03 June 2016

Guest blog: Investing in civil society is the ultimate commitment to sustaining momentum for nutrition

It is not often that I have guest bloggers on Development Horizons, but I feel so strongly about this topic that this was a no-brainer. 

Dear governments and donors: investing in civil society is the ultimate commitment to sustaining the momentum for nutrition.  Your Presidents, Prime Ministers and Ministers will sooner or later enough fixate on another issue.  But once you light a fire in the hearts and minds of citizens about malnutrition, that fire will burn on--it just needs enough oxygen to make sure it lights the way to effective advocacy, implementation and accountability.  Claire Blanchard's blog will help you make your case for funding CSOs so they can help end malnutrition by 2030.  

Dr Claire Blanchard, SUN CSN coordinator, makes the case for supporting civil society
Civil society plays an essential role within the Scaling Up Nutrition Movement, making the link between communities and the national and international platforms where governments, donors, agencies and others meet. In 39 high-burden countries, local, national and international organisations working on nutrition have come together into civil society alliances (CSAs). These CSAs occupy a unique position in the nutrition movement with many now being a recognised counterpart to government, with a place at the table and influence on nutrition policy and implementation.
Why are these alliances important in nutrition improvement?
They coordinate civil society to speak with one voice, raise the profile of nutrition, enrich nutrition policies by channelling the voices of those directly suffering from malnutrition, highlight the gender needs, promote and ‘walk the talk’ of accountability, strengthen local capacity, build sustainability of all nutrition efforts and are a real added value for money.
So what can civil society do that others can’t
Civil society operates at ground level in the communities most affected by the impact of poverty and poor nutrition – making these organisations ideally placed to design, deliver and monitor programmes, track nutrition-related spending, and verify that governments are delivering on commitments.
Civil society can:
ü  Share community knowledge of the needs of those directly suffering from malnutrition – as well as what works - to shape policies.
ü  Contribute to implementing nutrition actions and monitoring progress and impact.
ü  Raise community awareness of the importance of good nutrition and support them in understanding how to change behaviour.
ü  Help champions and citizens advocate for action and investment – and help people hold governments accountable for their commitments.
Investing in civil society can have significant impact
ü  In Peru, chronic infant malnutrition has been halved in less than a decade. Civil society advocacy has been a key driver of this progress sustaining prioritisation of nutrition.
ü  In Zambia, the CSA used public awareness and media campaigns to ignite national debate and convinced MPs to form All Party Parliamentary Caucus on food and nutrition
ü  In Guatemala, the CSA have 22 youth groups auditing the implementation of - and flag gaps in - the national 1,000 days strategy in ‘hard to reach communities’ – some suffering from as high as 90% malnutrition rates.
ü  In Zimbabwe, the Nyazhou Garden Project aiming at improving household income, food and nutrition security of vulnerable women in poor communities have changed the lives of 60 villagers. Sekai Tembo, a 72 year old widow said the project had completely changed her life.
“When my husband died, I had no choice but to carry on with life, though it was hard. I had no cattle, and you know the importance of draught animal power in our lives, but since I joined this project I now have two goats. Before, I used to do gardening but it would only sustain me and my family but now the produce is feeding me, my two grandchildren and I sell the surplus to surrounding villages. I get $15 dollars per week, which is $30 per month because the other two weeks the vegetables would be sprayed. Previously, it was hard to get hold of only $2,” Sekai Tembo, Uzumba Maramba Pfungwe, Zimbabwe
ü  Kenya’s CSA successfully advocated for revision of National Health Policy to include a stronger nutrition component.
ü  In Nepal, the CSA helped secure a directive that local level governments must include a nutrition program in their work plans.
ü  Budget tracking and advocacy efforts at decentralised level have shown increased nutrition investments by local authorities in Nigeria and Tanzania
Sustainability threatened by funding insecurity
Securing funding beyond 2016 is crucial for CSAs, with the SUN Multi Partner Trust Fund now coming to an end. Most CSAs are supported by their members through significant financial and in kind contributions and are seeking national funding as a priority.  Funding is also needed for the SUN Civil Society Network - the fastest growing network in the SUN movement with a combined membership of over 2,500 local, national and international organisations. SUN CSN is an accelerator– a fast-start mechanism enabling new national CSAs to quickly build capacity, set up appropriate governance and systems, and learn about effective advocacy from their well-established peers.
The recent independent evaluation of SUN’s Multi Partner Trust Fund praised the role of civil society in taking the SUN Movement into places it otherwise wouldn’t reach.
Donors want to see the best value for their investment, improved integration and innovation to ensure at scaled impactful and sustainable efforts.
We need more money for nutrition but more important a better use of existing moneys as highlighted by the recent World Bank estimates. However we also need to earmark some of these moneys to ensure civil society keeps doing what no one else can. We need existing and new donors investing but we also need to think of innovative and sustainable funding models, diversifying our funding sources and ensuring we are as effective with existing resources as possible.
Momentum is critical in any attempt to bring about a significant, lasting change. The momentum created by the SUN Civil Society Network over the last three years is significant – but is now in danger of being lost.
As Tom Arnold, Interim coordinator for the SUN Movement puts it: “Civil society has an absolutely pivotal role to play in the next phase of SUN. In order to build on investments to date and sustain its work, civil society needs funding to ensure that joint efforts are long-lasting and to ensure progress is accelerated.”

28 April 2016

Now is Japan's Time to Shine for Nutrition

Food and nutrition are high on the agenda in Japan policymaking circles right now.  The G7 meeting in a month, hosted by Japan, the passing of the N4G torch in Rio in early August, the TICAD (the Tokyo International Conference on  African Development) conference in late August—all are stoking interest. 
In this context it was great to be invited to Japan to launch the 2015 GNR in Tokyo earlier this week.  The launch was hosted by Save Japan, Results, World Vision and the Network for Action on Malnutrition.  Officials from the Japanese government were present: from the Ministry of Foreign Affairs (the Food Security Working Group), the Japanese International Cooperation Agency (JICA), the Ministry of Agriculture and some key parliamentarians.  Over 200 people attended.

In addition to the launch we met with JICA officials working on a new initiative to be launched at the G7, and with the G7 reps doing the background work for their government’s representatives to the G7.
In my presentation I urged the government to do the things in the slide below.  Japan is one of the most important donors for nutrition specific interventions at about $60m in 2014, but this is down from over $100m in 2013, so the first order of business is to get this back to over $100m in 2015 and then in 2016 to $150m, at least doubling over the 2016-2020 period compared to the 2010-2015 period.  

I also urged the government to estimate how much it is currently spending on nutrition sensitive actions.  I suspect it is quite a large amount, but Japan has not estimated this.  If they did it would help the government to assess where it is strong and where it could strengthen the nutrition impact of current resources.  We will invite them to do so for the 2017 GNR.
But Japan can play a bigger role than this. It can improve the enabling environment for nutrition in Asia and the Pacific -- and beyond.  Japan was a founder member of the SUN donor network, so it has shown vision and ambition on nutrition.  But Japan can play an expanded nutrition leadership role in the following ways.

Over 200 people attended the event in Tokyo
*As the 2020 hosts, Japan can really energize the N4G process after Rio through a 3-4 year series of stepping stones including making some ambitious and SMART pledges at the TICAD conference, pledges aligned with the aims of the recently announced Decade for Action on Nutrition. 
* As a leading practitioner in working with the private sector in development, Japan can bring some learning to the nutrition arena about the opportunities and pitfalls of working with business and how the former can be maximized and the latter minimized. 

*As the perennial holder of the Asian Development Bank brief, Japan should work hard to get them as interested in nutrition as the African Development Bank, under Akin Adesina’s leadership and the World Bank under Jim Kim, seem to be.  I still remember giving a talk with Stuart Gillespie in 2000 at ADB HQ on a project, funded by the ADB, looking at opportunities for advancing nutrition in the Asia Pacific Region.  In a large auditorium, the audience was 10!  Most malnutrition is in Asia.  If the ADB bankers want high and secure returns on their investments they need to invest in nutrition.

* In a country that has a high diet quality, Japan should lead the G7, N4G, TICAD and ADB towards this overlooked dimension of food security, one that is equally important for the prevention of malnutrition in all its forms.  Poor diet quality is now the number one risk factor in the global burden of disease, but food systems choices are not influenced by this fact.  Japan can be a leader in how to develop food systems that deliver more affordable diet quality.

I left Tokyo full of optimism that Japan will enhance its nutrition leadership over the next 4 years.  Japan’s leaders now have a once in a decade opportunity to inspire the entire world of nutrition. A great first step would be a breathtaking SMART commitment launched in August, either at the N4G or TICAD events. 

15 March 2016

The SDGs: A Great Gift to Nutrition Accountability – If We Accept It

Today I was at a workshop organized by the SDG2 Accountability Group, convened by ONE.

My presentation made 6 points about the gift that the SDGs represent to strengthen nutrition accountability.

1.  The 17 SDGs are said to be indivisible.  For nutrition this is certainly the case.  In the 2016 GNR (to be released on June 14) we analyse the 230 brand new SDG indicators and we identify over 50 that are highly relevant to nutrition, coming from 12 SDGs.  And SDG2 is not the Goal that contains the most of these indicators!  SDG2 is a starting point, not an end point for accountability on nutrition.

2.   The SDGs refer to malnutrition in all its forms.  This means overweight, obesity, high blood sugar etc as well as stunting, wasting anemia etc.  Bringing in stakeholders who care about accountability in these manifestations of malnutrition does not represent a distraction, but an opportunity.  The NCD Alliance, the Food Foundation and Jamie Oliver’s Food Foundation—to name a few—can strengthen accountability for all of us by bringing in citizens and others who would not normally focus on undernutrition.

3.   End Malnutrition.  Ending as opposed to halving (as in the MDGs) malnutrition means that we have to prevent and end malnutrition wherever it may happen.  High hanging fruit are no longer safe.  This means getting more disaggregated data.  In the 2016 GNR we conduct an analysis that compares stunting levels at the sub national level within 60 countries and find extraordinary differences between regions with the highest and lowest rates within each country.

4.   By 2030.  Having an endpoint is really helpful.  The MDGs obviously had this, but somehow the end date feels more meaningful when the goal is to end rather than halve malnutrition.  In terms of business as usual estimations, how long would it take for us to end anemia in women?  Never mind a Decade of Action, more like a Century of Action.

5.    Be SMART.  Too few countries (and other stakeholders) make SMART commitments.  As the 2016 GNR will show, only a small percentage of commitments made by governments are SMART.

6.    Collect more data.  Four of the WHA indicators rely on regular survey data like DHS and MICs: under 5 stunting, wasting and overweight and exclusive breastfeeding rates.  For these indicators across the 193 countries, we can only make on/off course country assessments for about half of the country-indicator pairs.  Targets without assessments are about as useful as an iPod Classic without headphones.

These SDG gifts need to be accepted and then used. 

A few quick reflections on the first 3 hours of the workshop (I couldn’t stay longer).

* It is great to see ONE back in the nutrition fold after a brief hiatus.  Welcome home.

* SDG 2 Accountability is a welcome initiative.  As I noted above, accountability in nutrition is weak.  More attention to it is welcome, especially as the initiative is trying to align with other accountability efforts such as the GNR.  

* The big value added of SDG2 Accountability (I think) is bringing in new and innovate ideas about (a) how to use existing data better, improving interoperability and user interfaces, (b) how to tweak existing data collection initiatives that are not motivated by nutrition but could work well for it, and (c) how to collect nutrition data in completely new ways.  Interestingly the 3 presentations I caught on “big data” were from companies.  Keeping my skepticism in check (e.g. data quality, data representativeness, the limits of interoperability etc.) I found the presentations intriguing.  I want to find out more.  We all should. 

I wish the SDG2 Accountability initiative well.

10 March 2016

Urban Jonsson: a towering figure in the world of nutrition and human rights

The late, great Urban Jonsson
We learnt yesterday that one of the giants of nutrition and of human rights, Urban Jonsson, had passed away.

If ever there was a better proponent of Neil Young's famous line "it's better to burn out than to fade away" I can't think of one.  Urban went down swinging, for nutrition, for rights, for humanity.

Why was he so great?

Well, for starters, he was a conceptual thinker.  Want to know where the UNICEF framework came from?  What the Lancet framework was inspired by?  Answer: Urban Jonsson.

He understood the importance of politics in nutrition. He had a stint as a politician in Sweden.  He was a master communicator and he understood how to do deals for nutrition.

He was practical yet idealistic.  He popularised the triple A cycle within UNICEF (assessment, analysis, action) and he popularised (with others) the importance of rights in nutrition and in development more broadly--he was eloquent in explaining how people had to have support to claim rights and how duty bearers often needed support to deliver on those claims.

He was fearless.  He basically said whatever he thought, no matter the consequences for himself (and sometimes for others).  This got him into trouble quite often.  Sometimes it made him unnecessarily controversial.  And while he often sucked the oxygen from a room, he usually substituted that with boundless energy and passion.  Read about him here, in his own words.

The first time I ever spoke to him was on the phone in 1994 while I was working in South Africa.  He called me up out of the blue to "summon" me to give a presentation at the UNSCN meetings that year.  It took me about 20 minutes to convince him I would not attend -- because I would be on honeymoon!

He was that kind of a person--he wouldn't take no for an answer when it came to nutrition.  We need more people like that.

I will miss him, as will thousands of others.

09 March 2016

Why Norway needs to get back it's nutrition mojo

From my presentation at the OSLO Global #NutritionReport launch
The Norwegian people and their government are some of the most generous in the world when it comes to development.

For example, Norway gives over 1% of its gross national income (GNI) to overseas development assistance (ODA).  And yet hardly any of this is going to nutrition, according to the OECD reporting system. 

For example Ireland spends $20 million each year on basic nutrition, Norway spends $0.8 million.  And yet Norway has given us some of the great thinkers on nutrition and used to be very active in nutrition 10-15 years ago.

I brought this up at the Oslo launch of the 2015 GNR today.  I also pointed out that Norway was not a signatory to N4G nor a member of the SUN donor group. 

So what is going on?  Several explanations were provided by various panelists.

1.  Norway provides funds to multilateral organisations and funds, many of which are highly relevant to nutrition (e.g. UNICEF, WHO, GAVI, GFF)

2. Norway's ODA climate agriculture, education, gender work is significant and contributes significantly to nutrition.

3. Norway has other priorities (education and women's health).

On the first and second, the assumptions are that these mechanisms are supporting malnutrition strongly.  They may be, but they may not be.  We know that funds going into sectors that could support nutrition are much more likely to actually support nutrition if they have a credible plan to do so.

If I were a Norwegian citizen, my response to the first 2 explanations would be "show me".  Show me that the spending in these areas is actually nutrition sensitive.  Use the methodology that the SUN donors have developed so you can make a comparison.

My response to the third explanation is: "you are undercutting your ability to reach these goals by ignoring nutrition".  Children learn less if they are malnourished at an early age.  Women who are malnourished at birth are more likely to have health problems throughout their lives.   So good nutrition is an essential precursor for achieving the other goals.

But even if we accepted these 3 arguments at face value, the lack of profile Norway gives to nutrition sends a poor signal to nutrition champions in Norway and elsewhere.  The Norwegian community needs to feel they are working in an enabling environment.  In addition, by not profiling nutrition, Norway is forgoing the opportunity to influence the multilateral funds and the rest of its ODA portfolio to work harder for nutrition.

Norway needs to signal its commitments to nutrition more clearly.  And if the commitment is found wanting once the funding flows have been counted, then the nutrition community in Norway needs to come together and project collective "people power" to get the government to pay more attention to this vital issue.

Norway has been an important leader in nutrition, but lately? Not so much.  Norway needs to get its nutrition mojo back.

25 February 2016

The Global Governance of Nutrition: Why it Matters

Recently I was asked to prepare 10 minutes of thoughts on the global governance on nutrition (I did not have much more guidance than this). It was for an influential group and I wanted to push myself to think more about the topic, so I said yes.

The picture in the blog is my attempt to put something down on paper.
Source: me
I did not think of it as a formal governance system.

Rather I thought of functions that make for good governance: (1) normative views that lead us to doing the right things, (2) reality checks on what is feasible politically and what actually works based on capacity, and (3) accountability mechanisms to tell us how well we are doing on improving nutrition outcomes and on implementing actions that we have  committed to, in one way or another.

I then hazarded a guess on where the centre of gravity is for various organisations and entities in nutrition. The placement reflects my own knowledge rather than any political world view.

The questions from the group were interesting:

Q1. Do we need a consensus map of nutrition global governance?

A.  I think we do.  Much like we have a map of the causes and interventions of malnutrition.  It helps locate activities and gives people a common language.

Q2. How do we assess the adequacy of nutrition global governance?

A. I suppose you could say things are better than they were in 2008 when the Lancet series of papers said global governance of nutrition was, essentially, dysfunctional.  Funding is up from donors, we have ICN2, an SDG on nutrition, the CFS is more focused on nutrition, the N4G moments of 2013, 2016 and 2020, governments who have formed a movement (SUN) etc.

But I have two problems with this perspective.

First it seems like a pretty low bar. Surely we want to assess whether our current global governance is good enough to get us to where we want to be?  Is it fit for purpose? The WB/R4D analysis highlighted in Ch 5 of the 2015 GNR suggested a doubling of government funding to nutrition and a quadrupling of donor spending is needed to reach the stunting WHA goal in 2025.  Is our global governance good enough to get us to this place?

Second, what will stop things backsliding to 2008?  Accountability mechanisms are stronger, but donors and governments are distractible and UN agencies are too.  The governance system has to have a set of one way valves that prevent the nutrition "blood" flowing backwards.

Q3. What is the value-added of good global governance?

A. There are lots of opportunities for nutrition in the next 5 years.  Good governance will help us seize them.  First, there are the political and resource alliances that are possible by a framing of nutrition "in all its forms". Second, food systems are big drivers of all forms of malnutrition--we need to engage with people outside of nutrition if we are to influence them. Third, the SDGs represent another big opportunity: there are at least 50 indicators in the 17 SDGs that are highly relevant for nutrition--to influence them we have to form partnerships outside of the nutrition bubble.  Good enough governance can help us get there.

Finally, what is there to push us towards seizing these opportunities? It is not clear to me.  Leadership is diffuse on nutrition and that can be a strength when things are going well, but where is the forcing moment every one or 2 years where everyone gets together and prioritises action step?  We need some kind of apex moment to force this prioritisation.

The nutrition global governance landscape is changing.  We need to shape it as well as be shaped by it. Governance matters.

24 February 2016

Anaemia Amnesia? Why does no one seem to care about it?

OK the title of this blog is perhaps a bit hyperbolic (I know plenty of people who care about it) but I just don't get the lack of urgency on anaemia.

Data on global anaemia

* A quarter of the world's population suffers with anaemia (see table on right from WHO). 1.6 billion people!

* Levels are high all over the world:  For girls/women 15-49 it is 15% in the UK, 12% in the US,  19.6% in Brazil, 22.5% in Indonesia, 48.1% in India and 48.5% in Nigeria.

* For children the data are even scarier: 47.4% of all preschool children--293 million kids.

* The rate of progress in reducing anaemia is very slow.  As the GNR 2015 highlights only 5 countries out of 185 are on track to meet the WHA 2025 target of reducing the 2012 base rate by 50%.

This is by far the worst performance of any undernutriiton indicator in relation to the 2025 targets.  By way of contrast 39 countries are on track to meet the stunting target.

* The consequences are significant and lifelong: reduced work capacity, impaired cognitive development, premature birth and low birth weight, perinatal, child and maternal mortality

And yet, I don't see or hear the outrage.  Maybe I am looking in the wrong places.  If I am please tell me.

What might be the causes of this lack of outrage?  I am not an expert, but let's speculate.

* Maybe the fact that it affects women so disproportionately, and yet men tend to be in powerful decision making positions.

* It has multiple causes--not just low iron intake, but hookworm infection, malaria, schistosomiasis--so it is complex to address

* The corollary to the previous point means it requires multi-sector coordination to address this effectively: infection control, food and diet interventions, iron supplementation, prevention of other micronutrient deficiencies etc. Such coordinated action is a challenge, but we now accept the need for it as the norm.

* The manifestations are not as obvious as they are for stunting or wasting and are certainly not as easy to assess.  Invisibility and inertia rule.

There are probably lots of other reasons (please share).

This is the year of Women Deliver: 16-19 May 2016, the world's largest conference on the health, rights, and wellbeing of girls and women in the last decade.  

Surely the time is right for a major new push on this condition?  

With such high levels of anaemia  women's ability to deliver is diminished.  We all need to deliver on a commitment to accelerate declines in anaemia rates for women, children and men.