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.

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

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

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

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

Natural disasters and armed conflict canlimit the effectiveness of nutrition interventions, for example by reducinglocal food availability. In these situations, the international system cansupport humanitarian responses. However, there is currently little publishedinformation on the impact of humanitarian responses on nutrition, or the impactof nutrition interventions in emergencies.

Although several organisations provideguidance on best practice in emergencies, no agency has overall responsibilityfor assessing the effectiveness (and cost-effectiveness) of differentinterventions. Documenting these and building on experiences will create aminimum set of operational standards. Meanwhile, better coordination wouldallow humanitarian organisations to improve emergency responses.

The shortage of appropriately skilledpersonnel is a major constraint to better nutrition programmes. Interviews attraining centres and universities showed that, with some notable exceptions,social, economic and food sciences are poorly represented amongst academicstaff.

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

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