Tuesday, 6 November 2012

Scaling Up Nutrition

Photo courtesy: ACF Kenya


In January 2008, the medical journal, The Lancet concluded a five-part series on Maternal and Child Under-nutrition in startling words uncharacteristic of scientific journals-“the international nutrition system is broken… (and) leadership is absent.” 

The Lancet provided evidence showing the first 1000 days of a child i.e. between 9 months of mother’s pregnancy and 2nd birthday of the child, are the most crucial in tackling under-nutrition. This “window of opportunity” was whereby any intervention would have the highest returns. Outside of this time period, irreversible damage such as poor cognitive development, stunting and potential economic losses due to lower productivity in later years, cannot be easily corrected.

Against the backdrop of this evidence and the poor progress of developing countries towards achieving MDG 1, urgent measures were taken to increase the pace and manner in which nutrition interventions were being implemented. Collaborative efforts between various entities in 2009 led to the development of a framework that would seek to improve maternal and child nutrition, especially in high burden countries. This framework was aptly named Scaling Up Nutrition (SUN). It was created for public good and soon evolved into a movement. 

The SUN framework employed a two pronged strategy in addressing under-nutrition, multi-sectoral approach and direct nutrition interventions. The former aimed to achieve this in three main ways: accelerating action on determinants of undernutrition such as low household income,integrating nutrition in other sectors such as education and increasing public coherence on the unintended negative consequences on nutrition policies by policies in other sectors such as food pricing, petroleum pricing or subsidizing of farm inputs. The use of direct nutrition interventions employed 13 interventions that were proven to have a high impact hence dubbed High Impact Nutrition Interventions (HINI). 

Kenya, along with over 100 other countries, has endorsed the SUN movement. Pilot studies were done in Isiolo, Samburu and Marsabit in order to gleam lessons and best practices before nationwide implementation.In consideration of the national launch on 5th and 6thNovember this year, a reminder of a few factors that are pivotal to the success of SUN is important.

Firstly, that nutrition cuts across diverse disciplines. Minor changes in one sector can have ripple effects on nutrition that can be beneficial or otherwise. Thus, policy makers ought to find a common ground on which guidelines are set. A case in mind is how the urban poor are most vulnerable to shocks in food prices. The outcome of a chronic exposure to such an economic environment is under-nutrition, especially in children below five years.

Secondly, Public-Private Partnerships (PPPs) are essential to SUN. Interventions such as provision of micro-nutrients through food fortificationcan only be carried out by involving the private sector. Efforts made towards this end such as the fortification of staple foods are highly commended.Nonetheless, more deliberate efforts towards partnerships would ensure that SUN in Kenya is a success.

Thirdly, it is crucial for all involved in nutrition, either directly or indirectly, to own this movement. We should speak in one voice without hidden agendas. SUN was created for public good. Hence, it is only natural that its core implementers should have the public good in view. It would be pathetically immoral if we use SUN as a parachute for our own selfish motives. 

Lastly, Political commitment is the fabric that holds SUN together. In its absence, all efforts aimed at reducing levels of under-nutrition in the country would be greatly frustrated. It is on this accord that the political class should put their best foot forward and be seen as ambassadors of SUN. History would judge harshly those who choose not to do so when it was in their power to do otherwise.

In conclusion, we should all take our part and act now. The stakes are high and so are the returns. Perhaps, in 2013, Kenya would obtain a favourable mention in the next series of The Lancet.

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