Roundtable: Government Action for Nutrition in South Asia
On September 7 and 8, 2017, the National Planning Commission (NPC) of Nepal hosted a two-day Roundtable focused on advancing multi-stakeholder and multisectoral national and subnational efforts for scaling up government nutrition programs. The event brought together 120 decision-makers and implementers from governments, civil society organizations, and donors to share their experience in designing and implementing programs that address malnutrition in the region.
The event was sponsored by the South Asia Food and Nutrition Security Initiative (SAFANSI), which is administered by the World Bank with funding from the UK Aid from the UK Government and the European Commission, and co-sponsored by ten development organizations.
For more information, please contact: Jamie Greenawalt - firstname.lastname@example.org
Addressing nutrition is not about dealing with it in one or the other sector. It is about human development as a whole.
Dr. Shereen Mustafa, Government of Sindh
Since 1990, chronic malnutrition (and particularly stunting) has declined by almost half in South Asia—falling from 61 percent to 36 percent. However, more recent data shows the rate of decline in stunting slowing, and even reversing in some countries. This is despite strong economic growth and a decline in poverty. Nutrition plays a critical role in the human resource base of a country, which in turn determines the economic development of a country. Therefore, the governments of South Asia have committed to taking strong action to improve the nutrition situations of their populations.
Within this framework, SAFANSI is supporting regional efforts towards more integrated food and nutrition security actions by working with existing knowledge networks to develop a strong cadre of advocates, policy-makers, and practitioners.
The September 2017 Roundtable focused on advancing multi-stakeholder and multi-sectoral national and subnational efforts and on identifying the best ways to scale up government nutrition programs for maximum impact. Discussions drew on the latest experiences from ongoing nutrition investments in the region to explore the practical challenges.
Participants worked on four specific topics: 1) providing nutrition services at the subnational level, 2) creating and tracking program budgets, 3) coordinating among different sectors, and 4) achieving behavior change among communities.
Setting the Stage: Progress to Date and Barriers to Multi-sectoral Nutrition at the Policy Level
Melissa Williams, Senior Rural Development Specialist, and Jamie Greenawalt, Operations Officer | WBG
Establishing and Defining Functionality of District Nutrition Coordination Committees in Lao PDR
Peter Newsum, Director, and Mr. Ranjan Shrestha, ENUFF Project | SNV
Nepal Sunaula Hazar Din Project
Dr. Manav Bhattarai | WBG
Sindh Case Study: Subnational Level Experience
Dr. Shereen Mustafa | Government of Sindh
Can Rural Leaders Play a Role? A Case of How Agricultural Workers Lead Research on Women's Work and Nutrition
Noorulain Masood, Director of Research to Action | LANSA
Insights from the Farming System for Nutrition Study in India
Dr. Bhavani RV, Project Manager | LANSA, MSSRF
Advancing a Multi-sector Nutrition Plan, Nepal
Prof. Dr. Geeta Bhakta Joshi, Hon. Member | National Planning Commission, Nepal
SAPLING: Promoting Cooperation Between South Asian countries and the Potential for Upscaling Local and Sub-national Strategies
Dr. Manu Raj Mathur MPH PhD, Senior Research Scientist & Associate Professor | Public Health Foundation of India
South Asia Food and Nutrition Security Initiative, SAFANSI
Jamie Greenawalt, Operations Officer | WBG
SecureNutrition Knowledge Platform
Laura Figazzolo, Consultant | WBG
Scaling Up Nutrition (SUN) Movement
Dr. Alam Khattak and Dr. Patrizia Fracassi | Scaling Up Nutrition (SUN) Movement Secretariat
Addressing the Nutrition Challenge: Leveraging the Institutional Platform of Sgh's in Bihar
Dr. Shobha Shetty, Practice Manager | WBG
Maharashtra State, India: Role of the State Nutrition Mission in Strengthening Nutrition Governance
Rajlakshmi Nair, Nutrition Specialist | UNICEF India
Financing of Nutrition Specific Interventions: Implications for Program Decision Making
Dr. Deepika Chaudhery, Nutrition Specialist | WBG
USAID SPRING work in Nutrition Planning and Budgeting
Amanda Pomeroy-Stevens | USAID/SPRING
Investment Framework for Nutrition: Afghanistan Case Study
Michelle Mehta, Consultant | WBG
The Cost of Achieving Nutritional Security and the Cost of Calories in India
Dr. Anjani Kumar and Dr. Avinash Kishore | IFPRI
Budgetary Analysis of Public Sector Development Program in Balochistan, Pakistan 2016-17
Shah Jehan, Chief, Nutrition and Health | Government of Balochistan, Pakistan
Mr. Nasrullah Arsalai, Director General of the Council of Ministers Secretariat, Islamic Republic of Afghanistan
It was important for me to hear experiences in other countries, such as the ones of Nepal and of the Maharashtra in India. In this latter case in particular, I was fascinated by how a visionary bureaucrat achieve so much. It makes me think that people should feel ownership to really feel they can play a role. Communities must be involved in nutrition work, and should feel they own the possibility of catalyzing change in nutrition. Second, I understood the positive role that education can play both as a sector and also in terms of nutrition education/behavior change communication to enhance outcomes. This leads me to a third key takeaway, which is.the need to work on nutrition by preventing malnutrition, rather than "curing" it when it becomes a problem. Nutrition education, particularly among children and women, can play a key role in this. Finally, I think the only way we can advance the nutrition agenda is by drawing from actual examples as the ones that have been presented here.
Prof. Dr. Geeta Bhakta Joshi, Hon. Member, National Planning Commission, Nepal
Approaching nutrition multisectorally is the only way in which the nutrition community can advance its agenda. Nutrition is a cross-cutting issue, it requires coordination of efforts across sectors, and, particularly, scaling up efforts requires a multisectoral approach. In this framework, key elements to consider to advance actual implementation of nutrition interventions seem to be, first, financing, and, second, capacity building within the sector. Proper costing exercises, clear budgets, and constant cost tracking within single interventions and at broader level are required to address nutrition effectively. At the same time, human resources within the sector should be adequately trained and capacitated to implement at the subnational levels the designed interventions. Enhancing awareness on the relevance of these two aspects can definitely help promoting the effectiveness of interventions, paving the way for further engagement by government.
Mr. Shah Jehan, Chief, Nutrition and Health, Government of Balochistan, Pakistan
During these two days, I got to know how partner agencies and other governments are advancing the nutrition agenda. Nepal provides a great example of this with its multisectoral nutrition plan. For instance, I learned the relevance of proper budgeting. Maharastra provides an excellent example of reduction in malnutrition indicators with appropriate budgeting, and I realized that we as a government never really understood the different steps involved. Now it is clear. Finally, I learned that it is key to empower the subnational level to implement nutrition interventions, and to adequately equip human resources at that level to work on nutrition. This will help engage the grassroots—the communities—which is another key area that should be addressed. These are the key points I understood these two days.
Dr. Bhavani RV, Project Manager, LANSA, MSSRF
We need a clear 'voice' to lead the nutrition agenda, a clear thrust that comes from the top. Governments should enhance efforts from different sectors; they should work towards creating an enabling environment for effective implementation of nutrition-sensitive interventions to attain desired nutrition outcomes, and give thrust to nutrition-sensitive agriculture. What is concerning is the fact that agriculture is not looked at as a priority. A clear voice coming from the top level of the government should highlight the relevance of agriculture as a priority sector to be leveraged and integrated within the framework of the broader approach to address malnutrition.
Dr. Manu Raj Mathur MPH PhD, Senior Research Scientist & Associate Professor, Public Health Foundation of India
During this roundtable, three key issues emerged that could be critical to enhance the nutrition agenda further, and are especially relevant with regards to the challenges that South Asia as a region is facing. First, there is need to integrate nutrition within broader development and health programs. Nutrition, health, and development go hand in hand—you cannot improve one without the other. Second, all stakeholders work on nutrition determinants and outcomes, not on the preventive actions. The nutrition community should focus on prevention and work on nutrition before it becomes a problem, within the framework of multisectoral interventions. Third, there are experiences from innovative approaches being implemented in the field, but these are hard to compare with what is happening in different contexts. To make such efforts effective, they have to be scalable.
Dr. Shereen Mustafa, Government of Sindh
Understanding the issue of nutrition from a multidimensional point of view is the first step to build strong leadership around nutrition in government. Addressing nutrition is not about dealing with it in one or the other sector, it is about human development as a whole. Nutrition is the key to human development. Once governments acknowledge this, they should translate it into action. Yet, governments should also acknowledge that certain issues are hindering the implementation of nutrition interventions. For instance, how are we addressing nutrition? Do we have enough nutritionists that can lead the way? Do we offer nutrition within school curricula? Can we ensure access to health and care services to ensure good nutrition outcomes? Here, the integration between various sectors comes in. Coordination, integration and balancing of activities between all relevant sectors are needed to address nutrition multisectorally.
Mr. Purna Chandra Wasti, Senior Food Research Officer, Department of Food Technology and Quality Control, Nepal
In order to advance the nutrition agenda, the nutrition community should better coordinate its advocacy efforts, make them more strategic and bring them to a higher level, in a way to force governments to put nutrition high on their agenda. Nutrition should be mainstreamed as a broader development goal, and not considered a sector issue only. How can this be achieved? By increasing the number of nutritionists doing development to enahcne the awareness of nutrition as a key issue within the sector, and by learning from the experiences carried out at subnational levels to inform planning.