The Report describes the processes behind the development of the plans, emphasising the trust building and effective communication between stakeholders. In particular the conclusion from the analysis is that the more inclusive and iterative, the more likely the plan is to be used (although this must be a prospective assessment).
The Report really hits its stride in section 2, opportunities for investments. Here the 20 plans are analysed in terms of spending on actions that are nutrition specific, nutrition sensitive and governance related (great to see this last set of items explicitly recognised).
Things that struck me:
- there was very little involvement of business in the development of the plans. Some will applaud this, others will lament it. As I have noted before, if the public health sector knows what it wants from an engagement with the private sector and the right governance arrangements are in place, the private sector can play a positive role as one voice among many
- in some plans over 80% of the resource allocation was to nutrition specific interventions (Benin, Kenya, Tanzania and Mozambique) while in others, more than 90% was allocated to nutrition sensitive investments (Peru, Guatemala, Indonesia, Bangladesh). More analysis needs to be done to understand why. Is it because the African countries have weaker health systems and need nutrition specific programmes to fill the gap? Or does it reflect something about nutrition outcomes in each set of countries? We need to know.
- the nutrition sensitive spending is dominated by food and health environment spending, with very little on care and with activities to empower women almost absent. Again there is huge variation in composition of nutrition sensitive spending: in Rwanda it is nearly all food security and in Kenya it is nearly all health environment. It would be good to know more about the drivers.
- on governance, there was more balance between the 3 sub-categories: information management and coordination; advocacy; communications and policy and system capacity building. Again there was wide variation, with Guatemala allocating nearly all its governance spending to information management and Indonesia nearly all to system capacity building.
- average costs of plans (over 4-5 years): $200m for nutrition specific, $1496m for nutrition sensitive and $114m for governance. I'm quite impressed by the level of spending on governance. A few tentative estimates of funding gaps are included but the Report highlights this as an area where much more work is needed
- only 12 of 20 plans showed some level of prioritisation of actions. Why could some and not others?
- "most plans do not currently include the requisite assumptions and detail on costing methodology that is required to understand, replicate and revise national plan". Again, good to know what the key bottlenecks were.
- Tanzania, Madagascar, Ethiopia, Malawi and Bangladesh were highlighted as places where the greatest progress was being made in costing plans, all using methods that they are comfortable with rather than an externally imposed method
I was asked to write a conclusion to the report and, after reading it, I was happy to do so.
This is how I concluded.
"Potential investors in nutrition should be encouraged and motivated by these plans. They may not be perfectly formed as yet, but they embody that most precious of development assets: the commitment and the determination of national champions to make them become so. In this way the plans serve as the most credible basis for investments to accelerate the reduction of undernutrition. They should be analysed, used, improved and backed."
Back the plans. Lives depend on it.