CSOs: Advocating for and supporting greater nutrition action

1. Fifty-six civil society organisations (CSOs) made 92 commitments with 207 goals linked to the Tokyo Nutrition for Growth Summit. The goals were ‘leadership and governance’ (54, 26%) (with most of these supporting the development and/or expansion of partnerships across organisations or countries), ‘nutrition care services’ (27, 13%) and ‘operational' (26,13%).
2. Impact and policy goals were lowest in SMARTness. This was mainly due to low scores for Measurability and Achievability of ‘diet’, ‘food and nutrition security’, and ‘obesity and diet-related non-communicable diseases (NCDs)’ impact actions, and of ‘food environment’ and ‘food supply chain’ policy actions.
3. CSOs show a strong commitment to tackling malnutrition in all its forms. While 46% of all commitments made by CSOs were focused primarily on maternal, infant and young child nutrition (MIYCN) targets of stunting, wasting, anaemia, low birth weight and exclusive breastfeeding, 37% were focused on both MIYCN and diet-related NCD targets.

If you would like to know more about any of the terms used in this chapter, you can visit the report glossary.

Civil society organisations (CSOs) had a key role at the Tokyo Nutrition for Growth (N4G) Summit representing the second larger stakeholder group (56 CSOs) after governments. The importance of the sector is captured by the ambitious pledge made by the SUN Civil Society Network (CSN).^[1] It pledged for the mobilisation of SUN CSN members to support national nutrition action plans in at least half of the 65 Scaling Up Nutrition (SUN) countries, equipping members with tools to track commitments (including the GNR’s Nutrition Accountability Framework) to hold stakeholders accountable to commitments, driving gender-transformative interventions at local and national levels and guaranteeing continued cross-sector and cross-country learning.^[2][3]

CSOs put forward important commitments to tackle malnutrition in all its forms. As noted in the SUN CSN pledge,4 Nutrition International committed to prevent 4.4 million cases of stunting among children and 60 million cases of anaemia across the globe. Other examples include the promotion of strong multisectoral approaches to tackle all forms of malnutrition or a strong focus on strengthening ties with the government. Gender equality and gender-transformative nutrition interventions were also core to the commitments made by SUN CSN members.^[4] CSO stakeholders committed to invest in nutrition-specific and nutrition-sensitive interventions including nutrition advocacy and programming, nutritional care for children and pregnant and lactating women, food fortification programmes, and social protection.^[5] Commitments made by the CSOs reflect noteworthy mobilisation across the globe with 56 CSOs registering a total of 92 commitments comprising 207 goals.

As noted in Chapter 2, this represents 21% of commitments (92 of 433) and 23% of goals across all stakeholders (207 of 897 commitments). Commitments were primarily focused on the N4G thematic area of ‘health’ (71, 77%), followed by ‘food’ (59, 64%) and ‘resilience’ (39, 42%) with ‘financing’ (25, 27%) and ‘data’ (21, 22%) thematic areas being the least common.^[6] CSOs primarily focused goals on the enabling nutrition action category (109, 53%), followed by policy (62, 30%), and then impact (36, 17%). The mean duration of goals was higher for impact (6.9 years) and policy (6.7 years) actions compared to the enabling category (4.4 years). Most goals were global in focus (83, 40%) while a quarter were at the national level (51, 25%). Just under a fifth were multi-country goals (38, 18%) while 25 (12%) targeted the subnational level. There were very few local goals (8, 3.9%) and two (1%) goals were missing or unclassified.

The CSO goals ranged from enhancing governance – with a focus on engaging key stakeholders and supporting micronutrient fortification – to creating an enabling environment. This includes supporting the development of national strategies to improve nutritional status and diets and diet quality of populations, fostering international and multisectoral collaboration, addressing gender inequities, and facilitating gender and youth-sensitive interventions. Actions from CSO were mainly driven by individual CSOs, with only 17 (18%) commitments jointly registered with other stakeholders. In most cases, joint commitments were submitted with other CSOs (35% of the joint commitments) with the remainder spread across other stakeholders (such as country governments, donor governments, multilateral organisations).

Given the concerted push by the SUN CSN to drive commitments by its member institutions and their substantial representation within the Tokyo N4G Summit, in this chapter we provide an initial analysis and recommendations on commitments^[7] made by CSOs in the Nutrition Year of Action and registered through the NAF. The first section assesses the types of goals categorised as enabling, policy and impact, the second section presents the ranking of goals with the Nutrition Action SMARTness Index, and the third section examines the alignment of CSO commitments to the 10 global nutrition targets.

The SMARTness of the commitments registered by CSOs varied across nutrition actions. A fifth (42, 20%) of all CSO goals were high in SMARTness, followed by 23 (11%) that were upper moderate, 58 (28%) lower moderate, and 84 (41%) low. Goals with low SMARTness were mostly those that were not trackable and required extensive clarifications and/or had a low SMARTness score (less than 3.5 out of 5). A third (31, 28%) of enabling goals were high in SMARTness, and a similar number (38, 35%) were lower moderate. A quarter (26, 24%) were low, and the remaining 14 (13%) were upper moderate. In contrast, over 70% (26, 72%) of impact goals and slightly over 50% (32, 52%) of policy goals were low in SMARTness (Figure 4.2). Very few impact (2, 6%) and policy (9, 15%) goals were high in SMARTness.

Most impact goals that were low in SMARTness were ‘diet’, ‘food and nutrition security’ and ‘obesity and diet-related NCDs’. Policy goals were ‘food environment’ and ‘food supply chain’ (Figure 4.2). Goals with low SMARTness were not trackable with minimal clarifications or not trackable with extensive clarifications, likely due to low scores in multiple dimensions. The low scores were also mostly due to missing or incomplete information on baseline level of indicators chosen to track the progress of commitments, the target level of the indicator, source of funding (missing or unspecified), and the amount secured for undertaking said commitment. For CSO goals, low scores in the Measurable dimension were found for ‘diet’ and ‘food and nutrition security’, while low scores in Achievability were observed for ‘diet’, ‘food and nutrition security’, ‘obesity and diet-related NCDs’, ‘food supply chain’ and ‘food environment’.

As part of the registration process, respondents were asked to self-report on alignment of their commitments to the 10 global nutrition targets.^[10][11] Of the 92 commitments made by CSOs, 42 (46%) had maternal, infant, and young child nutrition (MIYCN) targets. Only two (2.2%) had diet-related NCD targets and 34 (37%) had both MIYCN and diet-related NCD targets (Figure 4.3).

When examining specific nutrition targets (Figure 4.4), 63 (68%) were focused on stunting, followed by wasting (59, 64%), anaemia (50, 54%), breastfeeding (49, 53%), low birth weight (44, 48%), overweight (39, 42%) and obesity (30, 33%). The diet-related NCD targets diabetes (27, 29%), salt intake (26, 28%) and blood pressure (25, 27%) had the lowest alignment, and 14 (15%) had neither MIYCN nor diet-related NCD targets.^[12][13]

CSOs are a critical stakeholder playing a significant role in achieving goals and targets of the N4G, the United Nations Food Systems Summit, the global nutrition targets and the Sustainable Development Goals. They are often the frontline in supporting governments to achieve their priorities. A key constraint faced by CSOs is consistent financing for stability and sustainability. As observed in this analysis, despite challenges, CSOs have a strong and active presence globally, regionally, nationally and subnationally and are actively engaged in supporting and undertaking actions to support the Decade of Action on Nutrition.^[15] Commitments made by CSOs through the Nutrition Accountability Framework emphasised the increasing importance of tackling malnutrition in all its forms as well as supporting leadership and governance in target countries to support achieving tangible outcomes. An assessment of the SMARTness of commitment goals made by CSOs found those under the impact action category was in the lowest in SMARTness. Low scores in certain dimensions indicate the need for technical support to CSOs to ensure commitments are SMART.

Most CSO goals were aligned with either MIYCN or both MIYCN and NCD targets thereby emphasising the importance of tackling malnutrition in all its forms while ensuring efforts continue to support the alleviation of undernutrition and increasing food and nutrition security of vulnerable populations among other priorities. However, while many commitments tackled both MIYCN and diet-related NCD targets, the proportion of commitments focusing on tackling the targets of diabetes, blood pressure and salt intake alone were low.

1. CSOs should support and coordinate action at the national level to achieve impact goals set by governments, while ensuring that there is no ambiguity on attribution particularly of impact goals. In the Nutrition Year of Action, CSOs focused on leadership and governance, and 40% of goals had a global focus.
2. CSOs should improve their commitment reporting to improve their SMART score, particularly in the Measurable and Achievable dimensions, to ensure systematic and rigorous assessment of commitments. The Nutrition Action SMARTness Index found most impact goals were low in SMARTness. Assessment of the scores indicates missing information on baseline levels of indicators and type of commitments available and/or being sought.
3. There needs to be continued action and advocacy to support commitments that emphasise tackling all forms of malnutrition. CSOs have committed substantially to improving both undernutrition and overnutrition outcomes, but more need to commit, particularly if actions need to be at scale.