Our project partner African Population Health Research Center is working on a study looking at home based nutritional counselling interventions in urban poor settings in Nairobi, Kenya and asks whether there is a social return on investing in these initiatives? They have a blog where the progress of the initiative and its impacts are regularly recorded and updated.
An IFPRI blog by Kalle Hirvonen From market to mesob: Ensuring access to food is key to improving diets in Ethiopia highlights Transform Nutrition research in Ethiopia. This research finds that in order to improve diets in Ethiopia, policy makers have to ensure that caregivers have both access to nutritious foods and also the knowledge required to demand such foods. .
This blog by Kalyani Raghunathan, IFPRI was previously posted on the POSHAN website.
The most recent data on India from the Rapid Survey of Children (2013-14) shows that there has been considerable improvement in undernutrition indicators in India in the 9 years that passed since the last round of available survey data, the 2005-06 National Family Health Survey (NFHS-3). However with almost 40% of children under the age of 5 still stunted, and almost 30% underweight, there is ample room for improvement. One of the ways in which this can be done is to use the vast array of social protection programs in India as platforms for delivery of nutrition-specific and sensitive interventions, as well as drivers of change in the underlying determinants of these indicators. [Read more…]
Shweta Khandelwal and Purnima Menon
Course Directors: Prof. Lawrence Haddad (IFPRI-UK), Prof. Aryeh Stein (Emory University), Dr. Purnima Menon (IFPRI-India) and Dr. Shweta Khandelwal(PHFI)
The context: Facing simultaneous demographic, health and nutrition transitions alongside continuing poverty, deprivation, gender inequities and food insecurity, India faces a tremendous burden of malnutrition. On the one hand, India has the highest number of undernourished children, while on the other, overweight, obesity and non-communicable diseases are rapidly escalating, and micronutrient deficiencies remain stubbornly high. This triple burden of malnutrition is often inextricably linked biologically, socially and policy responses to the overall burden of malnutrition need to come together and evolve together to ensure that India’s health, as a nation, is strengthened.
The capacity challenge: At the same time, the strategic capacity to understand, interpret and manage this truly overwhelming burden of poor nutrition in countries like India is limited. This, in turn, can hamper India’s ability to tackle existing and emerging nutrition-related problems. In the context of this landscape of challenges, but an increasing political and economic awareness of the importance of good nutrition for development, the Centre for Chronic Disease Control (CCDC) and the Public Health Foundation of India (PHFI), together with international academic partners, aim to strengthen the ability of the Indian nutrition policy, technical and academic community to understand and mitigate this challenge through the development of various forms of public engagement and training.
The course: One method of strengthening strategic capacity for nutrition actions is through training and network-building. PHFI’s response to this is our short course on nutrition, in partnership with Transform Nutrition, a global research partnership that PHFI is proud to be a part of. The short course “Transforming Nutrition in India: Ideas, Policies and Outcomes” will be held from 7th-11th Dec 2015 in Gurgaon, Haryana, not far from New Delhi. This five-day course, initially developed for global nutrition practitioners and decision-makers, and already popular internationally, has now been tailored to be specific to India. In the course, we discuss the state of nutrition in India, links between nutrition and other determinants of health, the role of different types of interventions, challenges to scaling up and converging interventions, and thinking and acting multisectorally. A key feature of the course is to embrace the political economy of nutrition and discuss what it means to move nutrition up the political agenda, to understand and advocate for increased financing for improving nutrition.
Course faculty: Dr. Shweta Khandelwal, who has invested years of her career in understanding and mapping nutrition capacity challenges in India is the course convenor and coordinator. Faculty who support this course, through lectures, direct and intense engagements with participants, and as a continued resource even after the course ends, consist of Indian and international leaders in the area of public health nutrition research and policy. Core faculty include Professor Lawrence Haddad, Professor Aryeh Stein, Professor Reynaldo Martorell, Professor Srinath Reddy, Professor D. Prabhakaran, Professor Ramanan Laxminarayan, Dr Purnima Menon and others.
Who will benefit from this course? Applications are invited especially from early- to mid-career candidates who are either considering working in the nutrition policy and program areas or are already working on strengthening nutrition actions in public sector, private sector or civil society organizations. It is best suited to generalists who need to dive into and understand the state of play of nutrition in India, career nutritionists who want to “catch up”.
The course fee is INR 7500 for 5 days, not inclusive of travel, accommodation or transportation charges you might incur to attend. Meals are provided during the course. The final date for applications is 10 November, 2015. Seats are filling up!
POSHAN and Transform Nutrition Delhi seminar: October 16th
Register now, to avoid disappointment! (Registration is free) Registration link
You can find the draft agenda, here
In the past decade, India has witnessed a rise in the coverage and uptake of social protection programs including the Public Distribution System (PDS), the Mid-day Meal Scheme (MDMS) and Mahatma Gandhi Rural Employment Guarantee Act (MNREGA). Apart from ensuring greater equity, such programs have untapped potential to deliver nutrition outcomes because they directly address the underlying determinants of undernutrition such as food security, poverty, and education, among others.
With this in mind, POSHAN (Partnerships and Opportunities for Strengthening and Harmonizing Actions for Nutrition in India), Transform Nutrition, and 3ie are jointly organizing the seminar ‘Maximizing the nutrition impact of social protection programs in India: What will it take?’, which will be held on October 16th, 2015 in New Delhi.
The seminar sessions are built largely on findings from research currently being conducted both within and outside India, as well as a review of the literature around social protection programs in India and their nutritional linkages. The seminar is intended to bring together evidence that can inform and support policy initiatives aimed at maximizing the potential of social protection programs to deliver nutrition outcomes. It will offer a platform for the discussion of implementation experiences, research findings and policy mechanisms from across India, as well as an opportunity for the presentation of some important lessons from an international context. Within India, this seminar will be focused on the nutritional aspects of large scale Indian social protection programs such as the PDS, MDMS and MNREGA, on the ways in which these can be strengthened and improved. In addition, the event will also showcase global evidence from experiments with other transfer modalities.
By bringing practitioners and academics together we hope to throw some light on the following questions:
- How have government policies, especially social protection programs, succeeded or failed in achieving nutrition goals?
- What can be done to make the existing programs more nutrition sensitive in order to ensure faster progress in the future?
- Are there any lessons India can learn with the global literature around social protection?
On September 25th, the United Nations General Assembly adopted the Sustainable Development Goals (SDGs). For those keenly interested in nutrition – which given the centrality of nutrition to development should mean everyone – this is cause for two cheers, but not three.
The SDG predecessor, the Millennium Development Goals, included the halving of the percentage of underweight children, but not explicit measures of chronic or acute undernutrition. The SDGs rectify this. Goal 2, “End hunger, achieve food security and improved nutrition and promote sustainable agriculture”, includes ending all forms of malnutrition, including, by 2025, the internationally agreed targets on stunting and wasting in children under 5. These targets, first mooted by the High Level Panel of Eminent Persons Report in 2013, build on a growing evidence base that demonstrates that undernutrition in the first 1000 days has life-long damaging consequences. For stunting, the target is a 40% reduction by 2025 with 2012 being the base year. If achieved, the number of children chronically undernourished will fall below 100 million.
Goal 2 recognizes the importance of the nutritional needs of several key vulnerable groups, including adolescent girls and pregnant and lactating mothers. Not only are healthy mothers are intrinsically important, healthy mothers are the precursor to healthy children. And the path to healthy motherhood begins in adolescence.
But not three cheers
While there is much to be said for SDG2, there are at least three major concerns. At the top of the list is the issue of commitment and accountability. As the 2015 Global Nutrition Report (GNR) makes clear, not only is commitment to improved nutrition lacking across much of the globe, in many countries there is not even enough data to gauge commitment. When GNR 2015 asked country signatories to the 2013 Global Nutrition for Global Growth compact to report on their progress towards the commitments they had made only 18 months previously, 28 percent were unable to do so. As GNR 2015 notes, nonresponse equals unaccountability. Concerns regarding commitment are also supported by the recently released Hunger and Nutrition Commitment Index (HANCI) which shows that only eight out of 45 countries have a high commitment to tackling hunger and undernutrition and commitment by one third of countries listed – including Nigeria, Pakistan, and the Democratic Republic of Congo – is very low.
Second, while the explicit inclusion of the nutritional status of adolescent girls and pregnant and lactating women is welcome, neither an indicator nor a numerical target is proposed for these. In an environment where what can gets measured is what gets monitored, there is a real risk that this component of SDG2 will fade away. Lastly, the goals are ambitious. They imply an average annual rate of reduction (AARR) of 3.9 percent. Only 39 countries are currently on track. Ambition can be a spur to action but too much ambition can lead to disillusion and absence of commitment. Ominously, India is not on track and with approximately 40 percent of the global population of chronically undernourished children, failure to meet the goal for stunting reduction in India will make it enormously difficult to push global numbers below 100 million.
This blog is written by John Hoddinott, Babcock Professor of Food and Nutrition Economics and Policy, Cornell university and Research Director, Transform Nutrition
Nick Nisbett and Dolf te Lintelo from the Institute of Development Studies write in the Guardian about the need for the sustainable development goals to reflect the complex causes of malnutrition in order to tackle one of the world’s foremost health challenges.
By Masum Billah and Shams El Arifeen, ICDDR,B
Despite important economic progress and reaching lower middle-income status in 2015, Bangladesh remains one of the high under nutrition burden countries. This is not due to a lack of political will. In 2009, the Annual Program Review of the Health, Nutrition, and Population Sector Program of the World Bank recommended scaling up nutrition interventions in Bangladesh through mainstreaming critical nutrition interventions in health and family planning services. To achieve this goal, the country made nutrition a priority.
The National Nutrition Services (NNS) has since been pursuing a variety of key strategies and actions. In 2011, the operational plan (OP) of NNS under the current Health, Population and Nutrition Sector Development Programme (2011-16) was approved by the Government of Bangladesh which meant mainstreamed nutrition interventions should be implemented through the existing health system from July 2011 onwards.
But how well is this program working? A new report Bangladesh National Nutrition Services: Assessment of Implementation Status, published by the World Bank presents the findings of a research study done by IFPRI and icddr,b, partly supported by Transform Nutrition, to assess the implementation of the Government of Bangladesh’s National Nutrition Services Program (NNS). Importantly it also identifies the achievements, identifies key bottlenecks that adversely impact these achievements, and highlights potential solutions to ensure smooth delivery of the program in the future.
The overall objective of this study was to assess the effectiveness of the delivery of the different components of NNS. The report was written by a team from IFPRI and ICDDR,B, including Drs. Shams El Arifeen and Purnima Menon, who lead Transform Nutrition’s work on making health systems more nutrition-sensitive. The study focused on assessing issues related to management and support services; training and capacity development; service delivery; monitoring and evaluation, and; exposure to interventions. A mix of quantitative and qualitative methods were used to assess the quality of service provision related to integration of nutrition with antenatal care services and sick child care in health facilities: The research also focused on elements of the enabling environment to support the roll-out of the NNS interventions, examining institutional arrangements and the policy environment at the national level.
The study indicated that NNS lacked specificity in choice of interventions and preventive service platforms resulting in attempts to deliver too many interventions with limited coverage and quality. Frequent changes in leadership, coordination, capacity and workload-related challenges faced by the NNS have hampered the implementation of nutrition interventions. The study also reported slow roll-out and poor coverage of training, especially among the frontline health workers. Although the quality of nutrition service during antenatal care, one of prioritized health service delivery contacts, was somewhat better; height and weight measurements, provision of appropriate nutrition counselling and screening for severe acute malnutrition during sick child management contacts were sub-optimal. Critical challenges relating to service delivery at community and outreach level (preventive platforms), lack of systematic supportive supervision, poor recording and reporting of service statistics, and weak monitoring mechanisms have jeopardized the NNS’s ability to achieve adequate delivery of quality nutrition services.
Our study found that the overall NNS effort is an ambitious, but valuable, approach to support nutrition actions through an existing health system with diverse platforms. The results indicate that although the maintenance of strong and stable leadership of NNS is an essential element to ensure integrated and well-coordinated service delivery, the current arrangement is unable to ensure effective implementation and coordination of NNS. So how can this be improved?
- Focusing on some of the critical challenges related to leadership and coordination and then embedding a smaller set of priority interventions into well-matched health system delivery platforms is most likely to help achieve scale and impact.
- Strategic investments in ensuring transparency, engaging available technical partners for monitoring and implementation support, and not shying away from other potential high coverage outreach platforms, such as some NGO platforms, also could prove fruitful.
- The Government of Bangladesh, and the health system in particular, must lead the effort to deliver nutrition and the NNS is an important start towards this goal. Nonetheless, it is clear that development partners who have expressed a commitment to nutrition must coordinate their own activities both among themselves and with the government and provide the support that can deliver nutrition’s potential for Bangladesh.
Bangladesh is ranked 142 of 187 countries on the 2014 Human Development Index and 57 among 120 developing and transitioning countries on the 2014 Global Hunger Index. There is still some way to go to to ensure the population of Bangladesh is well nourished and able to make the most of economic progress. icddr,b, IFPRI and Transform Nutrition are working to generate evidence on effectiveness of different nutrition-specific and nutrition-sensitive interventions in Bangladesh to support strategic policy and intervention choices that can improve nutrition in Bangladesh.
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. [Read more…]
Purnima Menon, Senior researcher at IFPRI and Transform Nutrition blogs with her reflections from the Harvard Ministerial Leadership in Health Program
Earlier this summer, I was asked to speak about nutrition at the Harvard Ministerial Leadership in Health program in Boston, Massachusetts.This program is a joint initiative of the Harvard T. H. Chan School of Public Health and the Harvard Kennedy School in association with the Children’s Investment Fund Foundation (UK), the Bill & Melinda Gates Foundation, Bloomberg Philanthropies, the GE Foundation, and the Rockefeller Foundation. It was launched in 2012 and has seen participation from 56 ministers from 40 countries to date. [Read more…]