The international nutrition system – made up of international and donor organisations, academia, civil society, and the private sector – is fragmented and dysfunctional, and needs reform. These are the conclusions of Professor Saul Morris, London School of Hygiene and Tropical Medicine, UK, and Dr Bruce Cogill, Unicef, New York, USA, and colleagues, authors of the fifth and final paper in The Lancet's Series on Maternal and Child Undernutrition.
The authors say: “Financial, intellectual, and personal linkages bind these organisations loosely together as components of an international nutrition system…we argue that such a system should deliver in four functional areas: stewardship, mobilisation of financial resources, direct provision of nutrition services at times of natural disaster or conflict, and human and institutional resource strengthening.”
Their analysis of evidence to date finds that currently, there are substantial shortcomings in each of the areas above. Fragmentation, lack of evidence for prioritised action, institutional inertia, and failure to join up with promising developments in parallel sectors are recurrent themes. Many problems are systemic within organisations in the field.
The authors say: “The funding provided by international donors to combat undernutrition is grossly insufficient and poorly targeted, and is inappropriately dominated by food aid and supply-led technical assistance. Much more investment is needed in human and institutional capacity for nutrition in low-income and middle-income countries.”
They suggest five priority areas for action to create a much stronger international nutrition system. First, a new global governance structure, in which all stakeholders in undernutrition could come together to press for ways forward for the most pressing issues. The authors say this should take place within the next six months. Secondly, they call for a more effective UN: namely that the UN standing committee on nutrition becomes a forum that makes individual UN agencies accountable for results. Thirdly, less duplication by parallel organisations, eg, among individual donor projects coexisting with various initiatives. Fourthly, more investment in capacity strengthening in countries with high burdens of undernutrition, with the authors stating strengthening of regional and sub-regional networks should be a priority, due to its potential to reach a larger number of beneficiary countries.
Finally, the authors call for research leadership in areas that matter; on the editors of academic journals with an interest in maternal and child undernutrition to meet in 2008 to develop a strategy to increase the profile of the subject; on major donors to clarify how their funding will reduce the imbalances highlighted in the series; and on research and training groups in high-income countries to use their expertise to progress scaling up of successful nutrition projects.
The authors conclude: “The moment is ripe for these reforms. Their implementation would transform the political salience of undernutrition, and offer the chance of a better, more productive life to the 67 million children born each year in the countries most severely afflicted by undernutrition.”
Dr Bruce Cogill, UNICEF, New York, USA. T) +1 212 326 7400 / +1 646 288 4648 E) bcogill@unicef.org
Journal
The Lancet