Monday, 15 October 2012

Transforming nutrition – assessing the size of the task on World Food Day

by Nick Nisbett

Tuesday is World Food Day and – given that world food prices are once again making the headlines, it seems timely to be assessing the state of undernutrition in the world.  But it’s also depressing to see a topic returning to the media front pages that should never have gone away.  As David McNair blogged last week on Save the Children research (see also) “high and volatile prices are the new normal” and we shouldn’t allow the recent spikes in 2008, 2010 and this year to detract from both the constant urgency required to address global food security and undernutrition; and the longer term measures and understanding needed to ensure a century not as scarred by undernutrition and famine as the last. 

On World Food Day I will be meeting in Dhaka with partners from Bangladesh, India, Kenya, Ethiopia and the US to discuss our plans as part of an exciting new research consortium intended to transform thinking on nutrition relevant evidence in order to support the global effort to reduce undernutrition. Our work is intended to directly benefit the international momentum behind scaling up nutrition (SUN) or national efforts in countries such as India who have not signed up to SUN.

We’re shaping the research around three key research themes designed to tackle undernutrition holistically at its immediate, underlying and basic levels.  The first, led by Shams el-Arifeen of ICDDR,B, is focusing on approaches for scaling up direct nutrition interventions. There is a great deal of evidence on what works (in terms of public health, food and care interventions) in order to treat child and maternal undernutrition at this ‘immediate’ level, but a great deal still to be understood about how to turn this evidence into action on the ground rapidly, cost-effectively and at scale. 

Estimates suggest that direct interventions will only address one-third of stunting prevalence, with broader-based ‘indirect interventions’ needed to tackle the underlying drivers of undernutrition. So the second theme, led by John Hoddinott of IFPRI, is focusing on those wider ‘indirect’ interventions which are known to be effective, but where the evidence base is urgently in need of improvement. We need to know how to maximise interventions such as agriculture, social protection and women’s empowerment, so they are more nutrition-sensitive. 

IDS are leading on the third theme on the ‘enabling environment’ for undernutrition reduction. Why are some countries so much better at tackling undernutrition where so many others are failing? We think this is down to the politics and governance of nutrition - to tackling multiple political deficiencies, including: the lack of resources dedicated to direct and indirect measures; the lack of capable leaders with a the right knowledge and the means to implement a good plan; the lack of visibility of the malnourished; and their lack of power to access and monitor even basic nutrition services.

So this work incorporates and builds on some existing and exciting new work by IDS and our partners to try to better understand, measure and enhance enabling environments for undernutrition reduction. Behind this jargon, we’re looking seriously for example at the political economy of nutrition in Kenya; or how to enhance methods to hold policy makers to accounton their nutrition commitments. In Dhaka we’ll be discussing research planned by consortium partners on identifying political/governance determinants of undernutrition via multi-country analysis and at a district level in India; on building capacity for public health nutrition education in Bangladesh, India and Kenya; and on how to make nutrition more visible using frontline health workers equipped with mobile phone reporting. I’m particularly excited about a major trial we’re planning on how to support better integrated nutrition services at a community level via getting the community to monitor and feedback to providers on how services are delivered.

Please keep an eye on the Transform Nutrition website for further information about our plans and research.