Nutrition in the health sector: Urgent need to accelerate action and accountability

Addressing nutrition is foundational to a health system that promotes health and prevents disease. Undernutrition is linked to around 45% of child deaths under five years of age, and for those children who survive, cognitive and physical development is compromised. It is estimated that 11 million deaths per year are attributable to unhealthy diets and the 2022 State of Food Security and Nutrition in the World report indicates that almost 3.1 billion people globally cannot afford a healthy diet.

The compounding impacts of multiple crises provide the health sector with an opportunity to continue to scale up and deliver critically needed, life-saving nutrition interventions. One of the signature messages from the 2021 Lancet series on maternal and child undernutrition was “… low coverage of nutrition interventions relative to the reach of their related health services suggests that closing this opportunity gap is a first step for accelerating progress”, and authors called for urgent action to seize this opportunity. A review of a decade of programming by the World Bank’s Independent Evaluation Group noted that solutions in other sectors had seen increasing scale but noted that in the health sector “... nutrition-specific interventions that aim to address the immediate determinants of nutrition have not seen the same increase."

Nutrition for Growth (N4G) is one of the nutrition community’s major platforms for driving more investment, action and accountability for nutrition. The 2021 Tokyo Nutrition for Growth Summit was the most successful and most inclusive summit to date, with more financial pledges and more commitments from low- and middle-income countries than ever before – all in the midst of the most daunting pandemic in a century. The pillars of the Summit underscored the need to drive action and accountability across health and food systems and in both development and fragile settings.

Programmatic and financial commitments from several countries, including USAID nutrition priority and strategic support countries, focused on the essential importance of strengthening national- and local-level nutrition financing, coordination, human resources, policies and surveillance systems. For example, in Nepal the government committed to ensuring the provision of adequate nutrition commodities to deliver quality nutrition services equitably, increase their availability through health systems and strengthen health system competencies and coordination. A strong focus on strengthening nutrition financing and governance within the health sector was further echoed by commitments made in Ghana, Bangladesh, Zambia and many other partner governments. Through USAID’s own N4G programmatic commitments, we aim to partner with governments and other stakeholders to scale up life-saving nutrition services through the health sector.

These commitments were registered through a new system – the Nutrition Accountability Framework (NAF) – which was created by the Global Nutrition Report (GNR) in response to the recognition by N4G stakeholders of the need for stronger accountability around commitment-making. The NAF has been endorsed by USAID and many others. Any new commitments will be recorded, tracked and publicly shared through the NAF, including N4G commitments.

As we celebrated the success of the Tokyo summit in the face of the pandemic, little did we know that an even greater set of threats were looming for global nutrition, with the ravages of Russia’s war on Ukraine impacting the global supply of food and fertiliser, and compounding climate change-driven crises and ongoing conflicts. Analysis by the International Food Policy Research Institute and the Standing Together for Nutrition consortium underscores the dramatic impacts of food inflation on child nutrition with a real food price increase as modest as 5% predicting a nine percent increase in the risk of moderate or severe wasting, with the risk 1.5 times higher for children from poor households. The global stakeholder community has stepped up beyond commitments made at the N4G Summit, most notably at the Pledging to Save Lives event jointly organised by USAID, UNICEF and the Government of Senegal in September 2022. Over US$530 million in funds, additional to N4G pledges, have been raised to address acute malnutrition since July 2022.

Some actors are stepping up on food systems too, including increased investments in fortification of staples with essential vitamins and minerals by the Bill & Melinda Gates Foundation and USAID, and the G7-led Global Alliance for Food Security’s Global Food and Nutrition Security Dashboard, a platform that will track current data on food crisis severity, including explicit data on nutrition.

In the health sector, civil society partners, governments and bilateral and philanthropic donors, among other actors, play a critical role in the global response for nutrition. It is more urgent now than ever – in the aftermath of the pandemic, the climate crisis, conflict and the global food and hunger crisis are putting more mothers and children at risk – that health sector actors step up to seize the opportunities.

The good news is that the health sector is more prepared to act than ever before. More countries are investing in community health workers as the foundation of primary health care. During my recent trip to Nigeria, I saw first-hand some of the work USAID is supporting to strengthen delivery of nutrition services in primary health care. Such action is supported by: clear evidence that shows the cost-effectiveness of incorporating the delivery of nutrition services into the health system; emerging research that will help us determine the best pathway to scale up nutrition service delivery; and agreement about how to measure the coverage of nutrition interventions.

With the nutrition of mothers and children under threat across the globe like never before, bold commitments – like those of Ghana to dramatically scale up essential nutrition actions, including the Baby-Friendly Hospital Initiative – are urgently needed within the primary healthcare system. Rapid scale-up of life-saving nutrition interventions is foundational to mitigate the worst impacts of the food security and malnutrition crisis. Furthermore, when the actions following commitments are visible and measurable, the impact on nutrition can be even greater. Making, registering and tracking such bold commitments under the NAF are critical to facing down the worst consequences of these overlapping crises, and putting the world back on track to meet Sustainable Development Goals on nutrition.