Post on 13-Apr-2017
CORE Group MULTI-DIMENSIONAL APPROACHES A PERSPECTIVE FROM OUR NUTRITION STRATEGY May 17, 2016
© 2014 Bill & Melinda Gates Foundation
NUTRITION
Magnitude of malnutrition’s contribution to under 5 mortality known since early 1990s “UNICEF conceptual framework” – over 3 decades old
THE PROBLEM
FOR DECADES UNDERNUTRITION REMAINED A SILENT CRISIS The “forgotten MDG”
• Hidden under MDG 1c
Rarely talked about Rarely invested in And even more rarely acted upon at scale Th
e N
utrit
ion
Rev
olut
ion
2008: Revolution Begins • The Lancet series on
undernutrition: • Diagnosis of global
nutrition system – “broken”
• Copenhagen Consensus: – 5 of top 10 investments
are in nutrition
• Global Food Price Crisis The
Nut
ritio
n R
evol
utio
n
Revolution Continues • World Bank: Scaling Up Nutrition:
What Will it Cost? (2009) • IFPRI: Millions Fed: Proven
Successes in Agricultural Development (2009)
• Advances in treatment of severe acute malnutrition – community-based management of acute malnutrition (CMAM)
The
Nut
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n R
evol
utio
n
GLOBAL MOVEMENT
REACH: Renewed Efforts Against Child Hunger (UNICEF, WHO, WFP) 1,000 Days (http://www.thousanddays.org) CGIAR Agriculture for Nutrition and Health Nutrition Strategies of Major Donors: USAID European Union UK DFID World Bank
The
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ritio
n R
evol
utio
n
SCALING UP NUTRITION MOVEMENT: ENDORSED BY NEARLY A HUNDRED
PARTNERS – FROM CIVIL SOCIETY, GOVERNMENTS, REGIONAL ORGANIZATIONS, ACADEMIA,
UN AGENCIES, WORLD BANK, FOUNDATIONS, PRIVATE SECTOR GROUPS
National Nutrition Institute, MOH Egypt
Cornell University Division of Nutritional Sciences
Cornell University, USA
THE WORLD BANK
Public-Private PartnershipsThe International Life Science Institute Focal Point in China
, Th
e N
utrit
ion
Rev
olut
ion
• The Lancet series II on undernutrition
• Nutrition for Growth Summit – first global pledging moment: • Tracking of
commitments • Global Nutrition Report • Second Nutrition for
Growth Summit The
Nut
ritio
n R
evol
utio
n 2013: Revolution in Funding
© Bill & Melinda Gates Foundation | 9
GATES FOUNDATION NUTRITION REFRESH TIMELINE
March 5, 2014
Co-chair strategy
review, look back and
approval for refresh
June 9, 2014 First check-in
with Bill
June 24, 2014
First check-in with Melinda
Sept 11, 2014
Learning session
with co-chairs on healthy
birth, growth and
development
Sept 19, 2014
Co-chair meeting with India Minister
of Women and Child
Development and learning session on nutrition in
India
Oct 7, 2014 Learning
session with Melinda on maternal nutrition
Nov 4, 2014 Second check-in with Bill and
Melinda
Feb 3, 2015 Final strategy
approval meeting with
Bill and Melinda
Analyses and briefs exchanged virtually
June 2013 Launch of
Lancet Nutrition
Series and Nutrition for
Growth Summit
Our vision:
All women and children have the
nutrition they need to live healthy and productive lives.
45% of deaths of children under age 5 are attributable to undernutrition Millions more children suffer permanent physical & cognitive impairments as a result of undernutrition– reducing their productivity and earnings as adults.
THE PROBLEM
Sources: Black, et. al., “Maternal and child undernutrition and overweight in low-income and middle-income countries,” The Lancet, 2013; Bill & Melinda Gates Foundation analysis conducted in partnership with John Hopkins School of Public Health
No. of deaths 120K+
60-120K
20-60K
10-20K 0-10K
Estimated nutrition-attributable deaths in 2014
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CHILDHOOD DEATHS DECLINING WORLDWIDE
5M
10M
15M
20M
2012 1960 1965 1970 1980 1985 1990 1995 2000 2010 1975 2005
20 million
6.6 million
Source: The World Bank
A combination of vaccines, malaria prevention, and improved newborn health care has helped reduce under-five child mortality globally since 1960.
We aim to cut the number of under 5 deaths in half by
2030.
We cannot do this without addressing
malnutrition.
The consequences
The problem
The direct causes
Underlying causes
THE PROBLEM: A LOOK AT UNDERNUTRITION’S CAUSES AND CONSEQUENCES Undernutrition is a complex problem with serious consequences
PROGRESS IS POSSIBLE
15 © Bill & Melinda Gates Foundation |
Brazil: Stunting reduced by 80% in a generation Maharashtra: Stunting reduced by 1/3 in 7 years Global Vitamin A coverage increased from 16-75% Salt Iodization: Coverage -75%
• Under-resourced & under-prioritized
• Failure to scale proven solutions
• Lack of data
• Weak accountability
BUT MORE NEEDS TO BE DONE
• Focusing on the critical 1,000 day window • Investing in what works, including breastfeeding
and fortification • Researching the challenges and opportunities
for nutrition • Increasing the quantity and quality of funding • Generating the evidence-base
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BUILDING ON PROGRESS
• More purposeful country engagement
• Increase focus on adolescent girls, pre-conception and maternal nutrition
• Drive scale-up through advocacy and technical assistance
• Catalyze a data revolution
• Systematically bring nutrition and agriculture together
We’ll continue…
And expand to…
Food Systems Advocacy, Policy &
Alignment
Data, Analytics & Evidence
New Solutions
Country Impact
Strategy
Goals
Increase coverage of proven
interventions
Develop and test new solutions
Vision
All women and children have the nutrition they need to
live healthy and productive lives.
MOVING FROM VISION TO ACTION
Goal: Increase understanding of the nutrition-related determinants of healthy birth, growth, and development across the lifecycle; and identify, test, and introduce new solutions
Understand the problem Research to understand the actionable
drivers of healthy birth, growth, and development; the health and cognitive consequences of undernutrition; the optimal package of interventions; and the most impactful time to intervene
NEW SOLUTIONS
Introduce new solutions Develop, test, & rollout solutions to
undernutrition, including those already in the pipeline based on prior research (e.g., SQ-LNS, nutrient-dense crops, multiple micronutrient supplements) and new ones that emerge
Learn to implement better Research to address challenges that
impede implementation. Part of this effort will focus specifically on developing new approaches for reaching women and girls and on addressing social and gender norms
Our approach
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Goal: Valid, reliable and timely data are available to inform policy and programming and to track progress at the global and national levels; and high quality, up-to-date evidence is generated, interpreted, and disseminated to support country programs
Develop new data tools Develop new methods, tools, &
platforms to enable accurate and cost-effective collection and analysis of key nutrition data (e.g., IYCF practices; dietary intake; anthropometric & bio-chemical status, intervention coverage)
DATA, ANALYTICS, AND EVIDENCE
Expand use of data Support efforts to develop a global
consensus on a “blueprint for nutrition data.” In anchor countries, support efforts to improve nutrition data systems and analytic capabilities (in line with global guidance) and fill key data gaps
Make evidence actionable Develop and disseminate evidence on
the impact and cost effectiveness of nutrition interventions and support the WHO and other expert groups in developing guidance for countries on nutritional interventions
Our approach
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“Nutrition needs a data revolution”
--Global Nutrition Report 2014
Goal: Increase financial and political commitment to nutrition and more effective spending of existing resources by country governments and donors; and improve capacity and coordination of global architecture to catalyze and support country action
Mobilize resources Drive an increase in high-burden
country and donor funding for nutrition, by making nutrition a higher priority issue, holding funders accountable to existing commitments, and cultivating new spending pledges
ADVOCACY, POLICY, AND ALIGNMENT
Improve spending effectiveness Maximize the impact of nutrition
funding, by ensuring global focus is on achieving the 6 WHA nutrition targets and supporting efforts to improve donor coordination and ensure funding is directed to most impactful approaches
Build capacity to support countries
Strengthen the capacity of global institutions and actors to advise and support countries in developing and executing plans to tackle undernutrition
Our approach
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Goal: Ensure equitable access to safe, affordable, nutritious diets year-round
Data and Policy Drive an increase in data-driven
agriculture-nutrition policy-making and programs, by supporting efforts to fill evidence gaps, develop new data tools, and by advocating for agriculture programs / ministries to integrate nutritional goals
FOOD SYSTEMS
Production Leverage agricultural
production and extension systems to increase access to nutritious inputs (e.g., biofortified crops, seeds for nutrient-rich crops) and to deliver nutrition knowledge
Women’s Empowerment Increase women’s
empowerment in and through agriculture by increasing their decision-making power regarding agriculture production, expanding their access to and control of household resources, and reducing their workload
Our approach
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Markets & Demand Increase availability of,
access to, and demand for safe nutritious food by reducing seasonal fluctuations in the supply and price of foods, making food more affordable, increasing consumer demand for nutrient-rich foods, and improving the safety of food supply.
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COUNTRY IMPACT - OVERVIEW
Anchor geographies Replication geographies Partner with countries to: • Apply a systems approach to diagnose
challenges and opportunities • Coordinate high-impact solutions
Country Impact
Anchor geographies: Partner with countries to accelerate effective coverage at scale Replication geographies: Multiply impact of approaches and learnings
Multiply impact through: • Partners/grantees • Technical assistance • Advocacy
- Bangladesh - Burkina Faso - Ethiopia - India - Nigeria
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WE ARE SCALING UP INVESTMENTS IN THESE GEOGRAPHIES SEQUENTIALLY
2015 2016 2017 2018 2019 2020
INDIA: Scale up investment in Uttar Pradesh, BIHAR and National plays
Planning with NIGERIA partners
Scale up investment in NIGERIA
Scale up investment in BURKINA FASO
Planning with BURKINA FASO partners
Planning with BANGLADESH partners
Scale up investment in BANGLADESH
Scale up investment in ETHIOPIA
Planning with ETHIOPIA partners
OUR CURRENT AND FUTURE PRIORITY INTERVENTIONS
Conception to birth
0-6 months
6-24 months
Vision All women and
children have the nutrition they need to live healthy and
productive lives.
Maternal micronutrient and food supplementation (including SQ-LNS)
Dietary modification Fortification/Biofortification
Maternal nutrition Breastfeeding Neonatal Vitamin A
Breastfeeding Complementary feeding
(including SQ-LNS) Micronutrient supplementation Fortification/Biofortification Optimized food systems Treatment of Acute Malnutrition
(India)
Fortification Biofortification Optimized food systems …
Pre-conception
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Foundation priority interventions: • Are based on existing evidence • Fill gaps that would otherwise exist • Align with the foundation’s
expertise & experience • Apply to the foundation’s
Country Impact, Food Systems, and Advocacy, Policy, & Alignment work
NUTRITION CHALLENGES AND THE NGO COMMUNITY:
26 © Bill & Melinda Gates Foundation |
Visibility and Political Leadership: SDG 2, World Heath Assembly Targets, Decade of Action - offer unprecedented opportunity Investing: Nutrition remains dramatically under-resourced - ~1% of ODA and similar levels of Government spend in high-burden countries Coordination and Accountability: The nutrition “orphan” needs multiple caregivers Unpacking Complexity: Translate complexity of nutrition into actionable priorities for individual stakeholders and sectors Science of Scale: Applying rigor to “how” Capacity: Human resources for nutrition
VISIBILITY AND POLITICAL LEADERSHIP:
27 © Bill & Melinda Gates Foundation |
NGOs have a unique voice: • Visibility within your own
organization
• Use your voice globally
• Use your voice in the countries you serve
• Strengthen capacity of local civil society
“Our foundation is going to double down on nutrition.”
- Melinda Gates
“If I had a magic wand I would end malnutrition”
- Bill Gates
“Countries must invest in grey matter infrastructure”
- Akin Adesina “[malnutrition] bakes
inequity into the brains of children …”
- Jim Kim
INVESTING:
28 © Bill & Melinda Gates Foundation |
Investment Framework: Provides roadmap to mobilize the resources needed to meet World Health Assembly targets Nutrition for Growth II: • Make your own commitments
• Encourage donors to make new
commitments
• Support Governments of high-burden countries to make new political and financial commitments
COORDINATION AND ACCOUNTABILITY:
29 © Bill & Melinda Gates Foundation |
Scaling Up Nutrition: • New Strategy
• New Executive Committee
• New Coordinator
• New Lead Group
• Over 2,100 Civil society
organizations
• 56 countries & Indian states of Maharashtra and Uttar Pradesh
Mul
tiple
form
s of m
alnu
triti
on • Micronutrient
deficiencies: • Vitamin A • Folate • Iodine • Iron • Zinc
• Anemia • Small for gestational
age • Sub-optimal
breastfeeding • Chronic malnutrition • Wasting M
ultip
le in
terv
entio
ns
Specific: • Supplementation • Fortification & iodization • Biofortification • Breastfeeding • Complementary feeding:
• Promotion • Foods & related
products • Improving maternal diets • Treatment of acute
malnutrition Health & Family Planning Agricultural Structural
Mul
tiple
del
iver
y pl
atfo
rms
• Policy • Health system:
• PHC & Community
• Child health days
• Food system: • Agriculture • Food industry
• Community platforms
• Social safety nets • Mass & social media
• Survival • Physical and
cognitive development
• Economic growth
Strategic information use for coordination, planning, management & accountability
NUTRITION: UNPACKING COMPLEXITY: “I am only one, but still I am one. I cannot do everything, but still I can do something; and because I cannot do everything, I will not refuse to do something that I can do.”
- Helen Keller
SCIENCE OF SCALE:
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NGOs have comparative advantage in the “how”: • Opportunities to innovate
• Team up with research partners
to test, evaluate, iterate, document and disseminate
• Build in pathway to scalability from the beginning
“We know what to do, but we don’t yet know how to do it at scale.”
- Eva Monterrosa
HUMAN RESOURCES FOR NUTRITION:
32 © Bill & Melinda Gates Foundation |
Human Resources for Nutrition has suffered decades of neglect – NGOs can help close the gap: • Systematically build internal capacity
• Integrate capacity building into all
programs
• Use your programs as training ground for future leaders
• Bring skills-based approach to pre-service curricula
“Will our generation’s
legacy be more than a series of
broken promises.”
- Nelson Mandela