The prevention of chronic undernutrition is vital for reducing mortality and morbidity, for economic productivity, and for the respect and protection of human rights. Yet nutrition interventions tend to be low priorities for donors and developing country governments.
Despite past efforts by aid agencies, undernutrition still affects 2-3 billion people worldwide. In South Asia and sub-Saharan Africa, one third of children under 5 are chronically undernourished. In South Asia, the number of children under 5 who are low weight for age, or low height for age, is steadily declining in most but not all countries – but in sub-Saharan Africa (SSA), the number is steadily increasing (see Figure 1). Measuring the nutrition status of children is particularly important because nutrition losses incurred in childhood represent losses children will carry throughout life.
Figure 1: Numbers of undernourished children (aged under 5) in sub-Saharan Africa and Southcentral Asia, 1980–2005. Based on estimates from: The World Health Organization Global Database on Child Growth and Malnutrition: Methodology and Applications, International Journal of Epidemiology, 32, pages 518-526, de Onis and Blossner, 2003
These numbers remain high in South Asia and are worsening in SSA, despite undernutrition being fundamental for attaining the Millennium Development Goals relating to poverty, education, maternal mortality and child health. Do donors prioritise undernutrition? If not, why?
DFID and the EC
Research from the Institute of Development Studies, in the UK, looks at how highly two particular donors prioritise undernutrition – the UK's Department for International Development (DFID) and the European Commission (EC). This analysis was based on:
- their public commitments, from evidence of speeches and press releases
- their expenditure, based on data from the Organisation for Economic Co-operation and Development's Development Assistance Committee
- their opinions, assessed by interviews with key informants.
The research suggests that whilst DFID and the EC recognise chronic undernutrition to be important, they do not see investments in reducing it as fundamental to development. Whilst this is better than some countries, others prioritise nutrition more highly, including Canada, Norway, The Netherlands and the USA.
Much of this assessment depends on how 'nutrition-friendly' interventions in other sectors are, such as health care, water supply and sanitation, social protection and food security. The EC and DFID spend relatively large amounts in these areas (see Figure 2). These indirect nutrition interventions can have a positive impact on people's nutrition status. But the absence of a nutrition strategy to guide them does not generate confidence that they are having the maximum impact in improving nutrition.
Figure 2: Percentage of total overseas development assistance (ODA) spent on indirect nutrition interventions, 1995-99 and 2000-04. Source: International Development Statistics (IDS) online: Databases on Aid and Other Resource Flows www.oecd.org/dataoecd/50/17/5037721.htm
Challenges to prioritising undernutrition
Why is the commitment by DFID and the EC so lukewarm? First, there is the problem that chronic undernutrition is affected by many different sectors. It is therefore everyone's problem but no one's responsibility – a classic failure of collective action. As a result, there are few 'champions' promoting nutrition within the EC or DFID. This failure is mirrored in the nutrition community of research institutes, 'think tanks' and international non-governmental organisations. They should be putting pressure on DFID and the EC to demonstrate how their work is reducing undernutrition.
Second, there are issues specific to DFID and the EC. The current focus on achieving good governance does not easily support the allocation of resources to nutrition – links between governance and nutrition concerns are rarely highlighted. Nevertheless, there are clear opportunities to show that failures to reduce undernutrition represent a massive shortcoming in a state's capacity, accountability and responsiveness to their citizens
Third, the way in which DFID and the EC report on their progress means there are few incentives to prioritise nutrition. For example, DFID measures poverty using statistics about the number of people living on less than one dollar a day; a more reliable guide is how many children are underweight, as it is more consistent over regions and time.
Finally, DFID and the EC are not engaging with the international agencies responsible for nutrition. These agencies are too dependent on the donors to sufficiently challenge them, and so rely on the donors to proactively engage.
DFID and the EC could do more on nutrition. We recommend the following actions:
- Highlight the importance of nutrition for achieving the Millennium Development Goals, not only those on poverty and child mortality, but also on education, gender equality, maternal health and communicable diseases.
- Appoint a 'champion' to promote nutrition in all departments and build stronger links with and support for other agencies, particularly the Standing Committee on Nutrition – the only United Nations agency devoted to combating undernutrition.
- Use nutrition indicators (such as underweight for age) to report on progress towards reducing poverty.
- Conduct a nutrition audit of their spending in areas which have a potential nutrition impact – for example, are investments in social protection, agriculture and water as nutrition friendly as they could be?
The nutrition community needs stronger leadership to challenge DFID and the EC more effectively. They need resources to conduct independent nutrition audits, and to find better ways to link nutrition to existing donor priorities. The international agencies also need stronger coordinated action to argue the case for nutrition.
Andy Sumner, Johanna Lindstrom and Lawrence Haddad
Institute of Development Studies, University of Sussex, Falmer BN1 9RE, UK