comparison with other states. Yet Odisha has made significant progress in reducing child undernutrition—less than India as a whole, but more than many other richer states. How has it achieved this progress?
This book is an attempt to meet for narratives of what has worked well by combining a review of various analyses and studies with a narrative approach to convey the drivers and pathways of success in nutrition in different contexts and at different times. It seeks to inspire as well as to inform. In recent years, there has been a growing focus on the potential of narrative and storytelling to inspire and promote change.4 Stories can turn the key in ways that help the reader intuitively grasp why change is needed, what it involves, how it happens, and—crucially—how it can be made to happen. Stories enable listeners to extrapolate from case studies and to see analogies with their own backgrounds, their own contexts, and their own fields of expertise. Research has shown that stories catalyze change because they are natural and easy to tell, they show connections between things, and they cut through complexity. They are memorable, non-adversarial, non-hierarchical
THAILAND REDUCED CHILD undernutrition by more than half within one decade—an achievement recognized by the nutrition community as one of the best examples of a successful national nutrition program. Underweight rates among children under five decreased from more than 50 percent to less than 20 percent from 1982 to 1991, and severe and moderate underweight rates were nearly eliminated. The underweight rate was further reduced to 10 percent by 1996 and to 9 percent by 2012. Maternal care interventions were also successful. Thailand improved the reach of antenatal care—coverage increased from 35 percent in 1981 to near 95 percent in 2006. And iron-deficiency anemia prevalence among pregnant women was reduced from nearly 60 percent in the 1960s to 10 percent in 2005.
FEW SECTORS HAVE clearer links to nutrition than agriculture. Most simply, of course, agriculture is a source of food. Because many poor households around the world grow food that they both consume and sell for income, agricultural interventions can have a massive effect on the lives of people in developing countries. Through the decades, and most famously in Asia’s Green Revolution, development projects have sought to boost agricultural production of staple foods as a way of improving people’s nutrition. Yet, while consuming a sufficient quantity of calories is important, especially among undernourished populations, quality matters too. Thus, the traditional focus on producing enough food to meet people’s calorie needs has evolved into a deeper understanding that to improve nutrition, we also need people to consume balanced, high-quality, and diverse diets that contain enough essential nutrients to meet their daily requirements.
REMARKABLE IMPROVEMENTS IN welfare and human development indicators in Bangladesh—including a notable reduction in the poverty headcount—have accompanied recent economic growth.1 Some aspects of nutrition have been part of this success story. For example, the percentage of underweight children declined by 1.1 percent per year and stunting rates declined by 1.3 percent per year between 1997 and 2007.2 And this trend has continued, with rates of child stunting falling to 36 percent in 2014 (Figure 12.1). Other countries may have experienced shorter, quicker reductions, but the Bangladesh story reflects “one of the fastest prolonged reductions in child underweight and stunting prevalence in recorded history.
DESPITE SIGNIFICANT ECONOMIC growth, South Asia remains notorious for its alarmingly high rates of undernutrition. This “Asian enigma” has long puzzled both researchers and policymakers. However, Nepal’s recent experience presents yet another enigma: a rapid reduction in maternal and child undernutrition during a period of civil war and prolonged political and economic instability. From 1996 to 2011, the prevalence of stunting among children under two years of age fell from 48 to 27 percent, and the prevalence of maternal underweight decreased from 28 to 20 percent.
MORE THAN 660 million people lack access to an improved water source and 2.4 billion people lack access to improved sanitation. Growing awareness of the global challenge we face in improving water, sanitation, and hygiene, widely known as WASH, has gained the problem a prominent place on global nutrition and health agendas. And an expanding body of research points to the great potential of WASH, as a set of interventions, to improve nutrition and health. For example, systematic reviews have shown that improving water quality can reduce the risk of diarrhea by 17 percent; and introducing hand hygiene interventions can reduce gastrointestinal by 31 percent and respiratory illness by 21 percent
SEVERE ACUTE MALNUTRITION (SAM)—extremely low weight for one’s height—is a life-threatening condition affecting mostly children under five years of age. It is caused by a combination of infection, such as diarrheal disease, and poor diets that are inadequate for nutritional needs. SAM is one of the top three nutrition-related causes of death in children under five according to the 2008 Maternal and Child Nutrition Lancet Series. A child with SAM is 11 times more likely to die than a well-nourished child. Despite the size of the problem, until the early 2000s SAM appeared to be a so-called neglected disease: little support went to large-scale treatment programs targeted toward children with SAM. Few countries-even among those with a high prevalence of malnutrition-had a clear national policy for detecting and treating SAM children.10 The development and adoption of a new approach-the community-based management of acute malnutrition (CMAM)-was to change the public health nutrition landscape by bringing treatment out of hospitals and into the community
Ensuring agricultural biodiversity and nutrition remain central to addressing...Bioversity International
Given at Bioversity/FAO meeting on Biodiversity and sustainable diets, 3-5 November 2010. Read more about Bioversity International’s work on diet diversity for nutrition and health: http://www.bioversityinternational.org/research-portfolio/diet-diversity/
Ellen G. Piwoz
MARTIN J. FORMAN MEMORIAL LECTURE
Virtual Event - Seizing Opportunity from the Jaws of Crisis: A Playbook for Nutrition
DEC 10, 2020 - 10:00 AM TO 11:30 AM EST
Florencia Paz
SPECIAL EVENT
Funding Food System Transformation in Developing Countries: An example from Ethiopia
UNFSS Side Event -- Co-organized by IFPRI, The Alliance of Bioversity International and CIAT, CGIAR
SEP 24, 2021 - 08:00 AM TO 09:30 AM EDT
VIETNAM HAS MADE dramatic progress in improving nutrition over the past three decades. Following the introduction of Vietnam’s Doi Moi (“renovation”) economic policies in 1986, the country’s economic performance began to improve rapidly. By the 1990s, Vietnam was among the fastest growing economies in the world. From one of the five poorest countries in the world in 1984, Vietnam rose to a rank of 167 out of 206 by 1999. As the country transitioned to a market-oriented economy, rapid economic growth was accompanied by a similarly dramatic decline in the poverty rate, which fell from nearly 75 percent of the population in 1984, to 58 percent in 1993, and down to 37 percent by 1998. Economic growth enabled the country to provide improved health services, which contributed directly to reductions in child malnutrition.
"Empowering Women as Key drivers of Food System Change Lindiwe Majele Sibanda...ExternalEvents
"www.fao.org/about/meetings/sustainable-food-systems-nutrition-symposium
The International Symposium on Sustainable Food Systems for Healthy Diets and Improved Nutrition was jointly held by FAO and WHO in December 2016 to explore policies and programme options for shaping the food systems in ways that deliver foods for a healthy diet, focusing on concrete country experiences and challenges. This Symposium waas the first large-scale contribution under the UN Decade of Action for Nutrition 2016-2025. This presentation was part of Parallel session 3.3: Empowering women as key drivers of food system change"
4. day 2 session 1 nutrition sensitive programs and policiesPOSHAN
Presentation made at a two-day workshop "Stepping up to India’s Nutrition Challenge: The Critical Role of Policy Makers" for district administrators from India’s Aspirational Districts, on 6-7 Aug 2018, at Mussoorie.
Presented by Muntita Hambayi
Presented at Report Launch "Mapping Linkages Between Agriculture, Food Security and Nutrition in Malawi"
Ufulu Gardens, 28th April, 2015
Barry M. Popkin
SPECIAL EVENT
28th Annual Martin J. Forman Memorial Lecture
Confronting the New Face of Malnutrition: Regulatory and Fiscal Approaches to Improving Diets
OCT 29, 2018 - 12:15 PM TO 01:45 PM EDT
OVER THE PAST 25 years, Ethiopia has made remarkable headway in addressing the country’s nutrition situation. Despite ongoing challenges, significant progress has been made toward meeting the United Nations Millennium Development Goals, including halving child mortality, doubling the number of people with access to clean water, and quadrupling primary school enrollment. Ethiopia is also on track to eradicate extreme hunger and poverty. The country was one of the top five performing countries in the 2000s in terms of reducing stunting by reducing its prevalence from 57.4 percent in 2000 to 44.2 percent in 2011, although levels remained high at 40.0 percent in 2014.2 The same 2014 Demographic and Health Survey found that a further 9 percent of children younger than 5 years old experience wasting, and only 4 percent of children meet the standards for a minimal acceptable diet (a World Health Organization [WHO]/UNICEF indicator for complementary feeding).3 Significant regional differences persist, with the highest rates of stunting (52 percent) found in Amhara and the lowest found in Gambela (27 percent) and Addis Ababa (22 percent). Overall, stunting is more prevalent in rural (46 percent) than in urban areas (36 percent).
The economic case for investing in nutritionGlo_PAN
Presented by Shawn Baker, Director of the Nutrition team at the Bill and Melinda Gates Foundation, during the launch of "African Leaders for Nutrition" at the African Development Bank Annual meeting (23 May 2016, Lusaka, Zambia).
More info: Glopan.org/african-leaders-nutrition
Presentation made at a two-day workshop "Stepping up to India’s Nutrition Challenge: The Critical Role of Policy Makers" for district administrators from India’s Aspirational Districts, on 6-7 Aug 2018, at Mussoorie.
DESPITE SIGNIFICANT ECONOMIC growth, South Asia remains notorious for its alarmingly high rates of undernutrition. This “Asian enigma” has long puzzled both researchers and policymakers. However, Nepal’s recent experience presents yet another enigma: a rapid reduction in maternal and child undernutrition during a period of civil war and prolonged political and economic instability. From 1996 to 2011, the prevalence of stunting among children under two years of age fell from 48 to 27 percent, and the prevalence of maternal underweight decreased from 28 to 20 percent.
MORE THAN 660 million people lack access to an improved water source and 2.4 billion people lack access to improved sanitation. Growing awareness of the global challenge we face in improving water, sanitation, and hygiene, widely known as WASH, has gained the problem a prominent place on global nutrition and health agendas. And an expanding body of research points to the great potential of WASH, as a set of interventions, to improve nutrition and health. For example, systematic reviews have shown that improving water quality can reduce the risk of diarrhea by 17 percent; and introducing hand hygiene interventions can reduce gastrointestinal by 31 percent and respiratory illness by 21 percent
SEVERE ACUTE MALNUTRITION (SAM)—extremely low weight for one’s height—is a life-threatening condition affecting mostly children under five years of age. It is caused by a combination of infection, such as diarrheal disease, and poor diets that are inadequate for nutritional needs. SAM is one of the top three nutrition-related causes of death in children under five according to the 2008 Maternal and Child Nutrition Lancet Series. A child with SAM is 11 times more likely to die than a well-nourished child. Despite the size of the problem, until the early 2000s SAM appeared to be a so-called neglected disease: little support went to large-scale treatment programs targeted toward children with SAM. Few countries-even among those with a high prevalence of malnutrition-had a clear national policy for detecting and treating SAM children.10 The development and adoption of a new approach-the community-based management of acute malnutrition (CMAM)-was to change the public health nutrition landscape by bringing treatment out of hospitals and into the community
Ensuring agricultural biodiversity and nutrition remain central to addressing...Bioversity International
Given at Bioversity/FAO meeting on Biodiversity and sustainable diets, 3-5 November 2010. Read more about Bioversity International’s work on diet diversity for nutrition and health: http://www.bioversityinternational.org/research-portfolio/diet-diversity/
Ellen G. Piwoz
MARTIN J. FORMAN MEMORIAL LECTURE
Virtual Event - Seizing Opportunity from the Jaws of Crisis: A Playbook for Nutrition
DEC 10, 2020 - 10:00 AM TO 11:30 AM EST
Florencia Paz
SPECIAL EVENT
Funding Food System Transformation in Developing Countries: An example from Ethiopia
UNFSS Side Event -- Co-organized by IFPRI, The Alliance of Bioversity International and CIAT, CGIAR
SEP 24, 2021 - 08:00 AM TO 09:30 AM EDT
VIETNAM HAS MADE dramatic progress in improving nutrition over the past three decades. Following the introduction of Vietnam’s Doi Moi (“renovation”) economic policies in 1986, the country’s economic performance began to improve rapidly. By the 1990s, Vietnam was among the fastest growing economies in the world. From one of the five poorest countries in the world in 1984, Vietnam rose to a rank of 167 out of 206 by 1999. As the country transitioned to a market-oriented economy, rapid economic growth was accompanied by a similarly dramatic decline in the poverty rate, which fell from nearly 75 percent of the population in 1984, to 58 percent in 1993, and down to 37 percent by 1998. Economic growth enabled the country to provide improved health services, which contributed directly to reductions in child malnutrition.
"Empowering Women as Key drivers of Food System Change Lindiwe Majele Sibanda...ExternalEvents
"www.fao.org/about/meetings/sustainable-food-systems-nutrition-symposium
The International Symposium on Sustainable Food Systems for Healthy Diets and Improved Nutrition was jointly held by FAO and WHO in December 2016 to explore policies and programme options for shaping the food systems in ways that deliver foods for a healthy diet, focusing on concrete country experiences and challenges. This Symposium waas the first large-scale contribution under the UN Decade of Action for Nutrition 2016-2025. This presentation was part of Parallel session 3.3: Empowering women as key drivers of food system change"
4. day 2 session 1 nutrition sensitive programs and policiesPOSHAN
Presentation made at a two-day workshop "Stepping up to India’s Nutrition Challenge: The Critical Role of Policy Makers" for district administrators from India’s Aspirational Districts, on 6-7 Aug 2018, at Mussoorie.
Presented by Muntita Hambayi
Presented at Report Launch "Mapping Linkages Between Agriculture, Food Security and Nutrition in Malawi"
Ufulu Gardens, 28th April, 2015
Barry M. Popkin
SPECIAL EVENT
28th Annual Martin J. Forman Memorial Lecture
Confronting the New Face of Malnutrition: Regulatory and Fiscal Approaches to Improving Diets
OCT 29, 2018 - 12:15 PM TO 01:45 PM EDT
OVER THE PAST 25 years, Ethiopia has made remarkable headway in addressing the country’s nutrition situation. Despite ongoing challenges, significant progress has been made toward meeting the United Nations Millennium Development Goals, including halving child mortality, doubling the number of people with access to clean water, and quadrupling primary school enrollment. Ethiopia is also on track to eradicate extreme hunger and poverty. The country was one of the top five performing countries in the 2000s in terms of reducing stunting by reducing its prevalence from 57.4 percent in 2000 to 44.2 percent in 2011, although levels remained high at 40.0 percent in 2014.2 The same 2014 Demographic and Health Survey found that a further 9 percent of children younger than 5 years old experience wasting, and only 4 percent of children meet the standards for a minimal acceptable diet (a World Health Organization [WHO]/UNICEF indicator for complementary feeding).3 Significant regional differences persist, with the highest rates of stunting (52 percent) found in Amhara and the lowest found in Gambela (27 percent) and Addis Ababa (22 percent). Overall, stunting is more prevalent in rural (46 percent) than in urban areas (36 percent).
The economic case for investing in nutritionGlo_PAN
Presented by Shawn Baker, Director of the Nutrition team at the Bill and Melinda Gates Foundation, during the launch of "African Leaders for Nutrition" at the African Development Bank Annual meeting (23 May 2016, Lusaka, Zambia).
More info: Glopan.org/african-leaders-nutrition
Presentation made at a two-day workshop "Stepping up to India’s Nutrition Challenge: The Critical Role of Policy Makers" for district administrators from India’s Aspirational Districts, on 6-7 Aug 2018, at Mussoorie.
2022 Nutrition Month Presentation
This year’s campaign is guided by the theme “New normal sa nutrisyon, sama-samang gawan ng solusyon!” The theme was approved by the NNC Technical Committee through ad referendum in March. The theme calls for solidarity to address malnutrition in the new normal. It also holds the promise that after this once in a lifetime pandemic, we can recover and build back better through improved nutrition and resilience.
nutrition month campaign particularly its objectives and key messages, how the pandemic affected nutrition, how nutrition and resilience are linked, define new normal and the new normal in nutrition that we want. Lastly, I will share our call for support from among the different sectors so that through our collective effort, we can improve nutrition as we move forward to a better new normal.
Whatever advances have been made in terms of technologies, interventions, and their delivery platforms in recent decades, it is households and communities that remain on the front lines in combating malnutrition. During the past half century, several significant attempts have been made to initiate and implement community-based nutrition programs. This chapter assesses the evolution and performance of
This presentation covers the USAID Office of Maternal, Child Health and Nutrition; the Office of Health Systems; Office of Population and Reproductive Health; and the Center for Innovation and Impact.
A project proposal for East Timor on improving health and nutrition for women...Kazuko Yoshizawa
The presentation outlines a project proposal aimed at capacity building in health and nutrition for Timor-Leste, developed through extensive consultation with the Ministry of Health, development partners, NGOs, and civil society. The primary objective of the project is to enhance the nutritional status of women and children who are particularly vulnerable to malnutrition. The project proposal comprises four key areas that address the capacity gaps identified through stakeholder consultations and documented in published reports and strategies. By providing additional support and interventions, as well as strengthening existing structures, the proposed interventions would help to improve the nutrition status of children and women. The proposal further suggests that the capacity of Integrated Community Health Services (Sisca) could be enhanced to improve rural health services. Such improvements would help to address the existing disparities in health outcomes between rural and urban areas in Timor-Leste. Through the proposed interventions, the project aims to support the overall development of the health and nutrition sector in Timor-Leste. By addressing the identified capacity gaps, the project would help to build sustainable systems that can deliver effective health and nutrition services to the population.
In conclusion, the presentation explains a comprehensive project proposal that aims to improve the nutritional status of vulnerable women and children in Timor-Leste. The proposal is based on extensive consultation with stakeholders and would address capacity gaps identified through published reports and strategies. Through this project, it would be possible to enhance rural health services by strengthening the capacity of Integrated Community Health Services (Sisca) and supporting existing structures. Ultimately, the proposed interventions would contribute to the development of sustainable health and nutrition systems in Timor-Leste.
OVERWEIGHT AND OBESITY prevalence has increased substantially over the past decades, affecting 2.1 billion people worldwide and causing 3.4 million deaths globally.1 Currently, 42 million children are overweight or obese—the result of a staggering 47.1 percent rise in prevalence between 1980 and 2013.2 No longer exclusive to affluent societies, obesity has reached alarmingly high levels in many low- and middle-income countries (LMICs).3 In fact, the number of individuals who are overweight or obese (1.9 billion) has now surpassed the 794 million people who do not get enough calories.4 Nearly half of all overweight children under 5 years of age now live in Asia, and a further 25 percent are found in Africa.
Evaluate strategies for improving household nutritional diversity in Maliafrica-rising
Poster prepared by C.M. Sobgui, H. Diarra, P. Coulibaly, J.B. Tignegre and A. Tenkouano for the AfrIca RISING West Africa Review and Planning Meeting, Accra, 30 March–1 April 2016
Background of National Nutrition Program
Malnutrition in Nepal
Efforts to address under-nutrition
Objectives of National Nutrition Programme
Targets of National Nutrition Programme
Strategies of National Nutrition Programme
Transform nutrition in east africa an overview by Stuart GillespieTransform Nutrition
A presentation given by Stuart Gillespie at the Transform Nutrition regional meeting 'Using evidence to inspire action in East Africa' Nairobi, Kenya 8 June 2017.
These set of slides were presented at the BEP Seminar "Targeting in Development Projects: Approaches, challenges, and lessons learned" held last Oct. 2, 2023 in Cairo, Egypt
Caitlin Welsh
POLICY SEMINAR
Food System Repercussions of the Russia-Ukraine War
2023 Borlaug Dialogue Breakout session
Co-organized by IFPRI and CGIAR
OCT 26, 2023 - 1:10 TO 2:10PM EDT
Joseph Glauber
POLICY SEMINAR
Food System Repercussions of the Russia-Ukraine War
2023 Borlaug Dialogue Breakout session
Co-organized by IFPRI and CGIAR
OCT 26, 2023 - 1:10 TO 2:10PM EDT
Antonina Broyaka
POLICY SEMINAR
Food System Repercussions of the Russia-Ukraine War
2023 Borlaug Dialogue Breakout session
Co-organized by IFPRI and CGIAR
OCT 26, 2023 - 1:10 TO 2:10PM EDT
Bofana, Jose. 2023. Mapping cropland extent over a complex landscape: An assessment of the best approaches across the Zambezi River basin. PowerPoint presentation given during the Project Inception Workshop, VIP Grand Hotel, Maputo, Mozambique, April 20, 2023
Mananze, Sosdito. 2023. Examples of remote sensing application in agriculture monitoring. PowerPoint presentation given during the Project Inception Workshop, VIP Grand Hotel, Maputo, Mozambique, April 20, 2023
Seoul National University (SNU). 2023. Statistics from Space: Next-Generation Agricultural Production Information for Enhanced Monitoring of Food Security in Mozambique. Component 4. Crop analytics for forecasting yields. PowerPoint presentation given during the Project Inception Workshop, VIP Grand Hotel, Maputo, Mozambique, April 20, 2023
International Food Policy Research Institute (IFPRI). 2023. Statistics from Space: Next-Generation Agricultural Production Information for Enhanced Monitoring of Food Security in Mozambique. PowerPoint presentation given during the Project Kickoff Meeting (virtual), January 12, 2023
International Food Policy Research Institute (IFPRI). 2023. Statistics from Space: Next-Generation Agricultural Production Information for Enhanced Monitoring of Food Security in Mozambique. Component 1. Stakeholder engagement for impacts. PowerPoint presentation given during the Project Inception Workshop, VIP Grand Hotel, Maputo, Mozambique, April 20, 2023
Centro de Estudos de Políticas e Programas Agroalimentares (CEPPAG). 2023. Statistics from Space: Next-Generation Agricultural Production Information for Enhanced Monitoring of Food Security in Mozambique. Component 3. Digital collection of groundtruthing data. PowerPoint presentation given during the Project Inception Workshop, VIP Grand Hotel, Maputo, Mozambique, April 20, 2023
ITC/University of Twente. 2023. Statistics from Space: Next-Generation Agricultural Production Information for Enhanced Monitoring of Food Security in Mozambique. Component 2. Enhanced area sampling frames. PowerPoint presentation given during the Project Inception Workshop, VIP Grand Hotel, Maputo, Mozambique, April 20, 2023
Christina Justice
IFPRI-AMIS SEMINAR SERIES
A Look at Global Rice Markets: Export Restrictions, El Niño, and Price Controls
Co-organized by IFPRI and Agricultural Market Information System (AMIS)
OCT 18, 2023 - 9:00 TO 10:30AM EDT
Fousseini Traoré
IFPRI-AMIS SEMINAR SERIES
A Look at Global Rice Markets: Export Restrictions, El Niño, and Price Controls
Co-organized by IFPRI and Agricultural Market Information System (AMIS)
OCT 18, 2023 - 9:00 TO 10:30AM EDT
Abdullah Mamun and Joseph Glauber
IFPRI-AMIS SEMINAR SERIES
A Look at Global Rice Markets: Export Restrictions, El Niño, and Price Controls
Co-organized by IFPRI and Agricultural Market Information System (AMIS)
OCT 18, 2023 - 9:00 TO 10:30AM EDT
Shirley Mustafa
IFPRI-AMIS SEMINAR SERIES
A Look at Global Rice Markets: Export Restrictions, El Niño, and Price Controls
Co-organized by IFPRI and Agricultural Market Information System (AMIS)
OCT 18, 2023 - 9:00 TO 10:30AM EDT
Joseph Glauber
IFPRI-AMIS SEMINAR SERIES
A Look at Global Rice Markets: Export Restrictions, El Niño, and Price Controls
Co-organized by IFPRI and Agricultural Market Information System (AMIS)
OCT 18, 2023 - 9:00 TO 10:30AM EDT
Lead authors Jonathan Mockshell and Danielle Resnick presented these slides at the Virtual Book Launch of the Political Economy and Policy Analysis (PEPA) Sourcebook on October 10, 2023.
An output of the Myanmar Strategy Support Program, with USAID and Michigan State University. Presented by Paul Dorosh, Director, Development Strategy and Governance Unit, International Food Policy Research Institute and Nilar Aung, Research Specialist, Michigan State University.
Bedru Balana, Research Fellow, IFPRI, presented these slides at the AAAE2023 Conference, Durban, South Africa, 18-21 September 2023. The authors acknowledged the contributions of CGIAR Initiative on National Policies and Strategies, Google, the International Rescue Committee, IFPRI, and USAID.
Sara McHattie
IFPRI-AMIS SEMINAR SERIES
Facilitating Anticipatory Action with Improved Early Warning Guidance
Co-organized by IFPRI and Agricultural Market Information System (AMIS)
SEP 26, 2023 - 9:00 TO 10:30AM EDT
More from International Food Policy Research Institute (IFPRI) (20)
ZGB - The Role of Generative AI in Government transformation.pdfSaeed Al Dhaheri
This keynote was presented during the the 7th edition of the UAE Hackathon 2024. It highlights the role of AI and Generative AI in addressing government transformation to achieve zero government bureaucracy
Russian anarchist and anti-war movement in the third year of full-scale warAntti Rautiainen
Anarchist group ANA Regensburg hosted my online-presentation on 16th of May 2024, in which I discussed tactics of anti-war activism in Russia, and reasons why the anti-war movement has not been able to make an impact to change the course of events yet. Cases of anarchists repressed for anti-war activities are presented, as well as strategies of support for political prisoners, and modest successes in supporting their struggles.
Thumbnail picture is by MediaZona, you may read their report on anti-war arson attacks in Russia here: https://en.zona.media/article/2022/10/13/burn-map
Links:
Autonomous Action
http://Avtonom.org
Anarchist Black Cross Moscow
http://Avtonom.org/abc
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Nourishing Millions: Stories of change in nutrition
1.
2. How Nutrition Improves:
Half a Century of Understanding
and Responding to the Problem of
Malnutrition
Stuart Gillespie and Jody Harris
3. http://nourishingmillions.ifpri.info/
Understanding and responding to the problem
of malnutrition
• Undernutrition reduces global GDP by USD$1.4–2.1 trillion a year—
the size of the total economy of Africa south of the Sahara.
• While many countries are making progress in reducing child
undernutrition, another form of malnutrition—overweight and
obesity—is now changing the health landscape in every region of
the world.
• Lessons on how to improve nutrition in the real world and in real
time are needed.
• This book combines a review of various analyses and studies with a
narrative approach to convey the drivers and pathways of success
in nutrition in different contexts and at different times.
4. http://nourishingmillions.ifpri.info/
Paradigms in international nutrition (1 of 2)
• 1950–1960s: Focus on hunger, famine,
and the metabolic consequences and
treatment of severe protein deficiency –
the assumed mechanism for severe
malnutrition
• 1970s: The concept of multisectoral
nutrition planning gains momentum in
reaction to largely food supply–oriented
interventions that did not address the
wider, nonfood drivers of malnutrition
and had little impact
• 1980s: The failure of multisectoral
planning gives rise to the era of
“nutritional isolationism” with a focus on
micronutrient supplementation and
breastfeeding.
Panos/D. Rose
5. http://nourishingmillions.ifpri.info/
Paradigms in international nutrition (2 of 2)
• 1990s: UNICEF develops its nutrition framework and nutritionists
focus on micronutrients, while the nutrition policy literature
explores the political economy of nutrition
• 2000-2010: Work begins on promoting biofortified crops and the
Lancet Maternal and Child Nutrition series significantly raises the
profile of nutrition in the development community
• 2010-2015: High-level political commitment to address
undernutrition ramps up significantly among international UN
organizations, donors, NGOs, and governments
7. On the Front Line: Community
Nutrition Programming
Stuart Gillespie and Judith Hodge
8. http://nourishingmillions.ifpri.info/
Community nutrition
Community nutrition programming can be
community-based (referring to location of
intervention) or community-driven (active
involvement of community members in designing
and/or implementing the intervention).
Iringa Nutrition Program, Tanzania
• In 5 years, the program almost eliminated severe
malnutrition (from 6.3% to 1.8%) and reduced moderate
malnutrition by half.
Tamil Nadu Integrated Nutrition Project
• From 1980-1989, child underweight prevalence dropped
by around 1.5 percentage points per year in
participating districts, twice the rate of
nonparticipating ones. Panos/G. Pirozzi
9. http://nourishingmillions.ifpri.info/
Community nutrition case study: SHOUHARDO
(1 of 2)
Large-scale program that aimed to reduce malnutrition and chronic food
insecurity in poor and vulnerable households in Bangladesh. Provided
direct nutrition interventions and services to improve household food
production and water, sanitation, and hygiene.
Impact
• Phase I (2004-2009): Stunting among children 6-24 months old
decreased from 56% to 40% in the program’s operational area. Extreme
poor households experienced greater reductions in stunting than poor
households: 21.3% vs. 12.7%.
• Phase II (2010-2015): Stunting among children <5 yrs decreased from
61.7% to 48.8%.
10. http://nourishingmillions.ifpri.info/
Community nutrition case study: SHOUHARDO
(2 of 2)
Factors contributing to success
• Rights-based, livelihoods approach to address both the conditions
of poverty and to promote a ‘culture of equal citizenship rights'
• Targeting of the poorest and most vulnerable households
• Combined both nutrition-specific approaches (e.g. food assistance;
health, hygiene, and nutrition support) and nutrition-sensitive
approaches (e.g. economic interventions; access to safe water)
• Components to strengthen local governance and adaptation to
climate change added to second phase
11. http://nourishingmillions.ifpri.info/
Community nutrition: Lessons
learned
• Factors that contribute to successful community
nutrition programming include
• Favorable context and promotion of enabling
environments
• Process of program development driven by
participation, local ownership, and empowerment
• Appropriate program content and program design
with adequate coverage and targeting
• Program management and implementation with
effective intensity of resource use per participant
Panos/S. Das
12. Off to the Best Start: The
Importance of Infant and Young
Child Feeding
Judith Hodge
13. http://nourishingmillions.ifpri.info/
Infant and Young Child Feeding (IYCF)
• Best practices for IYCF in the critical 1,000 days window include
breastfeeding and complementary feeding
• Initiating breastfeeding within 1 hour of birth
• Exclusive breastfeeding for the first 6 months
• Continued breastfeeding up to age 2 and beyond
• Introducing safe, age-appropriate soft and solid food starting at 6 months of age
• 25 countries increased their exclusive breastfeeding rate by 20
percentage points or more, putting them on track to achieve the World
Health Assembly target of increasing the exclusive breastfeeding rate to
at least 50% by 2025.
• Education interventions increased exclusive breastfeeding by 43% at day
1, 30% at 1 month, and 90% from 1-5 months.
14. http://nourishingmillions.ifpri.info/
IYCF Case Study: Brazil (1 of 2)
Brazil improved breastfeeding practices from the mid-1970s to late
2000s through a national program and targeted communication
strategies.
Impact
• Increased median duration of breastfeeding from 2.5 months
(1974/5) to 14 months (2006/7)
• Increased exclusive breastfeeding rates from 4% (1986) to 48%
(2006/7)
15. http://nourishingmillions.ifpri.info/
IYCF Case Study: Brazil (2 of 2)
Factors contributing to success
• Launched National Program for the Promotion of Breastfeeding through
mass media campaign
• Targeted communication strategies through messages tailored to the
local context and specific barriers to breastfeeding
• Increased institutional capacity and reduced reliance on foreign aid to
fund the national program
• Overall improvements in access to maternal and child health and
nutrition services and pro-poor policies (e.g. targeted cash transfer
programs)
• Government support for human milk banks in neonatal intensive care
units throughout Latin America
16. http://nourishingmillions.ifpri.info/
IYCF Case Study: Bangladesh
Bangladesh re-evaluated its breastfeeding promotion efforts after
exclusive breastfeeding rates remained static between 42-46% from 1994-
2007.
Impact
• Exclusive breastfeeding rates increased from 48% to 88% in areas where
innovative community-based breastfeeding promotion approaches were
scaled up through the Alive & Thrive program (2010-2014)
Factors contributing to success
• Engaging with women who had little contact with health sector
maternity services
• Scaling up community-based approaches such as community nutrition
promoters and mother-to-mother support groups
17. http://nourishingmillions.ifpri.info/
IYCF Case Study: Sri Lanka
Sri Lanka improved EBF rates between 1995 and 2007 by extending
breastfeeding promotion from health facilities to the community.
Impact
• Increased average rate of EBF among infants up to 6 months from 17%
(1995) to 76% (2007)
Factors contributing to success
• Extensive lactation support training for health workers in hospitals and
field clinics and public health midwives making home visits
• Engaging with women at both health facility and community levels
• Outreach to extend breastfeeding into the community
18. http://nourishingmillions.ifpri.info/
IYCF Case Study: Alive & Thrive Program (1 of 2)
Alive & Thrive improved IYCF practices through multifaceted programs at
scale in three very different contexts: Bangladesh, Ethiopia, and Vietnam.
Impact
• Bangladesh: Exclusive breastfeeding in infants <6 mths increased from
49% to 86% in intervention areas from 2010-2014; 30 percentage point
increase in proportion of children consuming a diverse diet
• Vietnam: Exclusive breastfeeding nearly tripled in intervention areas,
initially lower than 20%
• Ethiopia: From 2009-2014, doubled the proportion of children meeting
minimum dietary diversity and minimum adequate diet in program
evaluation areas; minimum meal frequency increased from 46% to 70%
19. http://nourishingmillions.ifpri.info/
IYCF Case Study: Alive & Thrive Program (2 of 2)
Factors contributing to success
• National mass media campaigns allowing
millions of mothers to be reached in a
short time
• High-quality interpersonal counseling
services in health facilities
• Innovative social franchise model
(Vietnam) for delivering infant and young
child nutrition counseling services
Panos/B. Press
20. http://nourishingmillions.ifpri.info/
IYCF: Lessons Learned
• National plans can create an enabling environment through adoption of
legislation on marketing of breast-milk substitutes, baby-friendly maternity
facilities, and skilled support by health providers and community workers.
• In Brazil, tailored messages sensitized decision makers and the public and
addressed specific barriers to breastfeeding, such as the belief that women do
not produce enough milk for exclusive breastfeeding.
• In Bangladesh, community-based breastfeeding promotion helped reach
women that otherwise had little contact with health sector maternity services.
• In Sri Lanka, extensive training provided to health facility providers and
midwives making house visits helped engage women at the health facility and
community level.
• Alive & Thrive’s program of advocacy, community mobilization, and mass
media allowed countries to provide high-quality counseling in health facilities
and reach millions of mothers quickly through mass media.
22. http://nourishingmillions.ifpri.info/
Micronutrient interventions (1 of 2)
• More than 2 billion people suffer from micronutrient malnutrition,
known as “hidden hunger.”
• “The big 3”
• Vitamin A deficiency – leading cause of blindness in children
• Iodine deficiency – causes 18 million babies to be born mentally impaired
each year
• Severe anemia (iron deficiency) – associated with 115,000 deaths of
women during childbirth per year
• Targeting prevention/treatment to pregnant and lactating women,
infants, and young children yields higher rates of return by
improving health, nutritional status, and cognition later in life.
23. http://nourishingmillions.ifpri.info/
Micronutrient interventions (2 of 2)
• Global efforts to ensure access to iodized
salt reduced the number of iodine-deficient
countries from 130 before 1990 to 32 in 2011.
• Vitamin A supplementation was scaled up
to improve coverage rates of children from
16% in 1994 to 77% in 2009.
• Distribution of micronutrient powder
sachets by UNICEF and the World Food
Program rose from 50 million to 350 million
from 2008-2010.Micronutrient Initiative
24. http://nourishingmillions.ifpri.info/
Micronutrient case study: universal salt
iodization in China (1 of 2)
China successfully scaled up universal salt iodization through the
National Iodine Deficiency Disorders Control Program, forming a
partnership between the Ministry of Health and the salt industry.
Impact
• Consumption of iodized salt increased from 20% in 1990 to >97% of
salt consumed in 2005.
• Production and distribution of salt in China rose from 5 million tons
(not all iodized) to 8 million tons of iodized salt in under 7 years.
25. http://nourishingmillions.ifpri.info/
Micronutrient case study: universal salt
iodization in China (2 of 2)
Factors contributing to success
• High-level political leadership recognized the impact of iodine deficiency
on children’s intelligence and the implications for human and economic
development.
• The State Council established a special fund of US$125 million to upgrade
production facilities for iodized salt and re-centralized the salt industry
as a state monopoly with legal enforcement systems to prohibit the sale
of non-iodized edible salt.
• Iodized oil supplementation and subsidies for iodized salt reached
vulnerable populations.
• A shift from national to provincial standards addressed areas at risk of
iodine excess.
26. http://nourishingmillions.ifpri.info/
Micronutrient case study: “Sprinkles” in
Mongolia (1 of 2)
Mongolia’s Ministry of Health collaborated with development partners to
deliver an integrated nutrition package, including micronutrient powders
called Sprinkles, targeted to pregnant and breastfeeding women and
children <5 yrs to address alarming rates of anemia and rickets.
Impact
• Anemia prevalence fell from 55% to 33% during the pilot phase, 2002-
2004
• Rickets prevalence fell from 62% to 25% and stunting fell from 26% to 9%
during the 2nd phase, 2005-2010
• Program scaled up to national level reaching 50,000 children 6-24
months old
27. http://nourishingmillions.ifpri.info/
Micronutrient case study: “Sprinkles” in
Mongolia (2 of 2)
Factors contributing to success
• Powder wrapped in culturally acceptable packaging with local
language instructions and artwork
• Adjustments to pilot program included new amounts of nutrients
in Sprinkles, vitamin D supplementation, behavior change
initiatives, reduced production costs, and volunteer mothers to
mobilize communities
• Micronutrient working groups established at national, provincial,
and district levels
28. http://nourishingmillions.ifpri.info/
Micronutrient interventions: Lessons learned
• Staged approaches – from pilot to district to national levels –
afford opportunities to iron out issues such as the levels of
micronutrients required by different populations.
• Nutrition champions in influential positions help ensure support
and government buy-in for interventions.
• Integrating micronutrient interventions into existing health
programs and training community volunteers can help make them
more sustainable.
• Ongoing monitoring and evaluation is crucial for gauging whether
interventions are still relevant.
29. Addressing a Neglected Problem:
Community-based Management of
Acute Malnutrition
Judith Hodge and Jessica White
30. http://nourishingmillions.ifpri.info/
Community-based Management of Acute
Malnutrition (CMAM) (1 of 2)
• Development and adoption of CMAM moved treatment of Severe Acute
Malnutrition from inpatient hospitals and feeding centers to
communities – dramatic improvements identifying, rehabilitating, and
curing children with Severe Acute Malnutrition
• 3 components of CMAM
• Community members screen and identify Sever Acute Malnutrition cases by
measuring mid-upper-arm circumference
• Outpatient therapeutic program for children without medical complications and
provision of ready-to-use therapeutic food to last until next visit
• Inpatient care for children with medical complications and/or poor appetite
• Some countries include a 4th component: supplementary feeding for children with
Moderate Acute Malnutrition
31. http://nourishingmillions.ifpri.info/
Community-based Management of Acute
Malnutrition (CMAM) (1 of 2)
• CMAM officially endorsed by UN and WHO in
2007
• CMAM model has been found to perform
consistently well across varied contexts with
recovery rates over 90%, death rates below
2%, and default rates of less than 10%
Panos/S. Torfinn
32. http://nourishingmillions.ifpri.info/
CMAM Case Study: Malawi
Food emergencies in 2001/2 and 2005 led to global acute malnutrition rates reaching
6.2% in the country and >10% in 4 districts. Ministry of Health officials championed the
use of the CMAM approach and it was adopted as a national strategy in 2006.
Impact
• Malawi has the highest level of CMAM scale-up in the world: programs in all 28
districts and health facilities; in-patient care in 98% of hospitals; and 82% of health
centers act as outpatient therapeutic programs
• Under-five mortality rates have decreased from 174 to 71 deaths per 1,000 live births
from 2000 to 2012
Factors contributing to success
• Office of President assumed responsibility for coordinating nutrition
• CMAM Advisory Service provides advice on scale-up, integration, and service delivery
• Government has developed a plan to integrate the approach into Ministry of Health
services
33. http://nourishingmillions.ifpri.info/
CMAM Case Study: Ethiopia
The 2002/3 drought and food crisis catalyzed scale-up of the CMAM approach from pilot
programs in 2 sites to inpatient facilities and outpatient therapeutic programs in 165
hospitals and health centers. After Severe Acute Malnutrition cases spiked in 2008, the
government extensively decentralized treatment services to frontline health workers to
widen access to and coverage of services.
Impact
• The number of children treated for Severe Acute Malnutrition rose 12-fold from 2008
to 2011.
• Mortality rates for children <5 yrs fell from 146 to 68 deaths per 1,000 live births
between 2000 and 2012.
Factors contributing to success
• CMAM was included as a key component of the National Nutrition Strategy and
Health Sector Development plan, which guides investment in the health sector.
• Decentralization of treatment services to community-level health workers facilitated
rapid scale-up of community-based approach.
34. http://nourishingmillions.ifpri.info/
CMAM Case Study: Niger (1 of 2)
Global acute malnutrition surpassed the emergency threshold of 15% in
2005 triggering a major emergency response – national CMAM guidelines
were developed and included treatment of Severe Acute Malnutrition as
well as Moderate Acute Malnutrition. The government integrated all
stakeholders managing Severe Acute Malnutrition into the national health
system, and it launched the 3N Initiative (Nigeriens Nourish Nigeriens) in
2011.
Impact
• By 2011, all 50 national, regional, and district hospitals provided inpatient
care for Severe Acute Malnutrition and 772 of 850 integrated health
centers offered outpatient therapeutic program services.
• Prevalence of acute malnutrition remains high but the under-five
mortality rate has been halved from 227 to 114 deaths per 1,000 live
births from 2000 to 2012.
35. http://nourishingmillions.ifpri.info/
CMAM Case Study: Niger (2 of 2)
Factors contributing to success
• National CMAM guidelines, followed by
the government directive to integrate
operations for managing Severe Acute
Malnutrition, contributed to coordinated
scale-up
• High-level commitment to nutrition and
CMAM approach: Ministry of Health
leads expansion of CMAM through its
Nutrition Directorate and Prime
Minister’s Office assumes responsibility
for emergency nutrition response
Panos/D. Telemans
36. http://nourishingmillions.ifpri.info/
CMAM: Lessons Learned
• High-level political commitment galvanized scale-up of the CMAM
model.
• Engaging Ministry of Health is critical, especially for scaling up NGO-run
pilots to national programs.
• Severe Acute Malnutrition is a broad problem that needs to be built into
health and nutrition plans.
• CMAM programs need to be costed into government budgets but
Malawi is the only case study to have done so.
• Progress to reduce wasting will require prevention strategies in addition
to treatment of Severe Acute Malnutrition (e.g. improved infant and
young child feeding; hygiene & sanitation; social protection).
37. From the Ground Up:
Cultivating Agriculture for
Nutrition
Sivan Yosef
38. http://nourishingmillions.ifpri.info/
Agriculture
• Agriculture is linked to nutrition not only as a source of food but
also
• As a source of employment for the majority of the world’s rural people,
who can use the income they earn to purchase nutritious food or use
towards education or health
• Through policies on subsidies, taxes, and trade that determine the price of
crops and affect the income of sellers and purchasing power of consumers
• By exposure to vector-borne diseases from irrigation or zoonotic diseases
from animal husbandry
• Through gender roles – women’s control of resources and empowerment
has been linked to a larger share of the household budget allocated to
food and higher per capita calorie availability, household dietary diversity,
and better maternal nutrition
39. http://nourishingmillions.ifpri.info/
Agriculture case study: Homestead food
production (1 of 2)
Helen Keller International developed the homestead food production
model combining home gardens and animal husbandry with information
to help people adopt better agriculture, health, nutrition, and hygiene
practices, as well as with actions that give women more control over
resources and decisionmaking authority in their households.
Impact
• In Bangladesh, the project grew from a 1990 pilot covering 1,000
households to reaching 870,000 households – half of the country’s
subdistricts – and partnering with the government and over 70 NGOs.
• The model in Burkina Faso was improved, targeting women and children
in the first 1,000 days of life and incorporating behavior change
communication. It reduced wasting (low weight for height) in children
by 8.8 percentage points, diarrhea by 15.9 percentage points, and
anemia by 14.6 percentage points, suggesting that this type of model is
more effective than home gardening alone.
40. http://nourishingmillions.ifpri.info/
Agriculture case study: Homestead food
production (2 of 2)
Factors contributing to success
• Built on existing local practices and used local varieties
• Intervention model improved with better communication about
optimal agriculture, health, nutrition, and hygiene practices
• Emphasis on the role of women including training on best practices
and enlisting women in communities to share information about
health and nutrition
41. http://nourishingmillions.ifpri.info/
Agriculture case study: Biofortification (1 of 2)
HarvestPlus and its alliance of more than 70 partner organizations
are working to breed micronutrients such as vitamin A, zinc, and iron
into the staple crops that poor people commonly eat.
Impact
• A study in the Philippines showed a 20% increase in serum ferritin
and body iron among women consuming high-iron rice.
• In Mozambique, biofortification of orange sweet potato reduced
the prevalence of vitamin A deficiency among children by 15%.
42. http://nourishingmillions.ifpri.info/
Agriculture case study: Biofortification (2 of 2)
Factors contributing to success
• Biofortified crops have an
acceptable level of
micronutrients bred into them
and retained, and the
micronutrients must be
bioavailable
• Farmers accept and adopt
biofortified crops on a large
scale
• Target populations must accept
and consume biofortified crops
HarvestPlus
43. http://nourishingmillions.ifpri.info/
Agriculture: Lessons learned
• Combining agricultural programs with behavior change
communication and a focus on gender may have larger impacts
than standalone home gardening initiatives.
• Long-term impact is a challenge and will require working with local
partners around the world to help design, implement, and evaluate
programs to build up local capacity, and to share existing local
tools and practices.
• Research is key and contributed to the enthusiasm for and
improvements to programs for biofortification and homestead
food production. The relationship between agriculture and
nutrition deserves more research to generate stronger program
designs and understanding of impact pathways.
45. http://nourishingmillions.ifpri.info/
Social Protection
• Social protection usually comprises three types of public interventions
• Social safety nets – targeted, noncontributory programs to transfer resources to
poor households
• State-contingent insurance – pools contributions from individuals or households
to protect against risk; includes social or health insurance
• Social-sector policies – e.g. waived health care facility fees, free primary schooling,
or targeted preventative malnutrition interventions
• Social protection can positively impact nutrition directly (e.g. food
transfers) or indirectly (e.g. nutrition-sensitive interventions).
• Evidence of the impact of social protection on nutrition is mixed, but
case studies suggest that it may be effective when combined with
nutrition behavior change communication.
46. http://nourishingmillions.ifpri.info/
Social Protection Case Study: Mexico (1 of 2)
PROGRESA/Oportunidades/Prospera was initiated by the Mexican
Government in 1997 as a multisectoral poverty alleviation plan to break
the intergenerational transmission of poverty. Coverage increased from
140,500 households in 3,400 areas in the initial program to 2.6 million
households in 72,300 areas in 2000, and one quarter of the Mexican
population by 2008.
Impact
• 16% increase in average annual growth of children 1-3 yrs old and
boosted intake of iron, zinc, and vitamin A
• The program may also have had positive nutrition-related health impacts
including increased coverage of tuberculosis and measles vaccines,
reduced illness among children <5 yrs, and increased use of health
services
47. http://nourishingmillions.ifpri.info/
Social Protection Case Study: Mexico (2 of 2)
Factors contributing to success
• Conditional cash transfers
targeting mothers – research
suggests higher proportion of
investment will go toward health
and nutrition of children
• Provision of supplements as well
as cash to buy more nutritious
food to increase nutritional
quality and diversity of children’s
food intake
Reuters/A. Soomro
48. http://nourishingmillions.ifpri.info/
Social Protection Case Study: Bangladesh
(1 of 2)
Bangladesh has developed many social protection initiatives, including
• SHOUHARDO (Strengthen Household Ability to Respond to
Development Opportunities) – one of the world’s largest nonemergency
food security programs
• Food for Asset Creation – component of Bangladesh’s Integrated Food
Security program paying a daily wage of food plus cash
• Rural Maintenance Programme
• Chars Livelihoods Programme – works with ultra-poor households in
northwestern Bangladesh reaching >1 million people
• Transfer Modality Research Initiative – investigates effectiveness of
different forms of social protection (cash transfer; food transfer; cash &
food; cash with behavior change communication; food with behavior
change communication)
49. http://nourishingmillions.ifpri.info/
Social Protection Case Study: Bangladesh
(2 of 2)
Impact
• Preliminary findings suggest participation in Food for Asset Creation and Rural
Maintenance Programme increased per capita food consumption by 194 and
271 kilocalories per person per day, respectively
• Studies from the Transfer Modality Research Initiative suggest that all forms
of transfer meaningfully improved spending on food and nonfood
consumption, calorie intake, and diet quality. Cash transfers combined with
behavior change communication may have led to a decrease in child stunting
of 7.3 percentage points (almost 3x the national average decline)
Factors contributing to success
• Rural infrastructure built through Rural Maintenance Programme used to
provide food to communities during emergencies
• Inclusion of behavior change communication about nutrition and diet
diversity, hand-washing and hygiene, micronutrients, infant and young child
feeding, and maternal nutrition
50. http://nourishingmillions.ifpri.info/
Social Protection: Lessons Learned
• Combining social protection programs with behavior change
communication may have positive impacts beyond food security, such as
improved dietary diversity, child growth and health, use of health
services, etc.
• Social protection interventions can help smooth food security volatility
in times of crisis, particularly for poor and vulnerable households.
• Nutrition should be explicitly woven into social protection programs,
adding nutrition-related components such as supplementation or
behavior change communication, or changing the focus of a program
(e.g. including protection of children in addition to individuals involved in
productive labor).
• Care must be taken in program design so as not to produce unintended effects
such as increasing energy consumption among already-overweight populations.
52. http://nourishingmillions.ifpri.info/
Water, Sanitation, and Hygiene (WASH) (1 of 2)
• More than 660 million people lack access to an improved water source
and 2.4 billion people lack access to improved sanitation.
• Water, sanitation, and hygiene (WASH) can impact nutrition outcomes
through 3 direct pathways
• Diarrhea – access to WASH interventions such as safe and reliable pipe water
supply could prevent >360,000 diarrhea-related deaths among children <5 yrs in
low- and middle-income settings
• Other types of infection (e.g. parasites) – availability and usage of sanitation
facilities is associated with 46-78% reduction in soil-transmitted infections from
helminths (parasitic worms)
• Environmental enteropathy (ingestion of pathogens that damage the gut and
prevent full absorption of nutrients) – observational studies suggest physically
clean households had less severe environmental enteric dysfunction, higher
height-for-age z-scores, and 22% lower stunting prevalence than contaminated
households
53. http://nourishingmillions.ifpri.info/
Water, Sanitation, and Hygiene (WASH) (2 of 2)
• Research on impacts of WASH conditions
and interventions on nutrition is scarce, but
studies have found that
• 54% of variation in average child height in poor
and middle-income countries can be attributed
to open defecation
• Access to improved sanitation is associated
with lower child mortality and lower diarrhea
Panos/S. Das
54. http://nourishingmillions.ifpri.info/
WASH Case Study: Mali
A community-led total sanitation (CLTS) campaign was spearheaded in 2009 by the
government, with support from development partners, aimed at complete elimination
of open defecation and motivating participants to construct private latrines themselves.
CLTS was incorporated in the National Strategy for Rural Sanitation.
Impact
• 1,400 villages reportedly achieved open-defecation-free status as of 2014
• Children <5 yrs in villages participating in CLTS had statistically significant 0.18 higher
height-for-age z scores and were 13% less likely to be stunted
Factors contributing to success
• Reliance on communities to take initiative to tackle open defecation without financial
or capital assistance
• Follow-up visits conducted up to 3 months, and community celebration held when all
households have latrines and open defecation eliminated
55. http://nourishingmillions.ifpri.info/
WASH Case Study: Bangladesh
The government passed policies and plans directed at water and sanitation sector and
launched a National Sanitation Campaign that earmarked 20% of local development
funds to implement at scale. The SHOUHARDO Project (Strengthening Household
Ability to Respond to Development Opportunities) promoted WASH actions combined
with health education, exclusive breastfeeding, and supplementation.
Impact
• Open defecation decreased from 35% of people to 2.5% from 1995 to 2012
• 57% of the population had access to improved sanitation facilities by 2014
• SHOUHARDO: impact on children’s height doubled when sanitation was combined
with other maternal and child health and nutrition interventions
Factors contributing to success
• Cash grants of US$3000 provided when villages verified 100% latrine coverage
• Regional and local governments and NGOs worked together with communities
• WASH promoted in conjunction with health and nutrition interventions
56. http://nourishingmillions.ifpri.info/
WASH: Lessons Learned
• All levels of government and civil society – notably communities
themselves – are integral to success.
• Behavior change is critical to the success of WASH.
• Measuring the impact of WASH on nutrition is difficult and requires
further work.
• Different objectives of WASH (universal application) and nutrition
interventions (some universal, some targeted) must be taken into
account when designing effective programs and interventions.
58. http://nourishingmillions.ifpri.info/
Prevention of Obesity and Related
Noncommunicable Diseases
• 1.9 billion people are currently overweight or obese, now surpassing the
794 million people who do not get enough calories.
• 42 million children are overweight or obese, a 47.1% increase from 1980
to 2013. Nearly 50% of all overweight children <5 yrs live in Asia and
another 25% live in Africa.
• Obesity has reached alarmingly high levels in many low- and middle-
income countries, carrying significant health risks for noncommunicable
diseases (NCDs), but an investment of $1-3 per person per year in these
countries could dramatically reduce illness and deaths from NCDs.
• Multi-intervention packages including fiscal and regulatory measures,
health information, and communication strategies have been found to
deliver large and cost-effective health gains.
59. http://nourishingmillions.ifpri.info/
Case Study: Mexico’s Soda Tax (1 of 2)
Mexico’s 2006 National Survey of Health and Nutrition revealed
obesity in children ages 5-11 years increased 40% from 1999-2006.
Following a well-planned and coordinated strategy by scientists,
lobbyists, and consumer advocates, the sugar-sweetened beverage
tax was passed in 2013, increasing the average price of one liter of
soda by about 10%.
Impact
• Soda sales decreased 12% from December 2013 to December 2014.
The reduction was greater in households of low socioeconomic
status, who bought 17% fewer sugary drinks.
• Purchases of untaxed beverages (e.g. bottled water) rose by 4%.
60. http://nourishingmillions.ifpri.info/
Case Study: Mexico’s Soda Tax (2 of 2)
Factors contributing to success
• Experienced alliance of consumer
advocates developed high-impact
media campaign and engaged
lobbyists
• Timing: political transition and
government focus on raising
revenue, combined with efforts
to use revenue to provide water
fountains and potable water,
created opportunity to build
support for soda tax
Reuters/E. Garrido
61. http://nourishingmillions.ifpri.info/
Case Study: ACTIVITAL
In Ecuador, 26% of adolescents aged 12-19 yrs are overweight or obese. The
school-based ACTIVITAL (Health Promotion Intervention in Ecuadorian
Adolescents to Promote Healthy Dietary and Physical Activity Patterns) program
combined components directed at changing individual behavior and the
environment to improve dietary diversity and physical activity of adolescents.
Impact
• Added sugar, processed food intake during snacks, waist circumference, and
blood pressure all decreased among participants
• Trends toward lower fruit and vegetable intake, less physical activity, and
more sedentary behavior were also weakened among participants
Factors contributing to success
• Health program was integrated into broader educational curriculum
• Health education activities were combined with environmental changes
62. http://nourishingmillions.ifpri.info/
Lessons Learned
• Tackling obesity will require a “systems approach” and the
involvement of multiple actors including government, scientists,
civil society, the media, and communities.
• Engaging organizations with experience in media advocacy and
using scientific evidence to defend policy measures can be
extremely effective in building support for regulatory measures to
address overweight and obesity.
• Health promotion programs can result in successful outcomes by
combining health education activities with environmental changes
to enable healthy behaviors.
63. Local to National: Thailand’s
Integrated Nutrition Program
Stuart Gillespie, Kraisid Tontisirin, and Laura Zseleczky
64. http://nourishingmillions.ifpri.info/
Thailand
Thailand reduced child undernutrition by more than half
within one decade. The country integrated nutrition in its
national development plans and used basic minimum needs
indicators to support communities to monitor progress
according to local priorities and needs.
Impact
• Underweight rates among children <5 yrs decreased from
over 50% to less than 20% from 1982-1991, and further
reduced to 9% by 2012.
• Severe and moderate underweight rates of children <5 yrs
were nearly eliminated.
• Antenatal care coverage increased from 35% to 95% from
1981-2006.
• Iron-deficiency anemia prevalence among pregnant women
was reduced from nearly 60% in the 1960s to 10% in 2005.
Asian Development Bank
65. http://nourishingmillions.ifpri.info/
Thailand
Factors contributing to success
• Planning at micro and macro levels
• Micro level: Community leaders and experts identified basic minimum needs indicators
that translated into goals reflecting local priorities that could be monitored for progress.
• Macro level: Representatives from nutrition and health professions, the government, and
international agencies promoted collaboration among the health, agriculture, education,
and rural development sectors.
• Nutrition was understood to be a multifaceted issue, requiring change not
only in the health sector but also in agriculture and education.
• Service delivery was supported by a cadre of community health and nutrition
volunteers or “mobilizers” who were selected by their communities and
worked with households at a ratio of 1 mobilizer to 10-20 households.
• Regular weighing and health checks of all preschool children every 3 months
served as a screening, educational, remedial, and integrative tool for both
mobilizers and mothers.
66. http://nourishingmillions.ifpri.info/
Thailand: Lessons learned
• Recognition of the importance of nutrition at
the highest levels of the political system and
by all sectors ensured the central role of
nutrition programming in the nation’s
development efforts.
• Success was driven by strategic planning and
coordination at all levels combined with
government support for community priorities.
• Adequate ratios of community workers or
volunteers to the population were essential
for effective implementation of the national
nutrition program.
Thomas Fuller/ The New York Times/Redux
67. Nutrition and Equality: Brazil’s
Success in Reducing Stunting
among the Poorest
Meagan Keefe
68. http://nourishingmillions.ifpri.info/
Brazil
Rapid advances in economic development and healthcare in Brazil have
contributed to significant improvements in child health and nutrition in
recent decades. The country has also been successful in reducing
socioeconomic inequality in malnutrition.
Impact
• Prevalence of child stunting reduced from 37% to 7% from 1974/5-2006/7
• Exclusive breastfeeding in infants <6 mths increased from 27% to 41%
from 1999-2008 in Brazil’s 27 state capitals and partial breastfeeding
increased from a medium duration of 2.5 mths in the 1970s to 14 months
in 2006/7
• Children from poor families were 7.7x more likely than children from
wealthy families to be stunted in 1989, but by 2007/8 children from poor
families were only 2.6 times more likely to stuffer stunting
69. http://nourishingmillions.ifpri.info/
Brazil
Factors contributing to success
• A range of policies were implemented between 1996
and 2007 to ensure universal access to primary
education and to improve the quality of primary and
secondary schools across all municipalities.
• The government consolidated its cash transfers for
health and nutrition and linked smallholder farmers
to food-based social protection programs.
• Radical decentralization of the health sector allowed
for greater stakeholder participation and support for
national health policy implementation at all levels of
government.
• Access to improved sources of drinking water
increased and sanitation services expanded. Ministério do Desenvolvimento social e Combate à Fome/S. Amaral
70. http://nourishingmillions.ifpri.info/
Brazil: Lessons learned
• Expanding and better targeting pro-poor social
assistance programs accelerated progress in
reducing poverty, which contributed to
reductions in malnutrition.
• A multisectoral approach to program delivery
combined with funding mechanisms to promote
cooperation between ministries at local levels
supported poverty alleviation and reduction of
undernutrition.
• Civil society played a central role in bringing food
and nutrition security to the national agenda and
later in designing and implementing nutrition
policies.Reuters/N. Doce
72. http://nourishingmillions.ifpri.info/
Bangladesh
Bangladesh sustained reductions in child
underweight and stunting prevalence over the
1990s and 2000s.
Impact
• The percentage of underweight children
declined by 1.1% per year from 1997-2007.
• Stunting rates declined by 1.3% per year during
the same time period.
Panos/G.M.B. Akash
73. http://nourishingmillions.ifpri.info/
Bangladesh
Factors contributing to success
• Pro-poor economic growth was accompanied by declines in acute food
shortages, investments in assets, improved infrastructure, and increased
availability of nonfarm and manufacturing work.
• Agricultural production increased.
• Expanded family planning support reduced fertility.
• Maternal and infant mortality declined while antenatal coverage and birth
attendance by a skilled provider increased.
• School attendance increased and stipend programs improved enrollments.
• Access to improved drinking water sources and sanitation increased.
• Women’s educational achievement increased alongside widespread
participation of women in NGO-supported income generation and increased
employment of women with control of their income.
74. http://nourishingmillions.ifpri.info/
Bangladesh: Lessons learned
• Nutrition-sensitive drivers within a wider enabling
environment of pro-poor economic growth have
likely contributed to improvements in nutrition.
Such indirect drivers have multiple impacts and
are mutually reinforcing.
• Nutrition-specific interventions directly aimed at
improving nutritional status are needed to
sustain the gains already made and to make
further improvements.
Panos/G.M.B. Akash
75. Reaching New Heights: 20 Years
of Nutrition Progress in Nepal
Kenda Cunningham, Akriti Singh, Derek Headey, Pooja Pandey Rana, and
Chandni Karmacharya
76. http://nourishingmillions.ifpri.info/
Nepal
Nepal experienced a rapid reduction in
maternal and child undernutrition during a
period of civil war and prolonged political
and economic instability. Both nutrition-
specific and nutrition-sensitive factors
played a role in the gains made.
Impact
• Prevalence of stunting among children <2
yrs fell from 48% to 27% from 1996-2011
• During the same time period, prevalence
of maternal underweight fell from 28% to
20%
K. Das Shrestha
77. http://nourishingmillions.ifpri.info/
Nepal
Factors contributing to success
• Increased access to health services
including female community health
volunteers, the Safe Delivery Incentive
Program, and the Maternal and Neonatal
Micronutrient Program
• Household asset accumulation and
migration-related household income
growth (though not universal)
• Improvements in parental education,
mostly maternal education
• Increased toilet access through
community-led total sanitation and a
related school-led total sanitation
approach
K. Das Shrestha
78. http://nourishingmillions.ifpri.info/
Nepal: Lessons learned
• Improved service delivery was vital to reaching geographically and
socially isolated households and marginalized groups.
• Nutrition gains were made through the efforts of multiple actors
including different levels of government, multilateral and bilateral
development agencies, a wide range of NGOs, and communities
themselves.
• Nepal will need to scale up nutrition-related policies and programs and
find new creative ways to operationalize plans and policies to help those
who have thus far remained beyond reach.
• Cultural norms and practices, often embedded in longstanding gender
norms, influence household-level nutrition through women’s lack of
autonomy and decision-making power. There are opportunities for
policies and programs across a range of development domains to
catalyze women’s empowerment.
80. http://nourishingmillions.ifpri.info/
Peru
Peru achieved rapid progress in nutrition indicators not only at a national
level, but across all of Peru’s diverse regions including rural areas and
amongst the poorest 20% of the population.
Impact
• The rate of stunting in children <5 yrs fell from 29.5% to 14.6% in less than
a decade.
• Only 0.5% of children <5 yrs were moderately wasted and 0.1% were
severely wasted in 2013.
• From 2007-2012, the prevalence of stunting in children <5 yrs fell by 21.4
percentage points (54.7% to 33.3%) in districts targeted by the
government’s multisectoral nutrition strategy, CRECER, compared to a
10.4 percentage point reduction nationally (28.5% to 18.1%).
81. http://nourishingmillions.ifpri.info/
Peru
Factors contributing to success
• Multisectoral cooperation with central
roles played by civil society and
national and regional levels of
government
• Political will underlined by a pledge to
invest in and prioritize nutrition that
has sustained momentum for the fight
against malnutrition through multiple
political administrations
• A prevailing commitment to
accountability that extends from
national-level politics to more
mundane, day-to-day budgetary
processes
Reuters/E. Castro-Mendivil
82. http://nourishingmillions.ifpri.info/
Peru: Lessons learned
• Support for a multisectoral approach that
allows for coordinated policy interventions
and approaches is essential for improving
nutrition.
• Strong buy-in to the idea that nutrition
matters among diverse stakeholders and
at high levels, including from presidential
candidates and government ministries,
likely contributed to Peru’s success.
• Collecting national and subnational data is
important to allow for timely monitoring
of vital nutrition indicators and adjustment
of programs as required.
Reuters/M. del Triunfo
83. On the Fast Track: Driving Down
Stunting in Vietnam
Meagan Keefe
84. http://nourishingmillions.ifpri.info/
Vietnam
From one of the 5 poorest countries in the world in 1984 to the world’s 55th richest
nation by 2014, Vietnam’s economic growth enabled the country to provide improved
health services, which contributed directly to reductions in child malnutrition.
Impact
• Stunting among children <5 yrs fell from 50% to
34% from 1993-1998. Following a slowdown in the
early 2000s, stunting prevalence fell further from
29% to 19% between 2010 and 2013.
• Underweight in children <5 yrs fell from 32% in
2000 to 18% in 2010.
• Exclusive breastfeeding for infants <6 mths
increased from 17% in 2011 to 24% in 2014.
Panos/S. Sprague
85. http://nourishingmillions.ifpri.info/
Vietnam
Factors contributing to success
• Prioritization of nutrition by the national government
including a National Nutrition Surveillance System and
hosting of high-level international nutrition events
• Policies designed to improve infant and child feeding
practices, increased maternity leave (from 4 to 6
months) to reduce barriers to breastfeeding, and
expansion of the country’s ban on advertising of
breastmilk substitutes
• Efforts to reduce micronutrient deficiencies including
supplementation, diet diversification, and food
fortification
Panos/J. Visser
86. http://nourishingmillions.ifpri.info/
Vietnam: Lessons learned
• Commitment to nutrition at the national level was essential for the
development and implementation of nutrition-sensitive legislation.
• Strategies to improve infant and young child feeding contributed
to the significant gains in reducing underweight and stunting rates.
• Nutrition improvements did not reach all groups equally – moving
forward, improved policy implementation at local levels will be
necessary to reach vulnerable groups.
• The country has experienced difficulties in translating national
policy into service provision and action at the local level – further
reductions in malnutrition will require capacity building for
subnational planning and policy implementation.
88. http://nourishingmillions.ifpri.info/
Ethiopia
Despite ongoing challenges, Ethiopia has made significant progress in
addressing its nutrition situation. The government has been proactive in
addressing both immediate determinants of undernutrition (e.g. health
status and nutrient intake) and underlying determinants (e.g. education,
sanitation, and food security).
Impact
• Stunting was reduced from 57.4% to 44.2% between 2000 and 2011.
• From 2000 to 2010, government expenditures on education rose from
8.8% to 16.7%, and social protection program expenditures grew from 7%
to 19.8%.
• Food production per capita increased an average of 1.9% per year from
2002-2007 and 3.3% per year from 2007-2012.
89. http://nourishingmillions.ifpri.info/
Ethiopia
Factors contributing to success
• National improvements in agricultural
production largely driven by widespread
distribution of improved seed and fertilizer
• Improved sanitation through latrine-building
and hygiene initiatives coordinated by the
government’s National Health Extension
Program
• The government-led Productive Safety Net
Program provides food or cash transfers to
beneficiaries in exchange for their
participation in public works activities;
nutrition-sensitive provisions added in the
program’s third phase will be improved in
the fourth phase IFPRI/M. Mitchell
90. http://nourishingmillions.ifpri.info/
Ethiopia: Lessons learned
• Improved sanitation had an impact on improving
child growth outcomes but more community
participation, follow-up, and monitoring and
evaluation are needed to increase impact.
• While the Productive Safety Net Program could
serve as a model for other countries, it only
targets the most vulnerable to food insecurity –
quality and reach of agriculture and health
service provision will be key to further gains for
the rest of the population.
• The success of a single nutrition-specific
initiative, such as dietary supplementation, is
conditioned on meeting ongoing, deeper-rooted
challenges to livelihoods, food security, and
health.
IFPRI/M. Mitchell
91. 25 Years of Scaling Up: Nutrition
and Health Interventions in
Odisha, India
Purnima Menon, Neha Kohli, Mara van den Bold, Elisabeth Becker, Nicholas
Nisbett, Lawrence Haddad, and Rasmi Avula
92. http://nourishingmillions.ifpri.info/
Odisha
Odisha made significant progress in reducing child undernutrition – more than
many other richer states – despite a number of development challenges
including insurgent movements, social disparities, natural disasters, and a
relatively late fiscal turnaround.
Impact
• The proportion of stunted children <3 yrs fell from 49% to 44% between 1998/9
and 2005/6 (compared with an all-India decline from 51% to 45% during the
same period).
• Odisha performed better than richer states in a number of immediate
determinants of undernutrition and nutrition-specific interventions including
• Infants 6–8 months old receiving solid, semisolid, or soft foods
• Minimum dietary diversity during complementary feeding
• Mothers of children <3 yrs who received 3 or more antenatal care checkups
• Children 12–23 mths old who were fully immunized
93. http://nourishingmillions.ifpri.info/
Odisha
Factors contributing to success
• A vision for impact focused on accelerating
reductions in infant and maternal mortality
and total fertility rates
• Delivering interventions through multiple
operational platforms
• Catalysts for action, individual champions,
and ownership by leaders and bureaucrats
• Diverse pathways for scaling up
• Gradually building up strategic and
operational capacities
• Adequate, stable, and flexible financing
• Creating an enabling policy environment
• Measurement, learning, and accountability
DFID/P. Ranger
94. http://nourishingmillions.ifpri.info/
Odisha: Lessons learned
• Setting specific goals focused on infant
and maternal mortality rates contributed
significantly to several key actions that
were scaled up to successfully reduce
mortality.
• Ensuring bureaucratic stability, capacity,
and motivation to deliver was critical to
achieving these goals.
• Much of Odisha’s success was driven by
the creation of an enabling environment
with little to no political interference,
adequate financing from diverse sources,
and adequate technical support.
DFID/P. Ranger
95. Championing Nutrition:
Effective Leadership for Action
Nicholas Nisbett, Elise Wach, Lawrence Haddad, Shams El-Arifeen, Samantha
Reddin, Karine Gatellier, Namukolo Covic, Scott Drimie, Jody Harris, and Sivan
Yosef
96. http://nourishingmillions.ifpri.info/
Leadership
• The 2008 Lancet series on child nutrition
highlighted leadership as integral to
making progress on the international
and national nutrition stages.
• Scholars have identified a lack of
capacity to train and support individuals
to take on strategic roles in nutrition as a
major barrier to conceptualizing and
guiding national and subnational
nutrition agendas.
• Nutrition leaders enter the field for a
variety of reasons and at various points
in their careers.
Panos/G. Pirozzi
97. http://nourishingmillions.ifpri.info/
Leadership
• There is a relationship between effective
leadership and higher levels of adult
development, i.e. advanced analytical or
“sense-making” capabilities.
• The effectiveness of leaders and leadership
activities depends on the shape and
maturity level of the nutrition social
network.
• Leaders’ ability to effect change is
determined partly by the policy and political
environment, which can either promote or
hinder nutrition progress.
Panos/A. Loke
98. http://nourishingmillions.ifpri.info/
Leadership: Lessons learned
• Given the range of motivations for nutrition leaders to enter the field,
potential leaders from other disciplines should be exposed to both
nutrition data and firsthand experience as a way of garnering cross-
sector support for nutrition in the future.
• There is a need to help individuals within the nutrition community
increase their levels of adult development through coaching,
participatory stakeholder mapping exercises, or support programs that
aim to develop broader leadership qualities.
• Fragmented networks benefited from leaders who could cross
boundaries; more mature networks benefited from individuals who
could generate an environment of co-creation.
• Mechanisms are needed to hold ministers and bureaucrats accountable
for meeting their commitments in nutrition.
99. New Horizons: Nutrition in the
21st Century
Stuart Gillespie, Judith Hodge, Rajul Pandya-Lorch, Jessica White, and Sivan
Yosef
100. http://nourishingmillions.ifpri.info/
Key lessons from Nourishing Millions
• At the individual level, malnutrition is caused by inadequate dietary
intake, often interacting with disease and poor care. Nutrition-
specific interventions can make inroads if well-targeted and well-
implemented, but they cannot solve the problem by themselves.
• Transforming sectoral actions to make them more nutrition-
sensitive is critical for improvements at household and community
levels.
• At the country level, enabling environments are key and include
political commitment, governance, policy, legal frameworks,
capacity, and financing