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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

Haddad ator oct 2016

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Page 1: Haddad ator oct 2016

Scaling Up Nutrition Action for Africa

Where are we and what challenges

are need to be addressed to accelerate malnutrition?

Lawrence HaddadGlobal Alliance for Improved Nutrition

Page 2: Haddad ator oct 2016

•Why should African political leaders care about malnutrition?•What needs to happen?

Page 3: Haddad ator oct 2016

Good nutrition prevents

45%..

.....of all death under 3 years of age that is related to malnutrition

Page 4: Haddad ator oct 2016

Good nutrition “wires the circuits”

Page 5: Haddad ator oct 2016

Poor nutrition reduces the economic wealth of

nations16.5

11.510.3

7.76.3 5.6

3.1

% of GDP lost each year

AUC/WFP Cost of Hunger Studies

Page 6: Haddad ator oct 2016

Demographic Dividend for Africa?

With stunting? Forget about it.

19751980

19851990

19952000

20052010

20152020

20252030

20352040

20452050

1

1.25

1.5

1.75

2

Ratio

of w

orki

ng a

ge to

dep

ende

nt

popu

latio

n, s

ub S

ahar

an A

frica

Data from Bloom and Canning 2011

Page 7: Haddad ator oct 2016

Akin AdesinaPresident of the African Development Bank 2016

“We need to invest in gray matter infrastructure.”

“Neuronal infrastructure is quite possibly going to be the most important infrastructure.”Jim KimPresident, World Bank 2016

And the Development Bank Leaders Know It

Page 8: Haddad ator oct 2016

Scaling Up Nutrition.

Where Are We?

Page 9: Haddad ator oct 2016

Under 5 Stunting

Women’s Anemia

Adult Overweight

Ethiopia, Rwanda

Ghana, Senegal

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

Algeria, Gabon, Morocco, Seychelles, Tunisia

Botswana, Egypt, Equatorial Guinea, Lesotho, Libya, Namibia, South Africa, Swaziland

• All African countries have serious malnutrition problems• 25% have serious under and over nutrition

problems

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What is the rate of progress?

Highly variable—but there is cause for hope

Page 11: Haddad ator oct 2016

9Stunting children under 5

Wastingchildren under 5

Overweightchildren under 5

Anemiawomen aged 15-49 yearsExclusive Breastfeeding, <6 monthsAdult Overweight + Obesity (BMI≥ 25)

Adult Obesity (BMI≥ 30)

Adult Diabetes(Raised blood glucose)

3465

3

7

1

16

17

23

1

23

34

987

52

312

54

54

53 1

Global Target

Missing data Off course, little/no progress Off course, some progress On courseOn course, at risk

Number of African countries at stages of progress against global targets on nutrition

Page 12: Haddad ator oct 2016

Progress against Malabo Declaration target for stunting

reduction4

39

6How many African countries will attain stunting rates of 10% by 2025?

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What Needs to Happen?

• Commitment • Coverage• Coherence• Cash

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Must make the issue hard for African heads of state to

ignore

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Many African countries are members of Scaling Up Nutrition (SUN) Movement—but not all

Page 16: Haddad ator oct 2016

But commitment is not measured by membership alone.

Setting & working to meet SMART targets is key.

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There are not enough SMART targets in African nutrition country

plans

Stunting

Exclusiv

e breastfeeding

Wasting

Anaemia

in women

Low birt

h weigh

t

Under 5 ove

rweigh

t

75 73

5545

35

10

Percent of 40 African Nutrition Plans with SMART Targets for…

Page 18: Haddad ator oct 2016

Few African Countries have Targets for

Diet Related NCDs

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.

%

Percent of 40 countries with targets for…

Obesity Diabetes Salt Reduction

4035

15

Page 19: Haddad ator oct 2016

Nutrition Program Coverage?

Page 20: Haddad ator oct 2016

Coverage of nutrition-specific interventions remains highly variable across African countries

Exclusive breastfeeding

<6 months

Minimum dietary diversity (6-

23 months)

Zinc treatment for diarrhoea

(U5)

Iron-Folic acid suppl. 90+ days

(pregnant women)

Iron suppl. (U5) Vitamin A suppl. (U5)

Salt iodization (household)

0

10

20

30

40

50

60

70

80

90

100

Coverage of Nutrition Programsis too Low

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Coherence

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Coherence: Underlying determinant dashboard for Kenya

% Food insecure (FAO)

Nurses and Midwives/1000 people

% girls not enrolled in secondary school

Unimproved water (%)

Unimproved or no sanitation (%)

Gender inequality rank (1=best)

Gov Exp on Health, Ed, Ag (as % of budget)

24

0.792

39

44

122

37.7

http://globalnutritionreport.org/files/2014/11/gnr14_cp_kenya.pdf

Page 23: Haddad ator oct 2016

Cash: Invest more and

allocate better

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% of government budgets, Africa, 2010

Big chunks of African government budgets go to nutrition relevant

sectors

www.globalnutritionreport.org

Page 25: Haddad ator oct 2016

Source: OPM and SUN SMS

Cash: yet too little is spent on nutrition from related

sectorsBudget allocations to nutrition sensitive actions in these countries are relatively low

Comoros

Maurit

ania

ChadBenin

Ghana

Burundi

Gambia

Madag

ascar

Burkina F

asoKenya DRC

South Su

dan

Zambia

4.8

2.11.5 1.4 1.2 1.2 1.1 1 0.8 0.6 0.6 0.5

0.1

% o

f Gen

eral

Gov

ernm

ent E

xpen

ditu

res

Page 26: Haddad ator oct 2016

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.

Page 27: Haddad ator oct 2016

Ghana is re-writing the African story

Stunting rate of under 5 children, Ghana

%

Page 28: Haddad ator oct 2016

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

Page 29: Haddad ator oct 2016

Thank you