What can be done to accelerate progress against undernutrition?

Many organisations work to eliminate undernutrition in children and pregnant and lactating women in developing countries. These organisations – international organisations, donors, academia, civil society and private sector – are loosely linked as an international nutrition system. However, this system is fragmented and dysfunctional.

Research published in The Lancet identifies four areas in which the international system must improve.

Stewardship and guidance

The international nutrition system develops international legislation and provides guidance to national nutrition groups. However, this is often inconsistent, not prioritised and impractical. For example, the guidelines produced by different organisations on how to address micronutrient deficiencies offer conflicting evidence about the effectiveness of different approaches.

International organisations must work together to create simple, consistent and prioritised guidance. This should be based on evidence from impact evaluations of past projects and programmes, and careful analysis of the implications for nutrition of major global changes, such as climate change and rising energy prices.

Aid and investment

The amount of aid for direct nutrition interventions, such as vitamin supplementation and infant feeding, is comparatively low. From 2000 to 2005, aid for basic nutrition in low and middle-income countries (which includes providing key micronutrients and covering the needs of severely undernourished people) was between US$250 million and US$300 million each year.

By comparison, donor funding for HIV/AIDS was US$5.7 billion – about 20 times greater – even though no more Disability Adjusted Life Years (the years of life lost due to premature death) are lost to HIV than to maternal and child undernutrition. Funds for nutrition are an important investment in the future of low and middle-income countries. International donors should increase aid flows and better target them to the neediest population groups.

Direct service provision

Natural disasters and armed conflict can limit the effectiveness of nutrition interventions, for example by reducing local food availability. In these situations, the international system can support humanitarian responses. However, there is currently little published information on the impact of humanitarian responses on nutrition, or the impact of nutrition interventions in emergencies.

Although several organisations provide guidance on best practice in emergencies, no agency has overall responsibility for assessing the effectiveness (and cost-effectiveness) of different interventions. Documenting these and building on experiences will create a minimum set of operational standards. Meanwhile, better coordination would allow humanitarian organisations to improve emergency responses.

Strengthening resources

The shortage of appropriately skilled personnel is a major constraint to better nutrition programmes. Interviews at training centres and universities showed that, with some notable exceptions, social, economic and food sciences are poorly represented amongst academic staff.

Funding bodies must provide incentives to re-orientate research to more programme-relevant topics, such as ways to increase the scale of effective nutrition interventions. Better leadership from academic journals would support this; editors of academic journals should meet in 2008 to develop a strategy to increase the profile and relevance of nutrition research.

To improve in these four areas, individual organisations and the system as a whole must examine their strategies, resources and motivations. Organisations must significantly improve their links with national level processes, so that country level priorities are better reflected in international guidance, donor funding, research and training.

Ricardo Uauy
Public Health Intervention, Research Unit, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
Ricardo.Uauy@lshtm.ac.uk

See also

'Effective International Action Against Undernutrition: Why has it Proven so Difficult and What can be Done to Accelerate Progress?' The Lancet 371 pages 608–21, by Saul Morris, Bruce Cogill and Ricardo Uauy, January 2008

'Hunger And Malnutrition' Copenhagen Consensus Challenge Paper, by Jere R Behrman, Harold Alderman and John Hoddinott, 2004

Views expressed on these pages are not necessarily those of DFID, IDS, id21 or other contributing institutions. Copyright remains with the original authors but (unless stated otherwise) any article may be copied or quoted without restriction, provided both source (id21, insights) and authors are properly acknowledged and informed. Copyright © 2006 id21. All rights reserved.