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Stunted. Current attempts to Eradicate Undernutrition

Stunted. Current attempts to Eradicate Undernutrition. Lawrence Haddad Institute of Development Studies Global Classroom. Outline. What is undernutrition? Why does it matter? Why is it a matter for public Which interventions work and why?

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Stunted. Current attempts to Eradicate Undernutrition

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  1. Stunted. Current attempts to Eradicate Undernutrition Lawrence Haddad Institute of Development Studies Global Classroom

  2. Outline • What is undernutrition? • Why does it matter? • Why is it a matter for public • Which interventions work and why? • How to move nutrition higher up the development agenda?

  3. UN Conceptual Framework for Undernutrition Undernutrition Poor Diet Infection immediate Household food security Health and sanitation Care underlying Economic performance, Governance, political systems, natural resource endowment basic

  4. Why does nutrition matter? • Foundational for the MDGs • Mortality • Morbidity • Learning • Productivity

  5. Infant and Maternal Undernutrition is Leading Cause of Global Burden of Disease Source: Ezzati et. al. 2002

  6. Why is it a matter for public policy? • Missing markets • Financing the Lifecycle • Intergenerational externalities • Inequalities • Information symmetries • Economic growth is insufficient

  7. Irreversibility Shrimpton et. al. 2001

  8. Income Growth does not Reduce Child Undernutrition Quickly Enough

  9. Emphasis for direct interventions by country typology

  10. Emphasis at indirect level by country typology

  11. Commitments: Mentions of Nutrition • In Speeches (from Jan 2005) • DFID: 0/50 • EC: 0/28 • In Press releases (from Jan 2005) • DFID: 0/197 • EC: 0/239 • In policy documents • 0 in G8 2005 and 2006 • 12 in Commission for Africa Report • 0 in DFID Social transfers and chronic poverty

  12. Percentage of total ODA spend on Direct Interventions

  13. Percentage of total ODA spend on Indirect Interventions

  14. What constrains higher prioritisation? • The context-- weak institutional incentives • no nutrition indicators in reporting frameworks • institutional orphan • The message--lack of a simple story • “fuzzy” versus “silver” bullets • difficulty of attribution • lack of easy resonance with current policy frameworks • The connectors--few, isolated and lacking visibility • failure of professional education at tertiary level • weak professional career incentives

  15. Causes for optimism? • CCTs • Trends in randomised controlled trials • Long wave issues—youth perspectives • Diet-related chronic disease • Governance agenda

  16. Recommendations for Governments and Donors • The context • use underweight as indicator for MDG1 on poverty • The message • nutrition audit of indirect nutrition spend • support nutrition surveys to name and shame and highlight poor governance • generate research on a new generation of cost-effectiveness studies; policy process studies • The connectors--few, isolated and lacking visibility • appoint a nutrition champion • re-design higher education initiatives – e.g. Masters in Development Practice

  17. Implications for Research • Need a new generation of cost-effectiveness studies • More political and policy process studies • More institutional design studies

  18. The Cost-Effectiveness of Targeting: Progresa in Mexico Cost of targeted program to reduce poverty index by one unit Cost of non-targeted program to reduce poverty index by one unit Source: Adapted from Skoufias, Davis and de la Vega 2001

  19. Nutrition expenditure (rupees) per malnourished child in 8 Indian States Source: Measham and Chatterjee 1999

  20. Institutional arrangements and service delivery Rands to create one day of employment, South Africa Source: Hoddinott, Adato, Haddad and Besley 2001

  21. Conclusions • Undernutrition thinking desperately needs a development practice perspective—neither health nor agriculture sectors have made it a priority • More political, institutional, policy process analyses needed • Need a greater link to the governance agenda • Need new graduate programmes stressing connections and the politics of undernutrition • Some optimism that the context is becoming more receptive to changed thinking

  22. Example questions for local investigation • What percent of infants suffer from undernutrition in your local community? Check your perceptions against the data—how different? What do you think are the main causes of undernutrition in your area? • The pros and cons of targeting versus universal access—dividing or uniting communities? • The local politics of getting resources to children—mandated or voluntary? • Variations in the design of service delivery in your area—where is it most obvious? Why?

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