Keynote: Keeping the Complexities of Multidimensional Nutrition Strategies Simple and Doable SHAWN...

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

ritio

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

Nut

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n R

evol

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n

http://www.thousanddays.org/

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


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


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


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


“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


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


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.


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


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


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:


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:


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:


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:


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:


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:


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

Keynote: Keeping the Complexities of Multidimensional Nutrition Strategies Simple and Doable SHAWN...

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