14 May 2010

The first 1000 days: Hillary Clinton on Undernutrition

A welcome speech on May 11 from the US Secretary of State Hillary Clinton on undernutrition. Although USAID is under the Secretary of State, this is a fairly remarkable level of attention for this issue.

The speech was accurate in the stats, and reflected current thinking about the levels and consequences of nutrition and some of the technical things that can be done to reduce it. I liked the sticky messaging around the first 1000 days (the window of opportunity from pregnancy to 2 years of age).

One major disappointment--nutrition still has to work through other new US initiatives in agriculture and in health systems. Fair enough, this where the money is. The disappointment was the lack of attention given to the governance and leadership of the nutrition strategy.

As I have argued many times before, because undernutrition is a cross-sectoral issue and because it is quite invisible, fighting it requires strong leadership --and the supporting institutional infrastructure-- for advocacy and coordination. I very much hope this gets addressed soon.


  1. This comment has been removed by the author.

  2. Your point on undernutrition being a cross-sectoral issue, requiring strong leadership, chimed perfectly with the experience here in Peru over the last 5 years. Along with other national and international NGOs, donors and UN Agencies, CARE Peru set up in early 2006 the Child Malnutrition Initiative (“the Initiative”), an advocacy coalition seeking increased priority for and effectiveness from the fight against chronic malnutrition in Peru. Rates had remained stagnant at around 25% for the previous 10 years, despite some $300m annual government spending in food distribution and school feeding programs.

    In the run up to the 2006 Presidential elections, we managed to get the ten main Presidential candidates to sign up to a simple and catchy commitment: to reduce chronic malnutrition in children under 5 by 5 percentage points over 5 years, and to close the urban rural gap. Tackling undernutrition was subsequently made a major priority of the new Government, and President Garcia even increased the target to 9 percentage points in his inaugural address in July 2006.

    The Initiative then worked with the new Government to ensure responsibility for leading the fight against nutrition was housed in the Prime Minister’s Office, with the clout to coordinate different Ministries which was vital given the multisectoral nature of the problem. Over the last four years, the Initiative has played a role combining advocacy and technical support, at national and subnational levels.

    Most importantly, chronic malnutrition in children under 5 has fallen by 4 percentage points between 2005-2009, with greater reductions in rural than urban areas (see presentation by the Prime Minister’s office - this was with the provisional 2009 figure of 19%: the final DHS figure for 2009 is 18.3%).

    This would seem to be a good example of just what you called for in your blog in order to tackle the problem of undernutrition: leadership, advocacy and coordination.

    If you are interested in further information, there is more in Spanish on our website.

    Jay Goulden

    Program Director, CARE PerĂº


  3. I note Mr Haddad has nothing to say in response to the evidence I have given about the foolishness of vaccinating undernourished children in the third world. Does he think both he and Andrew Mitchell know better than Dr Kalokerinos who spent his life amongst such children, and concluded that what they needed was Vitmin C and not Toxic vaccines? I guess you don't reply to comments you cannot answer?