what is an enabling environment for nutrition
DESCRIPTION
Describes how an enabling environment for nutrition can be built--components--and brings in examples from around the world. By Lawrence Haddad of IFPRITRANSCRIPT
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What is an enabling environment for nutrition and how can it be built?
Lawrence Haddad, IFPRI
University of Zambia September 23, 2014
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Enabling Environments Make it Easier for Everyone to Contribute
to Nutrition Improvement
1. Building Awareness2. Making Commitments3. Governance arrangements4. Mobilising Resources5. Holding Stakeholders to Account6. Capacity and Data to support 1-5
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1. Building awareness of the problem and its consequences
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Thompson, R. A., & Nelson, C. A. (2001). Developmental science and the media: Early brain development. American Psychologist, 56(1), 5-15.
Human Brain Development
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5Bloom, D. and D. Canning. January 2011. Demographics and Development Policy. PGDA Working Paper No. 66. Harvard University
The Demographic Dividend will only be fully realised at low levels of undernutrition
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Effective framing of how little attention nutrition gets in aid spending
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2. Making Commitments
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Reasons for Weak Commitment to Nutrition
Adapted from Heaver, Richard. 2005. Strengthening Country Commitment to Human Development: Lessons from Nutrition. Washington, DC : World Bank. https://openknowledge.worldbank.org/handle/10986/7310
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1. Malnutrition is usually invisible to malnourished families and communities.
2. Families and governments do not recognise the human and economic costs of malnutrition.
3. Governments may not know there are faster interventions for combating malnutrition than economic growth and poverty reduction or that nutrition programmes are affordable.
4. Because there are multiple organisational stakeholders in nutrition, it can fall between the cracks.
5. Malnourished people have little voice.
6. Governments sometimes claim that they are investing in improving nutrition when the programmes they are financing have little effect on it
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9www.hancindex.org
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Civil Society, Galvanising Commitment: Hunger and Nutrition Commitment Index (HANCI)
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<1000 1000-1499
1500-1999
2000-3499
>=3500
High commitment
Malawi Guatemala
Madagascar
Brazil
Peru
Philippines
Indonesia
Moderate commitment
Mozambique
Burkina Faso
Tanzania Vietnam
Rwanda Gambia
Mali Ghana
Zambia Bangladesh
Low commitment
Niger Ethiopia Benin Cambodia India
Sierra Leone
Nepal Cote d’Ivoire
Nigeria China
Uganda Senegal Pakistan South Africa
Very low commitment
Congo,DR Togo Kenya Lesotho Angola
Liberia Afghanistan
Sudan
Burundi Guinea B Yemen
Cameroon
Mauritania
HANCI political commitment groupings by Gross National Income per capita
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Commitment to Nutrition is Not the Same as a Commitment to Hunger Reduction
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Locking in CommitmentNutrition and the post 2015
Development Goals
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3. Governance Arrangements
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Need for a more in depth and political analysis of nutrition governance
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Doing the right things in the right orderPrioritising and sequencing
Source: Doing Growth Diagnostics in Practice: A ‘Mindbook’ Ricardo Hausmann, Bailey Klinger, Rodrigo Wagner CID Working Paper No. 177 September 2008. Harvard University. 17
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Multistakeholder action—how coordinated does it have to be?
As coordinated as it needs to be
• Broad based action• Political shift in national identity, e.g. Brazil• Perfect storm: Good things happening for nutrition in a number of areas, some planned, some not
e.g. Maharashtra
• “Think intersectorally, act sectorally”• Convergence, e.g. India, open defecation• Coordination, e.g. SUN national plans of action
• Integrated action• Embedded components, e.g. DFID in Bangladesh• New interventions, e.g. HKI in Burkina Faso
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4. Mobilising Resources
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20Planning and costing for the acceleration of actions for nutrition: experiences of countries in the Movement
for Scaling Up Nutrition. SUN. May 2014. www.scalingupnutrition.org
Composition of costed country nutrition plans, SUN members
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How much money is needed for nutrition specific interventions?
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$4bn additional donor funding
pledged at Nutrition 4
Growth Summit
7 years 2013-2020
$10bn extra
spendingrequired
/year
Domestic $50bn
Donor $20bn
Total $70bn
Donor scale up $10bn
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Resources for Nutrition: Look everywhere but be guided by a plan, with checks and
balances
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Nutrition Sensitive
Different Spending
Categories for Nutrition
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The Private Sector and nutrition: why bother?
• The private sector already plays a large role in delivering to people in poor countries
• foods, health care, water and sanitation• in India, private health services accounted for 56 percent of health care use in the
poorest households
• Private sector has enormous logistical reach which could serve the poorest• in many developing countries, the private sector owns and manages 40 to 50
percent or more of the country’s health infrastructure
• Private sector may need the public sector to expand reach the poorest • Subsidies in rural areas• Increase demand through public health campaigns
• Regulation and tax changes could make private sector more pro-nutrition
Adapted from: Partnerships with the Private Sector in Health. What the International Community Can Do to Strengthen Health Systems in Developing Countries. Final Report of the Private Sector Advisory Facility Working Group. April Harding, Chair November 2009
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The Private Sector: Improving the nutrition status of the poorest
while making a profit—can it be done?
Improving nutrition outcomes for the
poorest
Strengthening the enabling
environment for nutrition
Making a profit
When does this overlap
exist?
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5. Holding stakeholders to account
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Making Commitment Transparent
• In Speeches (from Jan 2005-end 2006) • DFID: 0/50 • EC: 0/28
• In Press releases (from Jan 2005-end 2006)• DFID: 0/197• EC: 0/239
• In policy documents• 0 in G8 2005 and 2006• 12 in Commission for Africa Report• 0 in DFID Social transfers and chronic poverty• 0 in European Consensus on Development
Source: Sumner, Lindstrom and Haddad 2007. IDS Sussex
Public Commitments: Mentions of Nutrition
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Citizen Feedback: Are nutrition programmes working?
Randomised control trial of community-based monitoring of public primary health care providers in Uganda
• Citizen report cards reduced child mortality by 33 per cent
• The study documents large increases in utilisation and improved health outcomes
• Cost per child death averted was $300, well below the average of $887 for 23 other interventions.
Björkman, M and Svensson, J. (2009) 'Power to the People: Evidence from a Randomized Field Experiment on Community Based Monitoring in Uganda’, The Quarterly Journal of Economics, Vol 124: 2, pp 735–69
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Cumulative donor spending commitments on nutrition specific and sensitive programmes : 12 major donors
29SUN Donor Network. June 2014.
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SUN Review of Nutrition Budget Data Availability
• General budget allocation information was publicly accessible for only 32 of 51 SUN countries
• 28 of the 32 countries had up to date information • 21 of the 28 country budgets had the necessary detail at the programme level to
be able to assign line items in different departments to nutrition• In 10 of 21 countries there was a clear nutrition programme which helps to make
some nutrition spending more visible• Budgetary analyses like this are incomplete because they frequently exclude
recurrent costs such as staff costs• Information on actual expenditure is scarce• Different countries use different methods to track budget allocations and
expenditures on health, including: Public Expenditure Reviews (PER), National Health Accounts (NHA), the Clinton Health Access Initiative (CHAI) Resource Mapping Tool, and Public Expenditure Tracking Surveys (PETS).
30See Picanyol, C. and P. Fracassi (2014). “Tracking Investments at Country Level”, draft, 16th of June. SUN Secretariat .
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6. Capacity and data gaps that make an environment less enabling
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System capacity to address malnutrition is
inadequate-- and opportunities
are limited
Maternal and child undernutrition: effective action at national level
Jennifer Bryce, Denise Coitinho, Ian Darnton-Hill, David Pelletier, Per Pinstrup-Andersen, Lancet 2008.
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India: Filling front line vacancies to reduce child stunting in Maharashtra
• Even in Maharashtra, the wealthiest state in India, 39 per cent of children under age 2 were stunted in 2005–2006. But by 2012, according to a statewide nutrition survey, the prevalence of stunting had dropped to 23 per cent
• The State Nutrition Mission began by working to improve the effectiveness of service delivery through the Integrated Child Development Services and the National Rural Health Mission, the national flagship programmes for child nutrition, health and development.
Their focus was on filling vacancies in key personnel, particularly front-line workers and supervisors, and on improving their motivation and skills to deliver timely, high-quality services in communities.
Unicef 2013 Report
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Individual capacity can
make a difference:
Health Centre Workers in India, asked, without
prompting, “what is important for keeping a
child healthy and strong?”
www.hungamaforchange.org/ 34
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Evidence Gaps
• Data on current capacity levels• Better tools on how to sequence and prioritize all
nutrition actions• More evidence and impact evaluations on how the
private sector can best add value• Systems that allow governments to track nutrition
spending easily and accurately
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Summary
1. Building Awareness – tap into your audience2. Making Commitments – identify them, make public3. Governance arrangements – don’t get stuck on a model of horizontal
coordination, don’t forget about vertical coordination4. Mobilising Resources—make sure they are driven by a plan5. Holding Stakeholders to Account – transparency and civil society are
key6. Capacity and Data to support 1-5 – transparency and holding to
account requires data
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Thank You