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Informing Feed the Future: Integration Successes
Malnutrition is increasingly recognized as an under-addressed challenge to which over one third of child mortality is attributed. Chronic malnutrition stunts physical and cognitive growth, impacting educational achievement. Also, nutritional status and quality of diet have long-term impacts for adult disease and lifelong productivity, with effects seen from the household to the national level. The underlying causes of malnutrition are diverse and require multi-pronged efforts. Policy and program integration across sectors is increasingly seen as a strategy critical for success in reducing malnutrition rates. These priorities are highlighted in USAID’s Feed the Future strategy and the 1,000 Days partnership.
On December 12, University Research Co., LLC (URC) and George Washington University’s Center for Global Health sponsored a roundtable discussion, “Informing Feed the Future: Integration Success,” at the Global Health Council. Attended by over 70 participants, the roundtable focused on health and HIV/AIDS programs that have successfully integrated nutrition, food, and agricultural interventions, making effective use of public and private partnerships. Five panelists representing the US Agency for International Development (USAID), the United Nations Children’s Fund (UNICEF), Technoserve, and URC discussed approaches that link nutrition as a key component in health and HIV/AIDS programming, specialized food production for vulnerable groups, and small-scale agricultural production. Drawing from recent experience and new initiatives, the panelists discussed new solutions and partnerships that illustrate the practical integration of nutrition approaches into specific policy and programming frameworks. Audio recordings of the session are available at the bottom of the page and on YouTube.
- Nuné Mangasaryan, UNICEF’s Senior Advisor on Infant and Young Child Nutrition, set the policy stage by discussing the UN agency initiative REACH, which is supporting country-level comprehensive plans, strategies, and action. She used Laos as a case study, in which in-country advisors supported a number of processes, including the development and use of analytical tools. These tools led to a situational analysis and planning processes with participation by key government stakeholders, who were empowered to take ownership for them. She also emphasized the importance of the global Scaling Up Nutrition movement, which has gained broad support from many organizations and helped to galvanize expert agreement on evidence-based direct interventions for priority action, food security, agriculture, and other multi-sector approaches. She concluded by saying that future work at the country level must now focus on ensuring support for nutrition across sectors and stakeholders.
- John Borrazzo, USAID’s Division Chief for Maternal and Child Health, elaborated on the importance of nutrition to maternal and child health and its impact on mortality and morbidity. With one fifth of maternal mortality attributed to malnutrition, he welcomed the shift from focusing primarily on micronutrients to a broader perspective that acknowledges the health interface and incorporating issues such as anemia and low birth weight. He also cited the importance of approaches incorporating food security, specialized food products, and the broader value chains, working within local health and poverty contexts. He also emphasized the links between health, nutrition, and hygiene, citing diarrhea as a good example of the inter-relationship of problems and impacts.
- Tim Quick, USAID’s Senior Technical Advisor for HIV and Nutrition within the Office of Health and AIDS, presented a brief overview of the evolutionary process by which nutrition has been integrated into HIV/AIDS programming. Nutritional Assessment and Counseling Services are now a cornerstone of USAID’s approach to addressing the continuum of care across the lifecycle. Citing several country examples, he emphasized the importance of integrating policy and programs and using a variety of financial resources and projects, keeping the patient’s perspective as paramount. He noted the importance of getting implementation right, noting the contribution of quality improvement processes and supporting the human resources that provide key services.
- Tisna Velhuijzen van Zanten, Senior Vice President for URC’s International Development Group, talked about making nutrition integration work. She presented a multi-sector project example from Uganda, the USAID-supported NuLife project, to bring out key elements of integration success. She outlined both the challenges and the factors for success from NuLife, which sustainably established high rates of nutrition assessment and nutrition through HIV clinics, increasing survival rates. Moving from policy to guidelines to action takes concerted and coordinated effort, she said, describing three key steps in the process. In the case of integrating nutritional services into HIV/AIDS programs, the first lesson was to break down complex guidelines into smaller steps to solve operational challenges and build sustainability. Secondly, it was important to measure results for each step. Thirdly, evidence is crucial; it was important to document what worked through monitoring as well as evaluation. Overall, URC found that engaging in measurement empowers people at all levels to develop solutions and take ownership for results.
Project Snapshot: NuLife—Food and Nutrition Interventions for Uganda
Taking a holistic approach, NuLife addressed not just service quality and product demand, but also supply-side solutions. Taking up multiple aspects of the value chain for ready to use therapeutic foods (RUTF), NuLife supported a public-private partnership for RUTF production, took important steps to assure a market for the product, and found multiple input suppliers, supporting small-scale producers among the target population as well as commercial traders. Some project components will be sustainable at scale and others will remain as successful pilot-scale enhancements, dependent on the engagement of additional stakeholders.
- Susan Bornstein, a Senior Director for Technoserve, presented the African Alliance for Improved Food Processing (AAIFP), which brings private sector corporate expertise to local food processors in Ethiopia, Kenya, Malawi, Tanzania, and Zambia. It provides services such as mapping, training in food safety and quality standards, and market analysis, among others. Using long- and short-term advisors, AAIFP is helping to increase competitiveness, production and sales, and the availability of specialized processed or blended foods for local consumers as well as humanitarian use. Lessons learned have included the value of using local representatives while tapping global expertise, she said. In providing a set of value chain services to local food processors in multiple countries, support has to be tailored due to differences in diet, productions of raw material, and infrastructure. However, there is value in sharing experiences across countries. She said that the success of this sector-specific support project demonstrates that nutrition integration can take place at the policy level, while needed interventions and capacity building can be specialized.
The discussion was moderated by Jim Sherry, Chair of the Department of Global Health at George Washington University’s School for Public Health and Health Services. He announced plans for a food security and nutrition series in 2012, which would also take up related topics in a roundtable format.
A complete audio recording is available from the roundtable; select clips below to listen. Where available, Powerpoint presentations are also hyperlinked from the presenter's name.
|Introduction (4 min)||Audio|
|Nuné Mangasaryan (11 min)||Audio|
|John Borrazzo (10 min)||Audio|
|Tim Quick (18 min)||Audio|
|Tisna Velhuijzen van Zanten (20 min)||Audio|
|Susan Bornstein (25 min)||Audio|
|Discussion (40 min)||Audio|