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[pronut-hiv] The Neglected Crisis of Undernutrition: DFID's Strategy

  • From: "ProNut-HIV" <>
  • Date: Sun, 14 Mar 2010 08:21:22 -0400

Executive Summary

The problem
Undernutrition is a human disaster on a vast scale. Chronic undernutrition affects one in three children in developing countries. Every year it causes the death of more than three million children and more than 100,000 mothers. Undernutrition cripples the immune system, making children much more susceptible to disease. It increases the risk of anaemia and women dying during pregnancy and childbirth. It prevents proper brain development, which means children are less able to start school when they should, and less able to learn and perform. Adults who were undernourished in childhood earn significantly less and contribute less to economic growth. Undernutrition reduces GDP by at least 2-3%.

The global target of reducing by half the prevalence of underweight children under five years of age by 2015 shows wholly insufficient progress; progress which could be reversed by the economic downturn, the persistence of conflicts and state fragility and the increasing impact of climate change. With less than five years to go to 2015, a massive international effort is required as a matter of urgency. DFID has been supporting nutrition and investing heavily in related sectors but progress has not been fast enough. For these reasons, DFID has decided to increase its focus on nutrition and strengthen its capacity to respond to the ongoing nutrition crisis.

The determinants
Undernutrition arises from complex, multiple and interactive causes. The immediate causes include inadequate dietary intake and disease. Underlying these are causes operating at household and community levels: household food insecurity, inadequate care for women and children, and unhealthy household environments and lack of health services, with income poverty underpinning all three. Ultimately, these factors are determined by the larger political, economic, social and cultural environment. Gender inequalities act at all levels. Gendered power relations are a key factor in decision making within the household and often in ensuring the entitlement of female household members to adequate nutrition. The complex causality calls for a multi-sectoral approach and action at different levels to effectively address undernutrition in the long term.

The response
Delivering an effective multi-sectoral response requires strong co-ordination and leadership at national and international levels. However, national capacity and response are often weak and there is often low political demand for action against undernutrition. Top level leadership is needed to clearly define the roles and responsibilities of each sector necessary to achieve a common goal. Weaknesses of national level systems for nutrition are further compounded by an ineffective international system with weak co-ordination and limited collective action.

In spite of these challenges, evidence shows that improvements in nutrition are attainable. Economic growth is a crucial catalyst for improving nutrition, but on its own it is not enough. Given the major disparities in nutritional status between poor and better off families, inequitable economic growth does little to improve nutrition but economic growth that reaches the poorest can play an important part in the overall response. However, even if growth is equitable, it is not enough to deliver the fast results required, so investment in direct and indirect approaches must be given equal attention. Proven direct interventions can, if delivered at scale, reduce stunting by a third. These must be supported by indirect interventions to eliminate stunting in the longer term.

Framework for Action
This strategy rests on a set of core principles which commit us to concentrating our resources where we can achieve the greatest short and long term impact. We will focus on reaching pregnant women and children under the age of two in countries with the highest burden of undernutrition, because beyond a childâs second birthday the damage from chronic undernutrition cannot be corrected. We will invest in direct interventw achieve high impact at low cost, as well as indirect interventions which tackle underlying causes. And we will pay specific attention to womenâs power and agency, since gender inequality blocks progress in tackling undernutrition in multiple sectors.

The strategy has four strategic objectives:
1. MOBILISING AND COORDINATING THE INTERNATIONAL RESPONSE. We will work with our partners to secure a more co-ordinated and more effective international response to this neglected crisis. We will help to move this issue up the political agenda, help mobilise more resources where they are needed and monitor progress at the highest levels. In 2010 we will support the development of a Global Action Plan on nutrition to be launched at the MDG Review Summit in September.

2. REACHING 12 MILLION CHILDREN THROUGH PROGRAMMES IN OUR PARTNER COUNTRIES. We will focus our direct support on those six countries that together account for half of the worldâs undernourished children under five. We are confident that we can improve the nutrition of at least 12 million children over the next five years â 10% of all undernourished children around the world. We will also continue to focus on nutrition in our emergency response work.

3. INVESTING IN MULTIPLE SECTORS TO DELIVER IMPROVED NUTRITION. We will make sure our support for social protection, agriculture, health, water and sanitation, governance and education delivers meaningful improvements in nutrition too. This means, for example, making sure that our support to national health plans leads to more women and children getting the proven low cost interventions such as support for breastfeeding or vitamin and mineral supplements. Or, in social protection, making sure that women receive income support when they most need it over the maternity period.

4. BUILDING EVIDENCE AND DEMONSTRATING RESULTS. We will invest in research and evaluation programmes so that we can measure the impact of our work and make it easier for effective approaches to tackling undernutrition to be widely adopted. We know how to reduce undernutrition by a third, just by scaling up a small set of high impact health services. But the evidence on how to tackle the underlying causes is much less clear. We will address some of these critical gaps in knowledge.

We will monitor the implementation of this strategy on an annual basis and boost our own capacity to deliver it. Undernutrition must be addressed as a priority if DFID is to deliver on its commitment to poverty reduction. The strategy outlines how we will work with others to achieve this.

The document is at: