Nutrition Research: Measuring Outcomes in the Field

1. Nutrition Research: Measuring Outcomes in the Field Scott Bleggi, Senior International Policy Analyst for Hunger and Nutrition www.bread.org

2. Bread for the World Institute: …provides policy analysis on hunger and strategies to end it. The Institute educates opinion leaders, policy makers, and the public about hunger in the United States and abroad. Bread for the World Institute is a 501(c)3 organization.

3. What are nutrition outcomes? Reduce Stunting/Wasted/Underweight …….. • % Change in prevalence of stunted children under five years of age • % Change in prevalence of wasted children under five years of age • % Change in prevalence of underweight women

4. What are direct versus indirect nutrition interventions? Sumner at al., (2007) : Donors’ perception of nutrition affects how they fund related programming. If it is deemed a ‘supporting’ investment rather than a ‘foundational’ one, then it is assigned a lower priority. • Direct nutrition interventions are “nutrition-specific” (13), and address the more immediate determinants of undernutrition like quality of diet and access to individual health services. • They can be put in three main categories: • increasing the intake of vitamins and minerals • providing therapeutic feeding for undernourished children, and • promoting good nutritional practices

5. What are direct versus indirect nutrition interventions? • Indirect interventions are “nutrition-sensitive”, and address the underlying determinants of undernutrition • These can include: • Food availability • Water and sanitation issues • And they can be part of multi-sector programs like food security, education and health ACF (2012) reports that funding for indirect nutrition interventions is 5X greater than for direct nutrition interventions. What’s the ideal balance to ideally reduce undernutrition globally?

6. How important are nutrition-specific interventions? Undernutrition accounts for 33%

7. In a Decade, Nutrition Initiatives are Moving Beyond the Focus on Low Calorie Intake: • World Bank and Ashworth (2006) and the Lancet Maternal and Child Undernutrition series (Black et al., 2008) identify interventions to improve health and nutrition outcomes in countries with highest burden • FAO, WHO and UNICEF “Renewed Efforts Against Child Hunger and Undernutrition (REACH) suggests scaling up child undernutriton interventions through coordinated action • Copenhagen Consensus Challenge Paper (Martorell et al., 2008): achieving education, child mortality, and maternal health goals, combatting diseases all “depend crucially on nutrition” • President Obama addresses global hunger in his inaugural address, and countries pledge $22 billion over three years • G8 countries endorse the Muskoka Initiative (2010) focus on improved nutrition, safe water and sanitation to reduce maternal and child morbidity • SUN and the 1000 Days Partnership promote targeted action and investment to improve nutrition in women and children • The May 2012 G8 meeting will mention the importance of nutrition

8. The multi-stakeholder Scaling Up Nutrition movement was launched in 2009 and has gained momentum globally since its “Framework for Action” policy document was launched advocating targeted action and investment to improve nutrition for mothers and children in the critical 1000-day period. It proposes direct and indirect (across sector) nutrition interventions and encourages partnerships between donors, businesses, CSOs and governments.

9. Micronutrient Supplements Treatment of severe undernutrition with RUTF • Vitamin A • Iron-Folate • Zinc Community Management of Acute Malnutrition (CMAM) Improved Nutritional Value of Food • Better quality crops • Household Dietary Diversity • Fortification production to consumption Zinc Mgmt of Diarrhea Breastfeeding Promotion & Infant and Young Child Feeding (including complementary feeding) Malaria Prevention using Insecticide Treated Nets Deworming High Impact Universal Salt Iodization Improve Hygiene and Sanitation Pregnancy until 2 years old Nutrition Throughout the Life Cycle Pregnancy Infancy Childhood Adolescence Adulthood Birth

10. Key to Prevention: Improving Nutritional Quality of Food Production Consumption Increase income, gender equity & ability to eat more nutritious foods • Production and distribution of more nutritious staple crops, biofortified with vitamin A, iron, or zinc • Biofortification • Value-Chain assistance • Fortified crops • Kitchen/homestead gardening Increase household dietary diversity (& address hidden hunger) using quality, nutrient-rich local foods • Reduce poverty • Increase calorie intake

11. Collecting Evidence-based Nutrition Outcomes • Important to provide feedback to home offices, other Implementing Partners, USAID and USDA • Will enable the best possible, targeted program and policy decisions to be made • Recognize nutrition’s importance across development sectors: • Disaster Assistance • Food Security • Agricultural Livelihoods • Value Chain Improvements • Global Health • Questions in The Lancet Maternal and Child Undernutrition series remain: is enough money being invested? Is the money being invested at the right time? Is it reaching those most affected by undernutrition? The answers start with measuring nutrition outcomes in the field!

12. Thank You! http://www.bread.org http://notes.bread.org http://www.bread.org/institute/papers/