The global nutrition environment is changing in terms of issues,
approaches, structures and stakeholders. However, Norway’s engagement with the global nutrition processes is declining. Norway is, therefore, falling behind in its overall approach to nutrition. This report shows that whereas commitments to global nutrition are made in core Norwegian foreign policy and development assistance documents, there is no overarching policy framework for nutrition. Norway needs to develop an approach to build in the missing link to nutrition in its development strategies for food security, health, climate change and social protection.
Nutrition – everybody’s business and nobody’s business
Nutrition within Norwegian development policy
Fafo-report 2012:55 ISBN 978-82-7422-950-1 ISSN 0801-6143 Order no. 20282 P.O.Box 2947 Tøyen
N-0608 Oslo
www.fafo.no/english/
L. E. Torheim, M. M. de Paoli and R. D. Bezerra
Liv Elin Torheim, Marina Manuela de Paoli
and Riselia Duarte Bezerra
Nutrition – everybody’s business and nobody’s business
Nutrition – everybody’s business
and nobody’s business
Liv Elin Torheim, Marina Manuela de Paoli and Riselia Duarte Bezerra
Nutrition – everybody's business and nobody's business
Nutrition within Norwegian development policy
Fafo-report 2012:55
© Fafo 2012
ISBN 978-82-7422-950-1 (paper edition) ISBN 978-82-7422-951-8 (web edition) ISSN 0801-6143
Cover photo: Colourbox.no
Cover design: Fafo Information Office Printed in Norway by: Allkopi AS
Innhold
Tables ... 5
Figures ... 5
Abbreviations ... 6
Executive summary ... 9
Acknowledgements ... 12
1 Introduction ...13
2 Methodology ...14
2.1 Interviews ... 14
2.2 Desk review ... 15
2.3 Analysis of ODA flow ... 15
2.4 Research team ... 16
3 The case for nutrition ... 17
3.1 A conceptual framework for the causes of undernutrition ... 18
3.2 Consequences of undernutrition ... 24
3.3 Why is nutrition important for development? ... 25
3.4 Global actors in nutrition ... 26
4 The position of nutrition in Norwegian development policies ..35
4.1 White papers and strategies ... 35
4.2 Actual commitments ... 39
4.3 Nutrition stakeholders in Norway ... 48
5 Discussion of findings and conclusions ...63
5.1 What is the current situation?... 63
5.2 Possible explanations to the situation ... 65
5.3 Why should Norway place nutrition high on the political agenda? .... 66
5.4 How can Norway play a more substantial role in global nutrition? ...67
6 Recommendations ...73
Annexes ...75
Annex A – Overview of informants ... 75
Annex B – Conversation guide ... 78
Annex C – Norway’s engagement with global nutrition ... 80
Annex D – Right to food – an overview ... 82
Annex E – Glossary of selected terms used in the report... 85
References ... 88
Tables
Table 1. Scheme for categorising relevant projects identified through
the Norad aid database ... 16 Table 2. Disbursement of Norwegian ODA by sectors, 2000-2010 ... 40
Figures
Figure 1. Conceptual framework for the causes of undernutrition ... 19 Figure 2. Norwegian aid to nutrition and nutrition-related activities,
food security and emergency food aid as a percentage of total Norwegian aid ... 41 Figure 3. Norwegian partners for channelling aid to nutrition and
nutrition-related activities, food security and food aid ... 42 Figure 4. Distribution of Norwegian aid by sector (2000-2010) ... 43 Figure 5. Distribution of Norwegian aid by partner (2000-2010) ... 43 Figure 6. Organisational diagram showing public actors relevant for
nutrition in development aid policies. ... 50 Figure 7. Norwegian ODA and its relation to basic, underlying and
immediate conditions of children’s survival, growth and development. ... 64
Abbreviations
ACF Action Against Hunger (Action Contre la Faim)
CAADP Comprehensive Africa Agriculture Development Programme CERF UN Central Emergency Response Fund
CFA Comprehensive Framework for Action CFS Committee on World Food Security CRS Creditor Reporting System
DAC Development Assistance Committee of the OECD DCG Drylands Coordination Group
DFID Department for International Development
DI Development International
ECOSOC United Nations Economic and Social Council EWEC Every Woman Every Child
FAO Food and Agriculture Organization of the United Nations FIAN FoodFirst Information and Action Network
ForUM Forum for Environment and Development
GAVI formerly the “Global Alliance for Vaccines and Immunization”
(now the GAVI Alliance)
GFATM Global Fund to Fight Aids, Tuberculosis and Malaria
GSF Global Strategic Framework for Food Security and Nutrition HDir Norwegian Directorate of Health (Helsedirektoratet) HiOA Oslo and Akershus University College (Høgskolen i Oslo og
Akershus)
HIV Human immunodeficiency virus
HLTF High Level Task Force on Global Food Security
HOD Norwegian Ministry of Health and Care Services (Helse- og omsorgsdepartementet)
IBFAN International Baby Food Action Network
ICESCR International Covenant on Economic, Social and Cultural Rights
ICN International Conference on Nutrition
IFAD International Fund for Agricultural Development IFPRI International Food Policy Research Institute
LMD Norwegian Ministry of Agriculture and Food (Landbruks- og matdepartementet)
MDG Millennium Development Goal MFA Norwegian Ministry of Foreign Affairs MPTF Multi-Partner Trust Fund
MSF Médecins Sans Frontières (Leger uten grenser)
NCD Non-communicable diseases (i.e. diabetes, cardiac heart dis- ease, cancer, etc)
NEPAD New Partnership for Africa’s Development NGO Non-governmental organisation
NIPI Norway-India Partnership Initiative NNPI Norway-Nigeria Partnership Initiative
NOK Norwegian Kroner
Norad Norwegian Agency for Development Cooperation NPPI Norway-Pakistan Partnership Initiative
NRC Norwegian Refugee Council
NUFU The Norwegian Programme for Development, Research and Education (Nasjonalt program for utvikling, forskning og utdanning)
OCHA Office for the Coordination of Humanitarian Affairs ODA Overseas Development Assistance
OECD The Organisation for Economic Co-operation and Develop- ment
PMTCT Prevention of mother to child transmission of HIV RUTF Ready-to-use therapeutic foods
SUN Scaling Up Nutrition
UCFA Updated Comprehensive Framework for Action
UiO University of Oslo
UN United Nations
UN SG United Nations’ Secretary-General UNHCR UN High Commissioner for Refugees UNICEF United Nations Children’s Fund
UNSCN United Nations System Standing Committee on Nutrition
USD United States Dollar
VGRtF Voluntary Guidelines on the Right to Food (Voluntary Guide- lines to support the progressive realisation of the right to adequate food in the context of national food security)
WFP World Food Programme
WHA World Health Assembly
WHO World Health Organization
Executive summary
This report provides an overview of Norwegian development aid policies and official development assistance (ODA) in the area of nutrition. The report was commissioned by Save the Children Norway, to guide and support their future advocacy work on global nutrition. It is based on a desk review and an analysis of the Norwegian ODA disbursements to nutrition. Additionally, interviews with parliamentarians, political staff and civil servants at the relevant ministries, and representatives from academic institutions and non-governmental organisations were conducted.
Nutrition is a ‘missing link’ between food security and human development. Enhanced nutrition is necessary to translate improvements in food access into human develop- ment. Nutrition is also imperative for equity, human rights and economic development.
Better development results can therefore be achieved by mainstreaming nutrition into a range of sectors, in particular health, food security (including agriculture), climate change and social protection. Concurrently, the implementation of evidence- informed direct nutrition interventions, in particular improving breastfeeding and complementary feeding practices, is necessary to speed up the pro-gress in reducing child undernutrition.
The global nutrition environment is changing in terms of issues, approaches, structures and stakeholders. However, Norway’s engagement is on the decline. A number of new global nutrition initiatives have been established providing new avenues for a coherent support to nutrition. Simultaneously, nutrition is increasingly becoming an integrated part of both the food security and health agenda globally. The Government of Norway is not engaged with these global nutrition processes. Norway is therefore falling behind in its overall approach to global nutrition.
Commitments to global nutrition are made in core Norwegian foreign policy and development assistance documents. However, there is no overarching policy framework for nutrition. Norwegian support to global nutrition seems fragmented and random.
This lack of political priority is attributed to (i) many competing priorities for limited funding resources; (ii) the multi-sectorial nature of nutrition; (iii) limited understand- ing of the consequences of and possible solutions for undernutrition; and (iv) the lack of a stakeholder constituency for global nutrition in Norway.
Norway allocates only 0.5% of its official development assistance to nutrition specific activities. This low level of funding reflects the lack of coherence in the policy frame- work and the absence of a clear political commitment.
There is a limited stakeholder constituency for nutrition in Norway, and a limited un-derstanding of the issues. Since Norwegian stakeholders are not sufficiently involved with the current global nutrition processes, there are few advocates/change-agents for nutrition. There is a need for a nutrition stakeholder community to review the global processes, suggest what approach Norway could take to improve its work on nutrition and advocate for increased political attention to nutrition.
Norway needs to develop an approach to incorporate the missing link to nutrition in its development strategies for food security, health, climate change and social protection.
Norway should, as part of this approach, get involved with the new global strategic frameworks. These bring evolving norms and approaches into the national discussion.
The following recommendations have been developed to guide Norway’s work on global nutrition.
• Norway should support the global development target of reducing stunting by 40% by 2025 (adopted by the World Health Assembly in May, 2012) and promote inclusion of this target in the post-Millennium Development Goals.
• Norway should be represented at the International Conference on Nutrition +21 (ICN+21) in 2013 by a delegation led by the Minister of Foreign Affairs, and take an active part in influencing the processes and outcomes.
• Norway should increase nutrition investments in its development aid budget, both to direct nutrition interventions and to medium- and long-term actions to build resilience and address the root causes of hunger by:
• Supporting the Scaling Up Nutrition (SUN) collaborative process by providing funding to the SUN Secretariat in Geneva, and to at least one SUN country so that national nutrition policies and strategies can be implemented.
• Supporting nutrition-related activities and nutrition sensitive social protection programmes (e.g. through cash transfers). These should be in line with evidence- informed health interventions and/or food security or social protection projects with clear nutrition objectives.
• Norway should articulate and adopt concrete nutrition-related strategies in its efforts to combat child and maternal mortality, linked to the Every Woman Every
Child movement and to the partnership initiative programmes for maternal and child health in India, Pakistan and Nigeria.
• Norway should integrate nutrition objectives into its global health-, food security-, climate change- and social protection-strategies, and strengthen coordination to promote synergies between the efforts in these areas.
Acknowledgements
The authors would like to thank all those people who accepted to participate in the interviews and shared their knowledge, experience and insight with us. We would also like to thank Miriam Iuell Dahl, Wenche Barth Eide, Kaia Engesveen, David Gairdner, Sabrina Ionata de Oliveira Granheim and Unni Silkoset for their valuable inputs to the report. We also thank Laura Mitchell for her excellent work on editing and proof- reading the report. Finally, we also wish to thank Fafo’s Information Office for their assistance in preparing the manuscript for publication.
The responsibility for the final content and formulations rests with the authors.
1 Introduction
This report is the result of a project commissioned by Save the Children Norway as part of Save the Children International’s global advocacy work and specifically its campaign on child survival and the promotion of nutrition.
The main purpose of the project is to produce an overview of Norwegian develop- ment policies on nutrition, on Norwegian official development assistance (ODA) for nutrition and a stakeholder analysis of the key actors and decision-makers related to global nutrition. Based on this analysis, the report discusses why the Government of Norway should increase the attention and resources to nutrition in Norwegian devel- opment aid policy, and offers recommendations to how this may be done.
Chapter 2 outlines the data collection methods used and the methodology for analysing the information presented in the report. Chapter 3 presents a platform for understanding the links between nutrition and human development, provides a conceptual framework for understanding the causes of undernutrition1, and gives an overview of the most important global actors and recent nutrition-initiatives. Based on an analysis of policy and strategy papers, stakeholder interviews and other sources, Chapter 4 examines the position of nutrition in Norwegian development policies.
Chapter 5 analyses and discusses the findings from chapter 4, whereas chapter 6 pre- sents recommendations to the Government of Norway for moving nutrition higher up on the policy agenda.
1 The term ‘malnutrition’ includes both undernutrition and overweight/obesity. This report focuses mainly on undernutrition, while acknowledging that overweight/obesity is an increasingly important nutrition problem globally.
2 Methodology
To address the objectives of the project, three data collection methods were used for obtaining the required information: a desk review of relevant policies and literature;
interviews with key stakeholders; and an analysis of Norwegian ODA flow. The data gathered using these three methods were analysed in a triangulated manner.
2.1 Interviews
A list of key potential informants was developed in collaboration with Save the Chil- dren Norway. The informants sought were parliamentarians involved with global health or food security policies, the political staff of the Ministry of Foreign Affairs, and the civil servants who worked on global health or food security-related issues in the MFA, the Ministry of Health and Care Services (HOD), the Norwegian Direc- torate of Health (HDir) or the Norwegian Agency for Development Cooperation (Norad). Relevant persons from academic institutions, non-governmental organisations (NGOs), the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) were also included in the list, as were key persons involved with Norway’s partnership initiative programmes in India (NIPI), Nigeria (NNPI) and Pakistan (NPPI). In addition to the initial contact list, several informants also suggested relevant persons to be interviewed. Not everyone who was contacted responded, nor wanted to participate in the study. Relevant politicians were among the most difficult to contact – either they indicated that they were too busy or they did not respond to the request for an interview despite several reminders. A list of the persons contacted and of those interviewed is provided in Annex A.
A generic conversation guide was developed which covered the various topics of relevance and interest to the study (available in Annex B). For each interview, however, we drew on the guide but tailored the interviews to focus on the topics and issues of relevance to that particular person and his/her knowledge and expertise. Hence, individual interviews did not cover all of the same themes as the focus depended on the informant’s knowledge and experience.
The interviews were generally conducted with two of the researchers present.
Both of these researchers took notes during the interviews and compiled a merged
transcription of each interview. Transcriptions were sent to those informants who wanted to read them, so that they could control for errors and misunderstandings, as well as supply any additional information required. The interviews were subsequently analysed, and relevant information has been thematically sorted and included in the report when appropriate.
2.2 Desk review
Policy documents from the Government of Norway and key ministries and depart- ments (i.e. the MFA, the HOD, the HDir and Norad) were reviewed as part of the desk study. These documents were identified both through the individual interviews and through internet searches. The main results of this policy review are presented in Chapter 4. Also, the most important global organisations, initiatives and resources on nutrition are presented in Chapter 3.
2.3 Analysis of ODA flow
Providing information on Norwegian official development assistance from 1960 to 2011, the Norad aid database served as the main data source for the analysis of ODA flow in this report.2 Since the coding of the projects in the database seldom adequately reflects the objectives and activities of those projects, the projects examined were cat- egorised manually. The database was queried for the time period 2000-2010 (inclusive), using the following keywords: nutrition, feeding, food aid and food security. For each project containing one or more keyword, the project description was examined, and the project was categorised according to one of the six initial categories presented in Table 1 (see next page).
2 The team acquired the actual aid database (in Excel format) from Norad to enable more detailed analyses of the data. The database is the same as the Norwegian Aid Statistics found on Norad’s webpage: http://
www.norad.no/en/tools-and-publications/norwegian-aid-statistics.
Table 1. Scheme for categorising relevant projects identified through the Norad aid database Basis for categorisation Initial category Final category
Nutrition was the main objective of the project
Basic nutrition Nutrition and nutrition related
Health project with a nutrition component
Nutrition-related health activities
Nutrition and nutrition related
Food security project with a nutrition component
Nutrition-related food security activities
Nutrition and nutrition related
Emergency assistance project with a nutrition component
Nutrition-related emergency assistance activities
Nutrition and nutrition related
Food security project without a stated nutrition component
Food security Food security
Emergency food aid project without a stated nutrition component
Emergency food aid Emergency food aid
In some of the analyses presented, the initial categories are used, whereas some analyses use the final categories, where all nutrition-related projects are joined. In addition, official Norad figures on Norwegian ODA on health were found on the Norwegian Aid Statistics webpage of the Norad website.3
The analysis of ODA funding to nutrition recently conducted by Development Initiative (DI) [1] was taken into consideration. A summary of DI’s findings is provided, and these findings served as a comparative and complementary basis for the analysis conducted in this report.
2.4 Research team
Liv Elin Torheim was the project leader. She conducted the desk review and wrote most of the report. Two of the researchers, Torheim and Marina Manuela de Paoli conducted the interviews. de Paoli was responsible for the analyses and write-up of the informant interviews; she was part of the editing process and as such took an active role in the quality control. The third researcher, Riselia Duarte Bezerra, analysed the ODA flow.
3 The ODA to health was found by choosing the sector “Health and social services” on the Norad’s Norwegian Aid Statistics website: http://www.norad.no/en/tools-and-publications/norwegian-aid- statistics
3 The case for nutrition
This chapter gives the rational for why nutrition is important for development. A key issue is that enhancing nutrition is central in ensuring that improved access to food translates into human development. Better development results can be achieved by mainstreaming nutrition into a range of sectors, in particular health, food security (including agriculture), climate change and social protection. At the same time, evidence-informed direct nutrition interventions, in particular improving breastfeeding and complementary feeding practices, are necessary to speed up the progress in reducing child undernutrition and mortality.
The chapter further shows that the global nutrition environment is changing, in terms of which issues that are highlighted, the approaches taken, structures that are available and stakeholders involved. A number of new global nutrition initiatives have been established offering avenues for a coherent support to nutrition. Simultaneously, nutrition is increas- ingly becoming an integrated part of the global food security and health agenda.
To grow and develop physically and mentally, children need a diet that provides adequate amounts of energy and nutrients [2]. However, more than 200 million chil- dren under the age of five, suffer from undernutrition [3, 4], while an estimated 870 million people in the world are undernourished [5]. Undernutrition is the underlying cause of death for an estimated 2.6 million children every year, representing more than a third of all child deaths [6]. The magnitude of undernutrition is alarming, particularly since empirical evidence has revealed that undernutrition during pregnancy and the first two years of life may result in largely irreversible damage to cognitive and physical development [7]. The implications of this damage are extensive. Undernutrition during this critical and foundational period of the life cycle may adversely affect a child’s health, its ability to learn – and potential to generate a decent livelihood in the future [8].
Nutritional status4 is therefore both an outcome of development but also a major input to various development processes. The Scaling Up Nutrition (SUN) movement states a number of important reasons for focusing on nutrition [9]:
• Undernutrition is one of the world’s most serious, but least addressed health prob- lems, with enormous economic as well as human costs. At the same time, it is largely preventable, and there is evidence of exceptionally high development returns to a number of direct nutrition interventions.
4 For a definition of nutritional status and related terms, see Annex E.
• Successfully addressing undernutrition is essential to meeting the Millennium Development Goals (MDGs) and for respecting human rights to health and to food5.
• It is the world’s poor who suffer most from international economic disruption, such as the recent global crisis in food, fuel and finance. This further exacerbates the poor’s vulnerability to undernutrition.
Progress in reducing the prevalence of undernutrition has been slow and with consid- erable regional and country-level variation. While globally, the proportion of stunted children fell from 40% in 1990 to 27% in 2010, in Africa since 1990, the overall preva- lence of undernutrition has been reduced by only two per cent (from 40% to 38%) [10].
While it is crucial to address undernutrition through its underlying determinants, such as income growth, improved education and women’s empowerment, this will take time and result in several more decades of undernutrition [5]. Therefore, undernutrition must also be addressed through its immediate determinants, such as infant and young child feeding practices and diseases.
3.1 A conceptual framework for the causes of undernutrition
Undernutrition results from a number of processes occurring at several levels, as depicted in the conceptual framework developed by UNICEF in Figure 1 [11]. This conceptual framework is particularly useful in showing the complexity of the under- lying problems leading to undernutrition. The framework divides the causal factors into immediate, underlying and basic causes.
The framework illustrates how nutrition relates to both food security- and health- related issues, and to a nation’s governance and control of available resources. We will use this framework to argue for more targeted nutrition policies and funding in Norwegian development aid.
Child undernutrition manifests itself through three main conditions, namely:
stunting, wasting and micronutrient deficiency diseases. With stunting, children do not develop or grow properly due to insufficient intake of energy and/or nutrients.
Stunting is caused by chronic undernutrition and leads to a low height-for-age (short- ness). Secondly, wasting is a condition caused by acute undernutrition and is reflected in a low weight-for-height (thinness). Underweight where the child has a low weight- for-age is another manifestation of undernutrition, resulting from stunting or wasting
5 The right to food is recognised by several international legal human rights instruments, see Annex D.
or a combination of the two conditions. Thirdly, deficiency diseases are caused by inadequate micronutrient intakes, e.g. anaemia caused by inadequate iron intake. The most common micronutrient deficiencies representing public health risks in developing countries are iodine, iron and vitamin A. Inadequate dietary intake poses the highest risks during periods of rapid growth and increased nutritional needs, such as during infancy and childhood, and during pregnancy and lactation for women.
Figure 1. Conceptual framework for the causes of undernutrition Child undernutrition
and early death
Inadequate dietary intake
Resources and control:
Human, economic and organisational resources
Political, ideological and economic factors
Potential resources
Household
food insecurity
Inadequate care for children and
women
Insufficient health services and unhealthy environment
Disease
Based on UNICEF, 1998 [12]
Immediate and underlying causes
The immediate causes of child undernutrition are inadequate diet and disease. These two conditions often interact. An inadequate diet may make a child more susceptible to infectious diseases, and disease may lead to reduced intake of food and its absorp- tion and simultaneously increase the need for nutrients. This synergistic effect is an important reason for the high rates of undernutrition, disease and mortality in devel- oping countries [2].
WHO/UNICEF recommend that infants should be exclusively breastfed for the first six months of life, and thereafter, they should gradually be introduced to comple-
mentary food of adequate quality and quantity [13]. Breastfeeding is recommended to be continued until the child is two years of age. These recommendations are based on reviews of evidence on the optimal way of feeding infants and young children.
However, suboptimal infant feeding practices are common in many developing coun- tries. Water and foods are frequently introduced too early, and complementary food is often of low quality and is given infrequently [10]. In disadvantaged populations, the most common complementary food is a gruel/porridge often consisting only of cereals and water, with low energy and micronutrient density. Animal products, which are rich sources of a number of micronutrients, are rarely given to young children [14].
Inappropriate feeding of infants and young children may be caused by inadequate ac- cess to food in the household (household food insecurity) and/or by inadequate caring practices which may be due to lack of time, resources and/or knowledge on the part of the caretaker about the nutritional needs of infants and young children, but also due to many women’s low social status [4, 15]. Inadequate dietary intake of energy and nutrients, as a result of inappropriate feeding practices, will ultimately lead to undernutrition in the infant/child.
Common childhood diseases in developing countries, such as diarrhoea, upper respiratory infections and parasites are also important causes of undernutrition in children [16].
The underlying causes of undernutrition are thus food insecurity at the household level, inadequate prevention and control of disease, and inadequate care for vulnerable groups, including children and women. If one or more of these problems is present, it may lead to child undernutrition.
Direct nutrition-specific interventions aim at improving the diet of infants, young children and women by addressing the immediate causes of undernutrition [9]. The SUN movement recommends the rapid scaling-up of 13 direct nutrition interventions (see Text box 1). These interventions were adopted from the special series on mater- nal and child undernutrition in the prestigious medical journal The Lancet in 20086. These interventions focus on the ‘window of opportunity’ from minus 9 to 24 months (i.e. from conception through pregnancy to two years of age) with a high impact on reducing death and disease and avoiding irreversible damage.
Nutrition-related interventions are interventions targeting the underlying causes of undernutrition. These interventions should be designed to be ‘nutrition sensitive’, meaning that they should take nutritional aspects into consideration (see section 3.4) These include strategies related to agricultural investment, children’s education, public health services, social protection, and poverty alleviation (e.g. guaranteed employment).
6 http://www.thelancet.com/series/maternal-and-child-undernutrition
Food insecurity
Food security at the household level is a necessary, but insufficient prerequisite for individuals to enjoy a good nutritional status. The African Human Development Report from 2012 states that policies that enhance nutrition are central in ensuring that improved access to food translates into human development [17].
The Food and Agriculture Organization of the United Nations (FAO) defines food security as follows. “Food security exists when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life” [5]. In other words, food security requires not only the availability of food at regional or national level, but also access at the household level. Food security also implies food both in adequate quantities, and of adequate nutritional quality. Furthermore, the access has to be sustainable over time.
Text box 1. Evidence-based direct interventions to prevent and treat undernutrition
Promoting good nutritional practices
• improved breastfeeding practices
• improved complementary feeding for infants six months and older
• improved hygiene practices including hand washing
Increasing intake of vitamins and minerals
Provision of micronutrients for young children and their mothers:
• periodic vitamin A supplements
• therapeutic zinc supplements for diarrhoea management
• multiple micronutrient powders
• de-worming drugs for children (to reduce losses of nutrients)
• iron-folic acid supplements for pregnant women to prevent and treat anaemia
• iodised oil capsules where iodised salt is unavailable Provision of micronutrients through food fortification for all:
• salt iodisation
• iron fortification of staple foods
Therapeutic feeding for malnourished children with special foods
• prevention or treatment of moderate undernutrition
• treatment of severe undernutrition (“severe acute malnutrition”) with ready-to-use therapeutic foods (RUTF)
Source: Scaling Up Nutrition, 2011 [9]
Nutrition security has been defined as existing “when food security is combined with a sanitary environment, adequate health services and proper care and feeding practices to ensure a healthy life for all household members” [8].
Although the broad definition of food security embodies key determinants of good nutrition, the term food and nutrition security has been used as a way to combine the two concepts. A recent review by the Committee on World Food Security (CFS) on the use of key terms, recommended the following definition:
Food and nutrition security exists when all people at all times have physical, social and economic access to food, which is safe and consumed in sufficient quantity and quality to meet their dietary needs and food preferences, and is supported by an environment of adequate sanitation, health services and care, allowing for a healthy and active life [18].
This definition acknowledges the importance of key nutrition aspects such as care and feeding practices, public health and sanitation issues in addition to the emphasis on food availability, access and stability dimensions of food security. This termino logy also highlights the integral linkages between food security and nutrition security.
Food security should be understood as merely a precondition to adequate nutrition while different, but complementary actions are needed to achieve food and nutrition security. In other words, food security actions should ensure that food systems provide households with stable access to sufficient, appropriate and safe food, while nutrition- oriented actions should ensure that households and individuals have the knowledge and supportive health and environmental conditions necessary to obtain adequate nutritional benefit from the food [18].
The right to food has been articulated in numerous human rights instruments (listed in Annex D). The right to food has been interpreted in a way which closely links it to the right to adequate nutrition.
The direct causes of household food insecurity are related to the household’s liveli- hood and its level of vulnerability [19]. Most households in rural areas in developing countries rely on subsistence farming and are vulnerable to a number of food production factors, such as adverse weather conditions and inadequate access to land, manpower, agricultural inputs (fertilisers and pesticides) and agricultural tools. Households de- pendent on buying their food, are particularly vulnerable to food price increases. Most importantly, many food-producing smallholders around the world are net buyers of food – meaning they are vulnerable to both production- and market-related risks [19].
The main overall cause of food insecurity is poverty and lack of resources.
Inadequate prevention of disease
Access to preventive and curative health services is critical in ensuring good health and nutrition for all people. However, healthcare systems in many developing countries
suffer from lack of health personnel, medicines and equipment, reflecting structural problems at the governmental level [20]. In many developing countries access to health- care is largely dependent on households’ ability to pay for services and medicines [21].
Inadequate caring practices
Even if households have adequate access to food and health services, children depend upon others for essential care including provision of food, healthcare, stimulation and emotional support necessary for their healthy growth and development [22]. These caring practices translate food security and healthcare resources into a child’s well-being.
Even when poverty causes food insecurity and limited access to healthcare, enhanced caregiving can optimise the use of existing resources to promote good health and nutri- tion in children. Breastfeeding is an example of a caring practice that provides the child with food, health, and care simultaneously [22]. This concept of care would necessarily require time, support and adequate nutrition for mothers to breastfeed and care for the child. The caregiver should ensure that the child receives food of adequate quality and quantity, is fed frequently, and gets assistance with eating if necessary. Health-related caring factors also include timely care and medical treatment of children when ill, vac- cinations and professional follow up by health personnel when needed.
Factors leading to inadequate care include constraints related to time, capacity, resources and knowledge. In a development context, the role women play in provid- ing care is essential and needs to be fully understood and appreciated. Women’s weak social status can inhibit their ability to decide on, use and mobilise resources within the household to adequately care for their children and themselves [23, 24]. It is important to acknowledge that women are also regarded as a vulnerable group, because they have particularly high nutritional needs during pregnancy and lactation, but often consume a low share of the household’s food [25].
Basic causes
The fundamental causes of undernutrition are found in the availability of resources, and in their control and management. Thus, a country may be relatively rich in resources;
however, the benefits of these resources to much of the population are squandered due to inadequate management (i.e. bad governance, corruption, and unequal distribution).
This situation often results in undernutrition among the more disadvantaged groups.
Undernutrition, and stunting in particular, is therefore a sensitive indicator of the over- all level of development over time in a country, as well as reflecting inequality between social groups within a country. Also, both man-made and natural disasters – ranging from conflict and civil war to earthquakes and tsunamis – will affect the availability and distribution of resources.
3.2 Consequences of undernutrition
Undernutrition is the single largest contributor to the global burden of disease, account- ing for 10% of the total disease burden in the general population and for 35% among children under five years of age [26]. More than 35% of all child deaths are caused by undernutrition [6]. The Lancet series in 2008 estimated that the full implementa- tion of proven, direct nutrition interventions could reduce child mortality by about 25% [27]. Counselling pregnant women and new mothers about both the benefits of breastfeeding and the use of vitamin A and zinc supplements and fortified infant foods have the greatest potential to reduce the burden of child morbidity and mortality [27].
Nutrition is not only important for survival, but imperative for a child’s cognitive and physical development over the short and long term. For example, inadequate intake of iodine during foetal life and childhood has severe impact on the development of the brain, and iodine deficiency remains the most important cause of preventable mental diseases [28]. With girls, undernutrition-related stunting during childhood restricts growth leading to smaller pelvises and a higher risk of birth complications later in life [29]. The Lancet series showed that complementary feeding could be improved using strategies such as nutrition counselling, food supplements and conditional cash transfers – all strategies which can substantially reduce stunting and the related burden of disease [27]
Undernutrition also has intergenerational consequences. The mother’s nutritional and health situation before and during pregnancy determines to a large extent the nutritional and health status of the new-born. Low birth weight (i.e. under 2,500 g) affects 16% of new-borns in developing countries [4] and is an important cause of childhood stunting, morbidity and mortality [30].
Another serious consequence of undernutrition is that it increases the risk of non- communicable diseases (NCDs). Research over the past 20 years shows that children with low birth weight and who experience undernutrition early in life have a higher risk of becoming overweight and developing diabetes and high blood pressure as adults [31]. These diseases are on the rise in developing countries, and currently, more people die from NCDs than from communicable diseases in these countries [32]. Countries experiencing diseases related to both under- and overnutrition are often referred to as having a “double burden of nutrition-related diseases”.
3.3 Why is nutrition important for development?
From a development point of view, good nutrition is a prerequisite for a healthy popula- tion, which in turn is important for a country’s economic development. To enjoy good nutrition is a human right, articulated through the right to adequate food, the right to the highest attainable standard of health and the right to clean water and to care (see Annex D). For full realisation of these rights, women’s right to appropriate healthcare services throughout pregnancy and during delivery and the post-natal period, along with adequate nutrition during pregnancy and while lactating, are both important in their own right and indispensable for those of their children.
While hundreds of millions of people have improved their living standards over the past 20 years, the number living below the international poverty line remains high, especially in sub-Saharan Africa [33]. Beyond the uneven development glob- ally, inequality is increasing within countries [33]. Rising income inequality creates economic, social and political challengeswith various direct effects on nutrition [34].
Poorer people are worse off when it comes to most health and nutrition indicators (i.e.
under-five mortality and undernutrition) [34]. The poor people are also disadvantaged in terms of access to and use of health services [34], and are hardest hit by increased food prices [35].
Healthy, well-nourished populations play a significant part in economic growth and development. However, the economic losses due to undernutrition are extensive as the following statistics and estimates suggest:7
• Undernutrition affects national economic growth negatively and is estimated to result in GDP losses of low-income countries of as much as 2–3% per annum [36].
• The direct cost of child undernutrition globally has been estimated as being between United States Dollars (USD) 20-30 billion per year [37].
• Experimental evidence suggests that tackling undernutrition early in life can lead to as much as a 46% increase in earnings as an adult [38].
• A 1% loss in adult height due to childhood stunting is associated with a 1.4% loss in productivity later in life [39].
The Copenhagen Consensus, which is a group of the world’s leading economists, identified the smartest ways to allocate a notional USD 75 billion to respond to ten of the world biggest challenges. The Copenhagen Consensus 2012 Expert Panel found that fighting malnourishment should be the top priority for policy-makers and philanthropists [40]. It suggested doing this by combining or ‘bundling’ the following
7 Refer to Save the Children’s report, A Life free from hunger: tackling malnutrition [45].
interventions: micronutrient provision, complementary foods, treatments for worms and diarrhoeal diseases, and behaviour change programmes. Based on new research by John Hoddinott of the International Food Policy Research Institute (IFPRI), for just USD 100 per child, these interventions could reduce chronic undernutrition by 36% in developing countries [41]. Nutrition-related interventions occupied three of the top sixteen worthy investments proposed by the Copenhagen Consensus Panel (see Text box 2).
3.4 Global actors in nutrition
Who are they?
To briefly summarise the related roles of the key UN organisations, UNICEF and the WHO are the main UN actors working on the health-related aspects of nutrition, while the FAO and the International Fund for Agricultural Development (IFAD) are the main actors working on the food-security related aspects of nutrition. World Food Programme (WFP) is the UN’s ‘food aid arm’, with a particular responsibility of providing food in emergency situations. The United Nations Systems Standing Com- mittee on Nutrition (UN SCN) was established as a forum for harmonising food and nutrition policies for UN organisations by the United Nations Economic and Social Council (ECOSOC) in 1977. UNSCN has recently been reformed, and it aims to provide effective and coordinated UN responses to global nutrition challenges. CFS has also been reformed and is now steered jointly by the FAO, WFP and IFAD. A High
Text box 2. The top six investment priorities from the Copenhagen Consensus 2012
1. Bundled micronutrient interventions to fight hunger and improve education
2. Expand the subsidy for malaria combination treatment 3. Expand childhood immunisation coverage
4. Deworming of schoolchildren, to improve educational and health outcomes
5. Expand tuberculosis treatment
6. Research and development to increase yield enhancements, to decrease hunger, fight biodiversity destruction, and lessen the effects of climate change
Source: Copenhagen Consensus 2012 [40]
Level Panel of Experts (HLPE) on food security and nutrition was created as part of the reforms to advise the CFS.
A number of international NGOs and research institutions are also active in pro- moting nutrition, and most of these have joined the SUN movement.8 The interna- tional NGOs most actively working with nutrition programmes are Action Against Hunger (ACF), Concern Worldwide, Helen Keller International, Médecins Sans Frontières (MSF), the Micronutrient Initiative, Oxfam International, PATH, Save the Children International and World Vision International; all are partners in SUN.9
Global nutrition initiatives
Over the last few years, global nutrition-related problems have received increased international attention; partly brought about by the above-mentioned The Lancet series on maternal and child undernutrition. In addition, the unprecedented increase in food prices in 2008, combined with the fear of increased hunger and malnutrition, also contributed to the launch of new initiatives to promote food security and nutrition.
Nutrition initiatives
One of the largest recent global nutrition initiatives is the SUN movement. Initiated in 2009, SUN is a multi-stakeholder movement aimed at supporting national leader- ship on nutrition. The initiative involves focusing and aligning financial and technical support for nutrition-sensitive national plans, as well as promoting broad ownership of nutrition and development goals. A framework for action has been developed by a multi-stakeholder group (for the main elements, refer to Text box 3) [9]. The SUN framework recommends two priority policy responses for scaling up nutrition using a twin-track approach:
1. Implementing specific nutrition interventions with high coverage and proven efficacy and effectiveness. The interventions are divided into three main areas: 1) promot- ing optimal young child feeding and caring practices, such as breastfeeding; 2) increasing the intake of vitamins and minerals through both supplements and fortification; and 3) therapeutic feeding to prevent moderate undernutrition and treating both moderate and severe undernutrition. The recommended scaling up of these interventions was in part based on evidence of effective nutrition interven- tions as described in The Lancet series and cost-benefit analyses conducted by the World Bank [36].
8 For the NGO declaration and list of all member organisations, see: http://scalingupnutrition.org/wp- content/uploads/2012/09/archived/civil-society-statement-english-with-orgs.pdf.
9 The list is not exhaustive.
2. Nutrition-focused development through pursuing resilience-centred policies in key sectors that have an impact on undernutrition such as agriculture, food supply, social protection, health and education programmes.
A SUN Roadmap was developed in 2010 and updated in 2012. The roadmap provides principles and directions for increased support for countries as they scale up efforts to tackle undernutrition across a range of sectors [42].
Text box 3. Scaling Up Nutrition: a Framework for action
The main elements of the framework for action are as follows.
• Start from the principle that what ultimately matters is what happens at the country level. Individual country nutrition strategies and programmes, while drawing on international evidence of good practice, must be country-“owned”
and built on the country’s specific needs and capacities.
• Sharply scale up evidence-based, cost-effective interventions to prevent and treat undernutrition, with highest priority to the minus 9 to 24 month win- dow of opportunity for the highest returns on investments. A conservative global estimate of financing needs for these interventions is upwards of USD 10 billion per year.
• Adopt a multi-sectorial approach that includes integrating nutrition into related sectors and using indicators of undernutrition as one of the key measures of overall progress in these sectors. The closest actionable links are to food security (including agriculture), social protection (including emergency relief) and health (including maternal and child health care, immunisation and family planning).
There are also important links to education, water-supply and sanitation, as well as to cross-cutting issues like gender equality, governance (including account- ability and corruption), and state fragility.
• Provide substantially scaled up domestic and external assistance for country- owned nutrition programmes and capacity. Ensure that nutrition is explicitly supported in national and global initiatives for food security, social protection and health, and that external assistance follows the aid effectiveness principles stated in the Paris Declaration and the Accra Agenda for Action. Support major national and global efforts for strengthening the evidence base (i.e. through better data collection, monitoring, evaluation, and research) and for advocacy in particular.
Source: Scaling Up Nutrition, 2011 [9]
SUN has built up a global coalition of more than 100 partner organisations and secured high-level political commitment to nutrition in 30 high-burden countries10. The SUN countries have agreed on a number of processes, which include: (i) identifying a government focal point and a donor convenor; (ii) setting up and/or strengthening a multi-sectorial platform to engage multiple stakeholders; (iii) updating national policies, strategies and plans of action; and (iv) establishing a common results frame- work. Partner countries can contribute to national nutrition plans by building political momentum, and securing the investment of financial and technical resources to sup- port the country-specific priorities. The UN Secretary-General (SG) has appointed a high-level, multi-stakeholder Lead Group to provide overall strategic leadership.
Dr. David Nabarro was appointed as the Special Representative on Food Security and Nutrition by UN SG Ban Ki-moon. Dr. Nabarro is the coordinator of the SUN Secretariat, based in Geneva.
Renewed Efforts Against Child Hunger (UN-REACH) is an inter-agency initiative established in 2008 by the FAO, UNICEF, WFP and WHO [43]. Currently 15 coun- tries participate in the initiative. As part of the campaign to reduce undernutrition, the aim is to pioneer new ways for the UN to “deliver as one”. UN-REACH is committed to reduce child undernutrition by supporting countries to intensify efforts through government-led, multi-stakeholder partnerships involving the UN, civil society and the private sector. UN-REACH promotes interventions in priority areas relating to food security, health and care as strategies. The approach involves establishing facilitators in each country, usually under the UN resident coordinator, to assist UN country teams and partners to create operational synergies and apply successful practices.
The World Health Assembly (WHA) adopted resolutions on maternal, infant and young child nutrition and endorsed “The comprehensive implementation plan”
(A65/11) in May 2012 [44]. This plan contains six global targets for nutrition, includ- ing a global target to reduce stunting by 40% by 2025 (see Text box 4 on the next page).
The WHA plan also proposes actions to be implemented by member states and international partners in order to reach these targets. The WHA plan makes reference to SUN and the UNSCN and recommends that international partners engage in these partnerships and initiatives [44].
Launched in June 2012 at the Rio+21 Summit, the “Zero Hunger Challenge” re- cognised food as a human right, and the UN SG, Ban Ki-moon, called on governments, business partners and civil society to scale up efforts to end hunger. Partners in the initiative include the FAO, IFAD, WFP, UNICEF, the World Bank and Biodiversity International. The objectives are ambitious and focus on improving food security, reducing stunting in children under two years of age and reducing malnutrition in childhood and during pregnancy.
10 http://scalingupnutrition.org/countries-involved
In November 2013, the ICN+21 will convene in Rome, 21 years after the last ICN in 1992. This conference aims at: reviewing developments over the last two decades since the adoption of the World Declaration and Plan of Action for Nutrition; and identifying the opportunities and challenges for improving nutrition. The ICN+21 will bring together global actors in nutrition and aims at further increasing global political attention to nutrition.
Save the Children’s “Every one” campaign has as an overall objective to save chil- dren’s lives; the campaign focuses as a first step on hunger and undernutrition. Save the Children’s report, “A Life free from hunger: tackling child malnutrition”, describes the extent of the undernutrition problem and proposes interventions to tackle it [45].
The report provides a six-step strategy to achieve national and international attention and proposes actions and interventions to improve the nutritional status of children globally (see Text box 5).
Text box 4. Global targets for maternal, infant and young child nutrition adopted by the World Health Assembly, May 2012
Global target 1: a 40% reduction in stunting by 2025 for children under five years of age.
Global target 2: a 50% reduction of anaemia by 2025 amongst women of child- bearing age.
Global target 3: a 30% reduction in the prevalence of low birth weight by 2025.
Global target 4: zero growth in the number of overweight children by 2025.
Global target 5: a 50% increase by 2025 in exclusive breastfeeding during the first six months of an infant’s life.
Global target 6: Reducing and maintaining childhood wasting to less than 5%.
Source: World Health Assembly, 2012 [44]
Text box 5. Save the Children’s six key steps for transforming and tackling the malnutrition challenge
1. Make malnutrition visible: Chronic malnutrition is a hidden killer that kills slowly and doesn’t appear on death certificates. In order to make the deaths of these children count and to make governments accountable for preventing them, there must be an agreed global target for a reduction in stunting in the countries with the highest burden.
2. Invest in direct interventions: The cost of scaling up the ‘Lancet package’ of 13 interventions, including fortification, is USD 10 billion a year. It could save 2 million lives.
3. Fill the health worker gap: There is a critical shortage of at least 3.5 million doc- tors, nurses, midwives and community health workers, who are vital in delivering the direct interventions that can improve nutrition. Governments and donors should work together to fill this health worker gap by recruiting, training and supporting new and existing health workers, and deploying them where they are most needed.
4. Protect families from poverty: Many of the best examples of progress in tackling malnutrition have come from countries that have invested in effective social protection policies that reach vulnerable families. Countries should work to- wards establishing systems that reach pregnant and breastfeeding women, and children under two.
5. Harness agriculture to help tackle malnutrition: Governments must support small- scale farmers and female farmers, and ensure that making a positive impact on nutrition is an explicit objective of agriculture policies, by focusing on projects that are designed to improve children’s diet – for example, home gardening or education projects that focus on nutrition.
6. Galvanise political leadership: Raising the profile of malnutrition requires build- ing up political momentum to galvanise change. The US G8 and the Mexican G20 in 2012, as well as the UK G8 in 2013 all offer major opportunities for progress as food, nutrition and social protection are likely to be on the agenda. These countries should work together to ensure an ambitious action plan that aligns institutional reform with clear delivery of new resources. With support from the international community, countries with high malnutrition burdens should exhibit the leadership and commitment needed to eliminate malnutrition.
Source: Save the Children, 2012 [45]
Food security initiatives and frameworks
The most recent significant event in the global governance of food security is the CFS’s adoption of the Global Strategic Framework for Food Security and Nutrition (GSF) at its 39th session in Rome in October 2012 [46]. This framework is based on a number of earlier frameworks, namely: the MDGs; the Voluntary Guidelines on the Right to Food (VGRtF)11 [47]; the five Rome principles for sustainable global food security [48]; the Voluntary Guidelines on the Responsible Governance of Tenure of Land, Fisheries and Forests in the Context of National Food Security [49] ; the UN Updated Comprehensive Framework for Action (UCFA, see below) [50]; and various high-level forums on aid effectiveness.
The GSF recommends adherence to a twin-track approach implying concurrently implementing both: direct action to immediately tackle hunger and malnutrition; and medium- and long-term actions to build resilience and address the root causes of hunger [46]. This approach is in keeping with the five Rome principles adopted by the World Summit of Food Security, as well as the UCFA. The GSF suggests that social protection instruments such as safety nets (whether cash or food-based transfers) can serve as a bridge between the two tracks. The strategic framework further addresses the following priority areas: small-scale producers, in particular women; food price volatility; gender issues; increasing sustainable agricultural productivity and production; nutrition; the tenure of land, fisheries and forests; and food security and nutrition in protracted crises. The GSF reiterates that the VGRtF offers countries practical guidelines for the effective implementation and monitoring of the GSF framework [46].
The GSF has a separate section on nutrition where it argues for the implementation of specific actions to improve nutrition. This implementation should be done using both direct nutrition interventions and through integrating nutrition into national strategies, policies and programmes for agriculture, food security, health, food quality and safety, water and sanitation, social protection and safety nets, rural development and overall development [46]. The section on nutrition further refers to the VGfRT which has several nutrition-relevant recommendations. The GSF makes reference to the UNSCN, which is a member of CFS’s Advisory Group, UN-REACH, the SUN movement and the WHA implementation plan on maternal, infant and young child nutrition. The strategy states: “Future CFS work could leverage those and other initia- tives to agree on ways to promote deeper policy integration between agriculture, health and other sectors in favour of comprehensive food security and nutrition strategies and processes at national level” [46].
Regional initiatives, in particular the Comprehensive Africa Agriculture Devel- opment Programme (CAADP), which is the agricultural programme of the New
11 The complete title is “Voluntary Guidelines to support the progressive realisation of the right to adequate food in the context of national food security”.
Partnership for Africa’s Development (NEPAD), are also referred to as important partners by the GSF. CAADP is an Africa-owned and Africa-led initiative meant to improve food security and nutrition and boost agricultural productivity in the mainly farming-based African economies.
The HLPE recently published a report which synthesised the evidence on social protection for food security [19]. The report aims to serve two functions. It provides an evidence-based review of social protection interventions that have food security outcomes or intentions. Secondly, it supports efforts to frame social protection for food security in the context of international norms, principles and procedures for human rights, especially the right to adequate food and to be free from hunger and the right to social security as part of economic, social and cultural rights. The report recom- mends that all countries design and implement a comprehensive, legally-empowered, social-protection system to provide every citizen with the opportunity of enjoying a productive and healthy life. At the global level, the report recommends that the CFS assists establishing an Annual Social Protection Monitor, which would provide data on the steps taken in different countries to achieve the goal of sustainable food security through a rights-based and life cycle approach to entitlements.
Previous events include the establishment a High-Level Task Force (HLTF) on Global Food Security by the UN SG in 2008. The UN SG Special Representative for Food Security and Nutrition, Dr. Nabarro, is the coordinator of the HLTF. The HLTF developed a Comprehensive Framework for Action (CFA) in 2008 and subsequently updated it in 2010 (i.e. Updated CFA or ‘UCFA’) and complemented it in 2011 with a UCFA summary version. The UCFA is meant to be a UN system-wide coordinated approach for supporting country actions that lead to sustainable and resilient rural livelihoods and food and nutrition security [46].
At the 2009 meeting of the G8 in L’Aquila, Italy, world leaders agreed on five prin- ciples for sustainable global food security and committed USD 22 billion over three years for the development of sustainable agriculture and safety nets for vulnerable populations. The 27 countries and 15 international organisations involved named this effort the L’Aquila Food Security Initiative (AFSI). Impetus from AFSI was taken further by the G20 meeting in Pittsburgh which called for the creation of a World Bank- managed food security trust fund. The fund was named The Global Agriculture and Food Security Programme (GAFSP) and was launched in April 2012. The trust fund is based on aid effectiveness principles and coordinates donor support for strategic, country-led agricultural and food security plans.
At the Camp David G8 Summit in May 2012, food security and child nutrition were main themes, and President Obama committed USD 3 billion for the New Alliance for Food Security and Nutrition [51].
Global health initiatives
A number of maternal and child health initiatives have been initiated since the MDGs were adopted. The Global Campaign for the health MDGs was initiated in 2007, with Norway as a driving force. The campaign brings together global actions and initiatives that seek to accelerate progress towards achieving the health MDS through more efficient and effective collaboration.
The Partnership for Maternal, Newborn and Child Health brings together most of the actors in the global health community focused on improving the health of women and children, with the vision to achieve the health MDGs. The Partnership’s mission is to support partners to align their strategic directions and catalyse collective action to achieve universal access to comprehensive, high-quality reproductive, maternal, newborn and child health care.
The Every Woman Every Child (EWEC) initiative was launched by the UN SG during the UN MDG Summit in September 2010. EWEC aims at reducing maternal and child mortality. It is a global movement that mobilises and intensifies international and national action by governments, multilaterals, the private sector and civil society to address the major health challenges facing women and children around the world.
The Global Strategy for Women’s and Children’s Health presents a roadmap on how to enhance financing, strengthening policy and improving service on the ground for the most vulnerable women and children. The Global Strategy mentions prevention and treatment of nutrition as part of a comprehensive, integrated package of essential interventions and services.
The GAVI alliance, established in 1999, aims at reducing child mortality and pro- tect health by increasing access to immunisation in the world’s poorest countries. GAVI has four strategic goals, which are (i) to accelerate the uptake and use of underused and new vaccines; (ii) strengthen capacity of integrated health systems to deliver immunisa- tion; (iii) increase predictability and sustainability of financing for immunisation; and (iv) shape vaccine markets to provide appropriate and affordable vaccines.
