The nutrition barometer. Gauging national responses to undernutrition. embargoed

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1 The nutrition barometer Gauging nationa responses to undernutrition embargoed

2 Front cover: A young gir and her sister wait to be treated for manutrition at the medica cinic in Hiaweyn refugee camp in Ethiopia in October (Photo: Jan Grarup/Noor for Save the Chidren) Aemnesh and her daughter, Aya, in the Amhara region of northern Ethiopia. Rates of chid undernutrition here are high. (Photo: Coin Crowey/Save the Chidren)

3 The nutrition barometer Gauging nationa responses to undernutrition

4 Save the Chidren works in more than 120 countries. We save chidren s ives. We fight for their rights. We hep them fufi their potentia. Word Vision is a Christian reief, deveopment and advocacy organisation dedicated to working with chidren, famiies and communities wordwide to reach their fu potentia by tacking the causes of poverty and injustice. This report is written by Maricar Garde, Kate Eardey, Louise Hoy and Lisa O Shea, with the benefit of guidance on the design and methodoogy of the Barometer from Aex Cobham. Without impication, we thank Dof te Linteo for reviewing an eary draft. We are gratefu for comments and input from staff across Save the Chidren and Word Vision. Pubished by Save the Chidren Word Vision Internationa 1 St John s Lane 6 9 The Square, Stockey Park London EC1M 4AR Uxbridge, Middesex UB11 1FW UK UK +44 (0) (0) savethechidren.org.uk First pubished 2012 The Save the Chidren Fund and Word Vision Internationa 2012 The Save the Chidren Fund is a charity registered in Engand and Waes (213890) and Scotand (SC039570). Registered Company No This pubication is copyright, but may be reproduced by any method without fee or prior permission for teaching purposes, but not for resae. For copying in any other circumstances, prior written permission must be obtained from the pubisher, and a fee may be payabe. Typeset by Grasshopper Design Company Printed by Page Bros Ltd.

5 contents The Nutrition Barometer Executive summary Abbreviations v vi viii Introduction time for action on nutrition 1 Measuring commitments and outcomes 1 Box: Growing momentum for nutrition 3 1 The Nutrition Barometer expained 4 Box: The Nutrition Barometer and the Hunger and Nutrition Commitment Index 5 2 The findings commitments and nutrition & chid surviva outcomes 6 Highs and ows 7 Commitments matched by outcomes 7 Country case study: Guatemaa 8 Country case study: India 9 Commitments higher than outcomes 7 Country case study: Kenya 10 Country case study: Afghanistan 11 Outcomes stronger than commitments 12 Box: G8 donors highight nutrition but fa short on nutrition funding 13 Poitica wi and financing over time 13 Box: The roe of heath workers in tacking undernutrition 14 3 Concusions and recommendations 15 Appendix: Methodoogica notes 17 Endnotes 19

6 photo: Justin Dougass/Word Vision Mother Aima Maiga with her one-year-od daughter Fatoumata paying a hand-capping game during nutrition training for mothers in Mai. The training has improved the cooking habits of mothers with undernourished chidren, resuting in weight gain for the chidren.

7 The nutrition barometer The Nutrition Barometer provides a snapshot of nationa governments commitments to addressing chidren s nutrition, and the progress they have made. It ooks at 36 deveoping countries with the highest eves of chid undernutrition. The Barometer measures governments poitica and ega commitment to tacking manutrition (eg, whether they have a nationa nutrition pan), as we as their financia commitment. Countries progress in tacking manutrition is measured by chidren s nutritiona status the proportion who are underweight, stunted or suffering from wasting and chidren s chances of surviva. Countries are then ranked according to both their commitments and their nutritiona and chid surviva outcomes, as indicated in the adjacent tabe. For each category countries are divided into four groups of nine sound (green), fair (yeow), emerging (bue) and frai (red). FRAIL EMERGING FAIR SOUND For detaied notes on methodoogy and a fu ist of indicators, see the Appendix on page 17. Country Commitment Outcomes Afghanistan Angoa Bangadesh Burkina Faso Burundi Cambodia Cameroon Congo, DR Côte d Ivoire Egypt Ethiopia Ghana Guatemaa India Indonesia Iraq Kenya Madagascar Maawi Mai Mozambique Myanmar Nepa Niger Nigeria Pakistan Peru Phiippines South Africa Sudan Tanzania Turkey Uganda Vietnam Yemen Zambia v

8 executive summary 2012 A CRITICAL YEAR 2012 has been a critica year for action on nutrition. In May the Word Heath Assemby adopted a resoution on materna, infant and young chid nutrition, incuding a target to reduce the number of stunted chidren by 40% by US President Obama, together with the G8, African eaders and the private sector, aunched the New Aiance for Food Security and Nutrition. Even the Oympic Games incuded a focus on nutrition, with British Prime Minister Cameron and Braziian Vice-President Temer hosting a historic summit to tacke nutrition ahead of the cosing ceremony of the London 2012 Oympics. This summit set out measures that coud reduce the number of stunted chidren by 25 miion before the next Oympic Games in Rio de Janeiro, thus setting 2016 as a key miestone for reaching the ambitious Word Heath Assemby 2025 target. Increased internationa attention on the sient crisis of undernutrition is wecome, and ong overdue. One-third of a chidren under five in deveoping countries are stunted. Stunting irreversiby damages a chid s cognitive and physica potentia and has ife-ong consequences for heath, educationa attainment and economic productivity. In contrast with most other chid heath indicators, rates of stunting are faing too sowy, and the proportion of wasted chidren (suffering acute weight oss) actuay rose during the ast decade. Through initiatives such as the Scaing Up Nutrition Movement, the UN Secretary-Genera s Goba Strategy on Women s and Chidren s Heath (known as Every Woman Every Chid ) and the 1,000 Days partnership there is growing recognition of the importance of nutrition in achieving Miennium Deveopment Goas 4 and 5. Last year, a comprehensive report on commitments to Every Woman Every Chid highighted a ack of attention to nutrition, describing it as a negected area. We now have a window of opportunity to capitaise on increased attention on the crisis of undernutrition and the growing poitica wi to tacke it and to ensure that more chidren get a chance to deveop to their fu potentia. GAUGING PROGRESS In order to assess recent progress towards improving nutrition and to hep define the critica steps necessary to achieve the ambitious 2025 stunting targets, Save the Chidren and Word Vision have produced a Nutrition Barometer. The Barometer provides a snapshot of governments poitica and financia commitments on nutrition in the 36 countries that are home to 90% of manourished chidren, compementing other efforts to strengthen accountabiity for women s and chidren s heath. It reveas that many countries sti have a ong way to go to make nutrition a poitica priority, and then to transform commitments on nutrition into progress. The Nutrition Barometer measures two dimensions of a country s commitment to nutrition. The first ooks at aws, poicies and other efforts at the nationa eve to address undernutrition. The second assesses the resources that governments aocate to meeting their commitments. The Barometer aso measures chid surviva and nutrition outcomes by tracking the proportion of chidren who are underweight, stunted and wasted. Recognising that undernutrition is the underying cause of one-third of a chid deaths, it aso ooks at a country s progress towards Miennium Deveopment Goa 4 a two-thirds reduction in under-five mortaity by A countries featured in the Barometer continue to have very high burdens of undernutrition. Of the 36 countries featured, however, the countries making most progress are Guatemaa, Maawi and Peru. A three demonstrate sound commitments, and sound chid nutrition and surviva outcomes, reative to the other countries in the group. The Democratic Repubic of Congo, India and Yemen show the weakest performance, with frai commitments and frai outcomes. vi

9 In many of the countries surveyed, progress in tacking manutrition refects poicy commitments. However, some countries, such as Ethiopia, score we on commitments but their outcomes ag behind. This iustrates the fact that it can take time for commitments to be put into action, and for action to be transated into outcomes. It aso underscores the need for reguar monitoring of nutrition indicators. Other countries, ike the Phiippines, seem to have better outcomes even though they score ower on commitments. This coud be a resut of economic growth, rising househod incomes and other socia poicies that ead to improvements in nutrition across the genera popuation. WHAT NEEDS TO CHANGE A countries featured in the Barometer need to sustain efforts over generations. Enshrining commitments in aw wi aow peope to hod their government to account and ensure adequate investment in nutrition over time. The Nutrition Barometer shows that, whie in many cases the eve of poitica commitment to nutrition is an indicator of the ikey direction of nutrition outcomes, this is not necessariy the case. In order for nutrition outcomes to improve, there must be fu impementation of strong nutrition strategies that are backed up by ong-term investments of adequate finances and human resources, and sustained poitica wi. Reguar reviews of these country-specific nutrition strategies, aong with improved transparency and access to information, wi enabe greater accountabiity in reation to the progress of nationa governments in improving nutrition. Civi society has a key roe to pay in the accountabiity process. RECOMMENDATIONS Hoding governments to account for their commitments on a reguar basis wi be critica to reversing the unacceptaby high eves of chronic undernutrition and chid mortaity. By assessing countries readiness and wiingness to combine commitments with action, the Nutrition Barometer wi contribute to efforts aready underway to scae-up improvements in nutrition. Making significant reductions to the unacceptaby high eves of chronic undernutrition wi take a coordinated effort as we move towards the Word Heath Assemby s target of The 2016 Oympics wi be a key moment to stop and check that we are moving in the right direction. Save the Chidren and Word Vision ca upon more countries to demonstrate eadership on nutrition and ensure commitments are swifty transated into action. The internationa community must not squander this opportunity to address both the causes and consequences of undernutrition, and must take the foowing steps: Nationa nutrition pans shoud be costed and incude nationa and sub-nationa targets for improving nutrition and reducing stunting. They must: incude a focus on reaching the poorest chidren; incorporate the indirect interventions that are the responsibiity of other sectors; incude a strong monitoring framework that sets out a reguar (eg, annua) review process, with input from civi society and other stakehoders. Countries with a high burden of nutrition shoud increase and sustain investment in direct nutrition interventions and in strengthening heath systems (incuding human resources) that are needed to deiver those interventions. Countries shoud increase the transparency of and accountabiity for nutrition pans by making better data avaiabe. They shoud ensure that there are reguar nationay representative nutrition surveys to improve the monitoring of progress against nutrition indicators. Countries with a high burden of undernutrition shoud join the Scaing Up Nutrition Movement, and shoud fuy integrate nutrition into their efforts to improve materna and chid heath through the Every Woman Every Chid initiative and through the more recent A Promise Renewed movement (which came out of the Chid Surviva Ca to Action). The SUN movement shoud undertake a costing of country pans, to be competed by the end of 2012, whie donors and other deveopment partners shoud make ong-term financing commitments to meet any financing gaps in impementing ambitious nutrition pans. Donors shoud fufi their commitments and aso use forthcoming opportunities in 2013 to make further concrete commitments to supporting nutrition. ExECUTIVE SUMMARY vii

10 abbreviations DHS Demographic and Heath Survey DRC Democratic Repubic of Congo EU European Union HANCI Hunger and Nutrition Commitment Index HRCI Hunger Reduction Commitment Index ICDS Integrated Chid Deveopment Services IDS Institute of Deveopment Studies MDGs Miennium Deveopment Goas NGOs Non-governmenta organisations SUN Scaing Up Nutrition Movement UN United Nations UNICEF United Nations Chidren s Fund viii

11 introduction Recent decades have seen dramatic progress in chid surviva. The number of chidren dying before their fifth birthday decined from 12 miion in 1990 to 6.9 miion in 2011 according to UNICEF s 2012 Leves and Trends in Chid Mortaity report. In contrast to this overa positive trend, progress in reducing chidhood undernutrition has been sow. It remains the underying cause of more than a third of a chid deaths wordwide around 2.3 miion in Materna undernutrition, ong-term exposure to a poor diet and repeated infections have aso eft miion chidren under-five stunted, preventing them from reaching their fu potentia. (These are estimates from UNICEF and the Word Heath Organization.) Stunting is a hidden probem in many popuations, and chidren may not appear undernourished. However, stunting indicates impairment to both physica and cognitive deveopment, which can have ifetime consequences for a person s heath, educationa attainment and economic productivity. Aarmingy, the proportion of wasted chidren (suffering acute weight oss) actuay rose in the second haf of the 2000s. 1 The recent food crises in both west and east Africa have highighted the need for more effective responses to prevent undernutrition in emergencies, particuary in areas with recurrent food crises TIME FOR ACTION ON NUTRITION 2012 has been a critica year for action on nutrition. The US President Barack Obama, together with G8 and African eaders and the private sector, aunched the New Aiance for Food Security and Nutrition, aiming to take 50 miion peope out of poverty in the next decade. In May, the Word Heath Assemby adopted a resoution on materna, infant and young chid nutrition, incuding a target to reduce the number of stunted chidren by 40% by On the cosing day of the Oympic Games in London, UK Prime Minister David Cameron and Braziian Vice President Miche Temer co-hosted a hunger summit bringing together key government eaders, the private sector, United Nations, Word Bank, nongovernmenta organisations (NGOs) and foundations. Leaders attending the hunger summit took up the baton on what we hope wi be a significant push on hunger and nutrition. At the summit measures were announced to reduce the number of stunted chidren wordwide by 25 miion by the next Oympic Games in This woud put the word on track to achieve the even more ambitious 2025 target. The European Commission announced that it wi support high-burden countries to reduce stunting and accept responsibiity for 10% of the overa 40% reduction target agreed at the Word Heath Assemby. 2 The Scaing Up Nutrition (SUN) movement 3 is aso aunching a revised strategy this year. Increased internationa attention on the sient crisis of undernutrition is wecome, and ong overdue. But it is not enough if we are to deiver these ambitious targets. Countries with a high burden of undernutrition need to demonstrate high-eve eadership and ensure that commitments are swifty transated into poicies and pans, backed by additiona resources and propery impemented, to improve nutrition outcomes for chidren and their mothers. MEASURING COMMITMENTS AND OUTCOMES To assess nationa governments poitica and financia commitments to nutrition, Save the Chidren and Word Vision have produced a Nutrition Barometer. In the same way that a weather barometer measures changes in atmospheric pressure, the Nutrition Barometer gauges how governments are faring in poitica and financia commitments in ight of increased goba attention on the issue. 1

12 THE NUTRITION BAROMETER This first edition of the Barometer monitors governments poitica and financia commitments to nutrition in the 36 countries that are home to 90% of undernourished chidren. Poitica commitment, such as signing onto a goba pan ike Every Women, Every Chid or having a nationa pan on nutrition, is just one step towards addressing the issue. A poitica commitment may not aways transate into a financia commitment. There are a number of steps and measures that need to take pace between making a commitment, impementing programmes and, utimatey, having an impact. The Scaing up Nutrition (SUN) movement is a good exampe of this. This Barometer ooks at the first step of the process towards improved nutritiona outcomes. It shows that whie, in many cases, the eve of poitica commitment to nutrition is an indicator of the ikey direction of nutrition outcomes, this is not necessariy the case. In order for nutrition outcomes to improve, there must be fu impementation of strong nutrition strategies that are backed up by ong-term investments of adequate finances, sufficient human resources and sustained poitica wi. Reguar reviews of these country-specific nutrition strategies, aong with improved transparency and access to information, wi enabe greater accountabiity in reation to the progress of nationa governments in improving nutrition. Civi society has a key roe to pay in the accountabiity process, especiay in faciitating the diaogue between citizens and their eected officias. PHOTO: CJ CLARKE/SAVE THE CHILDREN Rani, eight, from Punjab in Pakistan, hoding her seven-month-od sister, Samia. Foowing foods in 2011, Samia was treated for severe acute manutrition. 2

13 The Nutrition Barometer compements other accountabiity efforts, incuding the work of the independent Expert Review Group and the Partnership for Materna, Newborn and Chid Heath. 4 It wi be used by Save the Chidren, Word Vision and other partners to acknowedge those countries that are moving in the right direction to reduce undernutrition, and to highight those making insufficient progress. In future editions, deveopments on nutrition wi continue to be monitored, as wi progress on other aspects of chid heath. INTRODUCTION GROWING MOMENTUM FOR NUTRITION The first 1,000 days from conception through to two years of age have been proven to be critica for growth, deveopment and ife-ong potentia. Looking back over the 1,000 days from the beginning of 2010 to the UN Genera Assemby in September 2012, there have been a number of key events and processes that have aid the foundations for potentia unprecedented improvements in materna and chid heath and nutrition. Momentum was gavanised eary in 2010 through the deveopment of the UN Secretary-Genera s Goba Strategy for Women s and Chidren s Heath, aso known as Every Woman Every Chid. 5 The estimated funding gap for materna, newborn and chid heath identified in the Goba Strategy incuded the costs of direct nutrition interventions, aong with a target of protecting 88 miion chidren under five from stunting by The subsequent aunch of this Goba Strategy in September the same year garnered US$40 biion in financia commitments pus a arge number of poicy and service deivery commitments. However, a detaied report on commitments to the Goba Strategy 6 highighted a ack of attention to nutrition, describing it as a negected area of the continuum of care aso saw the aunch of the Scaing Up Nutrition Movement a goba movement of governments, donors, civi society, mutiateras, private sector and other actors that aims to catayse and scae up current efforts to improve nutrition for pregnant women and chidren under two. The SUN movement deveoped a goba Framework for Action, a roadmap for impementation, and created severa taskforces to effectivey spur a scaing up of investment, advocacy and programming in nutrition. Key donors have identified the need to further mobiize resources for nutrition, and neary 30 countries with huge nutrition chaenges have signed up, keen to work with partners to increase their nutrition efforts. The 1,000 Days Partnership, ed by the US and Irish governments, was aso aunched in 2010 to bring high-eve poitica eadership and momentum to this movement. Adding further weight to the SUN movement, in Apri 2012, the UN Secretary-Genera personay appointed 27 senior representatives from governments, civi society, deveopment agencies, internationa organisations, business and foundation to provide strategic oversight, mobiize resources and improve accountabiity and coordination of the movement. Never before have so many eaders, from so many countries and fieds, agreed to work together to improve nutrition, said Secretary- Genera Ban Ki-moon of the SUN Lead Group, 7 which is chaired by UNICEF Executive Director, Tony Lake. There has aso been growing recognition of the importance of measuring stunting as a refection of continued, ong-term exposure to poor heath and nutrition, particuary during the first two years of ife. This is refected by the fact that stunting was one of three outcome indicators identified in 2011 by the Commission on Information and Accountabiity for Women s and Chidren s Heath to measure the impementation of the UN Goba Strategy. May 2012 saw agreement at the Word Heath Assemby of a new target to reduce numbers of stunted chidren wordwide by 70 miion by This new goba target to reduce stunting gives greater impetus for heath and nutrition stakehoders to work together, and in particuar for further integration between the SUN and Every Woman Every Chid movements. 3

14 1 The nutrition barometer expained The Nutrition Barometer provides a snapshot of nationa governments commitments and progress in addressing nutrition and chid surviva. It anayses commitments made by each country s government to fight undernutrition, and attempts to understand how these commitments move with chidren s nutrition status and surviva chances. The Nutrition Barometer buids on existing indices such as the Goba Hunger Index produced by the Internationa Food Poicy Research Institute and the Hunger Reduction Commitment Index reeased by the Institute of Deveopment Studies. 8 (For detaied notes on methodoogy and a fu ist of indicators, see the Appendix.) There are many diverse factors determining nutrition outcomes. UNICEF s conceptua framework on the causes of undernutrition indicates mutisectora intermediate, underying and basic determinants spanning food, heath and care practices. 9 Nationaeve factors such as economic growth, socia poicy, heath systems and governance are significant in combating and addressing undernutrition. Agricuture and food security pay a big roe as we. At the househod eve, income and education are two of the key factors that affect chidren s nutrition. We know where the highest burdens of undernutrition are and their causes. One area that needs examining, however, is how much nationa governments make a commitment to address nutrition in terms of poicies, participation in goba initiatives and aocation of adequate resources to nutrition-specific and reated interventions. The Nutrition Barometer gauges these commitments, which are measurabe and comparabe across the 36 countries that together account for 90% of the word s undernourished chidren. The Nutrition Barometer measures two dimensions of commitment. The first ooks at aws, poicies and other efforts at the nationa eve that address undernutrition. The second indicates the resources that governments aocate to see through their poitica and ega commitments. 10 The poitica and ega commitments incude seven indicators spanning economic and socia rights, the right to food, membership of SUN, nutrition-specific commitments to the Every Woman Every Chid initiative, 11 nationa nutrition poicies and reguar monitoring of nutrition outcomes. Pubic expenditure incudes three indicators. Two of these are measures of heath spending, whie the ast ooks at the existence of a current costed nutrition pan. We measure outcomes by ooking at three anthropometric indicators of chidren s nutrition status and chid surviva. The nutrition indicators incude the proportion of chidren who are underweight, stunted and wasted. Recognising that undernutrition is the underying cause of one-third of a chid deaths, we incude progress towards Miennium Deveopment Goa (MDG) 4 a two-thirds reduction in under-five mortaity by 2015 in our outcomes indicators. Of course, factors beyond nutrition aso contribute to mortaity, so this broadens the Barometer s scope. By providing a snapshot of country poitica and financia commitments and how they are progressing on addressing nutrition and chid surviva, we aim to stimuate a conversation about the accountabiity of governments to the word s undernourished chidren, incuding where nationa governments are doing we and where they need to do better. Through the Nutrition Barometer, we intend to provide a new perspective for nationa and goba debates about improving nutrition and reaching the stunting reduction targets set for 2016 and

15 THE NUTRITION BAROMETER AND THE HUNGER AND NUTRITION COMMITMENT INDEx The Nutrition Barometer compements the forthcoming Institute of Deveopment Studies Hunger and Nutrition Commitment Index. 12 Both toos anayse country commitments and ink them with outcomes, and both ook at factors deemed important to addressing hunger and nutrition. These incude indicators such as the right to food, government spending on heath, and nationa poicies to fight hunger and undernutrition. The Hunger and Nutrition Commitment Index (previousy caed the Hunger Reduction Commitment Index) empoys primary data to vaidate its assessment based on secondary data, and ooks at governance factors that the Barometer does not incude. It aso assesses commitment in deveoped countries to address hunger. The Barometer considers commitments to goba frameworks such as nutrition-specific commitments to Every Woman Every Chid and membership of SUN. Both toos ook at countries with high hunger or undernutrition burdens. In our sampe, we incude the 36 countries with the highest burden of undernutrition, whie the forthcoming Hunger and Nutrition Commitment Index wi incude about 40 countries. Both Maawi and Guatemaa come among the top countries in the Barometer and the Hunger Reduction Commitment Index. 1 THE NUTRITION BAROMETER ExPLAINED PHOTO: SIMON PETER. ESAKU/WORLD VISION Tony, 5, hods on to the goat his mother received through a community revoving anima fund. Word Vision s work in the Abim district of Uganda has enabed more famiies to reap the benefits of improved income and nutrition. 5

16 2 The findings commitments and nutrition & chid surviva outcomes The findings of the Nutrition Barometer indicate the strength of country commitments to addressing undernutrition and their nutrition status reative to other high-burden countries, as shown in the figure beow. In many of the 36 countries surveyed, commitments to nutrition tend to mirror outcomes in nutrition and chid surviva, whie severa cases indicate a more nuanced reationship between commitments and outcomes. Each country gets an overa cassification for commitments and outcomes. In recognition of the importance of foowing up high-eve commitments with adequate resources, commitments are further broken down into poitica, ega and financing commitments. FIGURE 1: COMMITMENTS AND OUTCOMES Commitments Sound Fair Emerging Frai Ethiopia Madagascar Niger Afghanistan Pakistan Democratic Repubic of Congo India Yemen Burkina Faso Burundi Nepa Bangadesh Kenya Mai Cambodia Nigeria Côte d Ivoire Sudan Tanzania Ghana Indonesia Mozambique Uganda Zambia Angoa Cameroon Myanmar Guatemaa Maawi Peru Egypt Iraq South Africa Turkey Vietnam Phiippines Frai Emerging Fair Sound Outcomes Notes: Commitments refer to poitica, ega and financia commitments. Outcomes refer to nutrition and chid surviva outcomes. As with any composite index, categorisation of countries can refect either 1) consistent performance or 2) an average of varying performance across indicators. For exampe, Guatemaa s sound categorisation refects good performance on chid surviva despite a stunting eve of 48%, which is a serious nationa probem requiring urgent attention. 6

17 HIGHS AND LOWS According to the Barometer, the countries that show sound commitments with sound nutrition and surviva outcomes reative to the other countries in the group are Guatemaa, Maawi and Peru. The Democratic Repubic of Congo (DRC), India and Yemen show the weakest performance, with frai commitments and frai outcomes. Outcomes for India are dated as they are based on the Nationa Famiy and Heath Survey-3 from However, since the country has not had a nationay representative survey since then, these figures are sti generay used. (For more information about India s performance on the Barometer, see page 9.) COMMITMENTS MATCHED BY OUTCOMES In 13 of the countries (just over a third of the sampe) we ooked at, commitments and outcomes point in exacty the same direction. Three countries Guatemaa, Maawi and Peru have both sound poitica and financia commitments and sound outcomes reative to the other countries in the group in this study. For exampe, Guatemaa shows exceent high poitica and ega commitments since it has signed and ratified the Economics and Socia Rights Convention, it is a member of SUN, and it has an overarching nationa nutrition poicy. These poitica commitments are matched by strong financing commitments. Perhaps due to these commitments, Guatemaa s proportion of underweight and wasted chidren, estimated at 13% and 1% respectivey, is much ower than most of the other countries. However, despite strong poitica wi to tacke undernutrition, 48% of Guatemaan chidren are estimated to be stunted. The nationa data aso masks disparities across socio-economic weath groups. (For more information about Guatemaa s performance on the Barometer, see page 8.) Peru, among its other commitments, has been monitoring heath and nutrition outcomes reguary with a roing DHS. Maawi, despite its ow-income status, aso comes out strongy in poitica, ega and financing commitments. This suggests that ow-income countries, as we as richer countries, can foow through poitica commitments to nutrition with adequate financing. Cambodia shows emerging commitments and outcomes, with the Barometer indicating fair poitica and ega commitments that are combined with emerging financing commitments. High-eve eadership, as shown by the Cambodian Prime Minister, is key to raising the profie of nutrition as a nationa deveopment priority. The country is aso deveoping a cross-sectora food security and ong-term nutrition strategy. Weak commitments in the DRC and Yemen are reated to very poor nutrition and chid surviva outcomes. Whie the DRC indicates emerging poitica and ega commitments, it suffers from a ack of adequate financing from domestic sources. The resuts for both countries have to be put in the context of fragiity and confict, which imposes heavy constraints. Fragie and confict-affected countries are among the furthest from achieving the MDGs, incuding targets to reduce the number of underweight chidren. Few fragie or confict-affected countries have signed up to the SUN movement, indicating that further, targeted support may be needed to enabe the invovement of some of the highest-burden and potentiay owestcapacity countries. COMMITMENTS HIGHER THAN OUTCOMES The Barometer shows 12 countries where there are high poitica, ega and/or financia commitments to nutrition, yet outcomes are ower. Nepa refects sound overa commitments matched with emerging outcomes. Breaking down Nepa s commitments, we see that the government has sound poitica and ega commitments and fair financing commitments. The government s determination to address the high rates of undernutrition is demonstrated in the effort put into the 2009 Nutrition Anaysis and Gap Assessment. The Muti-sectora Nutrition Pan for Acceerating the Reduction of Materna and Chid Under-nutrition was finaised and approved earier this year. The Demographic and Heath Survey for 2011 reports a reduction in stunting from 56% to 41% over ten years. However, gains were not equitabe across a popuation groups. Much of the progress occurred in the weathiest quintie, whie undernutrition increased in the poorest quintie. Underweight has aso, predictaby, diminished, though wasting has remained continued on page 12 2 THE FINDINGS COMMITMENTS AND NUTRITION & CHILD SURVIVAL OUTCOMES 7

18 THE NUTRITION BAROMETER GuaTemaa sti a ong way To Go It is worth unpacking Guatemaa s performance in the Barometer, which suggests sound commitments and outcomes for the country. Whie deveopments around the right to food, its membership of SUN, an overarching nationa nutrition poicy and financia aocations to heath have heped boost Guatemaa s commitments to nutrition in the Barometer, the definitive impact of poicies reducing manutrition in Guatemaa is sti to be seen. The country presents a nuanced picture of nutrition and chid surviva outcomes. Increases in coverage of effective ife-saving interventions such as immunisation, treatment of pneumonia and improved drinking water among others have heped reduce the country s under-five mortaity rate (see the 2012 Countdown to 2015 report for detais of coverage). Chid mortaity fe from 78 deaths per thousand ive births in 1990 to 32 deaths per thousand ive births in Nutrition, on the other hand, has not mirrored Guatemaa s reative progress in bringing down chid deaths. Whie acute manutrition has faen to about 1%, 48% of chidren beow five years suffer from chronic manutrition in the country. This is the GUATEMALA EMERGING FAIR highest stunting rate in the western hemisphere and the sixth highest in the word. The gap between surviva and chronic manutrition has to be put in the country s context. Guatemaa is a ower-midde-income country with widespread and severe poverty. The Word Bank estimated in 2006 that haf of the popuation ives beow the poverty ine. There are inequaities not ony across income groups but across regions and ethnicities, with endemic poverty in the indigenous popuations. Poverty and inequaity, together with natura disasters and recent food price increases, fue the gap between food avaiabiity and probabe food requirements. Poor and vunerabe househods often cannot afford a nutritious diet, with devastating consequences on chidren s growth. Stunting affects ong-term deveopment and can potentiay ead to poorer schooing and earning outcomes ater in ife. Whie poitica wi to address undernutrition is most wecome, there remains a huge job for the government, donors and other stakehoders to do to improve chidren s nutrition outcomes in Guatemaa. These commitments have to be sustained, and foowed through with concrete actions in the ong term, in order to bring down chronic manutrition. Increasing coverage of direct nutrition interventions, education and broader socia poicies are just some of the measures needed to ensure that future generations survive and reach their fu growth potentia. Outco mes Commitments SOUND FRAIL 8

19 india agging behind despite economic GrowTh Spectacuar economic growth has not transated into better nutrition outcomes for many of India s chidren. Growth has ifted miions out of poverty but it has aso been argey unequa, with the benefits accruing to a sma segment of the popuation. Many sources of data show that amost haf its chidren are underweight and stunted, and more than 70% of women and chidren have serious nutritiona deficiencies such as anaemia. Nutrition data at the nationa eve masks huge disparities across states and socio-economic weath groups. For exampe, chidren in the poorest househods are more than twice as ikey to be stunted as those in the richest househods. However, even in the weathiest 20% of the popuation, one chid in five is undernourished. Athough there are success stories and deveopments in some parts of the country, which show what can be achieved, the Prime Minister of India has referred to undernutrition eves as a matter of nationa shame, 13 with enormous costs in terms of heath, we-being and economic deveopment. India s performance in the Nutrition Barometer indicates both frai commitments and outcomes. Its showing on commitments was set back by the ack of nutrition-specific commitments to Every Woman Every Chid and not being a member of SUN as yet. Pubic spending on heath both as a percentage of government budget and in per capita terms is ow, especiay for a midde-income country. There are significant recent indications that commitment to fighting undernutrition is strengthening, incuding an announcement to tripe resources for the reform of Integrated Chid Deveopment Services (ICDS), the country s primary scheme to address chid heath and nutrition. Impementation of the programme has been mixed across states, eading to exceent outcomes in some paces and poor resuts in others. A criticism of the ICDS was its faiure to target chidren between the ages of 0 and two years, which is the crucia growth period. One reform invoves increasing the number of Anganwadi [community heath] workers in the 200 districts with the highest eves of undernutrition. This coud have a particuar impact on increasing interventions during the crucia first 1,000 days, from a chid s conception through to two years of age. The government is aso strengthening its participation in the goba stage when it comes to addressing nutrition. India co-chaired the Chid Surviva Ca to Action Summit in June 2012, with the USA and Ethiopia, and the Minister for Women and Chidren attended the 2012 UK hunger summit. We understand there have aso been discussions around India s engagement with SUN during the UK Hunger Summit. These deveopments are promising and, if foowed through and fuy impemented with adequate resources and proper oversight, can greaty hep improve the nutritiona status of India s chidren. In order to monitor the impacts of these commitments, India urgenty needs a new popuation-based, nationay representative survey to check what has happened to nutrition since The fourth Nationa Famiy Heath Survey is schedued for District-eve data coection is panned this year, which wi give a more accurate indication of where nutrition outcomes stand at present. INDIA FRAIL EMERGING Outco mes Commitments FAIR SOUND 2 THE FINDINGS COMMITMENTS AND NUTRITION & CHILD SURVIVAL OUTCOMES 9

20 THE NUTRITION BAROMETER Kenya commitments not yet refected in outcomes The government of Kenya scores fair in its poicy and ega framework for improving nutrition and in its financia commitments. Its nutrition outcomes, cassified as emerging, fare ess strongy. The need for sustained and further action is ceary outined by the continued poor nutrition status of many of the country s chidren. Over the past few years a number of key papers and strategies have signaed a new approach by the government on nutrition. The first of these was the 2008 Food Security and Nutrition Strategy, which sought to strengthen budgetary aocations, invovement of the private sector, intersectora coordination, monitoring and evauation systems and stakehoder participation. In 2011 the Cabinet endorsed the Nationa Food and Nutrition Security Poicy, impementation of which wi be guided by a Nationa Nutrition Pan of Action ( ), which is currenty being finaised. This Pan of Action provides a roadmap for coordinated impementation of nutrition interventions by the government and NGOs across deveopment sectors for maximum impact. It outines nine strategic objectives with corresponding activities and expected outcomes, KENYA FRAIL EMERGING Outco mes Commitments FAIR SOUND a monitoring and evauation approach, time frames and estimated costs. Despite Kenya not having formay joined SUN yet, eements of the movement s core activities and a set of high-impact nutrition interventions undertaken by SUN countries are aready being impemented. Centra to SUN is the engagement of stakehoders outside of government in the panning, impementation and monitoring of nutrition poicies, strategies and pans of action to scae up nutrition. In Kenya NGOs and UN agencies are incuded in the panning committee for the forthcoming Nationa Nutrition Symposium, aongside various ministries, incuding heath and agricuture. The aim of this event, which wi be opened by the President and have regiona deegates, incuding the African Union, is to raise the profie of undernutrition in Kenya and provide a greater focus on the roadmap for scaing up the response. Critica chaenges faced by Kenya incude the need to increase the share of government budget aocated to heath and, within that, to ensure adequate funding for direct nutrition interventions. The current eve of heath spending fas far beow the 15% of government spending agreed by a African governments in In addition, significant improvements can be made in the coordination of nutrition within and across government ministries, in ine with the pans for improving the institutiona framework for nutrition outined in the Nationa Food and Nutrition Security Poicy. To make greater progress in improving nutrition outcomes for mothers and chidren, the government of Kenya must prioritise the impementation of the existing comprehensive poicy frameworks for nutrition and food security, incuding the provision of adequate financia and human resources. 10

21 afghanistan some progress, but undernutrition sti high Despite severe security chaenges, weak governance, imited fisca resources and major human resource imitations, Afghanistan has made progress towards its socia and deveopment objectives over the past decade. Infant and under-five mortaity have faen from 111 and 161 per thousand ive births in 2008 to 77 and 97 per thousand ive births respectivey. However, Afghanistan s chidren continue to suffer from high eves of undernutrition: neary 60% of chidren under the age of five are stunted, and approximatey one-third of chidren are underweight. Widespread poverty and a ack of avaiabiity of diverse and good quaity food are major causes of undernutrition, and micronutrient deficiencies in particuar. Inadequate infant and young chid feeding practices, and infectious diseases such as diarrhoea, are aso a major cause of undernutrition. Around 40% of those admitted to therapeutic feeding units (for treatment of severe acute undernutrition) are under six months od, pointing to breastfeeding probems as a primary cause. Many househods sti have no access to safe drinking water and sti more aso ack access to improved sanitation. The poitica commitment required for tacking undernutrition is emerging. The Nationa Pubic Nutrition Poicy and Strategy and the Infant and Young Chid Feeding Poicy and Strategy are the government s key commitments reated to nutrition. However, to date neither poicy has been effectivey impemented. To cose the gap between poicy and practice, the government shoud review costed pans to effectivey impement the two strategies, taking into account the need for adequate technica and financia donor support. To demonstrate its eadership even further, Afghanistan shoud incorporate nutrition into its commitment to Every Woman Every Chid and join the SUN movement. The Ministry of Pubic Heath must aso improve coordination with other sectors such as the Ministry of Agricuture, Irrigation and Livestock, Ministry of Labour and Socia Affairs, and Ministry of Education to support a muti-sectora approach to impementing pubic nutrition and infant & young chid feeding poicies. AFGHANISTAN EMERGING FAIR 2 THE FINDINGS COMMITMENTS AND NUTRITION & CHILD SURVIVAL OUTCOMES Outco mes Commitments SOUND FRAIL 11

22 THE NUTRITION BAROMETER continued from page 7 near constant at 11%. Increasing resources to match these exceent commitments and focusing on very poor househods coud further acceerate Nepa s progress on undernutrition. In Ethiopia s case, the Barometer refects sound commitments but frai outcomes. In recent years the country has stepped up its heath and nutrition efforts and is increasingy aocating a greater proportion of the government budget to the heath sector. Pubic heath expenditure accounted for about 13% of government budget in 2010, but per capita government heath expenditure was ony US$23 (in purchasing parity terms) in This is far beow the Word Heath Organization target of US$60 per capita government spending on heath in ow-income countries. Poitica, ega and financing commitments are pointing in the right direction, however, and the Demographic and Heath Survey survey indicates that a three nutrition indicators improved between 2005 and Stunting fe from 51% to 44%, wasting from 12% to 10% and underweight from 33% to 29%. However, Ethiopia s undernutrition burden is sti very high and commitments have to be sustained and financing stepped up to further improve outcomes. In some countries, current or most recent nutrition data might not yet have captured the impact of commitments. For exampe, the most recent data from Mai and Uganda are from their 2006 nationa nutrition surveys. The nutritiona status of young chidren may we have improved in the interim, but the Barometer cannot refect any potentia changes without a recent nationay representative survey. This issue is certainy not ony about measurement; without reguar surveys, the abiity to track progress across popuation groups and ensure government accountabiity to reduce undernutrition is in question. This was highighted in a joint statement from the co-chairs of the recent UK hunger summit, David Cameron and Miche Temer, who said: Transparency of data sources and nutrition resuts have aowed governments in countries ike Brazi to track progress on nutrition indicators and aowed others to anayse the data and confirm the successes being made. 14 OUTCOMES STRONGER THAN COMMITMENTS In 11 countries, outcomes are stronger than commitments. Emerging commitments in Egypt, Iraq, South Africa, Turkey and Vietnam are paired with sound outcomes. Turkey and South Africa are cassified as higher midde-income countries, with far higher per capita incomes than the rest of the group. Despite having frai commitments, the Phiippines sti manages to show sound outcomes. Understanding these resuts requires putting them in the context of this group, which incudes midde-income countries. Some of these economies have been growing rapidy in recent years, eading to rising househod incomes that coud be expected to resut in an improved nutrition status of the genera popuation. It is therefore not surprising to find sound resuts in these countries reative to the rest of the group. However, as the Barometer covers the 36 countries with a high-burden of undernutrition, countries in this category sti have major chaenges to overcome. Whie rising househod incomes may improve the nutrition status of the genera popuation, nationa averages often mask huge inequaities. Economic growth does not automaticay transate into improved nutrition outcomes for chidren, especiay those in the poorest househods. And rising househod income on its own is not a sufficient condition for improving nutrition outcomes. In Egypt, for exampe, more than a quarter (27%) of chidren in the richest househods are stunted. 15 Education and proper feeding practices pay an important roe in ensuring the good nutrition status of chidren. The countries in this group might aso be refecting measures outside of the Barometer that are potentiay having a positive impact on nutrition. For exampe, South Africa is running a arge-scae socia protection programme incuding a chid support grant aimed at improving the ives of poor chidren. An evauation of the grant shows that chidren who benefit from the cash transfer are ess ikey to be i or stunted. 16 Egypt impemented a nationa programme of fortifying bread four with iron and foic acid between 2008 and

23 G8 DONORS HIGHLIGHT NUTRITION BUT FALL SHORT ON NUTRITION FUNDING 2012 saw the G8 increase their focus on tacking undernutrition, with wecome commitments to improving tracking and disbursements for nutrition and a ca for more nutrition-sensitive activities. 19 However, this must be matched by an urgenty needed increase in resources. Some G8 members have taken strong initiatives to tacke undernutrition and were prepared to work together to set a goba stunting target. But the G8 as a group missed the opportunity to coectivey address the chronic underinvestment in nutrition by adopting a commitment on undernutrition to There is a strong case for the countries in this category to formaise their commitments to nutrition. The sustainabiity of these outcomes coud be improved by enshrining nutrition measures in egisation (eg, the right to food) to make poicies, programmes and spending ess vunerabe to changes in poitica priorities. Pubicy made commitments aso aow stakehoders to hod the government to account, which increases transparency and accountabiity. The government of Brazi, which saw stunting rates haved in ten years under its Zero Hunger programme, has stated that there is no substitute for poitica wi and eadership and that guaranteeing the rights to food, education and heath were key factors in their success. 18 Given the ength of time it takes to reduce eves of chronic undernutrition, reguar reviews are needed to track progress against these commitments. POLITICAL WILL AND FINANCING OVER TIME The Nutrition Barometer gauges the direction of movement between poitica and ega commitments and nutrition and chid surviva outcomes. In severa cases the two move in the same direction, iustrating the importance of poitica and ega commitments to nutrition and ensuring that adequate resources are aocated to them. Whie poitica commitment accompany the one agreed in their New Aiance on Food and Security, which aims to move 50 miion peope out of poverty. Whie wecome, the G8 pedge to maintain robust programs to further reduce chid stunting woud have been stronger if accompanied by a specific target. Even with the current poor system for tracking aid to nutrition, it is obvious that current spending eves from the G8, other donors and nationa governments are woefuy inadequate, given the estimated US$10.3 biion annua funding needed for direct nutrition investment. 20 is crucia to improving chidren s nutrition outcomes, financing has to foow in order for sound outcomes to come through. As seen from the findings of the Barometer, it is important to examine not just the percentage of government expenditure aocated to heath and ideay, if this information is avaiabe, for nutrition as we but aso to consider the actua per capita expenditure that this transates into. We aso see a more nuanced reationship between commitments and outcomes in a number of cases. Some countries have higher commitment scores but with outcomes agging behind, whie others seem to have better outcomes even though they have a ower commitments score. The former iustrate the fact that it takes time for commitments to transate into good outcomes and the need for reguar monitoring of chidren s nutrition status, as expained above. The atter coud be a resut of economic growth and rising househod incomes which ead to improvements in nutrition across the genera popuation. Other socia poicies outside of the Barometer might aso be affecting nutrition. It has to be stressed, however, that these countries continue to have very high burdens of undernutrition and these outcomes have to be sustained over generations. Enshrining poitica commitments wi aow peope to hod their government to account and setting financia commitments wi ensure adequate funding for nutrition over time. 2 THE FINDINGS COMMITMENTS AND NUTRITION & CHILD SURVIVAL OUTCOMES 13

24 THE NUTRITION BAROMETER THE ROLE OF HEALTH WORKERS IN TACKLING UNDERNUTRITION In 2008, word nutrition experts identified a group of 13 cost-effective direct nutrition interventions that incude encouraging changes in behaviour to improve nutrition; provision of micronutrients; and treatment of severe acute undernutrition with specia therapeutic foods. 21 They estimated that if these interventions were scaed up to reach every chid in the 36 high-burden countries, approximatey 25% of under-five deaths coud be prevented. These interventions rey on a strong heath system with sufficient numbers of heath workers who have the right knowedge and expertise to prevent and treat undernutrition. However, miions of chidren ive out of reach of essentia nutrition interventions because there is no functioning heath service in their communities and no skied heath workers avaiabe to provide any form of heathcare. As the Nutrition Barometer shows, whie many countries have deveoped nationa nutrition strategies, deivery of these interventions is often inadequate. One of the major barriers is an overa ack of investment in heath, resuting in weak human resources and insufficient institutiona capacity to pan and impement effective responses. Athough heath worker density is not incuded in this first edition of the Barometer, it is reevant to note that of the 36 countries monitored, 31 have been identified by the Word Heath Organization as having a critica heath worker shortage. 22 Egypt, Guatemaa, the Phiippines, South Africa and Turkey the five countries that do meet the recommended ratio of 23 doctors, nurses and midwives per 10,000 peope are a categorised as having sound nutrition outcomes. The distribution of heath workers within a country affects outcomes; they need to be depoyed equitaby across regions and geographic areas to ensure that they reach the poorest and most vunerabe househods. Heath workers have a vita roe to pay in promoting good materna and chid nutrition, particuary during the crucia 1,000 days from the chid s conception through to two years of age. With the right support and supervision, we-trained heath workers without professiona quaifications, such as community heath workers, can deiver essentia nutrition interventions at the oca eve and hep reduce inequities in the coverage of nutrition services. In order to fufi commitments on nutrition and chid surviva, governments must deveop and impement nationa pans to attract, train and retain heath workers with the skis necessary to diagnose, prevent and treat undernutrition. Pans shoud focus on ensuring that heath workers are in reach of the chidren with the greatest needs, and that heath workers working in chaenging settings have sufficient support from the wider heath service in order to have the best possibe impact on nutrition outcomes. PHOTO: ANDY HALL FOR THE OBSERVER/SAVE THE CHILDREN Anjana (eft), a community heath worker in a rura district of Maharastra in India, visits Meena and her newborn baby. 14

25 3 concusions and recommendations By constructing a Nutrition Barometer, and anaysing nationa governments commitments to and outcomes in improving nutrition, Save the Chidren and Word Vision are seeking to capitaise on the current momentum around nutrition and contribute to a faster transition from pedges to impementation for resuts. This picture of countries readiness and wiingness to combine commitments with action aims to hep inform efforts which are aready underway to scae up improvements in nutrition, in ine with recenty agreed goba targets. Continuing and expanding these efforts to hod a governments to account for their own progress towards these targets (in ine with their existing commitments) wi be critica to acceerate the current overa sow rate of progress, as wi garnering new commitments, as necessary. It is critica that the internationa community does not squander this opportunity to address both the causes and consequences of undernutrition wi be a crucia year, with commitments from both the UK and Ireand to use their eadership of the G8 and EU presidencies respectivey to progress the nutrition agenda and the increased internationa profie of the SUN movement. Making significant reductions to the unacceptaby high eves of chronic undernutrition wi take a coordinated, marathon effort rather than a short sprint. A stakehoders shoud take fu advantage of the current momentum around nutrition, but with a cear recognition that the interva between commitments, fu impementation of agreed strategies and improved nutrition outcomes requires sustained and ong-term poitica wi and finance, and investment in human resources. These much-needed efforts to improve nutrition must be punctuated with reguar opportunities to assess progress and review directions. Governments shoud report reguary on nutrition spending and deveop a monitoring framework to measure progress towards ong-term and interim nutrition targets. This progress must be measured across popuation groups, disaggregated at a minimum by weath quintie, geographic ocation and gender, to avoid nationa averages that so often mask serious inequities. As construction of the Nutrition Barometer has shown, it can be difficut for civi society to access key documents and expenditure information in order to hod governments to account for their commitments. Improving transparency and access to information is a key principe to ensure increased accountabiity to a stakehoders, especiay citizens. We recognise that not a factors that contribute to improving nutrition are captured by the Barometer. Improvements in nutrition rey on functioning heath systems, working in conjunction with education, agricuture and socia protection efforts to address key underying causes such as food insecurity, ack of access to safe water and improved sanitation. In order to acceerate progress, Save the Chidren and Word Vision recommend the foowing steps: Countries revising or drafting nutrition pans shoud incude nationa and sub-nationa targets for improving nutrition and reducing stunting in ine with the recenty adopted Word Heath Assemby s Materna, Infant and Young Chid Nutrition Impementation Pan, with cear timeines and detais of investment required. Nutrition pans must incude a focus on reaching the poorest chidren; incorporate the indirect interventions that are the responsibiity of other sectors; and incude a strong monitoring framework which sets out a reguar (annua) review process, with input from civi society and other stakehoders. Countries with a high burden of nutrition shoud increase and sustain investment in direct nutrition interventions and aso in strengthening heath systems incuding human resources needed to deiver those interventions. Countries shoud increase the transparency of and accountabiity for nutrition pans by making better data avaiabe. They shoud ensure that there are reguar nationay representative nutrition surveys to improve the monitoring of progress against 15

26 THE NUTRITION BAROMETER nutrition indicators. Large-scae surveys such as the Demographic and Heath Survey and Mutipe Indicator Custer Survey shoud be conducted at east every four to five years, aongside nationa surveys, to strengthen monitoring. Countries with a high burden of undernutrition shoud join the SUN movement, and fuy integrate nutrition into their efforts to improve materna and chid heath through the Every Woman Every Chid initiative, and the more recent A Promise Renewed movement that came out of the Chid Surviva Ca to Action. The SUN movement shoud undertake a costing of country pans, to be competed by the end of 2012; donors and other deveopment partners shoud make ong-term financing commitments to meet any financing gaps in impementing ambitious nutrition pans. Donors shoud fufi their existing commitments and aso use forthcoming opportunities in 2013 to make further, concrete commitments to support nutrition. Specificay: The UK shoud use its convening power as Chair of the G8 to ensure increased resources for nutrition and agricuture, to fi the funding gap, and take concrete steps to address the major threats to progress, such as increasing voatiity of food prices. The Irish government shoud use its EU presidency to push for the EU to produce a roadmap on how it wi reach its recenty announced 10% share of the goba stunting reduction target, in addition to convening a high-eve conference on the impacts of cimate change on nutrition. PHOTO: ALBERT YU/WORLD VISION A gir in Cambodia gets a nutritious mea. Many chidren in Cambodia are sti undernourished but poitica attention to nutrition is growing. 16