Transform Nutrition Champions 2016

The Transform Nutrition Research Programme Consortium in partnership with Save the Children, invited nominations to recognise any individual who has had significant success in transforming thinking or action on nutrition.

Here you can read about the ten individuals that were selected as our 2016 Transform Nutrition Champions.

While evidence within the nutrition and public health arenas points time and again to the role of leadership in successfully crafting nutrition policies and movements, little is actually known about the characteristics of leaders in nutrition: who they are, how they function, with whom they work, and what makes them effective. This is why Transform Nutrition undertook research on Understanding, enabling and building effective leadership in nutrition. This then led to an initiative in 2013 and again in 2015 to invite nominations to recognise any individual who has had significant success in transforming thinking or action on nutrition.

These are the stories of 10 nutrition leaders that have been selected as nutrition champions of 2016. They reveal something of the variety and breadth of experience these people bring to the field of nutrition. They also provide an insight into the contexts in which those championing nutrition find themselves in, through their work to tackle nutrition at grassroots, regional and national levels around the world. Charismatic leadership is something that a few may be born into, but most types of leadership can be built up and supported.

Nick Nisbett (Institute of Development Studies) and Marie Rumsby (Save the Children) discuss the Transform Nutrition Champions 2016 initiative.

In March 2016 our champions were given the opportunity to take part in a 3 day media and advocacy training by Save the Children. These skills and networks will help them to galvanise public support for nutrition via the media and influence decision makers at national and international meetings and events. We hope this will further support their extraordinary efforts and successes in affecting positive change in the field of nutrtion.

Basanta Kumar Kar
Bangladesh and India

"My inner voice and passion drove me
to work on nutrition, hunger, food and
livelihoods security by addressing
structural and underlying causes
wherever possible."

PHOTO CREDITS: Field visit to BRAC and Banchte Shikha June 2012 and Shawn Sebastian, GAIN Bangladesh Team

Basanta Kumar Kar is a poet, a development practitioner and a nutrition champion. He has seen poverty and malnutrition at close quarters since childhood. He has led, or been involved in, many successful nutrition initiatives in South Asia (particularly in India and Bangladesh) whilst working at the National Dairy Development Board (NDDB) Oil Project, ActionAid International, CARE, Global Alliance for Improved Nutrition (GAIN) and The Coalition for Food and Nutrition Security (India).

One such initiative was the rolling out of a pioneering pilot programme on Vitamin A fortification of refined vegetable oil. The programme reached over 45 million people in Bangladesh. As the country lead for GAIN, Basanta subsequently worked with stakeholders to support the “Fortification in Edible Oil with Vitamin A Bill, 2013,” which was passed by the Bangladesh Parliament.

Basanta discusses his work.

Under Basanta’s leadership, GAIN - in partnership with the Ministry of Primary and Mass Education and others - pioneered the Community led Integrated School Nutrition Programme.

Launched in 2012, the programme combined delivery of high quality nutrition rich meals with strong community engagement. Following its success, the Government of Bangladesh has since requested that GAIN be involved in drafting the National School Feeding and Nutrition Policy and in supporting the formulation of the policy.

Basanta has come to understand that underlying and structural causes like unequal power relations, gender inequity, social and geographical exclusion, myths and misconceptions and poor governance are key contributors to the prevalence of malnutrition. He therefore believes it essential to address these causes in order to see a world without malnutrition.

Demonstrating impact

One of the challenges he faces in his position is the time and effort it takes to demonstrate meaningful impact of malnutrition initiatives to policy makers and political leaders. Additionally the poor still don’t see malnutrition as an important issue due to its lack of visibility in comparison to other health issues.

“You have to frame your issue or agenda under the larger country vision and country context. You have to contextualise the policy within the local political economy.”

Basanta Kumar Kar, 2016.

To overcome these barriers Basanta pays particular attention to using context-specific evidence to frame nutrition in a way that is appropriate for its audience- be it policy makers, political leaders or the public.

Basanta, Neerja, Christine, Manaan and SanSan. Five of the Nutrition Champions in London, March 2016

Basanta, Neerja, Christine, Manaan and SanSan. Five of the Nutrition Champions in London, March 2016

Basanta regularly engages with multi-stakeholder platforms on nutrition or other topics where nutrition can be mainstreamed, as well as relevant campaigns, movements and human rights organisations. He sees a great value in bringing actors together. As a member of various advisory bodies in India and Bangladesh, Basanta has influenced a wide range of policy makers and political leaders to effect the change.

Integrating nutrition into a complex political agenda

When India launched Swachh Bharat Abhiyaan (Clean India Campaign), nutrition was not integrated into it. Basanta and others worked on a paper which was shared in the National Consultation. As a result of this consultation, nutrition was subsequently integrated into the campaign.

In 2015 Basanta joined the Coalition for Food and Nutrition Security (India), and is providing leadership and management oversight to its Country Program and Operations. He hopes that working closely with this coalition of policy and programme leaders who are committed to achieving sustainable food and nutrition security, better public policy, access and control over nutritious food in India will be facilitated.

The people's agenda

Basanta would like to see nutrition becoming part of both the people’s agenda and the political agenda. He believes that increased ownership, political will, policy reforms, structural changes, multi-stakeholder platforms and more sustainable programmes are needed to unleash the true power and potential of nutrition in order to empower the present and future generation.

“Now nutrition is your agenda and my agenda. So I see a completely transformative change where it will become the people’s agenda."

Basanta Kumar Kar, 2016.

He led the Change agents becoming change leader initiative which facilitated the election of almost 10,000 marginalised women and girls to local government bodies. This led to his nomination for an India Innovation Award in 2005. He hopes that initiatives such as this will result in the South Asian enigma around malnutrition and growth being broken in the next 10 years.

Christine Muyama
Uganda

“I get to do what I want to do.
I get to save the lives
of children and I am very
passionate about that.”

PHOTO CREDITS: Sylvia Nabanoba and Samantha Reddin

Christine Muyama has always been passionate about children’s wellbeing. From a young age she wanted to be a doctor and later went on to study nutrition at University. It was during a study trip to a health centre in Northern Uganda that Christine first encountered the devastating effects of malnutrition on children.

“I walked into this ward and the first child I saw was called Joseph. He looked like he was about to pass on. I just could not believe a person could be in that state and all they needed to do was eat right. At that moment I just realised that I had more to do.”

Christine Muyama, 2016

This experience continues to inspire Christine to this day. She is now the Nutrition Programmes Officer at the Graca Machel Trust. In this role she supports civil society alliances in Malawi, Mozambique and Tanzania to lobby leaders to prioritise nutrition at the national, district and community levels.

In Malawi she organised a nutrition advocacy training with Members of Parliament (MPs). This training generated further interest from the MPs, especially regarding nutrition budget allocations at the district level. These MPs are now leading the movement to ensure funds allocated to nutrition reach the community level, thereby championing nutrition advocacy right to the grassroots.

Making malnutrition a key development issue nationally

Prior to her role at the Graca Michel Trust, Christine was National Coordinator for the Civil Society Coalition on Scaling Up Nutrition in Uganda (UCCO-SUN). On realising that nutrition had been left out of the first draft of Uganda’s National Development Plan (NDP), Christine and her team met with the national planning authority to present a position paper which detailed the views and perceptions of communities. Her team successfully advocated to ensure nutrition was addressed as a key development issue in the plan.

Christine discusses her work. 

Christine and her UCCO-SUN colleagues also brought to the attention of the King of Tooro (a Kingdom in the western part of Uganda) the fact that despite the region being described as the 'food basket of the country', it was also the one with the second highest levels of malnutrition. This led him to declare the first week of August (the week before his annual coronation when people are more receptive to messages) the week for nutrition awareness.

Building strong partnerships

Christine implements a range of key strategies to move nutrition policy forward in the countries she works in. One tactic is to build strategic partnerships with key stakeholders, such as coalitions working on nutrition, the media, MPs, and government officials.

When the District Nutrition Coordination Committees (DNCCs) were formed, Christine and her team at UCCO-SUN felt it was important to provide nutrition advocacy training to government officials in these newly established structures. The aim was to ensure that nutrition was being considered at the district level and included in the district level budget. Before being able to reach out to the DNCCs, UCCO-SUN had to get permission from the Prime Minister to do so. This process was facilitated by the fact that the Prime Minister is a nutrition champion, and his office coordinates the scaling up of nutrition in Uganda. Christine believes that it is crucial to invest in existing structures such as the DNCCs, because they can play a vital role in enabling the local delivery of nutrition initiatives continue when for the funding of intenrational programmes may end.

Raising awareness through evidence

In Christine’s opinion, one of the best ways to engage with decision makers, and MPs in particular, is to provide them with evidence. In parallel to sharing evidence papers and statistics, an approach she relies on is to share first-hand human stories with them. Hearing a mother explain what it is like to have a child suffering from malnutrition, and what can be done, helps bring the issue to life.

While awareness of nutrition may have increased at the national level, this is not necessarily the case at the district/community level. This is why Christine sees the work with the DNCCs as being key. Raising awareness within communities about issues affecting them will strengthen their power in demanding services they are entitled to. A persistent lack of effective coordination among civil society organisations, the United Nations, the private sector and the Government is another major barrier Christine encounters in her work in both Uganda and Malawi.

In order to reduce malnutrition in the next decade, Christine hopes that accountability measures will improve, and that an efficient delivery structure is in place to ensure that commitment to nutrition is actually fulfilled on the ground.

Christopher Dube
Zambia

"I came to realise that nutrition
is multi-sectoral in the
way it should be approached.
That got me excited and interested."

PHOTO CREDITS: Felix Clay/Duckrabbit, Worldfish, cclicense.

Being a medical doctor, Dr Christopher Dube has always been interested in nutrition and the wellbeing of children. But it was when he started working on the concept of the Mumbwa District Nutrition Coordination Committee (DNCC) – an initiative initially supported by Concern Worldwide as part of its Realigning Agriculture to Improve Nutrition (RAIN) project – that his passion for the subject intensified.

He has been involved in this initiative from the outset, and has been the chairman of the Mumbwa DNCC since 2012. The main goal of the committee is to coordinate all nutrition-related activities led by key ministries and other stakeholders at the district level. It is hoped this will lead to improvements in nutrition in the communities, especially in children under the age of five.

Coordinating action

The DNCC promotes one common and coordinated way of administering and monitoring nutrition issues in the district. Under Christopher’s leadership, this committee has evolved from six members (representatives from five ministries at the district level and NGOs) to around 25 members.

We had to come up with one voice to see how we could all speak the same language in regards to nutrition as we push this agenda.”

Christopher Dube, 2016

Christopher and his team engage with representatives from the ward nutrition development committees and this year the DNCC is engaging with the sub-ward level, which are called zones. This way, Christopher hopes that the DNCC will have a more bottom up approach.

It is not just the structure of the DNCC which has evolved, but members’ understanding of nutrition coordination has also changed over time. Christopher notes, “Initially everyone said, we’ll see how far this thing goes. But I think as we went on and the number of mentorships that were done through the District Nutrition Coordination Committee increased, we came to realise that nutrition is not just about an individual or an organisation but it is holistic. Something that you need to approach from all angles of life.”

Christopher in his office, 2016.

Christopher in his office, 2016.

Christopher’s role has been key in setting up and running the DNCC, although he insists that effective team work is one of the reasons it has worked well. He is responsible for coordination and ensuring everyone’s voice is heard, as well as for lobbying key actors for support and policy change.

In terms of what this approach has achieved, Christopher explains that, "the multi-sectoral approach has helped bridge the gap between stakeholders in the District and has brought the concept of nutrition as a cross cutting issue. This has helped improve and inform the citizens of the difference between having food and being healthy in the sense of nutrition. The combined efforts of stakeholders has improved food security, storage, utilisation and food diversification”.

Debjeet Sarangi
India

“When there is a reduction in newborn death
and in the infant mortality rate, you get a
sense of peace.”

PHOTO CREDITS: IFPRI SOUTH ASIA

Debjeet Sarangi heads Living Farms, an organisation that works with landless, small and marginal farmers and consumers in Rayagada district, Odisha, India. Twenty years ago he started working on the production of safe, nutritious and diverse foods that are locally grown, distributed and consumed.

In Rayagada district the death of newborn babies was frequent and young children and mothers also seemed to be particularly malnourished. Debjeet and his team identified a number of issues: government health and nutrition services were often not reaching all villagers, the quality of drinking water was poor, community practices that were detrimental to nutrition (e.g. early childhood marriage and pregnancy and food taboos during pregnancy) and the contamination of production habitats (i.e. agriculture land and forests) which were often being used for other purposes.

Community mobilisation

Under Debjeet’s leadership, the organisation implemented a number of strategies to tackle these nutrition issues. They hosted a series of monthly meetings aiming to mobilise the community. At these meetings communities diagnosed the different underlying factors of undernutrition in their area, decided on what needed to be done and then acted to collectively implement and monitor these activities. Debjeet and his team continue to support communities through this process.

This approach has led to change being implemented within the communities. As Debjeet explains, this is down to the power the process generates: “If we are able to create an appropriate space for the communities - and especially mothers - in a process where they are able to diagnose why there is malnutrition in the community, have a detailed diagnosis, and they are able to plan what the actions that need to be taken at the village level are, and they are able to implement, we see phenomenal change in the community.”

Debjeet and his team also work hard at ensuring that for every season communities have sufficient, diverse and nutritious food. Their focus is on how best to use agricultural land, forests and other commons at the village level to grow and collect food, and encompasses nutrition education, and other activities such as ideas for seasonal nutritious recipes prepared with the food available locally.

Debjeet discusses his work with Living Farms.

Working with government

Debjeet and his team often collaborate with the local officials to ensure that health and nutrition services are efficient and reaching those in need. Alongside explaining to communities the importance of using these services and in asserting their rights, the team works with government front line workers such as anganwadi workers and the Child Development Project Officers.

These interventions have proven particularly successful, contributing to a major drop in the infant and new-born mortality rate. As a result, the state government and other actors are taking note and Living Farms is sharing the lessons learned with other state governments interested in scaling this up in their own areas.

Effecting national change

Debjeet sees the current political environment in India as enabling in so far as the current discourse on nutrition is concerned. This is also reflected at the state level where the government is more than willing to collaborate or to support interventions that have proven results.

“In the country there is an environment now where people are realising that malnutrition is a major issue and one we need to address, we cannot afford to postpone it. That gives you a lot of support to do what you want to do.”

Debjeet Sarangi, 2016.

Through his years of experience Debjeet has learnt that strategies have to be continuously adapted to the local socio-political and cultural context and that nutrition is a power issue and therefore communities need to be supported to take control of the situation. He also notes that, “It needs a committed collaboration between communities, government, national and international organisations, and academic organisations.” He hopes that by working together with both local communities and government the challenge of malnutrition will become a thing of the past.

Debjeet would like to express his thanks to the partnering communities, a collaborating NGO: Ekjut and their donors: Welthungerhilfe , Misereor, and Bread for the World for supporting ourwork on Food and Nutrition.

Frealem Shibabaw
Ethiopia

"My argument was that there will be
no equality unless we address malnutrition."

PHOTO CREDITS: Ethiopian School Meal Initiative

When Frealem Shibabaw was running a private school in Bahir Dar, Ethiopia, a five year old child approached her and asked to be registered at the school despite him not being able to afford it. He was enrolled and performed very well until third grade, when he started bringing in an empty lunch box to school. This made Frealem realise how malnutrition affects child development and in particular school performance. She explains, “this was the incident that really stopped me and got me thinking about this whole nutrition issue. Right from that moment I started reading about nutrition in general, I began to ask how big this problem is in Ethiopia? how many kids are suffering because of this?, what is nutrition and what is it we need to know about it?”

Establishing the school meal initiative

Frealem then started a formal dialogue with Cabinet members and State presidents to discuss the issue and find out how much they knew about the problem. Based on the story of this child, she went on to write a concept note detailing how nutrition is connected to everything we do. The decision makers agreed to take action as long as the proposed solution would be affordable, manageable ( i.e. based on local skills and managed by local people)and sustainable (it should generate income and not require external support). This is how the school meal programme came to be designed and then piloted in various regions.

In less than three years, Frealem has managed to establish the school meal initiative in Ethiopia building on a sustainable community-centered approach in which small dairy farms are situated in each school. Twenty-three dairy farms have been established so far in five regional states, with on average 10 cows and six dairy farm workers per school. As a result, over 7,000 kindergarten and primary school students get a cup of fresh milk and bread every day before class.

This innovative initiative has been so successful – reflected by the increase in enrollment rates – that the regional governments are considering scaling up the school dairy farm model and the federal government is soon to turn it into a national school meal programme.

Alongside this initiative and with further lobbying, the Ethiopian government have made the “Seqota Declaration” this year - a new commitment to end child under nutrition in Ethiopia by 2030. All 11 regional presidents signed the declaration in August 2015 and stated target numbers to reach in each region. There are also plans to set up a Centre of Excellence. The declaration includes planning a wholesome approach to community transformation with a central goal of eradicating malnutrition in 15 years.

The school meal programme is taking a new exciting direction with its Future Student Initiative in Sequota. The aim of this initiative is to give pregnant women and younger siblings of children enrolled at school access to milk.

Making nutrition a national priority

A successful strategy Frealem has used is to frame the justification for the programme within the government’s priorities. This required her to read a lot about the government policies and political ideologies before engaging with key policy makers.

“This is a government designed to be pro-poor. Equity, equality –these are strong words you see everywhere in their documents. I justified my argument with their own ideology.”

Frealem Shibabaw, 2016.

She successfully lobbied the top political figures (i.e. those with final decision making powers) and focused her attentions on generating support from those that showed the greatest interest in her ideas, regardless of the sector they are working in.

The school meal programme team also engages with key actors (e.g. regional governments, mayors, cabinet members, non-profit organisations, community groups, schools) by sharing reports regularly. “Information exchange is huge” she says. The team also prepares exit reports for local governments with recommendations on scaling up efforts in to the region.

Whilst the government may be starting to understand the potential long-term negative effects malnutrition could have on the country, there is still is a lack of understanding around nutrition. This stems from not only the decision makers but also from communities in general. Furthermore, nutrition is not yet framed as a rights issue in practice.

Learning from the community

Whilst the government may be starting to understand the potential long-term negative effects malnutrition could have on the country, there is still is a lack of understanding around nutrition. This stems from not only the decision makers but also from communities in general. Furthermore, nutrition is not yet framed as a rights issue in practice.

The key lesson that Frealem would like to share with others, is that it is important to ensure communities are involved and feel ownership of initiatives. Observing communities and learning from indigenous knowledge is paramount.

Before we prepare our lessons I think we should sit down with the community and learn from them first… What is there, and what is not there, and what will work and what will not work and why. Unless you know the community very well it’s very hard to design strategies that work”.

Frealem Shibabaw, 2016.

In line with the Seqota Declaration, she hopes that Ethiopia will no longer have malnourished children in 10 to 15 years, and that Ethiopia can grow to become a country the international community and neighbouring countries refer to for successful malnutrition interventions. At the global level, she would like to see big institutions shifting their strategies into making more contextualised programmes instead of doing the same old thing over and over again. Because- in her own words- "times are changing, thinking is changing, so the way we do our programmes should also change, and I hope to see that.”

Manaan Mumma
Kenya

“The solutions are within reach. A lot was already
happening at the community level. For me it was
how we amplify this from the
sub-national to the national level.

PHOTO CREDITS: Manaan at the Nutrition spokesperson training, London March 2016 and launch of the Global Nutrition Report, Tanzania 2014

After training as a nutritionist, Manaan Mumma started her career working in maternal and infant nutrition. Working at the community level was a turning point for Manaan who witnessed how children suffering from acute malnutrition could recover when simple solutions, in the hands of community health workers, were applied.

Later in her career she came across a case that really affected her. David was a three year old orphan who was brought to the mission in Laikipia by his grandmother because he was severely malnourished. He had never walked or talked and only weighed about 6kg. Six months later his condition had improved drastically thanks to the nutrition programme he was enrolled in.

“After just 6 months if you see the picture of the same boy….he started walking, he said his first words, and you could see the difference that basic nutrition could have. Now the boy is turning 8, he is healthy and enrolled in school. However, if you put him against his peers who are the same age he is stunted. ”.

Manaan Mumma, 2016

Involving civil society in advocacy

It was while working in HIV for the Kenya AIDS NGOs Consortium (KANCO), that she realised the advocacy efforts and civil society involvement pioneered by the HIV sector could be useful to nutrition. When Kenya joined the Scaling Up Nutrition (SUN) movement in 2012, she saw this as a great opportunity. Manaan also became one of the founding members of the Scaling Up Nutrition Civil Society Alliance (SUN CSA) in Kenya. She has since moved on to be a Regional Nutrition and HIV Officer for the World Food Programme Regional Bureau for East and Central Africa.

Manaan discusses her work

One of Manaan’s key achievements was getting the First Lady of the Republic of Kenya, the Honourable Margaret Kenyatta, to accept the role of nutrition champion for Kenya. The First Lady was already raising awareness of maternal and child health, with her Beyond Zero Campaign, so the idea was to get her to share nutrition messages as well. Manaan seized the opportunity when KANCO hosted an event with Yvonne Chaka Chaka, an African musician widely known in Kenya and an ambassador and advocate for child health issues, to convince Yvonne to bring up this issue in her next meeting with the First Lady.

Manaan  talks about how evidence from the Hunger and Nutrition Commitment Index (HANCI) and the Global Nutrition Report (GNR), helped secure Kenya's First Lady, Margaret Gakuo Kenyatta, as a nutrition champion.

In 2015 she attended the Transforming Nutrition course at the Institute of Development Studies. The evidence-based discussions have been very useful to her in the work she is doing lobbying Parliamentarians and other decision makers on the importance of having a Kenyan pledge at the Nutrition for Growth Summit in Rio.

One successful initiative led by Manaan was the Global Nutrition Report East African launch in Dar es Salaam, Tanzania, in 2015, with representation from Kenya, Uganda, Tanzania, Ethiopia, Rwanda and Burundi. The event – along with its the media coverage, including opinion pieces in Kenyan newspapers by prominent people such as the First Lady and MPs – provided a platform at the regional level to discuss what could be done together.

These examples highlight some of the strategies she has identified as being successful in nutrition advocacy. These include identifying and building the capacity of nutrition champions. One way of building leadership is through training. While at KANCO, a key mandate for Manaan was to organise training on nutrition advocacy for a wide range of stakeholders, such as the members of the SUN CSA.

Other key strategies include achieving a balance between bottom-up and top-down approaches. Engagement with the grassroots level includes raising the awareness of community members and opinion leaders in the community, and empowering them to speak to their leaders and even write petitions with specific asks.

Engaging national government

In order to engage higher-level decision makers, Manaan uses the network of Members of Parliament that KANCO has developed around public health issues, to raise their awareness of nutrition. She also strives to sustain parliamentarian engagement through regular one to one meetings and ‘meet your MP’ advocacy days, where community members at the grassroots level all over the country have face to face meeting with their MPs.

In terms of the political environment, “I would say Kenya has a very vibrant and dynamic policy environment for nutrition. We have one of the few costed nutrition action plans in Africa; a constitution that explicitly mentions nutrition as a fundamental human right; good policies in place; and a strong Division of Nutrition under the Ministry of Health that is able to talk about these issues.” says Manaan. Kenya has indeed made great progress in improving nutrition outcomes for children, with a significant reduction in the national levels of stunting. Despite Kenya having many policies and strategies in place such as a strong National Nutrition Action Plan, there is inadequate multi-sectoral coordination, and outside the Division of Nutrition, there is limited political will to address malnutrition.

"We have to have the political will and leadership for nutrition. It’s worked in other sectors like HIV and it can work for nutrition.”

Manaan Mumma, 2016.

Looking ahead, Manaan would like to see strong political leadership for nutrition, with nutrition institutionalised in the highest office, at the very top of the political and development agenda, and prioritised in budgets. If and when this happens, Manaan believes Kenya will fully meet the nutrition targets set by the World Health Assembly.

Neerja Chowdhury
India

"There are times in the history of
nations when one idea grips the world
at the same time. The need to combat
malnutrition is now an idea which is
capturing the imagination of the world.”

PHOTO CREDITS: Suzanne Lee/Save the Children

Neerja Chowdhury is a political journalist with a strong interest in social activism and a member of the Citizens Alliance Against Malnutrition.

She was approached by UNICEF to help with child rights advocacy and became interested in nutrition following the 2005-06 National Family Health Survey, which highlighted distressing data about malnutrition in India. The realisation that rates of child malnutrition in India were among the highest in the world was a turning point for Neerja. “I remember at the breakfast table reading this headline and I said, ‘my god half our children are malnourished’. So my husband turned around to me and said ‘you have been the political editor of a national daily for 10 years; don’t tell me you didn’t know this’. I did not.”

Engaging with young MPs

Neerja then started thinking about how she could best get involved in tackling undernutrition. There had been a large number of young Members of Parliament (MPs) elected in 2004 and she decided to engage with them. She raised the issue with one MP, and together they decided to get MPs from other political parties and other eminent citizens on board.

This group decided to visit the areas most affected by malnutrition to see what was happening, starting with a district in Madhya Pradesh.

We found the situation ( in Madhya Pradesh) was abysmal. Some of the Anganwadi centres, where under six year old kids are fed and given basic health services and pre-school education, had not even opened. So we got a picture of what was going on.”

Neerja Chowdury, 2016.

During that visit, they got a lot of media coverage. Journalists were really interested in this group of young parliamentarians, who were cutting across party lines, to work together and take on the issue of malnutrition, while leaving politics behind. The group, known as the Citizens’ Alliance Against Malnutrition continued their visits to states where different political parties were ruling.

Neerja discusses her work.

Neerja works with the Citizens’ Alliance to identify entry points for nutrition action and attention in the government at the senior level, building on the MPs’ connections and her own. The Citizens’ Alliance may have encouraged the government to move ahead with its 2010 decision to focus on improving child and maternal health in 200 high-burden districts in the country. The Alliance is an advocacy initiative with no formal structure, convener or funding. But, says Neerja, “That’s the way we wanted it, rather than become a formal organizational structure. The important thing is that there is a committed core group and they have taken ownership. When momentum flags, I give it a push."

Scaling up

The Citizens Alliance’s current focus is on food fortification, as well as the setting up of Nutrition Missions in the states.

“The success of the Maharashtra Nutrition Mission really gave us this idea. Stunting came down by 16 percent in six years. We felt that the setting up of nutrition missions under the chief minister so that convergence and inter-sectoral coordination is easier, would be the way to go.”

Neerja Chowdury, 2016.

The Citizens Alliance also aims to identify pilots that are yielding positive results and then encourage the government to take these on and to scale them up. “Our view is, we have enough pilots in India which have worked. We have to show if they can be scaled up”, explains Neerja.

The Citizens’ Alliance has since encouraged the Naandi Foundation to carry out the HUNGaMA (Hunger and Malnutrition) Survey to help fill the wide gap in data and knowledge on child malnutrition in India. The group also facilitated a meeting between film star Aamir Khan and then–Prime Minister Manmohan Singh, which led the government to mount a multimedia campaign on malnutrition with the star.

Hopes for the future

Thanks to the work of UNICEF and others, there’s a growing awareness of the importance of nutrition –and yet there’s still a long way to go. At the community level, especially in tribal areas, people simply do not understand the consequences of malnutrition. This is why, in her view, messages from reputable academic reports, such as the Lancet Nutrition Series, need to be translated into catchy messages for the population.

Neerja has concerns about the future of India, as she explains: “65% of our population is under 35. We talk very proudly about that demographic dividend. We talk about India becoming a regional power, a world power in the future. Our Prime Minster is encouraging us to 'Make in India' but if one third of your children are stunted, and almost half of your children are undernourished, what kind of an India are you looking at? It’s not a productive India.”

Now that malnutrition is on the radar and the national government is now in the process of putting together a national nutrition strategy, Neerja hopes that undernutrition levels can be halved in India and globally in the next 10 years.

San San Myint
Myanmar

“ Nutrition is everywhere, in
the different population groups
I worked with, in the rural areas,
in the urban areas, in different
shapes and forms, overnutrition
and undernutrition."

PHOTO CREDITS: Andre Malerba/Save the Children.

Throughout her career working on health programmes in several countries in Africa and Asia, SanSan Myint, a medical doctor by training and currently the head of the the Three Millennium Development Goal Fund in Myanmar, became increasingly aware of the nutrition issues faced by the population groups she worked with.

So she decided to focus on nutrition, first by pushing for nutrition interventions in the health programmes she was involved in and later by becoming the coordinator for the Civil Society Alliance for Scaling up Nutrition (SUN CSA) in Myanmar while at Save the Children.

The overwhelming presence of the problem and the simple things needed to address it made me pick up on nutrition matters regardless of who I was working with and where I was.”

San San Myint, 2016.

Feeling that she had the right skill set and experience to take on the role of coordinator for the SUN CSA in its first phase, and motivated by the fact that she wanted to see the SUN movement thrive in her own country as she had seen it do in others, she took on the position. Nine months later, in February 2015, the SUN CSA was successfully launched in Myanmar.

San San discusses her work

Establishing a network

The first step was to set up the SUN steering committee with a group of staff members from international NGOs based in the country. She revived her network of contacts within the Ministry of Health, which she had built up during the 14 years she worked there at the start of her career. Taking into account the top down nature of Myanmar as a society, she ensured that she approached the community gatekeepers first in order to get to local NGOs and other actors involved. Tapping into the constituencies and networks of each of the SUN CSA Steering Committee members also mobilising and organising people to form the alliance within a short period of time.

San San giving nutrition advice to a community - Save the Children

San San giving nutrition advice to a community - Save the Children

She also believes that the key to any meaningful action is the process being participatory and inclusive from the very start. This means that activities need to be integrated into the routine work that the communities are doing in order for the initiative to be sustainable. Other strategies were to engage with the large media community prior to the launch event in order to get wide coverage, and ensuring any advocacy efforts were based on strong evidence.

“You shouldn’t try to start a movement without getting all the facts and the figures to support the message that you are trying to spread. If you want to get people to do something you have to be sure of the evidence base.”

San San Myint, 2016.

San San points out that setting up the SUN CSA came at the right time. The changing political environment and the arrival of Scaling Up Nutrition in the country (Myanmar joined the SUN Movement in April 2013) were the two key enabling factors.

The highest levels of government had just started to realise the importance of tackling undernutrition in the country in order to graduate from being a low-income country to a middle-income country. Average height in Myanmar was (and still is) lower than the accepted global standard because of chronic malnutrition, especially in the first 1,000 days. Therefore the government started sharing messages about the importance of good nutrition during this period.

Raising interest and awareness nationally

Government commitment to reducing malnutrition was also reflected by the increasing number of ministries focusing on nutrition issues. It was no longer just the focus of the Ministry of Health. Other actors in Myanmar were also raising awareness around nutrition. A video on the importance of the first thousand days was broadcast on TV and became very popular.

This interest in nutrition, though, is still very nascent in Myanmar. Government and non-government actors still sometimes consider nutrition activities as an add-on to their portfolio. SanSan highlights the serious knowledge gaps remaining for Myanmar. After years of sanctions, ground work for the demographic health surveys (DHS) is started in Myanmar for the first time in 2015. There hasn’t been a population census for over 40 years and region and population specific information for health and nutrition is also lacking.
Thanks to the Global Nutrition report we do however have the 2015 Nutrition country profile for Myanmar.

She hopes that in the coming decade nutrition will be improved equally across the country, and that as a result Myanmar will be able to become a middle-income country.

V. Ramani
India

“If you really have a conviction that something needs
to be done you find that the wider environment
very often supports you.”

PHOTO CREDITS: Prasanth Vishwanathan/Save the Children

Trained as an economist, V. Ramani worked in the civil services in India for thirty years until he retired in 2010 – starting and ending his career in the state of Maharashtra. His interest in nutrition began in 2001, when he was Divisional Commissioner of Maharashtra. A major incident occurred in the village of Bhadali in Vaijapur Taluka of Aurangabad District, where a large number of children died of malnutrition within a space of a few months. With UNICEF, his administration set out to tackle this problem. This was the wake up call for Ramani – the start of his drive to tackle malnutrition in the state.

Following the Bhadali incident, the Malnutrition Removal Campaign, also known as the ‘Marathwada Initiative’, was launched in Aurangabad Division in 2002. The campaign worked to shift the focus of the Integrated Child Development Services (ICDS) workers from simply providing food to actively measuring children to determine their nutritional status. It also sought to lay the groundwork for more cooperation between the ICDS and the health sector. The Marathwada Initiative lowered rates of severe malnutrition by 62 percent in two years. For Ramani it was successful because, “ a number of people got together at that point of time and we were able to build a coalition of interests".

Scaling up

When Ramani heard about another incidence of child deaths in 2004 in North Maharashtra, he decided to make a proposal to the state government and to the then Chief Minister to start a Mother-Child Health and Nutrition Mission in Maharashtra. This would draw on the lessons of the Malnutrition Removal Campaign in order to scale up efforts to the entire state and make a significant impact on malnutrition. The Mission started in April 2005 in Aurangabad, and Ramani took on the role of Director General. There were two main channels used, he explains:“we operated through two major systems: the Integrated Child Development Services (ICDS) and the public health system. Our efforts were really aimed at making these two wings of the government work together, centralise their working and ensure there was collaboration between them”.

After looking into the data available to decide who to target, where and how, the Mission decided to focus initially on five tribal districts in the first year, before extending to 10 more districts in the next two years, and to the entire state from 2008 onwards.

These efforts – led by Ramani – have been recognised as drivers of stunting declines in Maharashtra. Maharashtra is seen as a remarkable case of an Indian State’s successful efforts in addressing child undernutrition. Between 2006 and 2012, Maharashtra’s stunting rate among children under two years of age was reported to decline by 15 percentage points one of the fastest declines in stunting seen anywhere, at any time.

Not only did the Mission sensitise different stakeholders to the various issues in child malnutrition, it also created the confidence that the problem could be tackled in a systematic, time bound manner through improving public service delivery systems in the ICDS and health sectors and measuring accountability for outcomes. Most significantly, there was a marked sense of involvement and enthusiasm in field level health workers and ICDS workers who felt they finally had a voice in deciding how to improve the nutrition and health status of children in their areas. Bringing this issue to the forefront of public policy concerns and promoting teamwork and involvement at all levels of government and society were two of the major accomplishments of the Mission. The replication of this model in other states of India is testimony to the confidence that there is a clear path to effectively tackling child undernutrition.

Developing nutrition networks

Networking with the government, civil society, the political class and NGOs was a key strategy used by Ramani and his team, with most efforts focused on getting the government on board.

I think the most critical issue really is to get the government to accept the work. I think a very large part of the work that has to be done in India has to be done through the public service system…. You need to ensure that the government machinery is working according to a plan, in a systematic manner across the states.”

V. Ramani, 2016.

In order to do so, Ramani and his team held meetings with officials at various levels of the public health system, and as a result, the Health Department cooperated and contributed manpower and resources. Motivating staff in the ICDS and the public health service where levels of motivation are generally poor was a priority for the team. Ramani explains that it is important to, “make them realise they are doing a terrific job. And that they are doing one of the most important jobs in the world... The Anganwadi worker for me is the heroine of the entire drama. She’s the one who’s there at the village level, who has to work with families, who puts her heart and soul into it but gets nothing in return. Even today she only gets an honorarium.”

Ramani and his team have provided support and showed appreciation to Anganwadi workers and others through meeting them regularly, highlighting their work in meetings, organising star competitions (where Anganwadi workers get stars for their accomplishments), and in helping with operational difficulties (e.g. by providing equipment needed in their daily activities). These efforts set an example that change is possible within the ICDS and health systems with enhanced skills, knowledge, regular review, field visits and appreciation of those who delivered the services.

“If you really have a conviction that something needs to be done you find that the wider environment very often supports you” Ramani asserts. “Child nutrition is an area I don’t think anyone can question. I found tremendous support from the political class from the Chief Minister to the lowest political functionary at the district or sub-district levels.”

“My greatest hope would be that there is a commitment at all levels: the political level, the bureaucratic level, civil society level. This is not a problem that only concerns one section. We’ve all been parents, we’ve all been children, so I think this is a problem that concerns all of us.”

V. Ramani, 2016.

V Ramani writes a regular blog 'The Gadfly column"

William Chilufya
Zambia

“My hope is to have a Zambia where every mother and child is assured
of sufficient nutrition. This will be done through all players playing
their part, all sectors effectively working towards improving nutrition.”

PHOTO CREDITS: Scaling up Nutrition, cc license

William Chilufya is a civil society advocate with a background in international development and poverty reduction. As a child growing up in the Central Province of Zambia, he remembers how children at school were divided according to their school performance and how children with difficulties were made fun of. William started becoming passionate about nutrition around 2010. This was when he became aware of the 1,000 days window of opportunity and the importance of good nutrition to improve the cognitive development of children. At that time, political will in Zambia to address malnutrition was very weak and there was no civil society voice for nutrition.

Inspiring change

In 2012 Save the Children, as part of its work with the SUN movement in Zambia, reached out to William, who was working for the Civil Society for Poverty Reduction at the time. They asked him to put together a programme of work on nutrition advocacy in Zambia from a civil society point of view. The proposal he and others developed was successful, and William then spearheaded the setting up the Zambia Civil Society Scaling Up Nutrition Alliance (CSO-SUN) after a series of consultations.

CSO-SUN advocates for a policy and legal environment that promotes improved nutrition outcomes in Zambia, and its interventions have been focused around advocacy and creating demand for nutrition at the community level. CSO-SUN is also an umbrella body for smaller national CSOs working on nutrition and provides the link from national to international donors and organizations.

William’s role is to provide leadership for the network, to motivate and inspire civil society colleagues and to ensure activities are carried out effectively. Under William’s leadership, CSO-SUN has accomplished a lot in a short period of time. At the centre of its advocacy agenda, the CSO-SUN Alliance has developed “The 10 key recommendations to addressing under-nutrition in Zambia”. These are a set of recommendations developed in consultation with civil society, the cooperating partners and the government. They represent a multi-disciplinary effort to identify key areas for action across sectors to address the nutrition situation in Zambia.

Engaging with stakeholders

William and his team have worked with the government to ensure that both the National Social Protection Strategy and the National Agriculture Policy (still in draft) include nutrition objectives. They have been effective in creating strong relationships with key MPs including Hon Highvie Hamadudu, Chairperson for the Budget Committee of Parliament who has become a vocal advocate for nutrition in the Zambian parliament. The formation of the All Party Parliamentary caucus on Food and Nutrition has also been an important development as it brings together parliamentarians from different parties to have a coordinated voice for nutrition.

In terms of engaging key stakeholders, such as MPs, William has discovered that’s it’s vital to provide them with the evidence they need in the format they need it; effectively communicating why nutrition is important, understanding the actors they want to influence and motivating them to take action. For example, understanding the role of the various parliamentary committees in order to know which one is best placed to advance the nutrition agenda.

Media engagement is another key area for the team and their success is reflected by the increased number of radio slots and articles on nutrition in the Zambian papers. William was asked by the Zambia Daily Mail to write an articles on nutrition and has regularly been interviewed or quoted on several major Zambian radio and TV stations.

Mobilising civil society

In his paper The Role of Civil Society in Spotlighting Nutrition William explains why mobilising civil society to speak with one voice and strengthening capacity is key. Training CSO actors enables them to become nutrition ambassadors in their communities and training the media increases and improves coverage on nutrition. Publicly recognising these key actors’ contributions has also proven to be effective. For example, for the last three years William and CSO-SUN have organised a Nutrition Awards ceremony to inspire and reward journalists covering issues related to nutrition.