Optimistic about the Global Nutrition Compact

Do you remember that I wrote last year, in commenting on the Downing St Hunger Summit , that the main outcome was to set civil servants scurrying about to prepare a G8Group of Eight initiative for 2013? Well, scurry they did, not quite for the full G8, but for a pre-meeting held in London on 8 June. Overall, I think we are entitled to be positive about the outcome of the process. I could have wished for more ambition, in the numerical targets and the financial outcome. It would be good if more countries were to sign up before the deadline of 20 September (come on, India). But, as I discussed last year, nutrition has come a long way, and that can only be applauded.

The press release from the event does not mince its words: World leaders have today signed a global agreement that will prevent millions of infant deaths, and boost the life chances of millions more, by equipping the developing world with the means to beat malnutrition’. The G8Group of Eight communique echoes the optimistic tone. It says (para 55 ): ‘We welcome the recently announced Global Nutrition for Growth Compact which commits to under-nutrition reduction targets for 2020. We also welcome the financial and policy commitments to accelerate progress towards ending under-nutrition for women and young children. Progress on these commitments should be regularly reported and reviewed, including through the Scaling-Up Nutrition Movement, which we continue to support’.

Why nutrition matters

For all the reasons I gave last year, this is good news. The evidence on the personal, social and economic cost of malnutrition continues to accumulate. The Lancet has just published a series of papers on the subject, updating its analysis of 2008. The Executive Summary says that 165 million children in the world are stunted, that 26% of all under-5s in low and middle income countries suffer from this condition, and that undernutrition is implicated in 45% of all child deaths globally. Read those numbers again. No wonder the Lancet concludes that ‘nutrition is crucial to both individual and national development. The evidence (is) that good nutrition is a fundamental driver of a wide range of developmental goals. The post-2015 sustainable development agenda must put addressing all forms of malnutrition at the top of its goals.’ Quite so. Does the new Compact deliver?

What does the Compact deliver?

Leave aside for a moment the slightly odd title, ‘Global Nutrition Compact for Growth’, and the highly suggestive sub-title, ‘beating hunger through business and science’. The Compact itself makes the case and affirms the political commitment. More interestingly, the Summary of Commitments provides more detailed goals and lists specific commitments by 94 Governments, donor agencies, businesses, science bodies and NGOs.

In terms of goals, the headline is ‘preventing at least 20 million children from being stunted and saving at least 1.7 million lives by 2020’. This is presented as being a contribution to the World Health Assembly targets for 2025 . The first of these WHO targets is to reduce by 40% the number of children under 5 who are stunted, compared to 2010. The WHO itself, in its background document on the targets, says that ‘this would translate into a 3.9% relative reduction peryear between 2012 and 2025, and implies reducing the number of stunted children from the171 million in 2010 to approximately 100 million, i.e. approximately 25 million less than what thisnumber would be if current trends are not changed’. The last six words are important. As the WHO points out ‘an analysis of 110 countries for which stunting prevalence is available on at least two occasions in the 1995–2010 period reveals that global stunting is dropping at the rate of 1.8% per year (2.6% in countries with prevalence higher than 30%)’. So presumably the Global Compact goal is to deliver reductions in malnutrition over and above current trend reductions – i.e. to deliver 20 of the 25 m additional non-stunted children targeted. Is that the case?

Seen in this light, the both the WHO and Compact targets seem rather unambitious, a valuable but not completely transformatory addition to current efforts. The High Level Panel on post-2015 did not specify nutrition goals, but I wonder whether having 100 million stunted children in 2025 is consistent with the goal it did articulate, which was to eradicate extreme poverty by 2030. The Lancet sets its sights somewhat higher. It does not have a specific goal, but is optimistic about the impact of the interventions available, and favourable to initiatives like Scaling Up Nutrition. It points out that donors increased funding for nutrition by 60% between 2008 and 2011. It estimates the remaining financing gap at only $US 9.6bn p.a..

In terms of specific commitments, the Compact announces new commitments of $US 4.15 bn, of which $US 2.9 bn as core funding, with the remainder to be secured through matched funding. There are also commitments from businesses with respect to their workforce, to new research partnerships, to an annual Global Report on Nutrition, and to an annual meeting in the margins of the UN General Assembly. There will also be another big summit in 2016, during the Olympic Games in Brazil.

The summary then lists the specific commitments of all the participating entities. These vary from general commitment to information sharing, through various commitments on research, reporting and accountability, to very specific financial commitments. For example, the Vegan Society commits to sharing information on good nutritional practice, ONE says it will build an accountability mechanism to track delivery of commitments, and the EUEuropean Union says it will spend an additional $US 442m over 7 years on nutrition-specific interventions. Unilever is among those promising to do more, in this case focusing on hand-washing, nutritional fortification, and school meals. Developing countries themselves also either confirm existing commitments or make new ones: Bangaldesh, Brazil and Burundi fall into the first category, but Ethiopia, for example, makes additional commitments, including additional domestic financing of $US15m p.a.. Zambia pledges to increase nutrition spending from the national budget by 20% annually for the next ten years. Do they mean that, I wonder? It would mean multiplying the budget by 6 over the period. Perhaps the starting point is low.

Financial commitments

Money is not everything, but the Appendix to the document lists new financial commitments by donors. Of the $US2.9bn of new money promised, a fifth comes from the UK, just under a fifth each from the World Bank and the EU, and a startling 26%, $758m over eight years, from one of the co-sponsors of the event, the Children’s Investment Fund Foundation. On that figure, and taking account of existing programmes, CIFF will be a bigger donor to nutrition than anyone except for the UK and US Governments: half as big again as the EU, Gates or even the World Bank. Golly.

More detailed analysis of these figures will be valuable at some point, perhaps under the auspices of the ONE accountability project. It will be especially interesting to track promises to match others’ funding, like the UK’s commitment to an additional $US 427m ‘if matched by others’.  Does that include developing countries contributing from their own resources, I wonder?  In general, it will be helpful to add in and track developing country’s own commitments – and to see whether the total comes close to the financing gap identified by the Lancet.

Who is in and who is out?

It will also be interesting to see whether others join, from all the categories of governments, business, NGOs and so on. It is notable, for example, that India, home to more malnourished children than anywhere else, was not represented. Indeed, the Lancet lists 34 countries as containing 90% of the global burden of undernutrition.  Of these, and on a quick count, only 14 have so far signed up to the Compact. Other notable omissions include Pakistan, the Philippines, Sudan, South Africa, Angola and Ghana. Some of those missing in London include countries on the SUN list : Pakistan, for example, and Madagascar. This is obviously a process, and it is worth noting that the financial commitments are not tied to the countries which turned up.

Is the narrative right?

Over and above the money, what can be said about the content of the commitments? Remember that last year I laid out six principles for work in this area. In brief:

• Both transitory and chronic malnutrition matter for well-being and development: short term shocks as well as long term food poverty. That means paying attention to wasting as well as stunting, famine relief and safety nets as well as long-term poverty reduction and behaviour change.
• Measures to increase food production and food access are both important, but it is not axiomatic that one leads to the other. It is a mistake to confuse food production with what Amartya Sen called food entitlement.
• Tackling malnutrition is about more than producing and consuming food. As UNICEFdiscovered, the key ingredients include access to clean water, improved sanitation and health services, as well as the capacity to care for children within the household, including women’s education and the promotion of breast-feeding.
• As experience of food crises since 2008 has shown, global shocks affect local food prices and availabilities. That is why agricultural trade, biofuels policy, food aid and the management of commodity markets all need to be at least on the radar screen of nutrition policy.
• Sustainability and resilience need to be central to nutrition policy, especially in the face of climate change.
• Action on malnutrition will not happen unless it is prioritised, monitored and funded.

These principles are pretty well consistent with: (a) the approach in the Lancet , which has a useful diagram illustrating the links between health, income, household caring capacity and nutrition outcomes; (b) the WHO implementation plan on maternal, infant and young child nutrition, from 2012; and (c) the FAO’s latest report on the State of Food and Agriculture, which focuses on Food Systems for Better Nutrition. The last of these is especially good on local and international food policy issues, as might be expected; the first two are especially good on health and other community-level interventions. It is worth noting that there is also a strong rights-based approach running through the current discourse on nutrition. I discussed this last year in the context of the Brazilian contribution to the Downing Street Summit. Note that they were also co-sponsors of the event this year.

I should add, not only because I am on the Board, that it is good to see the International Food Policy Research Institute (IFPRI), making such a strong contribution to the conceptual underpinning of all this work, including two of the Lancet papers. IFPRI did not pledge independently, but hosts two of the key research programmes that the CGIARConsultative Group on International Agricultural Research offers as its contribution to the Compact, those on Agriculture for Nutrition and Health, and on Policy, Institutions and Markets.

Now, the authors of the Compact did not, quite understandably, set out to produce a PhD thesis on undernutrition. However, the Compact has some positive language. It says, inter alia, that

• ‘We particularly recognise the importance and support the progressive realization of the right to adequate food in the context of national food security.
• We commit to support the development of innovative, cross-cutting programs that integrate and mainstream nutrition objectives and outcomes by efficiently leveraging investments in maternal, newborn and child health; education; agriculture; water, sanitation and hygiene; gender equality and social protection.
• We recognise the importance of strengthening the link between sustainable agricultural growth and food systems in order to increase the availability of safe and affordable nutritious foods to support improved nutrition outcomes, but also that agricultural growth alone is not enough and requires a much more direct focus on nutrition.
• Governments addressing undernutrition specifically commit to provide strong national leadership to strengthen and develop high quality, validated, costed national nutrition plans and mobilise domestic resources for them’.

I think I could sign up to all of that. There’s quite a bit else, on science, monitoring, and the responsibilities of business that is also unexceptionable. Perhaps there should have been a bit more on transitory hunger and on avoiding famine.

Does the language of the Compact carry over into the commitments? That’s a more complicated question to answer, because the commitments are expressed in different ways by different contributors. It is mildly worrying that the title of the Compact is ‘Nutrition for Growth’. Whose growth is meant, I wonder, the individual or the nation? And it is also mildly worrying that the sub-title or strap-line is ‘beating hunger through business and science’. Is that intended to signal priorities? We could, for example, have had a Compact called, I don’t know, ‘Realising every child’s potential: delivering the right to food through social mobilisation and better service delivery’. I just wonder whether there was any tension in the messaging between DFID, the Brazilian Government and CIFF. It will be fascinating to see what title and strap-line the Brazilians choose in 2016.

Reading through the commitments, it is not surprising that the scientists emphasise science, the businesses business, and the NGOs a combination of service delivery and social action. Donors tend to tick all of those boxes. Interestingly, the UK makes a special point of launching new business and science initiatives. Developing country Governments tend to take an integrated view’ focusing on public sector initiatives rather than the role of the private sector. For example, Tanzania pledges to undertake a Public Expenditure Review on Nutrition. Interestingly, Tanzania is also one of the few contributors to emphasise the risk of obesity, the other aspect of the much-discussed double burden of malnutrition, pledging no increase in childhood overweight.

Overall . . .

I think we are entitled to be positive about the outcome of the process. I could have wished for more ambition, in the numerical targets and the financial outcome. It would have been good to see a rights-based approach even more prominent. Obviously, it would be good if more countries were to sign up before the deadline of 20 September (come on, India). But, as I discussed last year, nutrition has come a long way, and that can only be applauded.