Looking Back to Look Forward
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1 Looking Back to Look Forward Lessons from USAID investments in reducing micronutrient deficiencies Rolf Klemm, DrPH A2Z Technical Director Johns Hopkins School of Public Health
2 What has been the return on USAID s Micronutrient investments?
3 Key Factors Bold Leadership (combined with) Investments in 3D s Discovery Development Deployment Credible inter disciplinary expert groups Evidence summits Luck?
4 The Great Protein Fiasco, Lancet, 1974 Dogma Disputed
5 1974 Petroleum Crisis Ethiopian Famine Flooding in Bangladesh First World Conference on Nutrition, Rome, 1974
6 Today we must proclaim a bold objective that within a decade NO CHILD WILL GO TO BED HUNGRY, that no family will fear for its next day s bread, and that no human being s future and capacities will be stunted by malnutrition Henry Kissinger, World Food Conference, 1974
7 1 st Success Factor Bold Leadership
8 Martin Forman, USAID Leadership and Alfred Sommer, Johns Hopkins James Grant, UNICEF Nutrition Champions Duff Gillespie, USAID Ernest Loevinsohn, CIDA Frances Davidson, USAID Emorn Wasantwisut, Mahidol University Howdy Boius, Harvest Plus Meera Shekar, World Bank Melinda Gates Hillary Clinton
9 Institutional Champions and many others
10 2 nd Success Factor Investments in the 3D s Discovery Development Deployment Why? Acceptable? How to delivery at Where? Affordable? scale? l? Who? Safe? *Assessments What solution Delivery *Nat l policy dose, frequency? Mechanism? *Logistics/Supplies *Mgmt *Capability *Communications *Monitoring i *Evaluation
11 Discovery.
12 Vitamin A Reduces Preschool ChildMortality ~23% reduction
13 Therapeutic Effects of Zinc on Duration of Acute Diarrhea *India, 1988 *Bangladesh, 1999 *India, 2000 *Brazil, 2000 *India, 2001 Indonesia, 1998 India, 1995 Bangladesh, 1997 India, 2001 India, 2001 Nepal, 2001 Bangladesh, 2001 Pooled *Difference in mean and 95% CI Relative Hazards and 95% CI
14 Development of Solutions.
15 Home based Fortification Micronutrient Sprinkles Microencapsulated ferrous fumerate in powdered form are as effective as ferrous sulphate drops in treating anemia in infants 6 18 mo. Zlotkin, AJCN, 2001 Zlotkin, J Nutr, 2003
16 Bio fortification Tropical Maize varieties with high h levels l of bt betacarotene Orange fleshy sweet potato
17 Sodium Iron EDTA
18 Deployment
19 Deployment Using global lessons to move local programs 1998 MOST 2005 (ISTI) $/yr Focus Million Sustaining VAS coverage, Food Fortification, Maternal Anemia, ~8 Newborn VA VAS Child Survival Weeks, VA in PL480oil oil, Food based interventions, ~10 MN indicators in DHS Year USAID supported MN Projects 2005 "A2Z 2011 (AED) 1993 OMNI VAS, wheat flour & sugar 1998 (JSI) fortification, salt iodization, IFA ~10 VITAL 1989 Expand known methodologies to (ISTI) 1994 combat VA deficiency?
20 Example: VA Supplementation
21 Fortification Publications
22 Program Components for Successful Micronutrient Intervention Implementation Assessment Advocacy Policy Formation Inputs Process Political Support Logistics Outputs Capacity Building Communications Process Monitoring Outcomes Effectiveness Evaluation
23 3 rd Success Factor Credible Inter-disciplinary Expert Groups IVACG INACG
24 Interdisciplinary Expert Groups IVACG, INACG, MF
25 Innocenti Process, 2008 Evidence based stock taking taking of performance and effectiveness of micronutrient interventions at scale
26 4 th Success Factor Evidence Summits IVACG, INACG & MF meetings
27 Luck? Vitamin A Supplementation Simple Visible Inexpensive Life saving results Iodine Fortification Excellent food vehicle Simple technology Inexpensive Visible results
28 Lessons Bold Leadership & Powerful Champions Investment in the 3 Ds Eid Evidence is not enough. Credible cross disciplinary expert groups to accelerate the filling of the Know Do gap Evidence summits to rapidly promote & disseminate evidence based findings/practices Luck?
29 Remaining Challenges Sustaining gains of previous investments Moving from Donorship to Ownership Reducing anemia in women and children Delivery at scale of efficacious interventions Investment in how to move from Farm to Fork to enhance nutrient content & diversity of diets Maintaining visibility of MNs because preventing nonevents make it difficult sustain MN investments New discoveries for other MNs (e.g vitamin D) & enhanced discoveries of old MNs (e.g. long term effects)
30 Thank you!
31 Fortification Diet Supplements Deficient Population
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