14 September 2016

Reflections on 3 years of work with the Global Nutrition Report

On the 1st of October I step down as the co-chair of the Global Nutrition Report's Independent Expert Group and begin my work at GAIN.

I have been working hard on the GNR for nearly 3 years and I thought it would be a good time to share some reflections.  Here they are:

1.  The decision to focus the GNR on all countries and all forms of malnutrition was a good one.  Back in 2013 this was not by any means a given—there were varying views among the GNR stakeholders.  Some felt a focus on malnutrition “in all its forms” would draw attention away from undernutrition.  While this is certainly a risk, and one we have worked hard to manage, the GNR Independent Expert Group has always felt the risks of separating out different forms of malnutrition would be much greater.  The focus on all forms of malnutrition has allowed new alliances to form, new audiences and actors to be brought into the fight against malnutrition, new concepts and analyses to be drawn on and new actions to be contemplated and developed.  With 44% of countries facing a double burden of undernutrition and overweight and obesity, these connections are even more relevant.

2. The decision to make the GNR dig below nutrition status outcomes has also been important.  While the database for nutrition outcomes is weak, with much missing data, the database for things like investment, policies, legislation, coverage and commitments is even weaker.  It is hard to hold governments and other stakeholders solely accountable for nutrition outcomes as so many external factors are at play, but if the coverage of nutrition programmes is weak, if social protection and WASH programmes pay little heed to nutrition, if the breastmilk substitute code is not enshrined in legislation, if nutrition spending is low and flatlining and if employer workforces are not protected nutritionally in the workplace, then we know exactly who to hold accountable.

3.  A lot can be done with existing data.  The GNR does not collect new data, but uses existing data to track progress, gain new insights and make recommendations for action.  Perhaps it should, but there is a surprising amount that can be done with existing data:  things that are not being done.  Outcome data are available, but progress in them is not frequently enough linked to targets.  Overlaps in outcome data are not presented frequently enough.  Budget data are available, just not assembled in the right way for nutrition purposes.  Commitment data is available but not assembled and analysed.  Some data disaggregations are available but often they are glossed over in national numbers.

4.  The nutrition community has been really generous in its willingness to contribute to different GNRs.  We must have had over 250 different contributors over the past 3 years and the vast majority have been easy to work with: egos and logos have been checked at the door and we have gotten on with the work of shining a light on success and stasis.  Long may this continue.

5. The lack of analyses on why this country or that region or this actor has been successful in improving nutrition status was surprising.  We have tried to fill this gap and to encourage others (like CIFF who are supporting a set of case studies called Stories of Change) to do the same.  I believe it is vital to do more to fill the gaps.  In nutrition we need to see all the pictures: from things that work in one intervention in one region to things that have worked at a country level in several countries.  The incentives from scientific journals are to slice and dice our stories, but we have to work hard to stitch them together so we can see the woods for the trees--and especially to inspire those who are not in the nutrition echo chamber. 

6.  Despite our best efforts, it has been difficult to engage with those outside the nutrition community, and the GNR has only just begun to make progress on this.  In the first few GNRs it was important to engage and hopefully energise those within the nutrition community and try to generate some common language, statistics and messages. But it is past time to take the messages to other groups, groups that can expand commitment to nutrition to accelerate improvements (e.g. food systems, climate, early child development etc.).  How to do this?  It takes strategic alliances and that takes diplomacy and legwork.  Who has the incentive to do this? Everyone.  Who has the responsibility? No-one, as far as I can tell.  I don’t have the answer to how to do this.  It boils down to mandates and leadership.  Mandates make it easier, but leadership needs to transcend the lack of mandates.  We need people like Jim Kim and Akin Adesina, the Presidents of the World Bank and the African Development Bank, respectively, to not lose interest in nutrition—and whose job is that?  Everyone in the nutrition community.

7. The GNR has not done a great job of connecting with the private sector.  The reporting requirements are seen by some companies as too onerous, and the treatment of business in the GNR has been seen by some as too negative.  Businesses have hoped that the GNR would highlight the positive role they can play, and those suspicious of business have been concerned about whitewashing. This stalemate is a shame and is something I want to help fix in my new role at GAIN.  Business is too present in nutrition to say we won’t engage.  But its presence is not uniformly positive.  The goal of the GNR should be to help businesses to the right thing and make it harder for them to do the wrong thing.  The GNR should also help others to navigate this complex terrain of business and nutrition by promoting transparency in all dealings.  The chapter on business in the 2015 GNR has lots of potentially useful ideas on how to do this, but as far as I can tell, very few have been picked up on.  We need to work harder in this area.

8. Finally, I am reminded of how a small number of people can make a difference.  Not to blow our own trumpet too much but the core GNR team is a small one.  The independent expert group of 20 people each give us 20 days of their time a year.  We have 1.5 comms staff, and 1.5 data analytics staff, 3 co-chairs (summing to 1 full time equivalent) and 1 full time equivalent of management time.  That is 5 FTEs in the secretariat and 2 FTEs in the expert group.  Not much for a report that has been downloaded 70,000 times in 2016 alone, which has been used to influence hundreds and hundreds of decisions (we have our own examples of 60-70) and which has (we are told) changed the narrative on nutrition.  Of course the GNR team has had help: a great Stakeholder Group with 4 wonderful co-chairs over the 3 years; and support from more than 10 donors, many of whom have invested expertise way beyond the hard currency of dollars, euros and pounds. Support from – and collaboration with – partners in the nutrition community and beyond has been critical to the GNR’s reach so far.  All of these groups have supported, inspired, problem solved and championed the report in countless ways – and they have done so collectively.

I thank all of the above actors, organisations and people (and all of you reading this). Nutrition and the GNR needs you to remain restless for-- and engaged in -- change. I will commit to doing everything in my power to support the GNR from my new position at GAIN.  (More on that later.)


McKeown said...

Lawrence, congratulations on your appointment as Executive Director of GAIN. http://www.gainhealth.org/knowledge-centre/gain-appoints-lawrence-haddad-new-ed/
I hope you'll enjoy the NGO world. Warm wishes, Mary McKeown

orange county drug rehab said...

Superb story of your working life. Its just natural that we think of ways so we can feed more people with what we have. 'Global Nutrition Report' is a international name and i give you respect for serving.