By Stuart Gillespie, Purnima Menon and Andrew Kennedy
This blog is based on an article recently published in the ‘Global Nutrition Report 2015’.
Despite relative consensus on actions to improve nutrition globally, less is known on how to operationalize the right mix of actions - nutrition-specific and nutrition-sensitive - equitably, at scale, in different contexts. How to “put it all together” to maximize sustained impact?
In a recent review by the Transform Nutrition consortium of approaches to scaling up impact on nutrition, a number of elements repeatedly emerged as key factors. First, the start point for most successful large-scale programs (e.g. Progresa-Opportunidades in Mexico, Alive and Thrive in Bangladesh) was a discussion and ultimately a shared vision of what large-scale impact actually looks like — and not on any intervention per se.
Second, successful scale up usually requires the characteristics of selected interventions to be matched with the dynamic context, explicitly recognizing the need for adaptation and flexibility over time and space. Such experiences had usually involved an explicit focus on contexts – socio-economic, institutional, political, cultural – at different levels from households up to districts and beyond.
Scaling up was proactively pursued via defined strategies that went well beyond the quantitative (scaling out) aspects, to also consider functional, organizational and even political scaling. These strategies recognized key drivers and catalysts, including nutrition champions (e.g. Santiago Levy, the main architect of the Progresa-Oportunidades anti-poverty program in Mexico). They also recognized and anticipated potential barriers, and developed approaches to circumvent them (e.g., the use of mass media in Alive & Thrive in Bangladesh was central to a supportive social environment for promoted behaviors). Most scaling strategies were premised on the need for operational and strategic capacities to be developed over time to support scale up, and the need for adequate, stable and flexible financing.
Governance was also a pivotal concern in many reviewed programs, with structures and processes for ensuring accountability and facilitating an open and transparent monitoring and learning culture. The review called for more and better research on scaling up impact on nutrition, as many countries (including those in the SUN Movement) start to grapple with the nuts and bolts of implementing plans of action. More experiential learning (e.g. through “stories of change”) and a better sharing of lessons across contexts and countries, is needed.
Many successful large-scale nutrition programs of the past have had several of the key scaling elements described here. They have tended to focus mainly on nutrition-specific interventions, with good reason. But a new focus that also encompasses nutrition-sensitive development and the role of leadership and enabling policy environments is a new imperative for nutrition. This in turn will require a massive ramp-up in capacity. A growing cadre of nutrition champions is needed, supported by strengthened organizational capacity. Some countries have successfully established and funded strong national institutions to support the operationalization and scaling of nutrition — shining examples include the National Institute of Public Health in Mexico, the Institute of Nutrition in Mahidol University in Thailand, and the icddr,b in Bangladesh – but more are needed. “Scaling up” has become the mantra in international nutrition in recent years. To turn words to actions, talk to walk, a learning culture is needed in which lessons from the past are shared, and used better.
A new research brief has just been published Scaling up impact on nutrition: what will it take? which summarizes the evidence presented here.