From Traction to Action

Stuart Gillespie on the new Lancet nutrition series and why June 2013 has to be the turning point for nutrition

Following the path-breaking first series in 2008, The Lancet today released its second Maternal and Child Nutrition Series.  This comprises four state-of the-art review papers that focus on updating the evidence base on malnutrition and on the core nutrition-specific interventions to address it, followed by two new papers – on nutrition-sensitive programmes, and on the politics of reducing malnutrition.   As the priority attached to nutrition has grown in the last five years, the base for action has significantly broadened.  These two new papers reflect this shift, documenting what we know, what we need to know, and crucially, what needs to happen now to unleash the potential within these new arenas.

 Transform Nutrition partners have been very active in this new series, effectively leading the development of these two new papers:

Paper 3 – Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal undefiled nutrition? Marie T Ruel, Harold Alderman, and the Maternal and Child Nutrition Study Group*

Paper 4 – The politics of reducing malnutrition: building commitment and accelerating progress Stuart Gillespie,* Lawrence Haddad,* Venkatesh Mannar, Purnima Menon, Nicholas Nisbett, and the Maternal and Child Nutrition Study Group

Indeed the whole structure of the series maps well onto Transform’s research agenda, with papers 2-4 relating directly to TN’s research pillars 1-3.

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One of several major steps forward by the nutrition community in recent years has been the harmonization of thinking and action.  The past squabbles on this – often revolving around “either/or” misperceptions – appear to be over. It is now universally understood that there are three core levels of action required to make significant sustained impact on undernutrition:  nutrition-specific interventions and nutrition-sensitive programmes and approaches, with both being underpinned by an “enabling environment”.

Paper 4 on the enabling environment seeks to provide a clear structure for understanding the architecture and dynamics of politics and policies that are shaping the space for nutrition.  On the basis of a detailed literature review, we differentiate two stages a) building and sustaining political momentum, and b) converting momentum into impact on the ground.  We then summarize 3 core themes within these stages: i) knowledge, evidence and framing of narratives, ii) politics and governance, and iii) capacity and resources.  This leaves us with a 6-cell framework which we then use to structure the paper – highlighting evidence, challenges, gaps, and recommendations, along the way.

I will not try to summarize the paper here, but rather focus on one of the major challenges we identify.  Time and time again, the word “capacity” crops up in assessments, appraisal and evaluations — almost always as a major reason for failure, or linked to a discussion of constraints, in implementing programmes. The need for a concerted, comprehensive and long-term focus on capacity strengthening for nutrition was highlighted five years ago in the first Lancet series.  This is one area which unfortunately has not changed much since then. As the big push for scaling up nutrition continues, there’s an urgent need for a parallel focus on strengthening the capacities required for this all to happen. If not, we will eventually have to confront the real consequences of our rhetoric.

Different capacities are required for different purposes at different levels. At an individual level we need nutrition champions to continue to exert influence in high-burden countries – and we need strengthened cadres of frontline workers, empowered with knowledge and capable of doing what needs to be done, day after day. The capacity of mid-level programme managers – woefully neglected in the past – is key too.  But individuals also need to be supported by organizational capacity – from university curricula being revamped to target core challenges, to better incentives and approaches for building bridges between nutrition-relevant sectors.  Finally, systemic capacity needs to be developed so that institutional structures, roles, and responsibilities are clear to all, and better aligned to maximize impact on nutrition.

Will 2013 be the year when success in generating commitment and traction is channelled to strengthening capacity and action?