The SMARTness of nutrition commitments

As emphasised by the Global Nutrition Report (GNR), SMART (Specific, Measurable, Achievable, Relevant and Time-bound) nutrition commitments ensure focus and accountability in actions for nutrition.^[1] The UN Decade of Action on Nutrition advocated that governments work with SMART goals to achieve effective, sustainable changes, and improve global nutrition targets initially by 2025,^[2] recently extended to 2030.^[3] The need for trackable SMART nutrition commitments has been long emphasised as critical to monitor and report on how they translate into impact,^[4] and is increasingly being recognised as essential for accountability.^[5] SMART criteria have been used for the qualification of commitments in other contexts,^[6] yet their inclusion as a qualifying criterion in the context of nutrition, and in particular for commitments made in the Nutrition Year of Action, is novel.^[7]

The key aim of the independent global Nutrition Accountability Framework (NAF) is to ensure that all nutrition commitments made in the Nutrition Year of Action and beyond are SMART. This chapter provides an overview of the nutrition commitment qualification metrics, with a focus on defining and assessing SMARTness.

The GNR scores the SMARTness of commitments and calculates that using the Nutrition Action SMARTness Index. You can read more about SMARTness scoring and the Nutrition Action SMARTness Index on other pages.

Initially developed as a tool to formulate effective management goals,^[8] SMART criteria are frequently and increasingly being used by decision-makers to help them identify what programmes hope to achieve.^[9] The application of SMART criteria in the formulation of nutrition commitments ensures that the type of the commitments (such as financial, policy or impact), their goals and their expected outcomes are clearly articulated. This makes commitments easier to classify and monitor, and makes it possible to measure impact and demonstrate success.^[10]

Our approach to defining and assessing SMART nutrition commitments builds upon and expands our previous work (the 2016 Global Nutrition Report, previous N4G Commitment Registration Guide). To facilitate the formulation and assessment of SMART commitments, we have identified a set of commitment ingredients (defined as the individual characteristics that describe each of the SMART aspects), and mapped these to each of the five SMART aspects, as detailed in the sections that follow. These ingredients form the basis of the NAF Platform's Commitment Registration Form, and are captured by standardised data fields to ensure consistency and transparency in reporting (see A guide to the NAF Platform's Commitment Registration Form).

The following criteria are used to assess whether nutrition commitments meet the requirements to be considered SMART:

Specific

Each commitment should identify a specific measurable goal, or multiple measurable goals, to ensure it can be tracked.^[11] Each goal should define what the accountable stakeholder is committing to achieve. The goals should be nutrition-related (either nutrition-specific or nutrition-sensitive), for example: to reduce stunting in children under 5 years of age, invest a given amount in nutrition-sensitive interventions and, in particular, in the sectors of health and agriculture; or to establish a regulatory body for nutrition. The measurable goal(s) are used to track and assess progress made towards the commitment. Such goals must align with context-specific priorities (specific to a country, sector or organisation, for example) and should address its needs, including specifying the action plan, geographical coverage (setting) and target population.

‘Specific’ identifies and defines the following ingredients for the commitment:

1. The stakeholder accountable for achieving the commitment and reporting on its progress annually, including the stakeholder group (e.g., government, donor, private sector, civil society organisation) that best describes it. If this is a joint commitment made on behalf of multiple stakeholders, the names of each additional stakeholder are specified.
2. The number and description of the measurable goal(s) of the commitment.
3. The type (action category) of each goal. Nutrition for Growth (N4G) commitments will be classified using the types introduced in the N4G commitment-making guide,^[12] and re-classified using the comprehensive GNR nutrition action classification system introduced in The Nutrition Action Classification System.
4. The action plan that will be followed to achieve each goal. The action plan represents the ‘road map’ for reaching the goal of the commitment and ensures that possible pitfalls and challenges are identified.^[13]
5. The geographical coverage of each goal, such as global, regional, national, or subnational, including any additional specifications, for example names of geographical areas covered or if focused on geographic areas with a given characteristic (such as high prevalence of a given form of malnutrition, low income).
6. The target population of each goal, including population coverage (sample size and/or percentage of overall population covered). Additional specifications include whether the approach adopted to reach the population of interest varies by key population characteristics, for example by age, gender, income, location, ethnicity, education or disability.

Measurable

Each commitment should state clearly the indicators to be used to measure progress on meeting the commitment, taking into consideration available established indicator frameworks and building on those frameworks as appropriate. Quantifiable indicators are easier to monitor and should indicate the baseline and end-line, including interim milestones where relevant and whenever possible. The monitoring and evaluation of the indicators by national information systems (e.g., surveys) should also be stated.

‘Measurable’ identifies and defines the following ingredients for the commitment goal(s):

1. The primary indicator used to measure the commitment goal, assess and report on its progress, including its unit (if applicable).
2. The baseline, including the baseline level (using the same unit as the indicator) of the indicator and the year this is assessed (e.g., through a survey). The baseline year should be as close as possible to the starting year of the commitment (see Time-bound aspect below).
3. The interim milestone(s), specifying whether interim targets are set to be achieved within the commitment period, including the interim level (using the same unit as the indicator) and the year this is aimed to be achieved.
4. The end-line, including the end-line level (using the same unit as the indicator) of the indicator to be achieved by the end of the commitment period (see Time-bound aspect below).
5. The monitoring and evaluation plan, which describes the relevant plan that will be used to collect data on the indicator and measure its progress. For example, fruit and vegetable intake (in grams/day) may be routinely assessed through national dietary surveys, or the prevalence of stunting may be assessed in demographic and health surveys or other databases or surveys.
6. The reporting mechanism, which specifies whether the stakeholder is expected to report on the progress of the commitment goal to an additional – other than the GNR – tracking/accountability mechanism. This ingredient is not used to assess and qualify SMARTness, rather to understand reporting requirements and attempt to minimise reporting and accountability fatigue over time by aiming to coordinate with other reporting mechanisms.

Achievable

Commitments should, at a minimum, be consistent with the level of progress achieved in the past. They should be as ambitious as possible but mindful of the limits of what can be delivered in a realistic timeframe and with reasonable associated costs. Achievability takes into account the availability of financial resources necessary to cover associated costs and identify the supporting funding mechanism and funder. Achievability can also be assessed by comparing commitment goals against global nutrition target levels, where relevant and appropriate (this assessment will be performed by the GNR).

‘Achievable’ identifies and defines the following ingredients for the commitment:

1. The estimated total costs associated with the delivery of the commitment, if known, including accounting for human resources, equipment and infrastructure.
2. The financial resources, which identify the funding mechanism (such as private, public and/or internal/self-funded) used to cover total costs, including specifying the funder (organisation’s name) and the extent to which these resources are secured (e.g., absolute amount secured or fully/partially secured if exact secured amount is not known).

Relevant

Commitments should reflect the nutritional priorities and challenges relevant to the setting (at national, regional or global levels) and target population. These challenges can include sector bottlenecks, such as limited healthcare personnel, and aligning with broader national priorities. Relevance further takes into account potential alignment with global nutrition targets and links with key pledging moments, such as the N4G summit. Relevance can take into consideration other important global public health challenges, such as whether a given commitment goal has been developed to address impacts on nutrition related to the Covid-19 pandemic.

‘Relevant’ identifies and defines the following ingredients for the commitment:

1. The global nutrition targets(s) with which the commitment is aligned – on maternal, infant and young child nutrition^[14] and diet-related non-communicable diseases.^[15]

2. The requirements that the commitment needs to meet to qualify, which may vary by linked event.^[16] For example, to qualify as an N4G commitment, in addition to being SMART and agreeing to report on progress to the GNR annually, commitments should align with national priorities and the N4G principles of engagement.^[17] Of these requirements, the GNR will verify the self-reported SMARTness, which is facilitated by the standardised and comprehensive registration form. The intention is to work with stakeholders to obtain all the necessary information that will deem the commitment SMART. Additionally, for the N4G summit, the Access to Nutrition Initiative (ATNI)^[18] will verify compliance of breast-milk substitute manufacturers with the International Code of Marketing of Breast-milk Substitutes by 2030, in both policy and practice. The registration and verification of N4G commitments timeline pre- and post-summit is as follows:^[19]

• 31 October 2021: Commitment registration soft deadline
• Initial GNR verification (e.g. stakeholder group, commitment type, thematic area).
  • ATNI verification (BMS code of compliance)
• 15 November (TBC) 2021: Publication of a commitment registration summary (up to 31 October)
• 7–8 December 2021: Commitment registration deadline and publication of an updated summary (up to 8 December)
• After the Tokyo N4G summit, full GNR verification (including SMARTness) and analysis begin.

3. The thematic area of the commitment,^[20] if this corresponds to an N4G commitment.

4. The Covid-19 response, which captures whether any of the commitment goals were developed to address Covid-19-related impacts on nutrition. This ingredient is not used to assess and qualify SMARTness, rather to provide context for specific nutrition-related commitment goals developed as a response to the Covid-19 pandemic.

Time-bound

Ideally, commitments should have a realistic timeframe for delivery (achievement), with some commitments having a longer timeframe, and others a shorter one. In all cases, commitments should specify key goals to be achieved within the realistic timeframe.

‘Time-bound’ identifies and defines the following ingredient for each commitment goal:

1. The commitment period, specifying the commitment period start and end dates.

Within this section we provide examples of SMART nutrition commitments across the nutrition action categories introduced in the GNR nutrition action classification system (see The Nutrition Action Classification System).

Enabling

Policy

Impact

These examples are aligned with the GNR Nutrition Action Classification System (see The Nutrition Action Classification System for details and definitions of nutrition action categories and sub-categories). You can download examples of completed Commitment Registration Forms from the GNR website.

Last updated: 22 September 2021.