From global mantra to local results: scaling up impact on nutrition

From global mantra to local results: scaling up impact on nutrition

The Transform Nutrition consortium recently reviewed approaches to scaling up impact on nutrition, and a number of elements repeatedly emerged as key factors. First, the starting point for most successful large-scale programs (such as Progresa-Opportunidades in Mexico and Alive & Thrive in Bangladesh) was not any one intervention per se, but rather a discussion and ultimately a shared vision of what large-scale impact actually looks like. Second, successful scale-up usually requires that program designers match the characteristics of interventions with the dynamic context, explicitly recognizing the need for adaptation and flexibility over time and space. Such experiences usually involved an explicit focus on contexts—socioeconomic, institutional, political, cultural—at different levels from households up to districts and beyond. Program designers proactively pursued scaling up through defined strategies that went well beyond the quantitative (scaling out) aspects, to also consider functional, organizational, and even political scaling. These strategies recognized key drivers and catalysts, including nutrition champions (such as Santiago Levy, the main architect of the Progresa-Oportunidades anti-poverty program in Mexico). They also recognized and anticipated potential barriers and developed approaches to circumvent them. For example, the use of mass media in Alive and Thrive in Bangladesh was central to a supportive social environment for promoted behaviors. Most scaling strategies were premised on the need to develop operational and strategic capacities over time to support scale-up, and the need for adequate, stable, and flexible financing.

Governance was also a pivotal concern in many reviewed programs. Structures and processes are needed to ensure accountability and facilitate an open and transparent monitoring and learning culture. The review called for more and better research on scaling up impact on nutrition as many countries start to grapple with the nuts and bolts of implementing plans of action. More experiential learning (such as through “stories of change”) and a better sharing of lessons across contexts and countries is needed. Many successful large-scale nutrition programs of the past have had several of the key scaling elements described here. They have tended to focus mainly on nutrition-specific interventions, with good reason. But a new focus that also encompasses nutrition-sensitive development and the role of leadership and enabling policy environments is a new imperative for nutrition.This in turn will require a massive ramp-up in capacity. A growing cadre of nutrition champions is needed, supported by strengthened organizational capacity. Some countries have successfully established and funded strong national institutions to support the operationalization and scaling of nutrition—shining examples include the National Institute of Public Health in Mexico, the Institute of Nutrition in Mahidol University in Thailand, and the icddr,b in Bangladesh—but more are needed. “Scaling up” has become the mantra in international nutrition in recent years. To turn words to actions, talk to walk, a learning culture is needed in which lessons from the past are shared and used better.