International organisations, including multilaterals

1. International and multilateral organisations play a key role in supporting the global fight against malnutrition and poor diet contributing significantly to enhance political leadership and good governance in delivering effective nutrition policies (44% of all submitted goals) and to create an enabling environment.
2. Over half (18, 53%) of goals were high and upper moderate in SMARTness (trackable with minimal clarifications), most of which were enabling (12 of 19 enabling goals, 63%). Most impact goals were low in SMARTness (4, 80%), that is not trackable with extensive clarifications. The SMARTness level was largely affected by the lack of information specific to the Measurable and Achievable dimensions.
3. Most commitments focused on maternal, infant and young child nutrition global targets, with the largest proportion focusing on childhood wasting (9, 69%), anaemia, stunting and childhood overweight (7, 54%), low birth weight and breastfeeding (6, 46%). A smaller number of commitments were focused on diet-related NCD targets (4, 31%, for diabetes, 4, 31%, for raised blood pressure, and 2, 15%, for salt intake), and six (46%) were aligned with adult obesity.

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

The UN Decade of Action on Nutrition marked a new ambition and direction in global nutrition action. The Decade of Action provides an enabling environment for all countries to ensure that action is taken to develop and implement inclusive policies aimed at ending all forms of malnutrition.^[1] Under the auspices of the UN Decade of Action on Nutrition, United Nations Children’s Fund (UNICEF), Food and Agriculture Organization (FAO), World Health Organization (WHO), International Fund for Agricultural Development (IFAD), World Food Programme (WFP), and the UN Relief and Works Agency (UNRWA) submitted commitments at the Tokyo Nutrition for Growth (N4G) Summit 2021. Their actions ranged from prevention of stunting, wasting, micronutrient deficiencies, overweight and obesity to ensuring access and availability to healthy diets for beneficiary populations.^[2] As noted by the Chair of the newly formed mechanism UN Nutrition, UN agencies are ready to maximise opportunities and work to end all forms of malnutrition.^[3]

During the Nutrition Year of Action, seven international organisations, all UN agencies, submitted 13 commitments comprising 34 goals. Of these, one commitment with three goals registered by WHO was submitted outside the Tokyo N4G Summit 2021. This is an increase from the 28 goals submitted during the 2013 N4G Summit by seven UN agencies.

Commitments submitted were mostly developed unilaterally (10, 77%). Commitments jointly submitted with other stakeholders (3, 33%) were mostly developed in collaboration with donor governments or other UN agencies. Half of goals (19, 56%) were targeting specific groups of the population, either girls and women (2, 6%) and/or specific age groups (16, 47%).

Most goals committed by international and multilateral organisations were categorised as enabling (19, 56%) and focused on establishing an environment for effective nutrition action across all sectors. Policy goals (10, 29%) focused on strategies, policies, interventions or programmes that aim to improve nutrition outcomes both directly and indirectly. Impact goals (5, 15%) were aimed at directly improving poor diets and reducing malnutrition in all its forms. Over 40% of goals were submitted in response to the Covid-19 pandemic.

Estimated costs associated with commitment delivery were provided for three (23%) commitments but publicly disclosed for only one (7.7%) (the only one with ‘financial' goals). The ‘Scale-up nutrition for children’ commitment submitted by UNICEF during the Tokyo N4G Summit 2021 is associated with an estimated financial investment of US$2.4 billion.

The average length of goals submitted by the seven UN agencies was 3.7 years for enabling actions, 4.0 years for impact, and 5.4 years for policy. ‘Food environment’ and ‘nutrition care services’ goals are set to be achieved in the longest timescale (7.0 and 5.6 years, respectively); ‘research, monitoring and data’ goals were those with the shortest timescale (just below 2 years).

Given the key role played by international organisations in supporting governments in their fight against malnutrition and poor diet through the redistribution of financial and non-financial resources, in this chapter we provide initial analysis of commitments and goals submitted during the Nutrition Year of Action with a focus on the areas of action, the SMARTness ranking of commitments, and their alignment with the N4G thematic areas.^[4]

Of the 19 enabling goals submitted by international organisations, 15 (79%) were ‘leadership and governance’ and delivered effective nutrition policies globally (13 goals had a global focus; two had a multi-country focus). IFAD committed to address the nutrition needs of the rural poor by integrating nutrition into its existing programme of loans and grants. WFP committed to support governments through analytical tools (e.g. the WFP Fill the Nutrient Gap) to be used to inform policy and programming and build public–private partnerships in sectors that can contribute to improving diets and nutrition outcomes. Organisations committed to launch global alliances (e.g. UNICEF Global Alliance for Children’s Diets) to support public and private sector actors to take responsibility for their roles in transforming global and local food systems. This work supports global action plans (e.g. UNICEF Global Action Plan on Child Wasting, WHO Global Action Plan to prevent and manage anaemia in women and children, WHO Global Action Plan for Wasting) to produce updated context-specific nutrition policies and treatment protocols. UNICEF committed to support policies, strategies and programmes to prevent malnutrition in all its forms (e.g. UNICEF). They committed to ensure policy environments were supportive of achievements in nutrition outcomes including strengthening nutrition-specific activities and nutrition-sensitive approaches (e.g. FAO). The WHO committed to support countries to develop regulatory and policy actions by providing evidence-informed guidance and strengthening national regulatory and food control system capacities to improve the food environment and promote safe and healthy diets for all.

In terms of operationalising these commitments, IFAD deployed nutrition and social inclusions specialists to support teams and governments. The WFP increased advocacy and engagement to make nutrition a national priority that is integrated into national programmes. Both the WHO and FAO developed roadmaps and action plans. The WHO established alliances to advocate for specific forms of malnutrition, for example for the acceleration of anaemia action. The FAO will strengthen its capacity to design, implement and scale-up nutrition-sensitive projects and programmes for healthy diets and mainstreaming nutrition. UNICEF submitted three ‘financial’ goals, which were focused on increasing national budgets dedicated to nutrition and investments in nutrition-sensitive and nutrition-specific interventions. One goal was ‘research, monitoring and data’ and focused on developing and disseminating evidence-based guidelines for improving food environments and promoting safe and healthy diets.

The remaining goals (15) were impact and policy nutrition actions; seven policy goals were ‘nutrition care services’ and four impact goals were ‘undernutrition’. Examples of ‘nutrition care services’ include improving the prevention and treatment services for undernutrition, such as wasting and micronutrient deficiencies, as well as supporting nutritional improvements among patients with NCDs. No impact goals were submitted to tackle ‘food and nutrition security’ or ‘obesity and diet-related NCDs’ (Figure 7.1).

International organisations focused most of their commitments on enabling actions at the global level (17, 89%), 13 of which were ‘leadership and governance’. Most policy goals were multi-country (8, 80%), of which six (75%) were ‘nutrition care services’ (mostly aimed at integrating and enhancing nutrition services and interventions offered in public or private health systems).

Goals submitted by international organisations were split between high and upper moderate in SMARTness (18, 53%) – all trackable with minimal clarifications – and low and lower moderate (16, 47%) – not trackable with minimal (3, 9%) or extensive clarifications (13, 38%). The highest number of trackable goals (with minimal or extensive clarifications) was recorded for enabling (12, 63%), while the majority (4, 80%) of impact goals were not trackable with extensive clarifications (in the low level) (Figure 7.2).

SMARTness scores were particularly low for the Achievable and Measurable dimensions. These were mostly driven by the lack of specific information on the total and estimated costs associated with the delivery of the goal. For only one commitment (7.7%, registered by UNICEF) there was full public disclosure of the total delivery cost for the commitment, for two (16%) commitments the total costs were estimated but the amount was kept confidential and could not be disclosed either publicly or to the GNR, and for the remaining 10 (77%) commitments no amount was estimated or it was unknown. Impact goals scored the lowest in the Measurable dimension, while the Achievable dimension had the lowest score for policy and enabling goals.

As part of the registration process, respondents were asked to self-report the focus of their commitments in relation to the 10 global nutrition targets^[5] (Figure 7.3). Finding show that most commitments (which may focus on multiple targets) were focused on maternal, infant and young child nutrition global targets, with the largest proportion focusing on childhood wasting (9, 69%), anaemia, stunting and childhood overweight (7, 54%), low birth weight and breastfeeding (6, 46%). A smaller number of commitments were focused on diet-related NCD targets (4, 31%, for diabetes, 4, 31%, for raised blood pressure, and 2, 15%, for salt intake), and six (46%) with adult obesity. A quarter (3, 23%) of commitments registered at the summit included three or more diet-related NCD targets. Specifically, WFP registered a commitment focused on improving nutrition and diets, FAO on improving agrifood systems for healthy diets, and WHO on regulating the food environment. Both commitments from WFP and FAO also focused on all six maternal, infant and young child nutrition global targets.

The focus of the commitments included improving nutrition and diets through their integration in the agriculture system; integration of nutrition interventions into primary healthcare; providing an enabling environment for nutrition and nutrition security; and tackling micronutrient deficiencies (e.g. iodine deficiency among pregnant women and anaemia) with food fortification. Some of the commitments were aimed at preventing and treating child wasting and generating context-specific wasting guidance. Engaging with stakeholders was another area of focus including both the private sector and civil society.

The 13 commitments covered all N4G thematic areas, with the most focusing on ‘health’ (9, 69%) followed by ‘food’ (8, 62%), ‘resilience’ (7, 54%), ‘data’ (4, 31%) and ‘financing’ (2, 15%) (commitments may focus on multiple thematic areas, so percentages total over 100%). Over half of commitments submitted by international organisations included two thematic areas (7, 54%), while only a handful included three or more thematic areas (3, 23%) or one thematic area (2, 15%).

International organisations play an essential role in the fight against poor diet and malnutrition and importantly in achieving the goals and targets of the N4G, United Nations Food Systems Summit, global nutrition targets (as set out by the World Health Assembly) and the Sustainable Development Goals.

Overall international organisations focused their commitments on creating an enabling environment to improve nutrition by developing national and global action plans, developing regulations on food fortification and improved agricultural practices, and integrating essential nutrition interventions into the primary healthcare. They further aim to address undernutrition by committing to reduce specific forms of malnutrition, such as stunting, wasting and micronutrient deficiencies, through improving access to nutrition care and food fortification.

1. International organisations should keep providing support to governments to enhance impact actions. To do so, international organisations need to ensure coordination across stakeholders focusing on the same geographic target to promote integrated actions.
2. Additional effort is needed to improve the SMARTness of commitments to ensure focus and accountability in actions for nutrition. This is an essential requirement and aligned with the UN Decade of Action on Nutrition that advocated for stakeholders to work with SMART goals to achieve effective, sustainable changes, and improve global nutrition targets initially by 2025.^[6]
3. International organisations should work to ensure global engagement with nutrition actions aimed at diet-related NCDs, without halting or compromising the progress made in tackling maternal, infant and young child nutrition. While N4G is a global effort that historically has focused on maternal, infant and young child malnutrition, there should be recognition that obesity and diet-related NCDs are now global pandemics that are not limited to middle or high-income countries. Integrated actions are needed if there is willingness to tackle poor diet and malnutrition in all its forms globally.