Foro Global sobre Seguridad Alimentaria y Nutrición (Foro FSN)

Dr. Celeste Naude

Cochrane Nutrition; Centre for Evidence-based Health Care, Stellenbosch University
Sudáfrica

Cochrane Nutrition

Comments for the Online Consultation on

“Maximizing the Impact of the UN Decade of Action on Nutrition”

Cochrane Nutrition fully supports the UN Decade for Action on Nutrition to catalyze and sustain intensified and concrete actions to fix our food systems, end hunger and malnutrition and ensure that high quality, diversified and more sustainable diets can be accessed by all people, especially vulnerable groups. We welcome the opportunity to provide comments for this online consultation initiated by the UNSCN.

The UN Decade for Action on Nutrition has the potential to foster and strengthen the political will, accountability and inter-sectoral collaboration needed to translate the commitments of ICN2, the SDGs and the Global Nutrition Targets into effective actions in the form of policies, programs, and partnerships, accompanied by  feasible implementation plans, to improve nutrition and food security.

Critical activities for inclusion in the Work Programme for the implementation of the UN Decade of Action on Nutrition to reach the 2025 global nutrition targets

Cochrane Nutrition would like to raise three activities related to use of evidence and research approaches:

1. Activities that emphasise the value of using synthesised evidence for translating knowledge into effective, implementable and scalable actions to reach nutrition targets. Finding and implementing effective, scalable and sustainable solutions to address the complex, multi-sectoral nutrition burden is challenging for all stakeholders, particularly since decision-makers often have to deal with diverse and competing interests. Readily prepared syntheses of quality-appraised evidence, such as systematic reviews, deliver valuable support to decision-making by integrating findings from many studies to give a clearer and more comprehensive picture than any single study can produce.

Global synthesised evidence can be combined with national, sub-national or local evidence on service use, practice, costs, policy and organisational factors to inform decisions on what actions are effective and how to best implement and deliver these actions. Training of all stakeholders and organisations in using synthesised evidence can facilitate evidence-informed decision-making (EIDM).  EIDM involves using research evidence with expertise, resources, and knowledge about contextual health issues, local context, and political climate to make intervention, policy and program decisions. This systematic and transparent inclusion of research evidence in decision-making can strengthen nutrition actions, promote the provision of effective and efficient nutrition interventions and services, and support a more responsible use of financial and human resources.

2. Activities that support methodological research innovations to advance our knowledge on the ‘how’ questions - how do we implement an appropriate combination of actions (nutrition-specific and nutrition-sensitive) at scale, in an equitable way in different contexts?

We know a lot about the multi-faceted aetiology of malnutrition and about effective nutrition-specific interventions options.  But many questions still remain about how best to address some of the complex emerging and underlying drivers of malnutrition, especially when different forms of malnutrition coexist as is the reality in many countries. Furthermore, we face challenges on implementation and delivering impact, especially for prevention. Low intervention coverage and poor quality of implementation continues to contribute to poor nutrition outcomes in developing countries, and delivery itself needs to be improved. The effects of interventions depend on the extent to which they are implemented, as well as the dependability of their implementation. These two factors are enormously dependent on the capacity of ‘coalface’ workers, the quality of frontline facilities and organisation of intervention delivery platforms. To address these complex questions requires developing and applying innovative research approaches for both primary research and evidence synthesis. The ongoing work in this area needs support and growth to generate the required knowledge for solutions and actions to enable countries to reduce their nutrition burdens.

3. Activities that support and improve the quality of primary nutrition research and evidence synthesis

Nutritional epidemiology research has expanded over the last 50 years, and the number of trials and observational studies in nutrition has increased exponentially. Generally, this growth has not led to better quality or more useful research results, and duplication, as well as redundant efforts have characterized many research initiatives. Although there have been several activities to enhance nutrition research prioritization, design, management, reporting and interpretation, many of these aspects still need to be improved.  A strong interdependence between nutrition and the complex biological, physical and social systems that affect nutrition outcomes contributes to the difficulties of executing nutrition studies and synthesizing this evidence. As we answer nutrition research questions, there is a need to better understand and consider potential biases, as well as interactions with other systems, to improve nutrition research in general.

Cochrane Nutrition would also like to emphasise three research areas:

1. Activities to ensure that policies and programs to improve nutrition include cost-analyses. Understanding cost implications of interventions is a very important dimension for analysis of program delivery and implementation, and a key tool for policy and prioritization.

2. Activities and mechanisms to assist countries to ensure that public policies are coherent from food production through to consumption, and across sectors to meets people’s nutrition needs and promote safe and diversified healthy diets. Food system policies and interventions, particularly in trade and markets, should be designed in consultation with both food system stakeholders (e.g. agriculture, post-harvest, retailers, consumers) and health stakeholders to ensure they seek to balance health and nutrition with profitability and are coherent with health policies.

3. Activities to address the knowledge gap on effective actions to fix our food systems. The current knowledge base on food system interventions is sparse and more focussed research is needed to identify the ‘best buys’ within the different types of food systems, from industrial to rural, that enable all people to access healthier foods. More focus is needed on interventions that reduce commercial exploitation of people’s biological, psychological, social, and economic vulnerabilities enabling healthier diets.

Actions to accelerate and improve the quality of commitments from the various actors; Roles of public and private actors in monitoring their implementation

Greater emphasis on the role of civil society in monitoring implementation, improving governance and accountability of policies and commitments is needed. As consumers in food systems, an informed civil society can help to create the demand needed for healthier food systems.

Actions and contributions from other relevant forums, such as the CFS and the UNSCN

Supportive forums can provide the platforms needed to identify and pull together a critical mass of nutrition champions (in districts, countries and regions) to identify gaps, coordinate actions, strengthen collaborations, and monitor impacts within the shared framework of the ICN2 outcomes, the SDGs, and the Global Nutrition Targets.  Once identified and committed, the critical mass of all stakeholders can collectively work with the relevant forums to build leadership, advocate for and create demand for enabling environments, more resources and better governance to support the multi-level changes required for improved nutrition.  The forums are also in a position to promote knowledge sharing across borders and to build the leadership needed to put nutrition on the agenda and keep it there – strong and active nutrition champions within all sectors (private, civil society, academic, government, NGO etc.) can be identified and can be instrumental to build the coherence needed across sectors. Supportive forums can assist nutrition champions with prioritization of actions and competing interests.

Cochrane Nutrition looks forward to further engagements, and is committed to partnering to implement the Work Programme for the implementation of the UN Decade of Action on Nutrition.

Daniela Küllenberg de Gaudry, Cochrane Germany

Celeste Naude, Centre for Evidence-based Health Care, Stellenbosch University, South Africa; Co-director: Cochrane Nutrition

Solange Durão, Cochrane South Africa, South African Medical Research Council, South Africa; Co-director: Cochrane Nutrition

on behalf of Cochrane Nutrition, http://nutrition.cochrane.org/