26 November 2014

Panel Show: Check out the 24 Global #NutritionReport Panels http://goo.gl/rcTy0o

One of the best things about the Global Nutrition Report are the Panels.  There are 24 of them in all, giving insights on a wide range of subjects from over 50 authors.  

The Report contains the shorter versions, but here are the longer versions (screen grab below of some of them).  

You can download them here as one file or you can pick and choose the ones you want to download.  Please read them (they are 2 pages each) and share them.  



25 November 2014

23 November 2014

12 Killer Facts From the Global Nutrition Report


I have described the Global Nutrition Report as an evidence based Treasure Trove for influencing.  

You will have your own favourite stats, but here are some of mine:

1.   Malnutrition affects nearly every country: 120 out of 122 countries with data cross a nutrition “redline” in one of the following areas: under 5 stunting, anaemia in women of reproductive age, and adult overweight.  Only China and South Korea do not cross any of these 3 redlines, but China is very close to the anaemia cut-off of 20%. 

2.   Multiple burdens are becoming the new normal: 45% of all countries with data have undernutrition and overweight problems.

3.   Many countries are on track for some of the global targets: 69 out of 100 countries are on track for one or more of the WHA global targets.  31 are not on track for any.  Colombia is the only country that is on track for all 4 of the targets we can currently assess.

4.   Anaemia is a widespread problem on which little progress is being made, (although the data are modelled): Only 5 out of 185 countries are on track for anaemia reduction in women of reproductive age.

5.   Nutrition is only mentioned in one of 169 SDG targets.  Only 2 of the 6 WHA indicators are mentioned in the SDGs.

6.   Investments in nutrition outperform the stock market. For every dollar invested in nutrition specific scale up to 90%, 16 dollars are returned over the life course.  16 is the median value for 40 country estimates—the estimates range from 4 to 56.  Getting a 16:1 return over 30 years is equivalent to a 10% compound rate of interest.  Over 1930-2010 the Dow Jones Industrial Index gave a 9% compound rate of interest.

7.   Will India be the new China? The state of Maharashtra’s rate of stunting decline between 2005 and 2012 (7% Annual Average Rate of Reduction) has been bettered only by China’s 8% sustained over a longer period.  If Maharashtra were a country it would have the world’s 12th largest population (114m), just behind Mexico and ahead of the Philippines and Ethiopia.

8.   We need a data revolution in nutrition: 49% of all 193 UN member countries do not have the right data to be able to track their progress against 4 WHA global targets.  The latest under 5 anthropometric survey for 40% of countries is 5 or more years old.

9.   Nutrition for Growth (N4G) commitments are on track, but need sharpening.  Of the 168 N4G commitments, 43% are on course, 9% are off course, in 37% of cases it is not clear whether commitments are on or off course, and 11% of commitments were not reported on.

10. Government nutrition budget data are sorely lacking, making this basic component of accountability very weak: only 3 countries can share budget allocation data on nutrition spending.

11. Donor spending on nutrition is increasing, but is still a small share of ODA. Major donor disbursements on nutrition specific and nutrition sensitive programmes have increased by 30% and 19% respectively between 2010 and 2012.  Total donor disbursements in these 2 categories are just over 1% of official development assistance (ODA) in 2012.

12. The scope for an expansion of nutrition sensitive programmes is enormous:  for example, in Africa, a combined total of 35% of government budgets are allocated to health, education, agriculture and social protection. 

12 November 2014

The Teeth Behind ICN2 Commitments & Recommendations: Will They Bite or Merely Chatter?

Do have a read of the ICN2 Outcome Documents: (1) Rome Declaration on Nutrition and (2) Framework for Action.

They are very sensible: a good balance of nutrition status outcomes, programmes, sectors and policies.

These documents were very food focused 6-9 months ago, so FAO and WHO deserve a lot of credit for listening and responding to concerns.

The one section that worries me is the accountability section. Accountability is covered in 3 out of 60 recommendations in the Framework for Action.

Recommendation 58 says that "national governments are encouraged to establish nutrition targets and intermediate milestones, consistent with the timeframe for implementation (2016-2025).... they are invited to include" indicators for nutrition outcomes and policy.  "Encouraged" and "invited":  I understand that this is diplomatic speak, but couldn't  "strongly" or "urged" have featured?

Recommendation 59 says that reports on the implementation of the commitments of the Rome Declaration  on Nutrition will be compiled jointly by FAO and WHO drawing on country self reporting and other mechanisms (and it mentions the Global Nutrition Report).  But will these reports identity commitments, link them to responsible parties, assess delivery and make assessments publicly available?  There is silence on this when there needs to be clarity.

Recommendation 60 is really odd, saying that the governing bodies of FAO and WHO and other relevant organisations are "requested to consider the inclusion of reports on the overall follow up to ICN2 on the agendas of the regular FAO and WHO governing body meetings"  Requested to consider?  How about a commitment from the governing bodies to demand such reports?

Finally, two big omissions from the ICN2 documents:

* there is some complacency on the eventual prominence of nutrition in the SDG framework.  As the Global Nutrition Report notes, nutrition is only mentioned in one of the 169 SDG targets.  4 of the 6 WHA indicators are not in the SDG framework.  This is not good enough.  The best thing to come out of ICN2 would be a realistic plan to get nutrition more prominent within the SDGs.  The SDGs, after all, will be the main accountability mechanism for development over the next 15 years.

* what about an ICN3?  Will we have to wait another 22 years for an ICN? What about an ICN3 in 5 or 10 years?  One that focuses clearly on what has happened in the proposed Decade of Action for Nutrition.

So the ICN documents are good, but do the teeth behind the ICN2 have bite or do they merely chatter?

10 November 2014

ICN2: Time for Leadership -- in Nutrition and in Accountability

Well, the final week's build up for the Second International Conference on Nutrition (ICN2) has begun.

Panelists are being briefed,  speeches polished, press releases honed, op-eds hawked, social media plans finalised.

But ICN2 is about much more than these rituals, important as they are.

ICN2 is an opportunity for real leadership.

The kind of leadership that is permanent, not just for this week until the next podium comes along.

The kind that challenges conventional wisdom rather than bowing to it.

The kind that is far reaching and wide ranging, not focussed on short term parochial gains.

The kind that inspires as well as informs.

Most importantly it is a chance for leaders to demonstrate their accountability.

How clear will their commitments be?  How supportive will they be of efforts to track those commitments?  And will they be spurred on by assessments of their progress against commitments or will they stick their heads in the sand?

We need our nutrition leaders to be accountability leaders.

The Global Nutrition Report is one contribution to strengthening accountability in the nutrition system.

The Report will be made available on Thursday November 13, at 1400 UK time, on the website.

Further online materials will be available in the days leading up to the Rome launch:

* 193 Nutrition Country Profiles (2 pagers with 80+ indicators)
* 12 Technical Notes on analyses and measurement issues
* 30 or so Panels (shorter versions of some are in the Report, some are not in the Report)
* the detailed Nutrition for Growth (N4G) Tracking Tables that provide the evidence for the N4G assessments

The Report does the following things
  1. Notes the truly global nature of malnutrition--nearly every country has crossed the red line on nutrition
  2. Argues that multiple burdens of undernutrition and overweight/obesity are the "new normal"
  3. Documents global and country progress--who is on course for what and why
  4. Argues for stronger nutrition representation in the SDGs and more ambition on SDG targets for 2030
  5. Makes recommendations on actions to accelerate malnutrition reduction
  6. Evaluates progress on the N4G commitments--who is on course and who is not?
  7. Identifies key data gaps that need to be filled
  8. Makes recommendations on how nutrition accountability can be strengthened
We are presenting at the SUN Global Gathering on November 17 at WFP and formally launching at the ICN2 on Nov 20 at FAO, 18.30-20.00

Further Roundtable events are scheduled (in chronological order)

London (Dec 2), New York (Dec 8), Washington DC (Dec 9), Geneva (Jan), Delhi (Feb 4), Bhubaneswar, Odisha (Feb 6), Addis (Feb 24), Lusaka (Feb 26), Brussels (Feb/March), Mexico City (March 2), Jakarta (March).  More details to follow here

They will be advertised in each location--please watch out for them and we look forward to your participation.

06 November 2014

Undernutrition in India: Is the “Curse” Finally Lifting?

Five years ago Sushila Zeitlyn and I co-edited a collection of papers by Indian authors on why undernutrition was so persistent in India and why the government seemed so disinterested in making tackling it a priority.  At that time the Prime Minister called undernutrition a “curse”.  It must have seemed like that—rapid economic growth and high and stubborn levels of stunting, wasting and micronutrient deficiencies.

I just returned from a trip to Delhi and Lucknow and I have never been more encouraged.  Is the curse finally lifting?

First there was the Together for Nutrition Conference organized by two consortia, both convened by IFPRI: POSHAN and Transform Nutrition.   The conference explored different forms of collaboration in nutrition: from alignment to coordination to cooperation to integration.   What was so encouraging here was the participation from 14 different states.  The nutrition champions were everywhere.  We had great research papers and inspiring stories from a range of Indian and international practitioners and researchers.  Once again, there was the prevalent feeling that dynamism, innovation and commitment are coming from the States, not the central Government.   
 
Second, there was the Coalition for Food and Nutrition Security, chaired by M.S. Swaminathan, still driving the agenda with a razor sharp intellect and turn of phrase.  The Coalition is a group of civil society, government and research organisations and individuals who are fighting for nutrition.  I attended the launch of their Action Agenda. The Coalition outlines 5 urgent areas of action; coverage of evidence informed nutrition interventions, equitable access to services provided by sectors related to nutrition, adequate financing, nutrition as a development indicator with regular data collected every 3-5 years and institutional leadership within the offices of the Prime Minister and state Chief Ministers.  I like this set of 5, especially the last two as I think they set the tone.  

Speaking of Chief Ministers who take the lead, I next went to Lucknow in Uttar Pradesh (UP), to speak at the launch of the new State Nutrition Mission.  UP is the biggest state in India at 200 million people (the 6th largest country in the world, if it were one) and has the highest rate of stunting at about 56%.  That is about 13 million stunted children or about 8% of the world’s total.  8%.  The Chief Minister and his wife, an MP, spoke passionately about the need to reduce malnutrition.  The Citizen Alliance, a group of MPs and civil society featured strongly at the podium and are clearly powerful.  UP was strongly influenced by the Maharashtra experience (hence my invitation to present this report) and there were many officials from that state also present.  If things can get moving in UP it could be a real global game changer.
 
 
Finally, I returned to Delhi to co-teach in the Transforming Nutrition short course co-hosted by PHFI and IFPRI.  The quality of the participants was really excellent and it was inspiring to be around so many experienced and knowledgeable experts on nutrition.  Aryeh Stein from Emory University was a great addition to the PHFI/IFPRI faculty, especially with his knowledge of the double burden and developmental origins of health and disease.

There’s a real energy and excitement about the Indian nutrition scene: a sense that progress is being made.  Causes for optimism include:
 
* New headline figures from the yet to be released Rapid Survey on Children (Government of India and UNICEF)—under 5 stunting declines from 48% to 38%
* UP’s Nutrition Mission
* The new Government’s preparation of a National Nutrition Mission
* The new Government focus on sanitation
* The active role civil society is playing: the Citizen’s Alliance, the Coalition and Naandi’s Hungama 2
* Maharashtra, Odisha and Kanartaka’s leadership on nutrition at the state level
* A PDS system that seems to be lurching into life in terms of promoting food security
* UNICEF’s strong partnership of the States

Challenges remain: the promise needs to be delivered on and there are some very difficult hurdles to overcome (open defecation, caste barriers, sluggish agricultural development). But the sense I took away—perhaps for the first time in 20 years—is one of optimism.  People kept saying that they were “waking up to malnutrition”. 
 
Maybe the curse really is lifting.  Maybe India will join SUN.  Maybe India will hit the WHA targets by 2025 or even exceed them.  We shall see.