Lawrence Haddad Global Alliance for Improved Nutrition Scaling Up Nutrition Action for Africa Where are we and what challenges are need to be addressed to accelerate malnutrition? Lawrence Haddad Global Alliance for Improved Nutrition

Why should African political leaders care about malnutrition? What needs to happen?

Good nutrition prevents 45%.. .....of all death under 3 years of age that is related to malnutrition

Good nutrition “wires the circuits”

Poor nutrition reduces the economic wealth of nations

Demographic Dividend for Africa? With stunting? Forget about it. Data from Bloom and Canning 2011

And the Development Bank Leaders Know It Akin Adesina President of the African Development Bank 2016 “We need to invest in gray matter infrastructure.” “Neuronal infrastructure is quite possibly going to be the most important infrastructure.” Jim Kim President, World Bank 2016 Here are Two quotes from leaders of development banks—quite extraordinary—is this the beginning of a sea change in the way financial institutions think about nutrition? YES

Scaling Up Nutrition. Where Are We?

All African countries have serious malnutrition problems 25% have serious under and over nutrition problems Under 5 Stunting Ethiopia, Rwanda Botswana, Egypt, Equatorial Guinea, Lesotho, Libya, Namibia, South Africa, Swaziland Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Comoros, Congo (Republic of The), Côte d’Ivoire, Democratic Republic of the Congo, Djibouti, Eritrea, Gambia, Guinea, Guinea-Bissau, Kenya, Liberia, Madagascar, Malawi, Mali, Mauritania, Mozambique, Niger, Nigeria, Sao Tome and Principe, Sierra Leone, Somalia, Sudan, Togo, Uganda, Tanzania, Zambia, Zimbabwe Adult Overweight Algeria, Gabon, Morocco, Seychelles, Tunisia Women’s Anemia Ghana, Senegal

What is the rate of progress? Highly variable—but there is cause for hope

Number of African countries at stages of progress against global targets on nutrition Missing data Off course, little/no progress Off course, some progress On course, at risk On course Stunting children under 5 34 5 6 9 Wasting children under 5 34 17 3 Overweight children under 5 7 23 7 8 9 Anemia women aged 15-49 years 52 1 1 Exclusive Breastfeeding, <6 months 16 12 23 3 Adult Overweight + Obesity (BMI≥ 25) 54 Adult Obesity (BMI≥ 30) 54 Adult Diabetes (Raised blood glucose) 53 1 Global Target

Progress against Malabo Declaration target for stunting reduction How many African countries will attain stunting rates of 10% by 2025?

What Needs to Happen? Commitment Coverage Coherence Cash

Must make the issue hard for African heads of state to ignore

Many African countries are members of Scaling Up Nutrition (SUN) Movement—but not all

But commitment is not measured by membership alone. Setting & working to meet SMART targets is key. Why are we worried about SMART targets? Because they lend themselves to stronger accountability but also 2. they go hand in hand with performance (see next slide)

There are not enough SMART targets in African nutrition country plans Setting SMART (specific, measurable, relevant, achievable and time-bound) targets is one indicator of commitment This analysis is from the WHO team. Unfortunately looking at 122 country nutrition plans, less than half have set SMART targets for the 6 WHA maternal and child nutrition indicators. Stunting and EBF fare the best. Wasting, perhaps surprisingly, is given lower priority when it comes to setting SMART targets. KB: Analysis of plans from 40 of 54 African countries.

Few African Countries have Targets for Diet Related NCDs Percent of 40 countries with targets for… % On the NCD side of things, less than a third of 174 countries surveys by WHO had targets (SMART or not) for obesity, diabetes and reduction of salt intake Source: Unpublished self-reported data from the NCD Country Capacity Survey, provided by the WHO Surveillance and Population-based Prevention Unit, Department for Prevention of NCDs. Printed with permission.

Nutrition Program Coverage?

Coverage of Nutrition Programs is too Low Coverage of nutrition-specific interventions remains highly variable across African countries This slide shows that when it comes to nutrition specific interventions there is a wide range of coverage achieved by different countries. This is good and bad news. Bad news because we want more countries with high coverage. Good news in the sense that some countries have achieved high coverage but they are not obviously wealthier than the countries that have not. We need to understand more about why some countries are near the top of the lines and some are near the bottom

Coherence

Coherence: Underlying determinant dashboard for Kenya http://globalnutritionreport.org/files/2014/11/gnr14_cp_kenya.pdf

Cash: Invest more and allocate better Implementation takes financial resources. Some of it needs to be new. Some of it needs to be allocated differently.

Big chunks of African government budgets go to nutrition relevant sectors % of government budgets, Africa, 2010 www.globalnutritionreport.org

Cash: yet too little is spent on nutrition from related sectors Budget allocations to nutrition sensitive actions in these countries are relatively low But its not just about more money. Its also about making existing allocations to food and agriculture, health, education, social protection, WASH and women’s empowerment more effective in reducing malnutrition The graph shows the percent of government expenditures going to nutrition sensitive programmes (using the SUN donor network definition). The countries on the right of the graph allocated much less of their budgets to nutrition sensitive programmes than other countries—the potential to increase is clear. Source: OPM and SUN SMS

Conclusions Some countries are on course to meet targets. Many more are making some progress. Need more: commitment coverage coherence cash Malnutrition is not destiny. Ending it is a political choice—supported by SMART commitments for accountability.

Ghana is re-writing the African story % Stunting rate of under 5 children, Ghana

Three things you can do Challenge decision makers with evidence on the slow pace of malnutrition reduction Make those essential but challenging alliances for nutrition with those outside your immediate circle Make SMART commitments for nutrition and ask others to do the same

Thank you