course. Out of 107 countries with data on overweight of children under age five, 31 are on course. Finally—and of great concern—only 5 out of 185 countries with data on anemia are on course for anemia reduction. There is great potential to learn from country experiences, but it is not being exploited because of a lack of country case studies that examine the wide range of factors affecting progress.
5. THERE IS A BASIS FOR SETTING MORE CHALLENGING TAR- GETS FOR NUTRITION IMPROVEMENT. How is this finding consistent with a world that is off course for the WHA global targets? First, country-level variation suggests that there are plenty of examples of progress from which to draw inspiration and insight. Second, experiences from the Indian state of Maharashtra as well from Bangladesh, Bra- zil, and the United States suggest that significant change in nutrition status can happen over the medium term as a result of determined action sustained over a period of 6–12 years. If just a few large countries improved their performance, it would change the basis for earlier projec- tions of progress. Finally, for India—the second-most pop- ulous country in the world—new and preliminary national data suggest it is experiencing a much faster improvement in WHA indicators than currently assumed. For example, if the new preliminary estimates undergo no further signif- icant adjustments, then the numbers of stunted children under the age of five in India has already declined by more than 10 million.
6. THE FACE OF MALNUTRITION IS CHANGING: COUNTRIES ARE FACING COMPLEX, OVERLAPPING, AND CONNECTED MALNUTRITION BURDENS. Most countries experience some combination of under-five stunting, anemia in women of reproductive age, and adult overweight; fewer than 20 countries have only one of these forms of malnutrition. These different burdens are connected not only at a physi- ological level, but also at a resource and political level. Re- searchers and practitioners urgently need to develop tools and strategies to prioritize and sequence nutrition-relevant actions in these complex contexts. Given these multiple burdens and the trend toward decentralization of nutrition programming, disaggregated analyses of nutrition out- comes are more important than ever. This is a major data gap, though it may not exist in all countries.
Progress on Scaling Up Nutrition Action
7. COVERAGE OF NUTRITION-SPECIFIC INTERVENTIONS IS LOW. The lack of national coverage data for nutrition- specific interventions reflects the low coverage of the programs themselves. Of 12 key nutrition-specific inter- ventions that have been identified as crucial for reducing undernutrition, many countries have national coverage data for only 3 (vitamin A supplementation, zinc treatment for diarrhea, and universal salt iodization). Given the lack of progress on wasting rates, the lack of coverage data for programs to treat moderate and severe acute malnu-
trition (MAM and SAM) is a major concern. Geographic coverage is poor, even in countries with very large burdens of SAM. Direct coverage estimates are needed to properly assess people’s access to treatment for both MAM and SAM. Ways need to be found to get the best blend of rapid stand-alone surveys and periodic national surveys to estimate MAM and SAM coverage in a timely and credible way.
8. UNDERLYING DRIVERS OF NUTRITION STATUS ARE IMPROV- ING. Underlying drivers—such as food supply, clean water and sanitation, education, and health care—can contrib- ute a great deal to improving nutrition status. Estimates of undernourishment based on food supply are decreasing, but—with 805 million people below a minimum calorie threshold in 2012–2014—they are still high. Access to improved water and sanitation services is steadily im- proving, although large coverage gaps remain in Eastern, Western, and Middle Africa for water and in Southern and South-Eastern Asia and most regions of Africa for sanitation. Trends in female secondary education enroll- ment are positive for all regions, although the rate is still just 50 percent for Africa. Health services, though, are still lacking in Africa and Asia. Europe has the most physicians per 1,000 people (at 3.5) and Africa the least (0.5), while North America has the most nurses and midwives per 1,000 people (9.8) and Africa the least (1.3). Asia has two times as many community health workers per 1,000 peo- ple as Africa, but the numbers are low for both regions (1.4 compared with 0.7).
9. THE POTENTIAL FOR EXPANDING RESOURCES TO NUTRITION- SENSITIVE PROGRAMS IS CLEAR; THE QUESTION IS, HOW? Investments in nutrition-sensitive programs and approaches that address the underlying determinants of malnutrition can be important components of a portfolio of actions to improve nutrition status. We present data on government expenditures on the related sectors of agriculture, educa- tion, health, and social protection. Different governments make different choices about these sectors, and expendi- ture levels vary between regions and within regions. Social protection spending is increasing rapidly in many African and Asian countries, providing a major opportunity to scale up nutrition-sensitive actions. But evidence is limited on how to make interventions that address underlying determi- nants more nutrition sensitive. The report offers some ideas for agriculture; social protection; education; health; and water, sanitation, and hygiene.
10.COUNTRIES CANNOT CURRENTLY TRACK THEIR FINAN- CIAL COMMITMENTS TO NUTRITION. Several tools exist to accomplish this, and investments will need to be made to build the organizational capacity to do so. Guatemala pro- vides an inspiring case study. Spending by donors is some- what clearer than spending by countries. Between 2010 and 2012, commitments from 13 donors to nutrition- specific interventions rose by 39 percent, and disburse-
ACTIONS & ACCOUNTABILITY TO ACCELERATE THE WORLD’S PROGRESS ON NUTRITION xv
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116 |
Page 117 |
Page 118