29 July 2015

Nominate your Nutrition Champion. Do it today.

Don't ever let anyone tell you that one person can't make a difference.  My mother told me this when I was very young.  She obviously was practising what she preached. But it is easy to be cynical--individuals don't make a difference: policies or programmes or legislation do, surely?  But you know what? Those are manifestations of long drawn out processes that are political and often reward those with the best arguments, the best organisation and the most determination. In other words, people. People who are driven to make a difference.

Nutrition needs leaders more than most other issues.  Why? Well, nutrition has no obvious institutional home (no Ministries of nutrition), it cuts across disciplines and sectors and so requires leaders who can work across boundaries, it is invisible--it needs people who can stand up for it, and it affects those who are most vulnerable and have least voice--the poorest, the youngest and the most marginalised.

Where are these leaders? They are everywhere.  Some are in the spotlight, some are behind the scenes. Some are at the frontlines, some are working at headquarters.  Some are technicians, some are implementers.  Some see themselves as leaders, others would never recognize themselves as such. Some are recognized, some are unsung.  In short there are many types and forms of leadership.  The important thing they all share is people taking responsibility and doing things that might be inconvenient for them but make things better for others.  Lead from where you are, is the motto, and it is a good one.

Do we do a good enough job of celebrating leaders in nutrition?  No.  One of my former bosses always used to say its a shame we don't recognize contributions of people before they leave a job or before they pass on.

So I'm really pleased about the Transform Nutrition Champions awards from Transform Nutrition and Save the Children UK.  It recognizes unsung heroes and by doing so gives them a little more belief and fortitude and, more importantly, gives the rest of us their story to inspire us and help energize the leaders of the future. 

Nominate someone.  Do it today.

19 July 2015

Reflections on the IDS-IFPRI Transforming Nutrition Short Course

We just finished the fourth one week course on Transforming Nutrition.  We had 25 fantastic participants and the three course convenors (me, Purnima Menon and Nick Nisbett) shared with a series of presentations and discussions on the causes and consequences of malnutrition and the actions to overcome it. The course is based on the best evidence and helps participants think about strategies to overcome malnutrition in their contexts.  We had great faculty to help us out: Stuart Gillespie, Richard Longhurst, Mdu Mbuya, Namukolo Covic, Jodie Harris, Inka Barnett, Dolf te Lintelo and guest presentations from Corinna Hawkes, Emily Mates (ENN), Jessie White and Susan Elden (DFID), with fabulous after dinner speeches from Richard Jolly and Simon Maxwell.

Some reflections

1.  The cohorts coming through are getting more assured, confident and demanding about nutrition and what they want out of the course.  In the first year or two participants were more tentative about what they could achieve in nutrition in their context, now the sense I get is that they know exactly what to do and they want advice on how to strategise about that and make it happen.

2. The cohorts are getting more and more dominated by country leaders from government, UN agencies based in country and civil society.  There were about 5 participants from development partners, and they provided a valuable perspective, but the 20 country based participants ran the show, and it was refreshing. 

3. We talked about overweight, obesity and nutrition related chronic diseases more than ever before.  This probably reflects the presenters growing knowledge on the issues, but the discussions and questions were very focused on how to sequence action on undernutrition on top of all the other malnutrition issues manifesting themselves.  These two worlds are slowly converging, and that is a good thing. 

4. The group presentations at the end of the week were simply amazing.  The Nigeria team was large, determined, and impressive.  The Tanzania team was small in numbers but very thoughtful.  The Mozambique and Bangladesh teams innovated in their group presentations, using role play and film to communicate their problem, what they would do to overcome it and who they would influence to make it happen.  The calibre of all participants was exceptional. I was struggling to keep up at times. 

5. I remain amazed at how few country or state level case studies there are of change.  Why did stunting go down in this country?  Why is wasting static? Why is overweight declining? Why is anaemia static? Why is exclusive breastfeeding rates going backward in country x?  The nutrition journals currently disincentivise this kind of study, presumably because it is not methodologically pure enough.  This is a real shame.  Slicing and dicing research may help researchers get published, but who  is going to weave all the strands back together again?

It is really gratifying to see how strong the demand for this course remains.  We have had over 130 people go throughout the programme now.  They have energised us and we hope we have energised them.  We need all the energy going.  The force may be with us in nutrition right now, but we (yes, you, reader) have to be the force to sustain it and turn it into action that reduces malnutrition.  Nothing less will do.

06 July 2015

Guest blog from Stuart Gillespie: From the politics of commitment building to the politics of delivery

Guest blog from my IFPRI colleague, Stuart Gillespie, with some reflections on enabling environments for nutrition.  

“The microbe is nothing, the terrain everything” (Louis Pasteur, 1895)

"The objective of development is to create an enabling environment for people to enjoy long, healthy and creative lives." (Mahbub ul Haq, 1990)

We have learnt a lot about “enabling environments” in nutrition over the last few years -- about what they are, and why they’re important. In broad brush, an enabling environment is one in which there is a political commitment to address malnutrition, backed up by institutional commitment in the form of pro-nutrition policies, incentives and accountability. Nutrition-relevant data are generated, shared widely, and they inform action. Different elements of nutrition-relevant capacity are understood and strategies are pursued to address gaps and weaknesses. Nutrition champions build alliances and they work across sectoral boundaries to make the case for nutrition. The growing priority attached to nutrition is reflected in financing that is adequate, stable and flexible.

Such enabling environments (EEs) lie at the base of the Lancet (2013) conceptual framework, and they have opened the door to a more politically nuanced analysis of nutrition in recent years. EEs may be foundational but they are also dynamic. They can change….for better or worse. In tracking countries’ progress against four indicators, the SUN movement is monitoring the development of EEs at the national level.

This is clearly important, but it’s not enough. Between Pasteur and ul Haq, environments operate at different levels. Think of the layers of an onion. At the core, a child’s nutritional status represents an enabling (or disabling) environment for her/his growth and well-being, Pasteur, and his compatriot Claude Bernard, did not explicitly refer to nutritional status but it was the stability of the milieu intérieurthat was believed to be “the condition for a free and independent life”. Nearly a century later, when he launched the first Human Development Report, Mahbub ul Haq was building on Amartya Sen’s capability approach. Enabling environments were those that preserved the future capability to act, that kept an individual’s set of life choices open. Human development was about expanding the richness of human life, not the richness of the economy.

Between the outer and innermost layers of the onion – between macro and micro – there are district-level bureaucracies. A supportive policy climate does not automatically guarantee effective subnational implementation of nutrition-relevant programs. We need to move below the national level to better understand meso-level environments for nutrition. We need to pay more attention to vertical coherence (national to community) and go beyond the politics of commitment-building to the politics of delivery.

Creating and sustaining EEs is not easy, and it takes time. There are many moving parts, and there is no gold standard. Future research and action needs to recognize such complexity. One way to do this, and to foster sharing and learning across contexts, is to document real-world experiences in developing EEs at different levels.  Such “stories of change” – focusing as they do on the lived experience of key actors -- can be powerful.  Stories inform, but they also inspire.