Stunted. Current attempts to Eradicate Undernutrition

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Stunted. Current attempts to Eradicate
Undernutrition

• Lawrence Haddad
• Institute of Development Studies
• Global Classroom

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Outline

• What is undernutrition?
• Why does it matter?
• Why is it a matter for public
• Which interventions work and why?
• How to move nutrition higher up the development
  agenda?

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UN Conceptual Framework for Undernutrition
Undernutrition
Poor Diet
Infection
immediate
Health and sanitation
Household food security
Care
underlying
Economic performance, Governance, political
systems, natural resource endowment
basic
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Why does nutrition matter?

• Foundational for the MDGs
• Mortality
• Morbidity
• Learning
• Productivity

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Infant and Maternal Undernutrition is Leading
Cause of Global Burden of Disease
Source Ezzati et. al. 2002
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Why is it a matter for public policy?

• Missing markets
• Financing the Lifecycle
• Intergenerational externalities
• Inequalities
• Information symmetries
• Economic growth is insufficient

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Irreversibility

Shrimpton et. al. 2001
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Income Growth does not Reduce Child
Undernutrition Quickly Enough
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Emphasis for direct interventions by country
typology
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Emphasis at indirect level by country typology
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Commitments Mentions of Nutrition

• In Speeches (from Jan 2005)
• DFID 0/50
• EC 0/28
• In Press releases (from Jan 2005)
• DFID 0/197
• EC 0/239
• In policy documents
• 0 in G8 2005 and 2006
• 12 in Commission for Africa Report
• 0 in DFID Social transfers and chronic poverty

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Percentage of total ODA spend on Direct
Interventions
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Percentage of total ODA spend on Indirect
Interventions
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What constrains higher prioritisation?

• The context-- weak institutional incentives
• no nutrition indicators in reporting frameworks
• institutional orphan
• The message--lack of a simple story
• fuzzy versus silver bullets
• difficulty of attribution
• lack of easy resonance with current policy
  frameworks
• The connectors--few, isolated and lacking
  visibility
• failure of professional education at tertiary
  level
• weak professional career incentives

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Causes for optimism?

• CCTs
• Trends in randomised controlled trials
• Long wave issuesyouth perspectives
• Diet-related chronic disease
• Governance agenda

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Recommendations for Governments and Donors

• The context
• use underweight as indicator for MDG1 on poverty
• The message
• nutrition audit of indirect nutrition spend
• support nutrition surveys to name and shame and
  highlight poor governance
• generate research on a new generation of
  cost-effectiveness studies policy process
  studies
• The connectors--few, isolated and lacking
  visibility
• appoint a nutrition champion
• re-design higher education initiatives e.g.
  Masters in Development Practice

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Implications for Research

• Need a new generation of cost-effectiveness
  studies
• More political and policy process studies
• More institutional design studies

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The Cost-Effectiveness of Targeting Progresa in
Mexico
Cost of targeted program to reduce poverty index
by one unit Cost of non-targeted program to
reduce poverty index by one unit
Source Adapted from Skoufias, Davis and de la
Vega 2001
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Nutrition expenditure (rupees) per malnourished
child in 8 Indian States
Source Measham and Chatterjee 1999
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Institutional arrangements and service delivery
Rands to create one day of employment, South
Africa
Source Hoddinott, Adato, Haddad and Besley 2001
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Conclusions

• Undernutrition thinking desperately needs a
  development practice perspectiveneither health
  nor agriculture sectors have made it a priority
• More political, institutional, policy process
  analyses needed
• Need a greater link to the governance agenda
• Need new graduate programmes stressing
  connections and the politics of undernutrition
• Some optimism that the context is becoming more
  receptive to changed thinking

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Example questions for local investigation

• What percent of infants suffer from
  undernutrition in your local community? Check
  your perceptions against the datahow different?
  What do you think are the main causes of
  undernutrition in your area?
• The pros and cons of targeting versus universal
  accessdividing or uniting communities?
• The local politics of getting resources to
  childrenmandated or voluntary?
• Variations in the design of service delivery in
  your areawhere is it most obvious? Why?