For the past two days I have been at an EC-hosted consultation on how to configure governance architecture at the national and international levels to maximise efforts to address widespread malnutrition. Malnutrition is responsible for nearly a third of all child deaths, a third of the global burden of disease in the developing world and economic productivity losses of 3-5%. Nutrition status represents the building blocks of human, social and economic development.
Governance is crucial for nutrition because nutrition services are challenging to deliver. First because the determinants of nutrition are multisectoral. This means good work in one area (say health) is undone by vulnerabilities in other areas (e.g. food insecurity). Therefore nutrition reduction efforts require coordination across ministries where nutrition is usually not the number one priority. Second, reducing malnutrition requires a lot of behaviour change which is often very context specific (e.g. attitudes towards breastfeeding), so a strong capacity to adapt is paramount. Finally, malnutrition, unless it is very acute, is a silent killer and a subtle destroyer. Its presence is not easy to detect. It requires height and weight measurements to be compared to international standards. A high degree of vigilance is required. Capacities for coordination, adaptability, and vigilance need to be deliberately built up accordingly—among all stakeholders, not just governments.
The 2-day meeting also highlighted global and national nutritional trends. First, we don’t actually know what is happening post food, fuel and financial crises—highlighting just how difficult it is for our monitoring systems to keep up with the real world. Second, pre-crisis trends are encouraging in Asia (excluding India) and less encouraging in sub Saharan Africa (although there are exceptions and also the average rate is still lower than South Asia).
We had some terrific national-level presentations showing how strategic some of the nutrition leaders have been (e.g. Malawi, Brazil, Cambodia, Peru) in positioning nutrition within government (usually in a central location such as the Ministry of Planning and Investment or the Prime Minister’s Office), in setting up inter-ministerial coordinating mechanisms and in setting public goals in terms of outputs and outcomes.
Most people agreed that a global nutrition strategy would help raise the profile of nutrition on Davos-like stages (where it is not even on the radar screen) helping to generate more resources for the country level processes to focus them. Much inspiration was drawn from the reframing of global efforts to combat HIV/AIDS and the water security.
The importance of process in constructing this global vision for nutrition was brought home by the country level leaders. They insisted that global processes are not framed only by the multilateral agencies. Programmes that aspire to global reach need to be globally constructed, not from Washington, Brussels, New York, London or Rome, but from everyone who needs to play a role.
The EC hosted the meeting. The gathering sparked a re-commitment of support from the major UN agencies for the Standing Committee on Nutrition (SCN). The SCN has the potential to be a leading mechanism for creating interagency synergies at the global level if it can get its focus, governance and resourcing right. The meeting was thus important for that re-commitment.
The meeting was also important in that it helped maintain the immediacy and urgency of the malnutrition issue within the EC. The EC and the EU are major international development players and already exhibit strong leadership in food security. I hope they are also becoming convinced that they can and need to play the same European leadership role in the fight against malnutrition.