13 November 2017

Scaling Up Nutrition (SUN) – the 2017 Global Gathering: Inspiration, Connection, Progress and Love

I just returned from the 2017 SUN Global Gathering (GG) in Abidjan, Cote d’Ivoire. This three day meeting brought together teams from all of the 60 SUN member states, the four Networks (civil society, UN, donors, business—including a few GAIN colleagues), the SUN Movement Secretariat, the SUN Movement Executive Committee (which I am a member of) and the Lead Group (the highest level officials and champions, chaired by UNICEF’s Executive Director, Tony Lake).
This was the first GG since 2015 and the first held in a SUN member country. Its objectives include to energise and inspire, to reconnect and network, and to learn and reflect. The GG did brilliantly on the first two, but we could, in my opinion, improve on the “learn and reflect”.
On the energise and inspire front, the GG was remarkable. For instance, we had the Vice President of Cote D’Ivoire, the former President of Tanzania, many ministers from Africa and many other senior government officials from Africa, Asia and Latin America. Tony Lake was also present for the full three days, testimony to his dedication. These senior politicians and officials (such as Akin Adesina, the President of the African Development Bank) talked with great passion, authenticity and fluency. They knew the core facts: malnutrition affects one in three people, is responsible for nearly half of all under five deaths, leads to losses in GDP of at least 11 percent and investing in preventing it yields benefit cost ratios of 16:1. They weren’t speaking from scripts they were speaking from the heart and from a place of pragmatism (malnutrition is holding our economies back). This was mightily impressive and it is too bad that the top officials from donor agencies were not present to witness it.
But inspiration was not just restricted to these folks: for example, we had a junior Parliamentarian, 15 year old, Spectacular Gumbira from Zimbabwe (a well named, amazing and powerful speaker, completely unfazed by an audience of 900 people), Myriam Sidibe a powerhouse behaviour change advocate from Unilever and Catarina de Albuquerque, Executive Chair of Sanitation and Water For Allmaking connections into the WASH sector.  In addition, a range of inspirational nutrition leaders were honoured by Sight and Life and by SUN, including Ellen Piwoz from the Gates Foundation who won two prizes, both richly deserved.
On the reconnect and network front, the GG did a great job. There were the marketplaces that were set up by all 60-country members, the long breaks in-between sessions, the network meetings and the well-chosen venue with plenty of meeting spaces. Having the meeting in a SUN member country also gave the proceedings a feeling of balance. People like me from European and North American organisations were not able to dominate the proceedings—this was a country first meeting, where egos and logos were checked at the door. The feeling was one of solidarity not hierarchy; one of ideas, not protocol. There was, as David Nabarro (Special Adviser to the UN Secretary General on Agenda 2030 and former SUN coordinator) put it, a lot of love. And I would add solidarity, too.
On the learning and reflection front there was a good session on nutrition in fragile contexts and how SUN could be more relevant, there was some progress on getting civil society and business networks talking to resolve issues around due diligence and accountability of businesses, and there was a short plenary on the new Monitoring, Evaluation, Accountability and Learning (MEAL) resources for guiding us along the SUN theory of change. Despite this, and this is solely my own view, we could have done better on the learning and reflecting front. This really matters greatly, as we know more about the damage malnutrition does, than what works to combat it.
For example, there are some big questions looming which we did not really take on:
  • SUN is scaling well and thinking more about impact, but what about its sustainability beyond 2020, which marks the end of the current funding cycle? Can we really call ourselves a movement if we are so reliant on donor funding? Shouldn’t some of the direct funding for SUN infrastructure come from members (to be fair, I know much of the indirect funding does already come from members)?
  • The double burden of malnutrition is rapidly increasing—the latest Global Nutrition Report (2017) counts 60 percent of countries facing significant burdens of undernutrition (under five growth faltering or adult micronutrient deficiency) as well as overweight/obesity. That percent is likely to grow before it diminishes, so what is the SUN movement’s response? What will we do differently? Can we shy away from the difficult but inevitable discussions which surround curbing some of the unhealthy dietary trends driving this?
  • Urbanisation is growing rapidly in Africa as elsewhere—this presents both an opportunity and a challenge to nutrition—what does the SUN movement need to do adapt? For example, SUN already has Indian States as members, should it also invite cities to be members?
All in all the GG was a great success. The SUN Coordinator, Gerda Verburg, deserves a great deal of credit for her energy and her “telling it like it is” style.  Her team did a superb job of making all the thousands of moving parts mesh together well.
I leave you with one positive and I believe insightful reflection someone shared with me at the end. It was that at the first GG, country members looked a bit bewildered—what is this SUN Movement and what does it mean for me? Country representatives knew what they needed, but were less sure of how to articulate it and to negotiate for it. In Abidjan, they said, it felt as if the country members were in control of the movement: there was a clarity from them about what was needed from others, a confidence on the articulation of those needs and an abundance of know-how on what to do to secure the needed support.
And this country driven approach is essential to Scaling UNutrition. SUN’s ultimate success will be measured in terms of whether it contributed – at the country level – to mobilising additional domestic and external resources to nutrition advancement, whether it contributed to existing resources being spent more effectively and whether it contributed to nutrition being increasingly seen as a core driver of the SDGs. We must never forget that SUN is a global movement.  That means movement the world over as well as movement in more “global” circles. The movement marches on!


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07 November 2017

The 2017 Global Nutrition Report: Nourishing the SDGs

How nice to be asked to write a blog about the 2017 GNR “Nourishing the SDGs” (of course I would have anyway!).
I love the title and the narrative behind this year’s report, which can be summarised as:
1. “Let’s make good nutrition the global social norm”;
2. Disparate communities working on different nutrition outcomes need to come together to have a stronger voice. Implementers, investors and policymakers can do this by looking for double/triple duty actions that address more than one type of malnutrition;
3. Nutrition needs to be made compatible with other sectors – not just what they can do for nutrition, but what nutrition can do for them. Also we need coherence across sectors – even if we can’t convince sector x to do more for nutrition, let’s at least make sure it does not undermine nutrition; and
4. People should be put at the centre of our efforts—no person should be left behind and every voice should count.
I particularly like the sentence near the beginning of the report and repeated towards the end: “The bottom line is that nutrition needs some staying power. While global goal setting and dedicated decades for nutrition are important to spur action, let’s work to mainstream nutrition, so much so that it is considered commonplace to have optimal nutrition.”
Staying power, think about that. “Staying” implies that the good profile nutrition has right now is at risk – it might not stay. “Power” implies that nutrition is the vital “cog” in the SDG machinery.  If it is not working, then things will grind to a halt. We have to find ways to make it stay around; we need to emphasise and enhance its cog-like functions in the SDG juggernaut.
But let’s get to the numbers between the beginning and the end of the report. There are plenty. Here are some facts that made me sit up and take notice:
On the magnitude, location, targets and pace of change of malnutrition outcomes:
  • All 140 countries with data on under five growth, women’s anemia and adult overweight suffer from one of these burdens. All of them.  In previous reports at least we had one or two exceptions.
  • 85 out of 140 countries have serious levels of overweight and one form of undernutrition. That is 61 percent, up from 44 percent in previous reports. The double burden of malnutrition really is the “new normal”.  The challenge now is to make good nutrition the new norm.
  • Women’s anemia rates have increased overall, but more countries seem to be making progress—these are new World Health Organization (WHO) estimates that contain good and bad news.
  • Adolescents: “The nutritional status, behaviours and outcomes of adolescents form a very small part of global monitoring frameworks for nutrition. The only targets that address adolescent nutrition directly are the Maternal, Infant, Young Child Nutrition (MIYCN) target for anemia of 15-49 year olds, but these are not broken out by adolescents.” While the obesity target includes an indicator for adolescent obesity, the anaemia target does not look at anaemia in adolescents separately. Beyond these, indicators are largely missing.”
  • Why does the absence of data on adolescent nutrition matter? “Where estimates are available, from the WHO, these suggest that iron deficiency anaemia is the leading cause of disease burden and disability among adolescents in 2015”. Read that again: anemia is the leading cause of disease burden in adolescents, yet we have very poor data on it.
Funding
  • Nutrition specific spending from aid donors as a percentage of total Official Development Assistance (ODA) actually declined from 0.57 percent to 0.5 percent in the past year. What more can we do to support our donor champions to get this number up to at least the 2-3 percent needed to meet the World Health Assembly (WHA) targets?
  • Country budget allocations to nutrition as a percentage of overall national budgets: once again the country estimates of nutrition spend (specific +sensitive) show wild variations. We need some analysis on why some countries are so low (e.g. Nigeria on 0.2 percent and why some are so high e.g. Nepal at 13.1 percent).
  • Of the nutrition sensitive ODA spending, only 11 percent is found in the education sector – are we doing enough here? Is this where we should be focusing much more on double duty actions?
  • ODA spending on obesity and diet related Noncommunicable Diseases (NCDs) constitutes only $25m – about 0.01% of global ODA. Feeble – we know it is difficult, but donors must do better, for example through double duty counting.
  • There are essential calls to improve the way nutrition actions are reported in the ODA Creditor Reporting System (CRS): to better align the nutrition specific codes with actual interventions and to also introduce a nutrition policy code in CRS for nutrition sensitive and policy actions. Donors can change this. But I suspect the nutrition champions within them need some evidence on the consequences of our current miscounting of nutrition spending.
N4G commitments
  • The (self) reporting on the 2013 Nutrition for Growth (N4G) commitments continues in this GNR. This year the no response rate from the 200 or so commitments made in 2013 was 49 percent– worse that the 45 percent in 2016.
  • Businesses were the worst offenders: with a 66-70 percent no response rate. My colleagueJonathan Tench has some great and sophisticated ideas for improving response rates in a panel in the report. My suggestion is less sophisticated. Name the companies. This will get their attention and the attention of their investors.
  • On donor financial commitments I like Fig 5.3, which compares commitments made over the 2013-2020 period versus disbursements made over the 2013-15 period. Most donors seem to be on track.
Away from the numbers
But numbers are not everything. Imagery is important and the report also does well here.
For instance, the language around universality of the SDGs is motivating: we need greater disaggregation of data to ensure no one is left behind and less disaggregation in country groupings—north/south dichotomies are increasingly meaningless in a multiple burden world.
I like the idea of data value chains to help us identify the weak links in the generation, understanding and use of data, but how to get governments and donors more excited to invest in this? We really need a study showing the value added of good data. How do we make the benefits visible to stack up against the very visible costs?
The five areas for action that are illustrated beautifully on the cover are a nice way to reach across the 17 SDGs (roughly, food systems, infrastructure, health systems, equity & women’s empowerment, and peace).
There is the nice quote about “Improved nutrition cannot be a singular set of targets in a silo – rather it is an indispensable cog, without which the SDG machine cannot function smoothly.“
The examples of “double duty” actions introduced in the 2016 GNR are nicely expanded. Examples include paying more attention to NCDs within undernutrition interventions delivered by the health system, and focusing on access to improved water, not only for infection prevention, but also to act as a counterweight to high soda consumption.
The “gatefold sleeve” graphic (I’m really showing my age here) on pages 10-11 is great – stick it on your wall – as a visual story of the report.  Indeed the graphics in the report keep getting clearer and simpler every year.
In general the “call to action” language was downplayed in this GNR but the four sets of actions remain powerful:
  • Build for nutrition while harnessing nutrition’s power across the SDGs.
  • Stand shoulder to should on obesity and diet related NCDs when addressing undernutrition.
  • Be bold in your commitments to nutrition improvement—we will not get the window of another Decade for Action—this is likely to be it, folks.
  • Invest in understanding and strengthening resource data value chains.
So a massive congratulations to the GNR secretariat, the Stakeholder Group, the Independent Expert Group, the funders, the authors, the other partners, the reviewers and, especially, the GNR co-chairs: Corinna HawkesJessica Fanzo and Emorn Udomksemalee. I am proud that GAIN is a member of the report’s stakeholder group.
By nourishing the GNR, they are all nourishing the SDGs.
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