Essential Nutrition Actions Framework

Potential for the SUN Movement Victoria Quinn, PhD Helen Keller International Core Group Spring meeting 5 May 2014

Essential Nutrition Actions

Relevance to global nutrition

movements

“new opportunities for ENA”

Scaling Up Nutrition –SUN Movement

SUN is a unique Movement founded on the principle that all people have a

right to food & good nutrition.

4

Lancet Nutrition Series

February 2008

These data had an immense impact on

subsequent nutrition strategies and global development events

Funded by BMGF

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Increased focus on the ‘Global Nutrition

Architecture’

Lancet 2008 Nutrition Series

“The international nutrition system—made up of international

and donor organisations, academia, civil society, and the private sector— is fragmented and

dysfunctional…”

Morris et.al, 2008 Lancet Nutrition Series Paper 5

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Sparked series of

consultations in nutrition community to rally around

the new 2008 Lancet nutrition findings which

provided evidence on ‘what worked’.

Publication of

‘Scaling Up Nutrition:

Framework for Action’ (Feb. 2010)

released by coalition of nutrition partners

representing many different

constituencies

Endorsed by nearly a hundred partners – from civil society, governments, academia, UN agencies, World Bank, Foundations & private sector groups

National Nutrition Institute, MOH Egypt

Cornell University Division

of Nutritional SciencesCornell University, USA

THE WORLD BANK

Public-Private Partnerships

The International Life Science Institute Focal Point in China

,

Exceptionally unique point in time for nutrition!

SUN is a unique Movement founded on the principle that all people have a

right to food & good nutrition.

Over 165 million children under 5 are stunted as a result of malnutrition. • 52 million children are too thin and require special

treatment.

• At the same time, 43 million children are overweight - some as a result of poverty, when families are unable to afford a balanced, nutritious diet.

• 2 billion people are deficient in key vitamins & minerals

A reminder - why nutrition? The facts

ROOTED IN

Poverty Disempowerment of women

Political & Cultural Environment

Insufficient access to affordable, nutritious

FOOD throughout the year

Lack of good

CARE

for mothers & children & support for parents on appropriate child feeding

practices

Inadequate access to

HEALTH

sanitation & clean water services

SUN recognizes the causes of malnutrition are interconnected

Environmental Degradation

Feeding Practices & Behaviors: Encouraging exclusive breastfeeding up to 6 months of age and continued breastfeeding together with appropriate and nutritious food up to 2 years of age and beyond Fortification of foods: Enabling access to nutrients through incorporating them into foods Micronutrient supplementation: Direct provision of extra nutrients Treatment of acute malnutrition: Enabling persons with moderate and severe malnutrition to access effective treatment

Agriculture: Making nutritious food more accessible to everyone, and supporting small farms as a source of income for women and families Clean Water & Sanitation: Improving access to reduce infection and disease Education & Employment: Making sure children have the nutrition needed to learn and earn a decent income as adults Health Care: Access to services that enable women & children to be healthy Support for Resilience: Establishing a stronger, healthier population and sustained prosperity to better endure emergencies and conflicts

Nutrition-Sensitive Strategies Specific Actions for Nutrition

Nutrition strategies increase the impact of specific actions for nutrition

Feeding Practices & Behaviors: Encouraging exclusive breastfeeding up to 6 months of age and continued breastfeeding together with appropriate and nutritious food up to 2 years of age and beyond Fortification of foods: Enabling access to nutrients through incorporating them into foods Micronutrient supplementation: Direct provision of extra nutrients Treatment of acute malnutrition: Enabling persons with moderate and severe malnutrition to access effective treatment

Agriculture: Making nutritious food more accessible to everyone, and supporting small farms as a source of income for women and families Clean Water & Sanitation: Improving access to reduce infection and disease Education & Employment: Making sure children have the nutrition needed to learn and earn a decent income as adults Health Care: Access to services that enable women & children to be healthy Support for Resilience: Establishing a stronger, healthier population and sustained prosperity to better endure emergencies and conflicts

Nutrition-Sensitive Strategies Specific Actions for Nutrition

Nutrition strategies increase the impact of specific actions for nutrition

Countries around the world have committed

to making nutrition a priority

& global partners

are working together to support the

efforts of SUN countries.

Countries are at the center of scaling up nutrition

The SUN approach – starting in 2010

• The Scaling up Nutrition Movement relies on national leaders taking ownership and responsibility for delivering sustainable solutions to improve nutrition in their countries.

• Through country-led efforts that focus on equity and realization of rights,

SUN countries are enabling women, families & communities to create stronger foundations for their people & transforming the

future of our world.

• SUN enables countries to take a collaborative approach

bringing together the people & resources needed to rapidly scale up nutrition-specific interventions as well as implement cross-sector strategies that are nutrition-sensitive.

The SUN approach –Country level

Country governments lead national efforts to scale up nutrition.

Within each country a

SUN Focal Point is identified

The SUN approach – Country level

The Focal Point brings people together in a multi-stakeholder platform

Technical Community

United Nations

Government Partners

Civil Society

Donors

Business

The SUN approach – Country level

The multi-stakeholder platform

Works to align and coordinate action

across sectors.

Women’s Empowerment

Health

Development & Poverty Reduction

Agriculture

Education

Social Protection

The SUN approach – Global level

Using a unique approach that

works for each country. These efforts are underway

in all SUN countries

Multi-sector, multi-stakeholder platform

Together the combined efforts of all countries make up the core of the

Movement - The SUN Country Network

With overall support and coordination provided by the

SUN Secretariat and

SUN Lead Group

Country Network

Donor Network

Civil Society Network

Business Network

United Nations Network

Global Networks of stakeholders shift

resources & align actions to support

country efforts.

The SUN approachn – Global level

Making progress – Country level

Creating Political and Operational Platforms, with strong in-country leadership & shared multi-stakeholder spaces where people come together to align their activities & take joint responsibility for scaling up nutrition.

Incorporating Best Practices into National Policies for scaling up proven interventions; including the adoption of effective laws & policies

Align Actions Across Sectors around high quality and well-costed country plans, with an agreed results framework and mutual accountability.

Increasing Resources and Monitoring Implementation for coherent, aligned, effective action and maximum impact.

1 2

3 4

Within each country, SUN Movement stakeholders are brought together around

4 key processes: progress is reviewed every six weeks

Tracking and reporting impact

Establishing targets to measure impact: Countries are encouraged to establish their own ‘costed plans’ with targets for nutrition goals in the following areas:

Annual SUN Movement Progress Report: Released in September each year by the SUN Movement Secretariat, the report provides updates on progress in achieving the Movement’s goals and strategic objectives.

Supporting global impact

Together, countries and supporting stakeholders are collectively working to reach the global targets by 2025 set out by the

World Health Assembly 2012 Resolution:

Reducing and maintaining childhood wasting to less than 5%

Target 1:

Target 2:

Target 3:

Target 4:

Target 5:

Target 6:

40% reduction of the global number of children under 5 who are stunted

50% reduction of anemia in women of reproductive age

30% reduction of low birth weight

No increase in childhood overweight

Increase exclusive breastfeeding rates in the first 6 months up to at least 50%

Today the SUN Movement is growing in numbers & strength

100+ global stakeholders are providing support to

46 countries with the opportunity to reach

82 million stunted children

How does the ENA framework fit in?

Creating Political and Operational Platforms, with strong in-country leadership & shared multi-stakeholder spaces where people come together to align their activities & take joint responsibility for scaling up nutrition.

Incorporating Best Practices into National Policies for scaling up proven interventions; including the adoption of effective laws & policies

Align Actions Across Sectors around high quality and well-costed country plans, with an agreed results framework and mutual accountability.

Increasing Resources and Monitoring Implementation for coherent, aligned, effective action and maximum impact.

1 2

3 4

Within each country, SUN Movement stakeholders are brought together around

4 key processes: progress is reviewed every six weeks

Creating Political and Operational Platforms, with strong in-country leadership & shared multi-stakeholder spaces where people come together to align their activities & take joint responsibility for scaling up nutrition.

Incorporating Best Practices into National Policies for scaling up proven interventions; including the adoption of effective laws & policies

Align Actions Across Sectors around high quality and well-costed country plans, with an agreed results framework and mutual accountability.

Increasing Resources and Monitoring Implementation for coherent, aligned, effective action and maximum impact.

1 2

3 4

Within each country, SUN Movement stakeholders are brought together around

4 key processes: progress is reviewed every six weeks

Country Level - how does the ENA framework fit in?

Nutrition specific actions

Feeding Practices & Behaviors: Encouraging exclusive breastfeeding up to 6 months of age and continued breastfeeding together with appropriate and nutritious food up to 2 years of age and beyond Fortification of foods: Enabling access to nutrients through incorporating them into foods Micronutrient supplementation: Direct provision of extra nutrients Treatment of acute malnutrition: Enabling persons with moderate and severe malnutrition to access effective treatment

Specific Actions for Nutrition

Nutrition specific actions

Feeding Practices & Behaviors: Encouraging exclusive breastfeeding up to 6 months of age and continued breastfeeding together with appropriate and nutritious food up to 2 years of age and beyond Fortification of foods: Enabling access to nutrients through incorporating them into foods Micronutrient supplementation: Direct provision of extra nutrients Treatment of acute malnutrition: Enabling persons with moderate and severe malnutrition to access effective treatment

Specific Actions for Nutrition

Nutrition specific actions

Feeding Practices & Behaviors: Encouraging exclusive breastfeeding up to 6 months of age and continued breastfeeding together with appropriate and nutritious food up to 2 years of age and beyond Fortification of foods: Enabling access to nutrients through incorporating them into foods Micronutrient supplementation: Direct provision of extra nutrients Treatment of acute malnutrition: Enabling persons with moderate and severe malnutrition to access effective treatment

Specific Actions for Nutrition

Nutrition specific actions

Essential Nutrition Actions

The ‘what’ of ENA…

Creating Political and Operational Platforms, with strong in-country leadership & shared multi-stakeholder spaces where people come together to align their activities & take joint responsibility for scaling up nutrition.

Incorporating Best Practices into National Policies for scaling up proven interventions; including the adoption of effective laws & policies

Align Actions Across Sectors around high quality and well-costed country plans, with an agreed results framework and mutual accountability.

Increasing Resources and Monitoring Implementation for coherent, aligned, effective action and maximum impact.

1 2

3 4

Within each country, SUN Movement stakeholders are brought together around

4 key processes: progress is reviewed every six weeks

How does the ENA framework fit in?

So… “how” do we do it?

The ENA Framework may provide a nice fit for what is needed to scale

up proven nutrition actions under the SUN

movement

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1st task… Reach women and children at

broad scale with the Essential Nutrition Actions

to make a public health impact

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2nd task…. Provide the right nutrition

support at the right time to the right person

(e.g. children, women and …

adolescent girls)?

Critical Life-Cycle Contact Points for the Nutrition of Women, Infants and Young

Children? pre-pregancy and adolescence

during pregnancy & lactation

at birth

during post-natal period

from 0-6 months

from 6-24 months

Source: adapted from Lancet Nutrition Series 2013

Providing the right support at the right time:

3rd task… Reduce the many ‘missed opportunities’ in existing

health programs to provide nutrition support

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•Nutrition Programs

•Child survival programs

•Neonatal

•Reproductive health

•Infectious diseases

•Agriculture

•Education

•Micro-credit

•Emergency

•Social

Protection

•WatSAN

Outside

the health

sector

Within the

health

sector

Potential to integrate ENA into health sector and non-health sector programs

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•Nutrition Programs

•Child survival programs

•Neonatal

•Reproductive health

•Infectious diseases

•Agriculture

•Education

•Micro-credit

•Emergency

•Social

Protection

•WatSAN

Outside

the health

sector

Within the

health

sector

Potential to integrate ENA into health sector and non-health sector programs

42

•Nutrition Programs

•Child survival

programs

•Neonatal

•Reproductive health

•Infectious diseases

•Agriculture

•Education

•Micro-credit

•Emergency

•Social

Protection

•WatSAN

Outside

the health

sector

Within the

health

sector

Potential to integrate ENA into health sector and non-health sector programs

43

•Nutrition Programs

•Child survival

programs

•Neonatal

•Reproductive health

•Infectious diseases

•Agriculture

•Education

•Micro-credit

•Emergency

•Social

Protection

•WatSAN

Outside

the health

sector

Within the

health

sector

Potential to integrate ENA into health sector and non-health sector programs

44

4th task…

Lots of partners!

Need to align ourselves in each country

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National Nutrition Institute, MOH Egypt

Cornell University Division

of Nutritional SciencesCornell University, USA

THE WORLD BANK

Public-Private Partnerships

The International Life Science Institute Focal Point in China

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All these groups are aware, committed and mobilized!!

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Under USAID funded LINKAGES Project (1996-2006)

• Ethiopia: >60 ENA partner groups

• Ghana: ~ 15 nutrition partners groups (regional & district networks)

• Madagascar: >50 ENA partners groups (national & regional networks)

Create broad partner networks to increase coverage, allow fast-tracking and

and leverage of resources

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5th task…

Choosing a starting point.

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Where to start - harmonize and strengthen existing field programs

Fine-tune existing programs to make them

better

Focus on capacity development of government & NGO staff, key community members, etc…

especially in behavior change and counseling

Strive for same nutrition messages, BCC strategy, IEC materials, training materials...

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Where to start - harmonize and strengthen existing field programs

Fine-tune existing programs to make them

better

Focus on capacity development of government & NGO staff, key community members, etc…

especially in behavior change and counseling

Strive for same nutrition messages, BCC strategy, IEC materials, training materials...

Different customized training targeted to:

Health workers (government

and CSO staff, etc..) Community members &

volunteers

• Short-term, skills-based ENA training • Heavy on interpersonal communication skills (e.g.

counseling/negotiation) • Lots of practice with real mothers

Capacity building in ENA for health workers and community members

The Core Group

http://www.coregroup.org/resources/core-tools

New Generic ENA Behavior Change Training for Health Workers and Community Level: English & French

The ENA Framework may provide a nice fit for what is needed to scale

up proven nutrition actions under the SUN

movement

• SUN Secretariat Powerpoint (December 2013) downloaded from SUN Website (adapted for this presentation)

• Why Nutrition The Facts: UNICEF-WHO-The World Bank: Joint child malnutrition estimates - Levels and trends. Global Database on Child Growth and Malnutrition

• A Smart Investment: Lawrence Haddad. Child Growth=Sustainable Economic Growth: Why we should invest in Nutrition. May 2013

• Experts Agree: Copenhagen Consensus: Solving the world’s challenges. May 2012

• SUN Countries’ success in reducing stunting: The number of countries with AARRs greater than 2% is calculated based on historical data from 2000 to mid-2013. This figure is currently under review, and the new number will be reported once the reanalysis of latest available data is finished.

The SUN Movement Secretariat is supported by Canada, France, Germany, Ireland, the Netherlands, the United Kingdom and the European Union, together with the Micronutrient Initiative.

How has stunting been reduced? References and Technical Notes References & technical notes from SUN website

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