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Dear Moderator and friends
I like to draw attention to, why investment from the private sector will only go some of the way to ending undernutrition. It covers two broad arguments. Firstly, when considering how the private sector could contribute to improved nutrition outcomes, it dispels two common misconceptions: the first is that all that is needed is a production-based model with a minor tweak towards nutritionally enhanced harvests. The second is that all countries and regions in the midst of the global nutrition crisis are equally attractive for private sector contributions. The reality is that by eliminating food availability through increased yields we will only take a minor step towards eradicating undernutrition (Smith and Haddad; 2000). Secondly it emphasizes that new investments have so far been very biased towards agriculture and have not been mirrored by investments in other sectors such as nutrition, health, education or rural infrastructure. The G8’s ‘New Alliance’, which has food security and nutrition as its headline goals, is regarded as the flagship programme to catalyze investments from the private sector. Examining the six country frameworks that so far have been published, it appears that few private sector investments are planned for nutritious crops and foods. More than half of the 111 planned private investment projects focus on non-food crops and only four mention specific, nutrient-dense food products to be sold locally (Robinson and Humphrey, IDS Blog 2013).
The first misconception is that increased production of nutritionally rich crops will be a major step in combatting the global nutrition crisis. While evidence exists suggesting that improved agricultural can lead to improved food security and nutrition outcomes, evidence also exists proving that this will not happen automatically and that regulated, multi-sector interventions are needed to ensure that the increased food resources are distributed evenly at household level and that food of the right quality is accessible by all. To maximise availability at the household level, production models need to be adjusted with three key policy measures in mind:
- Empower women farmers, both to allow them more control over income and household spending — which usually leads to more being spent on the feeding and care of young children, and to correct for unequal access to labour and inputs which results in women’s plots often achieving lower yields than men’s;
- Promote home gardens and small-scale livestock rearing in order to increase the diversity of production and consumption and
- Complement agricultural programmes with programmes to improve education, health services, water and hygiene (Hunger Alliance and ODI, 2013). To ensure the effectiveness of new investments, such a complex strategy must be guided by increased dialogue between civil society and policy makers. However by delegating the fight against undernutrition to private sector preferences, which are heavily anchored in the agricultural sector, future efforts are unlikely to reach those in most need or address the underlying factors driving undernutrition.
The second misconception is that private sector interest in development is equal to the interest shown in public private partnerships (PPP). The encouraging theme of the World Economic Forum in 2010 (Realizing a New Vision for Agriculture and Nutrition: A Roadmap for Private Sector Stakeholders) did result in some support towards the resolution of problems related to water quality, hygiene, disease prevention, livelihoods and commodity supply chains. However it is probably reasonable to state that private sector food companies have yet to become pro-active towards the needs of the very poor and malnourished who may be perceived to be outside their future customer base. The above analysis of the New Alliance confirms this trend.
The groundbreaking work which led to the development of Ready To Use Therapeutic Foods (RUTF) to treat Severe Acute Malnutrition (SAM) through the CMAM approach has given frontline medical professionals a product which can be used under clinical or community supervision in controlled dosages to save the lives of many. Considering the caseload of 19 million children in need of these products globally, this is surely an interesting investment proposition. However there are apparently some major blockages to engaging business actors to invest in it.
To attract new actors to contribute to efforts to improve nutrition, it is of paramount importance to narrow the current funding gap and the unpredictability of the current market place. Funding for RUTF is more forthcoming in response to emergencies: 60% of current investments involving the treatment of SAM with RUFTs are in short-term, emergency settings, rather than in protracted crises. Increasing the funding for nutrition in chronic crises where there are on-going baseline needs would be more conducive to private sector investments (ACF’s Aid for Nutrition Series 2012-13) and would potentially attract new actors.
Not only does funding need to be increased and delivered more consistently, but the supply chain also needs to be reformed. One of the key challenges is that the sustainable provision of RUTF by external actors is only possible if UNICEF plays a pivotal role. Governments, donors and civil society organisations should explore and trial innovative financing to provide long-term, sustainable and predictable funding for the full package of direct nutrition interventions which is aligned with complementary initiatives in health, food security and agriculture. The vacuum of private sector interest in undernutrition can only hope to be closed when a credible costing to improve nutrition by an external actor is integrated with national nutrition plans.
Equally, donors within the SUN Movement are taking very different approaches to tackling undernutrition. While the EC is the primary funder of the Secretariat, DFID’s support appears to focus on advocacy and the stimulation of partner government involvement rather than the supply of digestible nutrients. In contrast, USAID’s approach through the Feed the Future initiative is to improve food security by boosting harvests, nurturing agricultural development and expanding business opportunities. In some respects this is a return to development through market economics and livelihood improvement rather than a direct move to addressing malnutrition on the ground or through its health and social drivers. Despite the positive messages printed in their policies, such inconsistency between major donors is sending mixed messages to potential private investors.
An additional barrier to private sector investment in nutrition is the limited potential for additional stocks of RUTF. It is unlikely that a new PPP for RUTF would be successful as the current producers of the product are operating well below their available capacity. An alternative would be to direct the capacity of the private sector to the manufacture of Ready To Use Supplementary Products (RUSF) which could be used address Moderate Acute Malnutrition (MAM). MAM is much more widespread and there is a much greater potential to develop new, innovative types of RUSF. Therefore the private sector could play a very positive role here by working with the public sector to ensure the institutional supply of products to address MAM and by potentially providing the consumer with the product free of charge.
The development of products and services for the treatment and prevention of MAM probably offers the greatest potential for the private sector in nutrition programmes. Private sector investments would to reduce the need for treatment and free up the resources of governments to target the underlying causes of undernutrition within the health, food security and education sectors. This will also require a rethink of how civil society operates and the role of NGO’s play in addressing MAM.
Finally we should consider whether there is a preference for local or multinational companies to invest, bearing in mind that multinational companies are likely to contribute the most financially. While global or regional private partnership initiatives would contribute significant value to the distribution of products around the world, they would also undermine the desired objective of integrating the manufacture of RUTF within national governments where it is needed. Also there must be a transparent agreement between the private sector, civil society and government at national level which defines the extent to which external engagement is in the interest of all parties. This is especially the case when foreign exchange is needed for the purchase of milk powders, micronutrients and packaging.
The lack of funding, stability and strategy to tackle acute malnutrition and to produce RUTF therefore requires initiatives to be started at government level and progressed by engaging in discussions with affected civil society. These challenges are unlikely to be fixed by the private sector.
If the private sector is to play a new and positive role in addressing undernutrition, governments and civil society must be clear on where and how to encourage the development of future markets. Discussions must outline where the gaps in funding are and how new investment could free resources in other areas where private sector investments have not been forthcoming. Furthermore, given that there is unequal progress in different sectors and regions, donors must be able demonstrate that there is a real need to tackle undernutrition beyond emergencies. This would create long-term markets which interested companies could enter. In 2008, the first Lancet series concluded that the approach to tackling nutrition crises was fractured. Since then much energy has been expended to improve coordination and increase the evidence-base. If future efforts to address hunger are dictated by disjointed and biased private investment, we are in danger of losing much of this progress.
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Dear HLPEWhilst the agricultural sector cannot create all preconditions for a healthy start in life – this is the joint task by the health, education, social protection sectors among others– smallholder investment must play a central foundation to enable the rural environment where by smallholders can strive to build the nutrition security for under-fives, mothers and thier households.At ACF International we would like to see more specific proposition in respect to the specific nutritional requirements of under-fives, pregnant and lactating mothers within the small holder development discussion.Four areas we see need for improvement in the next drafts:The role of smallholder agriculture in nutrition security needs to be more analytical and precise defined, draft 0 largely considers nutrition as an add-on to food security.Often when the terms food and nutrition security are used in the text, there is little following mention of nutrition and it invariably refers only to food security- (for example in the summary, in the section on Smallholder Agriculture: the Way Ahead- past the initial assertion in paragraph 12 there are no further mentions in the section on nutrition, but only food security.) Food security and nutrition security should be two separate terms rather than merged as in current draft. By referring only to food security, there is the risk of the assumption that increased production for smallholders will automatically lead to better nutrition, which may lead to agricultural development programs that do not program adequately for improved nutrition as an outcome. Increased agricultural production can even cause possible harm to nutrition status (for instance where smallholder investment shift towards cash crop and thus reduce dietary diversity, women workload, diseases related to use of agro-chemicals).We will where available cross reverence to some ACF examples and research that outline way how to program for nutrition impact.Programming for nutrition impact means including it as an explicit objective of nutrition-related programs…Little mention of the significance of smallholder agriculture on nutrition at the individual and household levelThere appears to be no section on the significance that smallholders can have for improvements to nutrition. It would seem to be relevant to include some information on this in section 2, in particular considering that there is a section included on smallholders significance for food security etc. but no thoughts given to the role of nutrition - more specifically the role in growing complementary food for children of 6 to 24 months. The report could highlight the available evidence that smallholder agricultural development leads to more effective food utilisation and dietary diversity. (We do however acknowledge that there needs to be further scientific research on the link between smallholder agriculture and nutrition, as clearly acknowledged in the last systematic review on the subject Masset. et all, 2011).Smallholder agriculture can increase food production, raise rural incomes, and push down food prices; all of which should improve the access of poor and vulnerable people to food and thereby contribute considerably to improving their food security. Smallholder agricultural interventions can be made more sensitive to nutrition in two key ways; by reducing female disadvantages in farming, for example poor access to inputs, seasonal credit and technical assistance, thereby increasing women’s returns from their farming, and through this giving them more opportunity to spend on the nutrition and care of their children — and themselves. The other is either to promote home gardens and small livestock keeping to encourage more diverse diets at the household level and especially under the control of the women, or to fortify staples with added minerals and vitamins such as Vitamin A through plant-breeding, or a combination of these two.ACF International has their own program evidence of the impact of small scale agriculture and complementary nutrition activities on nutrition and dietary diversity:
- Health Gardens project in Mali (2010 evaluation): project which comprises the improvement of availability and access to high quality food through vegetable gardens, the increase of households’ incomes and the good use of food and incomes generated by the gardens for the improvement of the family and children’s health. Our evaluation found participants had more production from gardens; more income; were eating a more diverse diet; and that child malnutrition had fallen in participating villages
- Low Input Gardens (LIG) project in Zimbabwe: The project evaluation found that participants in the project had better dietary diversity (higher HDDS scores than control groups) following the conclusion of the project as well as social impacts (greater acceptance of HIV/AIDS patients).
SeasonalityFollowing on from the above point, it seems important to include some discussion in the report on the effects of seasonal hunger and food availability, which is the reality for many smallholder farmers in low income countries. (Relevant to mention seasonality in section 4.2. Persistent poverty and lack of access to resources (as a constraint to smallholder investment). It is well known that the poorest households – even those relying predominantly on small scale agriculture for their livelihoods – are reliant on the market to purchase food once their harvest runs out. It would be encouraging to read more in this HLPE report on interventions that aim to reduce the hunger gap by ways of food and seed storage, or how to reduce dependency on markets, especially during the hunger gap with interventions such as Inventory Guaranteed Credit Schemes (Warrantage), building storage solutions, affordable food processing on village level and the like to increase food and nutrition security during seasonal deprivation.The gains made during the prosperous times of year are often negated by forced sales of assets and other coping mechanisms families are forced to undertake to survive during the hunger season. Seasonal changes in the local market can push vulnerable households closer to a threshold beyond which they cannot afford to cover their basic (qualitative and quantitative) dietary needs, eroding their resilience and preventing investment in their livelihoods. Many programmes fail to address seasonality of hunger and undernutrition… This could also be mentioned in 5.2.1., as methods to tackle seasonal hunger amongst smallholders could be a major way of improving their well-being and hence improving investment (for example pre-positioning of health and nutrition resources before the hunger season, employment guarantee schemes and cash transfers during the hunger season). The care giver should increasingly be educated on the dietary needs of growing children so that they can make the best choice for planting, selling, saving and purchasing food commodities throughout the annual cycle.Recent ACF research emphasised the importance of designing food and nutrition security interventions around rural-urban linkages (migration during the hungry season to cities, and cash sent back from families in the city to rural relatives during this time) to help increase the impact of these interventions. These linkages are most important during seasonal periods of hunger and poverty. These linkages often represent efforts by the households to create their own safety nets, reflecting their own priorities and capacities. This report should point to ways and needs how to strengthen these self-generated safety nets linking rural smallholder with urban relatives and food markets to progress nutrition security.Acknowledgement of the importance of nutrition interventions in under-fives and mothers.As clearly reported in the paper, the health and well-being of individuals involved in smallholder agriculture clearly affects agriculture itself- an unhealthy agricultural population constrains resources and labour for investment. In section 5.2.1: ‘Access to rights: smallholders’ family needs for well-being.’ The first paragraph mentions the importance of strengthening the well-being of women and children for investment in smallholder agriculture. While the draft discusses action for school age girls and boys, its proposition in respect to under-fives within the small holder development discussion is unclear. Pregnant and lactating women, babies and children have heightened nutritional requirements, particularly between conception, complementary feeding phase and age two. Smallholder investment must therefore be planned and monitored in how far it is addressing these nutrition needs for children under five during ‘the window of opportunities” to prevent impaired child growth, create healthy conditions for the women during pregnancy and that put the growing child at a lower risk of suffering from chronic diseases in adulthood. In addition, interventions that target maternal health can help to prevent low birth weights and stalling progress in later child development, and the smallholder agenda can take specific care to create healthier environments, lower workloads and production focus to raise availability and utilization of adequate diets.There are a range of proven direct and indirect nutrition interventions that could be included in the report for this ‘the window of opportunity’. These include the promotion of breast feeding and optimal complementary feeding, the increase of micronutrient interventions and strategies to improve family and community nutrition and reduction of disease burden (e.g. promotion of hand washing and strategies to reduce the burden of malaria in pregnancy). (For further information, see ACF International Manual, Maximising the Nutritional Impact of Food Security and Livelihoods Interventions, 2011).Samuel Hauenstein Swan - Senior Policy AdvisorJennifer Stevenson - Policy ResercherAction Against Hunger - ACF International
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先生 Samuel Hauenstein - Swan
Dear ICN2 Organisers and Friends,
I like to commnet on behalve of Action Against Hunger on the Draft of the Zero plus one Draft Rome Declaration on Nutrition.
ACF International recognises that the ’Draft of the Rome Declaration on Nutrition’ has made advances in broadening the scope of the ICN2. In particular, we acknowledge the inclusion of a wider definition of food systems, the commitment to under-five malnutrition and the commitment to linking the ICN2 to the Post‐2015 Development Agenda.
However, there is significant space and need for further promoting a balance between food systems approaches, nutrition sensitive interventions, and nutrition specific interventions. The Rome Declaration of ICN2 should include commitments on the strengthening of health systems, in order to ensure the full integration of direct nutritional interventions within basic health care. The ICN2 will be in danger of failing its aims if it does not acknowledge the importance of health, care practices, and education. The final declaration should more generally reaffirm agreed and ratified human rights language, including explicit reference of the right to adequate food and health.
Despite various reasonable and pragmatic proposals from Civil Society Organisation coalitions on ways forward, there remains a lack of adequate interaction between the Secretariat, Member States and CSOs. The ICN2 process must be made more inclusive, accountable and transparent. We acknowledge the electronic consultation on the various stages of the outcome document, at the same time we do not believe these intermittent points to be sufficient in the run up to the November high-level conference and would like to see a more interactive discussion as this will improve the quality of the event and its outcomes. ACF, together with over a dozen CSOs, hosted a successful roundtable event during the WHA on 22 May in Geneva, bringing together informally the Secretariat, Member States and CSOs to help create clarity, shared understanding and promote constructive dialogue. We welcomed the open and productive interaction during the event with the Joint Working Group (JWG) and the Secretariat and hope all stakeholders seize the opportunity presented by the demonstrated commitment and fully adopt the principle discussion. We suggest that the JWG and the Secretariat consider similar public meetings in Rome and Geneva later in July following the expected publication of the first draft of the Framework for Action, to inform and collect input in a timely and transparent way.
We also urge the ICN2 Secretariat and the JWG to work with the WHO and FAO and propose an inclusive discussion before, during and beyond the November Meeting on opportunities to further mobilise multi-stakeholder interaction.
Lastly, we restate the need to include accountable commitments and the setting up of a Framework for Action. This framework must be a legacy of the ICN2 after November 2014 that rallies governments and international platforms to take accountable collective and individual actions to end malnutrition. It must also be a place that enables progress on the country level.
With only six months to go, ACF believes the ICN2 should reaffirm its commitments of coherence and consistency between the various global frameworks on nutrition and food security by adopting the widely agreed and achievable WHO nutrition targets as part of the Rome Declaration and a foundation for the subsequent discussion on the Framework for Action. The ICN2 must build bridges with global initiatives on food and nutrition security such as the SUN Movement, Nutrition for Growth initiative, REACH and the CFS to ensure to maximise its impact. The declaration should call for more coherence among the sectors, including in regard to land rights, health supply, gender, social protection and education.
Enclosed ACF submission of detailed recommendations to improve the Draft Rome Declaration paragraph by paragraph.
ACF considers the ICN2 to be a unique opportunity and we remain fully committed to bringing about change for better nutrition and to share our expertise with the organisers. We would especially like to offer the ICN2 the knowledge, expertise and perspectives that our day to day contact with the most affected people and communities – those that ultimately are at the centre of a successful ICN for whom ‘better nutrition for all’ is not a slogan but a desperate need.
Thanks Samuel Hauenstein Swan
Senior Reserch and Policy Advisor
ACF International