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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 HaddadGlobal 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
nations16.5
11.510.3
7.76.3 5.6
3.1
% of GDP lost each year
AUC/WFP Cost of Hunger Studies
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
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
Scaling Up Nutrition.
Where Are We?
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
What is the rate of progress?
Highly variable—but there is cause for hope
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
Progress against Malabo Declaration target for stunting
reduction4
39
6How many African countries will attain stunting rates of 10% by 2025?
What Needs to Happen?
• Commitment • 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
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…
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
Nutrition Program Coverage?
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
Coherence
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
Cash: Invest more and
allocate better
% of government budgets, Africa, 2010
Big chunks of African government budgets go to nutrition relevant
sectors
www.globalnutritionreport.org
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
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