Building on last year's momentum, nutrition projects have the potential to improve the lives of vast numbers of children, as long as we learn from past successes and failures.
Last year's momentum for nutrition -- with ramped up political attention and massive financial pledges -- will be telling in 2014. This year the global healthy community aims to see that momentum translate into measurable impact with a dramatic reduction in child stunting globally.
Six years afterthe first Lancet Nutrition Series in 2008, the Scaling Up Nutrition (Sun) movement now drives the global momentum. Forty five countries (which include nearly 60% of the world's stunted children) have now signed up to the Sun movement. 2013's Nutrition for Growth summit generated over $23bn in pledges to tackle undernutrition. These initiatives -- the Sun movement and Nutrition for Growth -- have both made progress on the issue of nutrition, but in 2014, we need a greater understanding of how to reach more children. What can we learn from past successes and failures to create clearer strategies for the future?
Lessons from successful projects of the past
Qualitative aspects of scaling must not be forgotten alongside the quantitative aspects. India's late 1990's rush to universalise the integrated child development scheme saw little change in malnutrition levels in the years that followed. Many villages didn't have the means to implement the scheme.
The state of Maharashtra's nutrition mission shows us, instead, what is possible. With a focus on strengthening implementation of existing programmes, ensuring existing vacancies are filled, and frontline workers are supported (and motivated) Maharashtra saw an enormous improvement in the interaction between community workers and mothers. As well, the rate of stunting decline between 2005 and 2012 was more than quadruple that of 1999 to 2005.
In Thailand a generation below, basic minimum needs indicators was the key to plummeting child undernutrition rates. These indicators revealed problems that were then addressed with a menu of nutrition-relevant actions that were implemented. The success of these project's was a manageable ratio of community-level mobilisers and district-level facilitators. Wider collaboration between health, agriculture, education and rural development sectors supported these community initiatives.
Four key paths for large-scale impact of the future
Our starting point should be a vision of what success looks like, not asking the question of how to expand intervention. This vision may require different routes. These four key pathways to reach large-scale impact of NGO activities from an influential paper in 2000 by Peter Uvin:
1. Quantitative ( or 'scaling out') in which the coverage of an intervention increases.
2. Functional, in which horizontal (cross-sectoral) or vertical (national to local) linkages are made.
3. Organisational, in which capacities of organisations are strengthened.
4. Political, which reflects a move towards progressive empowerment of communities to make demands and national leaders' being held accountable for public action.
Most of these pathways will need to be pursued to achieve wider impact on nutrition because of its multi-sectoral nature.
What we know right now
- 10 nutrition-specific interventions reaching 90% coverage in 34 high burden countries will avert 20% of the global burden of stunting
- There is huge potential for enhancing the nutrition sensitivity in agriculture, health, social protection, water and sanitation sectors – though we need more and better evaluations.
- We have already seen political progress in creating a better environment for nutrition.
But, as with any major global issue, there are no simple solutions. A new set of international development goals on our horizon means we should look back on 2014 as the watershed for nutrition. The year when the grand words and pledges of past high-level summits get turned into large-scale action, millions of children get healthy fulfilling lives.
This article appeared in the Guardian on 14 March by Stuart Gillespie is a senior research fellow with the International Food Policy Research Institute and chief executive of the Transform Nutritionconsortium. Follow @TN_NutritionRPC on Twitter