Purnima Menon, PhD Research Fellow

Transcription

1 Nutrition ii in South Asia: Opportunities and Continuing Challenges Purnima Menon, PhD Research Fellow International ti lfood dpolicy Research hinstitute t New Delhi December 2, 2008

2 2008 Global Hunger Index Hunger still ALARMING in South Asia

3 Current nutrition situation in S. Asia among children under five * For age group 6 59 months 1. National Family Health Survey, India, Nepal Demographic Health Survey, Bangladesh Demographic Health Survey, Pakistan Demographic Health Survey, Sri Lanka Demographic Health Survey, 2007

4 Improved understanding of undernutrition < >35 0 HAZ -0.5 WAZ Mean Z scores (weighted) -2.5 Age groups (months) Source, NFHS-III

5 Drivers of maternal and child undernutrition Resources that enable families to care for their children are important! Black et al., Lancet 2008

6 Women s status is an important contributor to improving i child undernutrition and particularly l important for S. Asia Contributions to reductions in child malnutrition, Source: Smith and Haddad 2000

7 Caste and regional identity in Nepal November 25, 2008 Source: Lynn Bennett, World Bank, Nepal

8 India: vast regional variability India State Hunger Index Serious in 4 states Alarming in 12 states Extremely Alarming in 1 State October 14, 2008 India State Hunger Index 2008

9 Opportunities and Challenges November 25, 2008

10 Political windows of opportunity Global MDGs Global Hunger Index Evidence onlong term impacts ofpoorearly nutrition India: High level political interest/awareness of issue (driven by global comparisons) Media portrayal Civil society groups (e.g, Right to Food) Bangladesh BINP and NNP have led to national awareness, awareness among large andsmallngos NGOs, etc. Increasing media coverage

11 Knowledge base on what works 2001 ADB RETA series on Nutrition in Asia 2008 Lancet Series on Maternal and Child Undernutrition Makes the case for investing in nutrition Summarizes evidence on best bet interventions i for rapid reductions But lft left open the challenge hll of how best tto operationalize and ensure access to essential interventions

12 Policy response and challenges India India Integrated Child Development Services Targets 0 6 yrs; major focus on food and reaches 3 6 yrs better than 0 3 years (misses critical window) Many known implementation and capacity issues but some well known successes too (INHP, TINP) Participation and use of services is low but new legislations aim to increase program coverage and quality Side tracking of primary design and implementation issues over debates on topics such as ready to eat vs. cooked foods No broader focus on women s status, empowerment in nutrition policy community ( food rhetoric)

13 Policy ocyespo response se and dchallenges Bangladesh gades Bangladesh BINP/National Nutrition Program/Health, Nutrition and Population Sector Program Targets under twos (but only severely malnourished not preventive ), ),pregnant and lactating women Does not cover entire country (1/4 th of districts); Implemented through NGO network (managed by GoB) Quality of programming and management quite variable Societal efforts to improve women s status have been substantial (microcredit to women, girls education, etc.) andlikelyhave had, and will have, some impact

14 Policy ocyespo response se and dchallenges Sri Lanka a Sri Lanka Current nutrition response: food assistance, poverty reduction programs, integrated dhealth hand nutrition ii programs. Continuing undernutrition attributed to maternal undernutrition, i low birth and water and sanitation i challenges Program challenges include poor reach of vulnerable groups (social, age) and low resources to address key issues for vulnerable age groups like under twos Political economy fragmented discourse on causes and potential ti actions; further complicated by emerging overweight and obesity. Early investments in health and education and gender equity thought ht to have had hdimpacts; continuing i undernutrition needs other gaps to be closed.

15 Cross cutting challenge: A weak program evidence base India (ICDS): No large scale evaluations with rigorous designs; difficult to attribute impact (orlack thereof) to program investments Bangladesh (BINP): Flawed evaluations and substantial bt tilcontroversy over program design and impact. Sri Lanka: Program documentation is not substantial; program learning culture needs attention November 25, 2008

16 Some questions for discussion How can investments/programs with social development, gender and health be aligned to achieve better social and nutrition outcomes (convergence)? When resources are scarce, where and how should we act for accelerating nutrition improvements at the national level (regions, age groups, other groups)? How can we strengthen the knowledge base around programs in S. Asia (learning across the region)

17 November 25, 2008

18 Reductions in child underweight from to Source: Global Hunger Index 2008; Appendix C

19 Gender and nutrition in S. Asia Source: Gender Gap Index report 2008; NFHS and DHS reports for S. Asian countries

20 Underlying social and economic causes Household level Poverty Food availability Access to water, sanitation, etc Exclusion (social, geographic, caste, etc) Caregiver level l Access to resources (physical, mental, social, etc.) Knowledge and education Physical and mental wellbeing Social support and time Women s status is a major driver of undernutrition

21 Nutrition success factors in S. Asia Policy/social factors political commitment at all levels of society grass roots involvement in decision making the presence of community organizations a high level of female literacy infrastructure for the delivery of basic services female empowerment child centered local culture charismatic i leaders parallel implementation of poverty amelioration programs November 25, 2008 Program factors awareness of nutrition problems community involvement in program planning, definition of time bound goals at all levels strengthened understanding of malnutrition support from community mobilizers and facilitators community mobilization, community based monitoring, ownership by community and government income generation opportunities capacity building good management increased cost consciousness involvement of NGOs Jonsson, U., 1997