Planning a national strategy

1. Planning a national strategy

2. Advocacy/initiation • Planning • Implementation • (Evaluation/adjustment)

3. Advocacy

4. http://www.undp.org/mdg/goallist.shtml

5. Concept note “Fighting Malnutrition in Africa: lessons learned and future strategies” Conceptual outline JBM/MG 9 Jan 2007 Why do it? Can we do it? How do we do it? What will it take? What next? Audiences 1. W Bank: RLT, senior management 2. Donors, CSOs, SCN 3. Scientific community 4. Media (NYT, Economist. BBC …) 5. Gates etc.

6. 1. What is the problem and why tackle it? (‘Why do it?’) • - extent trends and consequences of malnutrition • - economic and • - human costs • - hence benefits of success; • - relation to MDGs (#1); • - causes to address; • - potential goals.

7. 2. Experience of current actions – “do we think it can be done?”… [how to select to keep manageable?] • - description of current programs (type, coverage, intensity) • - probable effectiveness of current programs • - relevance of experience from elsewhere (esp. CHNPs, CCTs, Asia, LAC) • - current supporting policies, context, and changes needed for more effect • - institutions

8. 3. New strategies – How do we do it? • - where we need to get to in terms of programs (design, coverage, type, intensity...) hence program gaps? • - what policies are needed for supporting programs and for context? • - how could the needed programs be developed? • - what new ideas could be developed and how • - CCT • - communication strategies • - using cell phones and web2.0 • - others

9. 4. What will it take? - funds and institutions for program development - funds and institutions for program implementation and expansion - benefit-cost estimates 5. What next? - what can the Bank do? - what do we advocate that others do?

10. Initiation • Survey • International mandate (ICN/NPANs; MDGs; H rights …) • Intersectoral bodies, institutions to plan • External assistance

11. Planning First, direct interventions Then, context and supporting policies

12. RETA approach (see Annex 1) 1. Situation analysis 2. C-based programs and service delivery (including micronutrients) 3. Context and supporting policies 4. An improved nutrition strategy 5. Financing

16. Current program analysis • current coverage, intensity, targeting • current content • Suggest new resources and content • Hence calculate new costs (and likely effects)

17. Until something better is established: • adequate program produces acceleration of about 1 ppt/yr reduction in underweight • adequate program costs about $5-15/child/year (including costs of screening targeting) • (Gillespie/Mason’s rule of thumb)

19. Context and supporting policies • In Asian study, five contextual factors seen as crucial for success • women’s status and education • community organization • lack of social exclusion • political commitment • literacy • From: Mason, Hunt, Parker, Jonsson. ‘Investing in child nutrition in Asia’, Asian Dev Review, 17 (1,2) 1-32, 1999; ‘Improving child nutrition in Asia’, Fd Nutr Bull, 22 (3 suppl) 5-80, 2001.

25. Gaps (e.g. B’desh, Pakistan, Sri Lanka, Vitenam, Cambodia) • $160-250 million/year (@ $5/ch/yr addl) • Facilitators: 200,000 • Mobilizers: 4 million

26. Implementation

27. For CHNWs, issues of • Training • Supervision • Incentives • Remuneration

28. Needed for implementation • Mix of top down and horizontal/grass roots • Effective institutions • Sustainable finance • Decentralized decision-making • Adequate information/surveillance

29. CHNWs are observed to work at some times-and-places -- with favorable context, adequate resources, effective technology, etc. • Policy implications include: • invest in context -- human rights, addressing destitute sick ... • political commitment; judicious donor input • counteract unsustainable stresses (economic, political) • sometimes crucial to address context first, rather than throwing resources ineffectively at problem