14 December 2015

Guest blog by Uma Lele: Advocacy essential, but now we need long-term investments to drive nutrition change on the ground in India

Lawrence Haddad’s uplifting blog after his visit to India followed by a passionate appeal by Purnima Menon and Neha Raykar to “Invest in Our Girls” in The Hindu illustrate both the power and the limits of advocacy.  

The power of advocacy is demonstrated in a few ways.  

First, it engaged policymakers in two key ministries of Health and Women and Child Development.  

Second, it brought together some of the best thinkers on nutrition in India and abroad around two important reports— The Global Nutrition Report 2015 (GNR) with its updated India Nutrition Country Profile, and the India Health Report on Nutrition, 2015 (IHR). Both reports are data and evidence driven, both within India and in terms of India’s performance in a global comparative context. Third, it got two important philanthropists, Ratan Tata and Bill Gates to stress the importance of investing in nutrition education and training in their joint editorial giving it a great deal of publicity.

The two reports and the Haddad, Menon and Raykar blogs stress that while there is much progress on nutrition in India in the last decade, there is much variation among states. The poorest states display performance comparable to, or worse, than Africa’s. Besides having started from a low base even the current levels keep India, particularly Indian women, adolescent girls, and children off track in meeting global goals. Moreover the Indian undernutrition problem has been long standing, first highlighted by the pioneering work of the Ramalingswami team in the early 1990s and indeed going back decades.

This excellent work also shows the limits to advocacy:  to show impacts on outcomes on the ground, this advocacy needs a follow up.

First, in a continental sized country like India, state level action is critical. Central government can prod, nudge and nod but state governments must act.

Second, engendering political commitment and capacity at the state and local levels among communities is critical.

This calls for investment in high quality data collection, training and analysis in the form of routine publication of state level reports followed by advocacy in the states. This requires long term investments (five to 10 years) by the Tatas’ and the Bill Gates’ in building commitment and capacity at the state and local levels in frontline states like Bihar and U.P. They should support the establishment of outstanding non-governmental institutions striving for excellence and hold governments the private sector and other stakeholders accountable. The state level institutions need to be mentored by national and international institutions and should continue advocacy such as this bolstered by publication of more state level evidence of performance on a routine basis.

Independent evaluations of global partnerships have shown that donors spend a great deal of money on advocacy and little on investments in building capable domestic institutions. The latter takes time and patience. The Tata family have a near century long track record in building some of the best institutions in India. That is why the Tata-Bill Gates Partnership is more promising, one which international agencies and bilateral donors may wish to join. All the power to the nutrition initiatives conceived with such strategic long term perspectives. 

Uma Lele is Co-chair of the Technical Working Group on Measuring Food and Nutrition Security of the Food and Nutrition Information Network of FAO, WFP and IFPRI and author of the forthcoming book: Food for All.

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