The nutrition community is, I think, uniquely blessed with some very good NGO research and evidence gathering. Perhaps the NGO work is filling a gap that the UN and research organisations have inadvertently created, I don’t know, but I am continually impressed by their work.
Two recent reports are good examples of the value they add.
First, there is a report by ACF International on the financing of nutrition. It is a short Information Note on Aid for Nutrition. It builds on some work that IDS and others contributed to. The thing I really like about this note is the exceptional clarity it brings to a topic that is not a natural fit with the nutrition community. The crux of the note is a table ranking 5 different financing mechanisms (nutritional impact bonds, matched funds, financial transactions tax, high fat, sugar and salt tax and solidarity lottery against undernutrition) by 5 different criteria (additionality, predictability, feasibility, economic efficiency and nutritional impact). The 5 financing mechanisms are clearly explained (and that is not easy), the criteria are the right ones, and the ratings, while essentially guesses based on a weak evidence base, are intelligent guesses, transparently explained.
The second report is by Save the Children UK on Superfood for Babies: Overcoming barriers to breastfeeding. In terms of the list of priorities for the London pre-8 meeting on nutrition on June 8, breastfeeding has to be near the top. Failure to exclusively breastfeed is an invitation to increase the relative risk of death due to diarrhea and pneumonia by 10-15 times. The Save report describes exclusive breastfeeding for the first 6 months of a baby’s life as the closest thing to a silver bullet in the fight against malnutrition and newborn deaths. Like all silver bullet analogies, if only it were that simple. As the report itself describes there are many barriers to exclusive breastfeeding.
The most interesting chapter in the Save report was the one on the conflict of interest the infant formula industry faces: it’s main competitor, breast milk, is free and superior and so there is a commercial interest in reducing its provision. The question is how to incentivise countervailing behaviour? The International Code of Short of Marketing of Breast milk Substitutes adopted by the UN’s World Health Assembly, is not legally binding, although it is increasingly being enshrined in national law (Kenya, Vietnam and South Africa have all done so in 2012). When governments have the capacity to hold powerful multinationals to account, the Code is clearly very helpful. But the power imbalances in resources and information make enforcement, even of legislation, a constant challenge and there is constant testing of boundaries by the companies and documentation of frequent violations. The descriptions of the violations are the best I have seen because they try to find evidence from a number of sources and they highlight good practice. And solutions are proposed—for example combining the standards of the Code in a FTSE4GOOD-type ethical investment index approach.
In this year of Nutrition2013 it feels good to be working in an environment where our civil society is not just advocating for more to be done, but they are thoughtfully highlighting problems and proposing solutions.