Scaling Up Nutrition Action for Africa Where are we and what challenges are need to be addressed to accelerate malnutrition? Lawrence Haddad Global Alliance for Improved Nutrition
Why should African political leaders care about malnutrition? What needs to happen?
Good nutrition prevents 45%.....of all death under 3 years of age that is related to malnutrition
Good nutrition wires the circuits
Poor nutrition reduces the economic wealth of nations 16.5 11.5 10.3 % of GDP lost each year 7.7 6.3 5.6 3.1 AUC/WFP Cost of Hunger Studies
Demographic Dividend for Africa? With stunting? Forget about it. 2 Ratio of working age to dependent population, sub Saharan Africa 1.75 1.5 1.25 1 Data from Bloom and Canning 2011
And the Development Bank Leaders Know It We need to invest in gray matter infrastructure. Akin Adesina President of the African Development Bank 2016 Neuronal infrastructure is quite possibly going to be the most important infrastructure. Jim Kim President, World Bank 2016
Scaling Up Nutrition. Where Are We?
All African countries have serious malnutrition problems 25% have serious under and over nutrition problems Under 5 Stunting Ethiopia, Rwanda Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Comoros, Congo (Republic of The), Côte d Ivoire, Democratic Republic of the Congo, Djibouti, Eritrea, Gambia, Guinea, Guinea-Bissau, Kenya, Liberia, Madagascar, Malawi, Mali, Mauritania, Mozambique, Niger, Nigeria, Sao Tome and Principe, Sierra Leone, Somalia, Sudan, Togo, Uganda, Tanzania, Zambia, Zimbabwe Botswana, Egypt, Equatorial Guinea, Lesotho, Libya, Namibia, South Africa, Swaziland Algeria, Gabon, Morocco, Seychelles, Tunisia Women s Anemia Ghana, Senegal Adult Overweight
What is the rate of progress? Highly variable but there is cause for hope
Number of African countries at stages of progress against global targets on nutrition Missing data Off course, little/no progress Off course, some progress On course, at risk On course Stunting children under 5 5 6 34 9 Wasting children under 5 3 34 17 Overweight children under 5 7 7 8 9 23 Anemia women aged 15-49 years Exclusive Breastfeeding, <6 months 1 16 52 12 3 1 23 Adult Overweight + Obesity (BMI 25) 54 Adult Obesity (BMI 30) 54 Adult Diabetes (Raised blood glucose) 53 1 Global Target
Progress against Malabo Declaration target for stunting reduction 39 How many African countries will attain stunting rates of 10% by 2025? 4 6 On course Off course, but making progress Off course, not making any progress
What Needs to Happen? Commitmen t Coverage Coherence Cash
Must make the issue hard for African heads of state to ignore
Many African countries are members of Scaling Up Nutrition (SUN) Movement but not all
But commitment is not measured by membership alone. Setting & working to meet SMART targets is key.
There are not enough SMART targets in African nutrition country plans Percent of 40 African Nutrition Plans with SMART Targets for 75 73 55 45 35 10 Stunting Exclusive breastfeeding Wasting Anaemia in women Low birth weight Under 5 overweight
Few African Countries have Targets for Diet Related NCDs Percent of 40 countries with targets for % 40 35 15 Obesity Diabetes Salt Reduction Source: Unpublished self-reported data from the NCD Country Capacity Survey, provided by the WHO Surveillance and Population-based Prevention Unit, Department for Prevention of NCDs. Printed with permission.
Nutrition Program Coverage?
Coverage of Nutrition Programs is too Low 100 90 80 Coverage of nutrition-specific interventions remains highly variable across African countries 70 60 50 40 30 20 10 0 Exclusive breastfeeding <6 months Minimum dietary diversity (6-23 months) Zinc treatment Iron-Folic acid for diarrhoea (U5) suppl. 90+ days (pregnant women) Iron suppl. (U5) Vitamin A suppl. (U5) Salt iodization (household)
Coherence
Coherence: Underlying determinant dashboard for Kenya Gov Exp on Health, Ed, Ag (as % of budget) 37.7 Gender inequality rank (1=best) 122 Unimproved or no sanitation (%) Unimproved water (%) 39 44 % girls not enrolled in secondary school Nurses and Midwives/1000 people 0.792 % Food insecure (FAO) 24 http://globalnutritionreport.org/files/2014/11/gnr14_cp_kenya.pdf
Cash: Invest more and allocate better
Big chunks of African government budgets go to nutrition relevant sectors www.globalnutritionreport.org % of government budgets, Africa, 2010
Cash: yet too little is spent on % of General Government Expenditures 4.8 2.1 1.5 1.4 nutrition from related sectors 1.2 1.2 1.1 1 Budget allocations to nutrition sensitive actions in these countries are relatively low 0.8 0.6 0.6 0.5 0.1 Source: OPM and SUN SMS
Conclusions Some countries are on course to meet targets. Many more are making some progress. Need more: commitment coverage coherence cash Malnutrition is not destiny. Ending it is a political choice supported by SMART commitments for accountability.
Ghana is re-writing the African story % Stunting rate of under 5 children, Ghana
Three things you can do Challenge decision makers with evidence on the slow pace of malnutrition reduction Make those essential but challenging alliances for nutrition with those outside your immediate circle Make SMART commitments for nutrition and ask others to do the same
Thank you