28 November 2011

MVP again

You would have thought I'd have had enough by now.

The American Journal of Clinical Nutrition-- a big deal journal in the human nutrition world--has just published a paper by the MVP team on "Multisectoral intervention to accelerate reductions in childstunting: an observational study from 9 sub-Saharan African countries". The Conclusion in the Abstract "These findings provide encouraging evidence that a package of multisector interventions has the potential to produce reductions in childhood stunting".

It is such a shame that the impact evaluation design does not allow us to say anything more than that. After all one would be surprised if a multisector package did not have the potential to reduce childhood stunting.

The need to word things so carefully originates from the lack of comparator stunting data from similar communities over the same time period. If we had this we could compare the stunting reductions to see if they are faster in the MVP villages.

The comparison the authors make is:

MVP village declines in stunting over the 2005-6 to 2008-9 period vs stunting declines in those same 9 countries, but at (a) a national level and (b) over the period 1988-2008.

If the authors had data from the same time period and from similar (even better, matched) areas then we could plausibly attribute a certain percent of the declines to the MVP.

So, the paper is not able to say too much.

The data are encouraging in that there is a significant downward trend in stunting in 6 of the 9 sites, but we would expect such a big intervention to have an effect on stunting rates in any case.

The real questions remain: (a) how much of the effect is due to the MVP? and, more fundamentally, (b) what happens after the MVP finishes?

22 November 2011

DFID x 0.02 = ?

Just what can a foundation achieve with a budget between 1-2% of DFID's? Well, this is the spend size of relatively large foundations such as the Rockefeller Foundation.

As one of the participants of the Bellagio Initiative Summit on Wellbeing, Philanthropy and Development pointed out, television programmes like the UK’s “The Secret Millionaire” remind us, small amounts of money can transform lives so annual giving of $100m-$200m can have substantial transformative power. The question is how to maximise that power.

The obvious thing for Foundations to do is to work with those with deep knowledge of the context in question to unearth, develop and test innovations (technological, organisational, social), and to link up early in the process with those who might scale the innovations (e.g. National Governments and development agencies).

It is clear from the 2 days I have been at this summit that these kinds of partnerships are the exception rather than the norm. Listening to voices and constituencies on the ground and linking up with partners who have the capacity to scale does not happen nearly often enough. Why? My hunches:

(a) there are few incentives for foundations to do this. It is much easier to develop a pilot that shows a temporary positive effect but has weak origins in the context and little legacy in terms of what it leaves behind, and

(b) power gets in the way. Public development agencies (at least the bilateral ones) are directly accountable to taxpayers in ways that Foundations are not. The former are custodians of everyone’s money, the latter are custodians of one family’s money.

Without the right checks and balances Foundations can get carried away with their own sense of power and this can make linking with communities and development agencies seem like unnecessary exertions.

But my sense is that the appetite for change is growing, perhaps pushed by the transparency and accountability agenda.

One response to accountability and transparency is “just make sure we do good things” by, say, improving standard M&E. Another response is “make sure we do the best we can”. While the first response is a minimum, the second surely has to be the goal of visionary philanthropists.

If done right, this way of working promises more sustainable and transformative action.

But it will require a greater acceptance of the need to invest more in relationship building, a greater willingness to work with others’ agendas, a greater preparedness to be seemingly sidetracked and a willingness to develop and use the tools to redefine and assess impact in these new contexts.

Working with others from different cultures is hard and risky. But the potential benefits are enormous—much greater than 1-2% of what DFID can achieve.

Foundations are well placed to calculate those risks--and then to bear them.

21 November 2011

Philanthropists: Dare to be Different

I’m currently in Bellagio for the Bellagio Initiative on the Future of Philanthropy and Development in the Pursuit of Human Wellbeing, organised by IDS, the Resource Alliance and the Rockefeller Foundation.

Foundations spend private money. They don’t have to chase money like us mere mortals. As such they can dare to be different from public sector funders of development. They can afford to spurn fads and be fashionably unfashionable.

They should, for example,

• Help redefine the objectives of development

Public development agencies are more focused on the tangible development outcomes—these are straightforward to explain to taxpayers. Philanthropists can focus on other dimensions of wellbeing: trust, solidarity, self confidence, and freedoms. Wellbeing is important because it a truer way of assessing what it is to live well, but also because the nonmaterial dimensions force us to be more grounded, because to affect the nonmaterial dimensions of living well requires a greater understanding of context.

• Do things that others cannot

What is it that philanthropists have a comparative advantage in?
o Work on unfashionable issues
o Take risks and accept failure as a part of the innovation process—redefine success, don’t get trapped in electoral cycles.
o Reproduce—support the creation of other foundations

• Organise for the long view

Many philanthropists take a lifetime to build up their success and money—why do they expect to be able to effect change in 3 years?

o Get a better balance between delivering services for people in urgent need and building resilient societies, societies with strong organisations and institutions that can deal with unanticipated shocks.
o Build leaders and leadership. We know how important leadership is at all levels—household, community, district, national—in all sectors.

And yet, there seems to be convergence between the taxpayer driven results for development and the philanthropies’ impact innovations work. What is driving this? The private sector backgrounds of the new philanthropists? The need to work with public sector development agencies? The human desire to look good?

I don’t know, but we need philanthropy to dare to be different. The last thing we need is a McDevelopment monoculture of goals, ideas, innovations and actions.

More tomorrow as I try to absorb the exciting ideas swirling around the hilltops.

18 November 2011

Richard Jolly: From Structural Adjustment to Human Development

Yesterday we kicked off a two day workshop "From Structural Adjustment to Human Development" in honour of Professor Sir Richard Jolly, an IDS Associate and former IDS Director.

I first met Richard in the mid 1990s when he was the Chair of the rather obscure UN/ACC-SCN, the UN's standing committee on nutrition. The SCN's aim is to bring together different parts of the UN working on nutrition to help the whole be greater than the sum of the parts.

Watching Richard chair this 2 day meeting, I learned 5 things about him: (1) his deep commitment to the UN (why else would he have put up with those squabbling UN agencies?), (2) the breadth of his intellect (he can talk agriculture, sanitation and infant feeding with the best of them), (3) the respect in which he was held (he had recently worked with Frances Stewart and Andrea Cornia on the ground-breaking Adjustment with a Human Face), (4) his relentless focus on putting people at the heart of development and (5) his optimism and total lack of cynicism (essential to get those sometimes warring factions to agree).

His contributions to development and to development research (for he is a man of action as well as of intellect)

* "Redistribution with Growth (which rejected the early 70s separation of optimal growth and redistribution) -- the Occupy movement would be inspired by this
* Adjustment with a Human face (which argued, amongst other things, that the poorest should be protected from austerity measures) -a guideline to any policymaker grappling with the global recession
* the regional Human Development Reports (Richard was instrumental in getting the HDRs going) and their ability to create a space to speak truth to power and cut through GDP/capita-only narratives--important in the context of the Arab Spring uprisings, I am told.

On a day to day level Richard is a delight to have at IDS--always generous with this time and never pulling the "when I was Director" routine (at least to my face!).

Richard remains active, working to spearhead a new coalition to get inequality issues higher up the development agenda. His energy and optimism are quite timeless.

13 November 2011

Why India Needs a National Nutrition Strategy

This article was just published in the British Medical Journal.

Over the past 15 years India’s economic growth rate has been unprecedented. The International Monetary Fund reports an average growth in real gross domestic product (GDP) of nearly 6% in the 1990s and of 8% in 2000-10. The economic growth has not, however, been associated with corresponding reductions in the rates of childhood undernutrition. The National Family Health Survey, which provides India’s most authoritative statistics on nutrition status, showed that 43% of children under 5 years old were underweight for age in 1998-9; by 2005-6 the percentage had only dropped to 40%. At that rate of progress India will not reach its millennium development goal target (to halve the proportion of underweight children by 2015) until 2043. By contrast, China has already met its goal and Brazil is expected to do so by 2015.

Undernutrition is responsible for 35% of deaths among children under 5 and 11% of the total global disease burden. It also reduces schooling attainment: an improvement in height for age z scores of 1 is a predictor of an extra half a year of schooling and substantially increases the likelihood of being poorer later in life since less schooling is a predictor of lower wages (46% in a longitudinal study from Guatemala) and lower lifetime incomes.

During 1981-2005 India’s poverty rate fell from 60% to 42%. This decline is similar to China’s more lauded poverty reduction (a fall from 40% to 29%) over the same period. Yet unlike China, India is not reducing undernutrition. Given the importance of childhood nutrition it is important to ask why high levels of undernutrition are so persistent in India.

(For more see the above link).

07 November 2011

How much money is invested in nutrition?

It is usually easier to find out how much money is being spent on something than how much money should be spent on it. Not so, nutrition.

Thanks to many cost-effectiveness studies we can isolate the 13 essential nutrition interventions and we know roughly how much it costs to make a big dent in undernutrition rates. For example, the Scaling Up Nutrition movement (SUN) estimates the annual amount to be $10 billion.

But how much is actually spent by donors and by multilateral agencies? It turns out this is a really difficult question to answer, at least for nutrition.

Last week my IDS colleague Stephen Spratt and I were at Action Against Hunger at their London offices. We are working with them on a project on innovative financing for nutrition.

Stephen is an expert in development finance and has ideas about how to finance nutrition scale ups, drawing on ideas from climate financing and a range of transactions taxes.

But to do this modelling of financing and taxes, we need to have accurate and specific nutrition resoruce data.

There are two types of intervention to assess current investment flows for: direct and indirect.

The direct interventions are things like breastfeeding promotion, complementary feeding promotion (for infants post weaning) and micronutrient supplementation. It should be easy to get resource flow data for this tangible category, right? Wrong. It turns out that the CRS data held at OECD DAC for donor countries has a category "basic nutrition programme", but when you trawl it project by project, only about a third of that spend is actually on one of the 13 essential nutrition interventions. Interestingly other CRS line items, not labelled with nutrition but with obvious connections to nutrition, contain more spending on the essential nutrition interventions than the "basic nutrition programme" line item.

For the indirect interventions such as agriculture, social protection, health, water, sanitation, women's empowerment it gets even more complicated. Do we use indirect intervention spending (a) only from CRS categories that have something to do with nutrition, (b) from all CRS categories, but only for indirect projects that have nutrition outcome aspirations or (c) from all CRS categories for all indirect projects, whether or not they have nutrition outcome aspirations? I favour the second and the third, because the second gives us the full amount that is being spent on nutrition-focused indirect interventions and the third gives us the potential resource flows that could be supercharged for nutrition.

On top of all this, the range of helpfulness from the 6 bilaterals and the 5 multilaterals approached by Action Against Hunger for clarifications was very wide, with some being right on top of resource flows, some not knowing, and some unhelpful.

The bigger point to be made here is how on earth are we going to be able to track SUN's progress if we cannot even get a fix on resources flows to nutrition? Moreover what are the obligations on agencies to share their resource flow information by issue? There is a clear job for Publish What You Fund and International Aid Transparency Initiative here.

For nutrition, the CRS clearly needs a revamp and on transparency part of the SUN initiative should be to get some sunlight onto nutrition resources flows. Otherwise the SUN will be operating in the dark.