Foro Global sobre Seguridad Alimentaria y Nutrición (Foro FSN)

Save the Children

Comments for the Online Consultation on

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

1. What are your expectations for the UN Decade of Action on Nutrition and how could it make a significant difference in improving nutrition and food security of the people in your country within the next ten years?

Putting in place the resources required (financial and non-financial) to meet global, national and local commitments for nutrition to ensure that no child is left behind. Commitment by all governments to meet their international obligations relating to the right to food, health, development and survival with effective policies, funding and implementation. Rallying all stakeholders, including civil society, around a common cause in alignment with Sustainable Development Goals (SDGs), World Health Assembly (WHA) targets, Scaling up for Nutrition (SUN) and The Second International Conference on Nutrition (ICN2) commitments, and human rights standards. Contribution of the UN Decade of Action to effective accountability mechanisms in order to monitor and ensure progress towards SDG2, including the requirement for the goals and targets to be met for all nations and peoples and for all segments of society, and the  endeavour to reach the furthest behind first.

1. What critical activities need to be included in the Work Programme for the implementation of the UN Decade of Action on Nutrition to reach the 2025 global nutrition targets? Which activities would need to be accelerated in your country to reach these targets? How could these activities be funded?

Emphasis should be placed on initiatives which will contribute to eliminating exclusion, marginalisation and discrimination in all its forms.  Illustrative but not comprehensive examples of specific activities and policies which should be considered include:

• Establishing universal child-sensitive social protection that includes specific nutrition objectives.
• Ensuring universal health coverage to eliminate inequalities.
• Developing and implementing policies to keep girls and boys in school beyond primary education.
• Activities around integrated water, sanitation and hygiene, and nutrition response.
• Developing and implementing policies that build resilience, promote livelihoods and address malnutrition, especially in the most marginalised areas.
• Establishing innovative partnerships to share experience and knowledge in how to address malnutrition.
• Establishing social accountability mechanisms at the local level and learning in and across supported countries.
• Citizen-led data collection funded through innovative strategic partnerships with ICT businesses could help fill data gaps and that enhance accountability.
• Activities that enable development and implementation of policies for control of overweight and obesity at all levels and across social strata.
• Promoting and supporting mothers to start breastfeeding their newborns within the first hour of birth, to breastfeed exclusively for six months, and to continue breastfeeding—with complementary foods—for two years or beyond.

With 16 million adolescent girls giving birth each year, urgent attention is needed to keep girls in school, delay the age of marriage and increase access to family planning. Targeting women and girls wit initiatives to improve their nutrition only when they are pregnant is often too late to break the intergenerational cycle of malnutrition, because this often misses a crucial part of the first 1,000 day window. In addition, adolescent girls are more likely to die during childbirth than older women, or to be left nutritionally depleted by pregnancy. Their babies are also more likely to die or be born with nutritional deficits. The infants who survive have a greater risk of growing up to be stunted mothers or fathers. Therefore:

• Governments, donors, academics and NGOs should invest in platforms (including but not limited to schools) to reach adolescent girls

The frequency and impact of extreme weather events are set to rise in the future, with increasing impact on people’s food and nutrition security, therefore:

• National governments, with the support of the international community, should deal with chronic malnutrition as a long-term priority within integrated humanitarian and development action that strengthens the resilience of vulnerable population groups.
•  Governments of countries vulnerable to environmental shocks should invest in and manage well emergency food reserves, in order to reduce food price volatility and ensure that countries can quickly deal with food shortages.

1. What can be done to accelerate and improve the quality of commitments from the various actors? What role(s) should public and private actors play in monitoring their implementation?

Commitments and activities to address malnutrition for all should begin with the moral and legal imperative for the right to food and nutrition – drawing upon the right to food, health, development and survival.

For those governments without national nutrition targets in place, these should be developed taking into account national trends and context and harmonising relevant frameworks (such as WHA targets, SDGs, ICN2 commitments). The second ‘Nutrition for Growth’ summit is the right place to announce national nutrition targets. Appropriate finances must be in place.

In order to ensure progress against malnutrition for all, all actors should adopt a ‘leave no-one behind’ approach – an appropriate policy and programme response based on the national context accompanied by robust accountability mechanisms. 

All actors should collect, analyse and share nutrition data disaggregated by, at a minimum, income, sex, age, race, ethnicity, migration status, disability and geographic location. Sample sizes for disaggregated groups should be large enough to enable effective monitoring of outcomes, collected on a regular and systematic basis, and to make results accessible to all, while protecting the privacy and safety of people. This should be a core part of SDG accountability as part of the ‘leave no one behind’ agenda, with capacity development to ensure its realisation.

Governments should support regular data collection and quantitative data analysis to assess the burden of acute malnutrition, nutrition and infection (including malaria and HIV) as well as examine trends and patterns regarding health-seeking behaviors.

4. How can other relevant forums, such as the CFS and the UNSCN, contribute, and how can other movements (e.g.     human rights, environment) be involved in the Decade?

Existing networks like the SUN Civil Society Network can play a key role in coordinating and delivering adequate nutrition for all with appropriate support. Involving human rights, equity and environment movements are key to the sustainability and success of efforts and should be brought in at all levels to ensure active engagement across the board. CFS and UNSCN can be used as mechanisms for tracking efforts and supporting cross learning. CIVICUS can be a key stakeholder in supporting civil society space, direct citizen participation and social accountability.  Where there are no effective governance structures, alternative means must be sought to ensure that these basic needs are met.

Comments provided by:

-       Claire Blanchard – Head of Advocacy & Nutrition, Global Theme on Health and Nutrition, Save the Children International

-       John Engels - Director, Advocacy, Communications & Knowledge Management, Saving Newborn Lives, Save the Children US

-       Alexandra Rutishauser-Perera, Humanitarian Nutrition Adviser, Save the Children UK

-       Sylvia Szabo, Nutrition Policy and Advocacy Adviser, Save the Children UK

-       Giorgiana Rosa, Senior Health Advocacy & Policy Adviser, Save the Children UK

-       Katherine Richards, Senior Nutrition Policy and Advocacy Adviser, Save the Children UK

WaterAid thanks FAO and the UNSCN for the opportunity to input into the development of the UN Decade of Action on Nutrition work programme.

As articulated in the concept note, the Decade of Action on Nutrition should act as an umbrella for the various initiatives and stakeholders involved in nutrition, unifying different voices and serving as a platform for coordinating and strengthening networks and collaborations across different actors and importantly across different sectors.  The Decade of Action on Nutrition should encompass key principles to guide its work, including that of country ownership, the universal nature of malnutrition, shared responsibility, integration and collaboration, equity and sustainability.

Our submission focuses on four recommendations for the work programme:

1.       Greater prioritisation of the prevention of undernutrition through improving the environments in which people live: The proposed principle focus areas, or ‘pillars’ for the Decade of Action on Nutrition fail to adequately address prevention of malnutrition, particularly with regards to improving the environments in which people live. Given that 50% of undernutrition is associated with infections caused by poor water, sanitation and hygiene (WASH), greater focus and attention on the underlying causes of malnutrition, particularly WASH, is missing from the proposed framework, yet will be fundamental to improving undernutrition. Pillar 5 suggests that this covers recommendations 50, 51 and 52 of the ICN2 framework for action, however although improving WASH in healthcare facilities is a key component of building strong health systems, universal access to WASH requires action outside of the health sector to ensure every household and community realise their rights to water, sanitation and hygiene. This broader role that the environment plays in contributing to undernutrition needs to be more clearly articulated and prioritised within the principle focus areas of the Decade of Action.

2.       Place multi-sectoral collaboration, relationships and networks at the centre of each of the 6 pillars/principle focus areas: The Decade of Action can play an important role in facilitating links among a broad set of stakeholders across multiple sectors, particularly health, education, water, sanitation and hygiene (WASH), agriculture, and social protection, while also linking with the climate change agenda. The Decade should advocate for and support countries to build and strengthen institutional mechanisms and structures for nutrition that allow cross-sectoral working and coordination across ministries, and for the more systematic integration of nutrition into nutrition-sensitive sectors, including through building capacity on nutrition in these sectors. The success of these coordination mechanisms requires high-level political support, such as through the President or Prime Minister’s office, along with human and financial resources to ensure its functioning.   

3.       Improving data, evidence and accountability: Weaknesses in nutrition-related data and spending, particularly that which is disaggregated by various parameters, is an important barrier to scaling up equitable access to nutrition-specific and nutrition-sensitive actions. Supporting the strengthening of information systems to better collect, analyse, track and share data, making it accessible for all, is essential to maximising the impact of investments, directing limited resources and improving accountability. Better documenting and sharing of lessons, including through more operational research, will also be essential to building the knowledge base of what works, and filling in current gaps in knowledge.

4.       Building political will and the critical role of advocacy: The challenge will be to translate this global momentum around nutrition into concrete actions and SMART commitments, both in terms of policy and financial commitments, at regional, national and local levels. An ambitious advocacy agenda should enhance the profile of nutrition as an underlying determinant of sustainable development, linking to other SDGs, while developing high-level champions, including parliamentarians, as a way to leverage national and international financing for nutrition.

I attach our recent report ‘The Missing Ingredients: are policy-makers doing enough on water, sanitation and hygiene to end malnutrition.’

On expectations in improving nutrition and food security in Asia:

One key issue in human nutrition is that science is still too open for wide interpretation. It has been established through the animal health science but also through successful feeding programs by the WFP in refugee camps and crisis feeding that only a well-balanced nutrient portfolio shows desired results in improving the health status of targeted populations. The argument of too high cost is not valid, the cost to provide all essential B-vitamins to 100 mio people is estimated at approx. 15 mio US$ per year.

Given the significance of the first 1000 days it is important that adolescent girls, pregnant and lactating mothers receive foods that have a balanced nutrient portfolio. If dietary diversity is too expensive the cheapest and most effective way is fortification of locally accepted foodstuffs.

ARoFIIN is currently studying the existing information on the nutrient gap between actual intake and the WHO recommendations for targeted population groups. With this data we will discuss with the food industry what nutritional interventions are possible.

Governments and the UN can contribute to allow accessibility and distribution of these foodstuffs and approve locally acceptable, highly fortified low cost food solutions.

On critical activities:

Educational programs on the importance of dietary variety is essential, i.e. home gardening for rural populations and the increased use of vegetables and fruit for urban poulations. For policy discussions an important aspect is how fruit and vegetable can become more affordable to increase usage in the food portfolio.

Policy makers, health authorities and the food industry need to engage in discussions aiming to widen the access to dietary diversity but also to fortified foods.

When mandated food fortification is discussed we need to realize the the past iron / folic acid fortification strategy of many countries was not successful. Reconstitution of rice and wheat to its original nutrition content before milling is essential.

On quality of commitments

15% of the processed food supply is provided by the multinational food companies, 85% by small medium enterprises.

If business cases to support the fortification of foodstuffs can be created the commitment to provide more healthy food choices can be increased. The UN should work with the food industry to discuss, develop and support the free access to nutritious food solutions.

1.       My expectations are that it will lead to increased production and marketing of safe food with emphasis on regional comparative advantages. Nigeria is still import dependent on major food items and it should be reversed.This as adversely affected the economy.

2.       Critical activities to be included in the work programme are expansive food production using improved varieties/breeds and technologies; safety measures in crop/animal selection, production, processing, packaging and sales; capital investment in agric and agro- allied sectors; human capital development; enlightenment and education of women and girl child who are mainly households’ food preparers; funding of relevant research in these area.

3.       Quality of commodities can be accelerated via establishing and ensuring that universally accepted standards are maintained in the food system. Government regulatory bodies should be involved while private advocates and monitors sustain the crusade for quality nutrition.

4.       Other relevant fora and movements can be involved through funding of research, supporting advocacy, enlightenment of girl child and women, aids and grants, enforcing sanctions as well as evaluating projects and programmes over time to ensure expected target are achieved.      

English translation below

Je pense qu'il faut favoriser l'alimentation d'origine végétale, surtout dans les pays ou une partie de la population souffre de mal nutrition. Je pense par exemple à la spiruline, un aliment intéressant sur le plan nutritionnel, car très complet. La permaculture est aussi un enjeu majeur pour atteindre l’autonomie alimentaire. Cette autonomie est la seule solution pérenne pour les pays en voie de développement.

Pour les pays plus aisés la diminution de la consommation de produits carnés est également un enjeu pour des raisons plus éthique et écologiques.

I believe that it is important to promote food which is vegetable in origin, in particular in countries where a part of the population suffers from malnutrition. I am thinking for example of spirulina, an interesting food in terms of nutrition because it is most complete. Permaculture is also a major challenge for the achievement of food autonomy. This autonomy is the only durable solution for developing countries.

For the more affluent countries, reducing the consumption of meat products is, for more ethical and ecological reasons, equally an issue.

English version

Hello everyone. Measures taken from the beginning of the Decade of action on nutrition, will be achieved to the extent that real commitments are taken by strategic stakeholders. Political and economic factors are vital from the field nationally and globally. The mechanisms of international trade must establish reasonable fees to facilitate the access of food to countries and sensitive areas and highisk. International speculation of prices and availability of infrastructure affect access and distribution of food, besides the waste remains an element important to consider.

In the nutritional field there are plenty of options to provide basic diets and containing the necessary nutrients to the population in general - with an emphasis on children and women in gestation -. According to is what is raised in the statement.

Interaction with other areas is vital, and undoubted, but synergies get lost or diluted in the coordination, in the case of the problem of landholding, health centres, assistance (extension) agricultural, soft loans and access to markets for small producers, whose role in a local production of robust and constant, will give options to the communities and will boost growth (sustainable) based on resources available in the locations, reducing the ecological footprint, benefiting everyone. Agricultural assistance should provide knowledge regarding the nutritionally necessary and vital foods that can be planted by farmers, according to their land and climate conditions.

Actually, financial resources are plenty! If they are not used to buy weapons and to allow land concentration and market manipulation. Supermarkets and fast food chains cancontribute to campaigns and make more social use of foods not eaten, weight - without beating or consumed –, industrial producers must continue to innovate on food without so many harmful additives and here the universities and researchcenters can provide guidance.

Then we find more, to a situation of will political and of sensitivity human (Moral?) - lack of resources or instruments - and therefore, think that the goal could - and should - be done before.

Best regards!

Spanish version

In the context of discussion regarding the high priority needing to be placed on enhacing diet quality for all, allow me to point members to the new report on Food Systems and Diets: Facing the Challenges of the 21st Century. This was prepared by the Global Panel on Agriculture and Food Systems for Development.  First launched at FAO in Rome in September, it had a North America launch yesterday in Des Moines in the context of the World Food Prize. It is free to download here: http://www.glopan.org/foresight. Also attached to this message.

The key message is that poor quality diets now contribute the greatest share of risk factors to the global burden of disease. This means that a lack of diversity, adequacy, key nutrients, safety, etc. underpin not only undernutrition but diet-related NCDs that often go hand-in-hand with overweight and obesity. No country in the world is immune to one or other form of malnutrition; hence every country in the world needs to place a high policy priority on addressing diet quality issues to achieve nutrition (and health) goals. 

Cheers

Patrick

As part of supporting the UN Decade we would like to focus on technical support in evaluating the efficacy of national and state governments schemes on nutritional improvement of children, lactating mothers, and old aged populations in our country.

Declaring the Decade is a great start to maximising concerted efforts in nutrition. It provides an ovearching platform for nutrition interventions and advocacy. However, we need to localize global concepts and contexts to suit the needs of our smaller island nations; and we'll need technical support and expertise.

Fiji is currently revising its Fiji Food and Nutrition Policy, that will be operationalized by the Fiji Plan of Action for Nutrition 2016-2020. We have already gleaned from international documents to provide the framework for interventions, with the focus being children U5. Some of the activities are funded by the Government, while others will be taken care of by donor funds.

Greetings.

The following is my contribution to the subject of discussion.

What are your expectations for the UN Decade of Action on Nutrition and how could it make a significant difference in improving nutrition and food security of the people in your country within the next 10 years?

1. I expect funding of the Uganda Nutrition Fellowship in this decade. That NGOs implementing Nutrition especially directly commit to a program that builds capacity of recent graduates in soft skills. These young nutritionists bring on board great enthusiasm and creativity towards achieving goals.

2.  I expect increased advocacy in nutrition both funded and voluntarily. This advocacy should mostly involve rallying the public so as to drive demand for nutrition services from the government. Public demand I believe enables achieve political attention  from which we could get champions for nutrition with minimum efforts.

3. I expect the government of Uganda to strengthen and sustain the multi sector approach for Nutrition that has seen integration of nutrition into sector activities initiated by USAID Uganda. This integration has achieved evidently, if consistently strengthened has potential to reduce rates of malnutrition in the country. Of course, effectively and efficiently. Less money wasted, more to save!

How can other relevant forums, such as the CFS and UNSCN, contribute, and how can other movements (e.g. human rights, environment) be involved in the Decade?

They should create or support platforms like the Uganda Nutrition Fellowship more extensively in various countries as a contribution to building capacity of future nutrition leaders who would take up the nutrition agenda further even after the decade.

Apio Benardate Okiria,

Uganda Nutrition Fellowship.

USAID FANTA project.