17 Jun 2015

Architecture for Impact: Nutrition and the Sustainable Development Goals

Leith Greenslade MDG Health Alliance

How can we make sure that nutrition has the policy, financing and program architecture needed to drive the major advances that are so desperately needed to achieve the ambitious, new Sustainable Development Goals (SDGs) by 2030?

On the policy front, we seem to have learned our lessons from the errors of the Millennium Development Goals (MDGs). Nutrition is not only mentioned in the Sustainable Development Goals, it has its own goal 2 (to end hunger, achieve food security and improved nutrition and promote sustainable agriculture), and an ambitious target 2.2 (by 2030, end all forms of malnutrition, including achieving, by 2025, the internationally agreed targets on stunting and wasting in children under 5 years of age, and address the nutritional needs of adolescent girls, pregnant and lactating women and older persons).

The real test is which nutrition indicators will be endorsed to monitor national nutrition progress to these goals. Ideally, rates of stunting, wasting, anemia, low birth weight, and overweight would be included as official indicators, but the UN Statistical Commission included only two in their initial assessment - child stunting and overweight - both scoring highly on feasibility, support and relevance. A new Interagency and Expert Group on SDG indicators will release a further list in July 2015, but the final list may not be revealed until 2016. Nutrition advocates have already united behind a set of Priority Nutrition Indicators and need to ramp up the advocacy NOW!

It’s good to see nutrition in the draft Global Strategy for Women’s, Children’s and Adolescents’ Health which will be the official policy framework for global action on reproductive, maternal, newborn, child and adolescent health through 2030, but there are still gaps that need to be filled - most notably the absence of breastfeeding which is not mentioned. This needs to be corrected. Nutrition needs to be front and center in the Global Strategy to attract its fair share of new commitments as part of the UN Secretary-General’s flagship global health movement - Every Woman, Every Child in the years ahead.

In terms of financing, things are unequivocally looking up for nutrition. The new $4 billion Global Financing Facility (GFF) that the World Bank and partners launched to assist in closing the financing gap for women’s and children’s health singles out nutrition more than thirty times as an “historically neglected and underfunded” area that is a “special focus” of the GFF. It is up to the first round of countries who have access to the Facility to make sure nutrition is a top priority in their national investment cases. In addition, several new initiatives focused on nutrition, including the Power of Nutrition Fund, UNITLIFE and the new $776 million nutrition strategy launched by the Bill and Melinda Gates Foundation will increase the financing available for nutrition programs.

But ultimately, impact is in the hands of the programs that are implemented among the populations struggling with the highest burdens of undernutrition, overnutrition, and increasingly, both. New financing needs to be allocated both effectively and efficiently among the highest impact interventions (i.e. breastfeeding, treatment of malnutrition, and preventive micronutrient supplementation and fortification) prioritizing the populations with the greatest need (i.e. newborns, children, adolescent girls, and new mothers) in the countries where poor nutrition is contributing to massive burdens of death and disability. Greater impact can be achieved by integrating the delivery of nutrition programs with broader maternal, newborn and child health and related programs and both the private and public sectors need to be part of the solution. The movement for integration is just getting started - much more needs to be done.

If these new policy, financing and program opportunities are aligned, nutrition has the architecture for impact that was missing under the MDGs and is better placed than ever before to achieve its development promise. One thing is certain - ending the SDGs with nutrition an underlying cause of 20% of maternal deaths and 45% of child deaths and a leading risk factor in more than 13 million deaths, is not an option.