textarchive.ru

Главная > Документ


TO O L S A N D M E T H O D S S E R I E S

Reference Document No

Addressing undernutrition in external assistance

An integrated approach through sectors and aid modalities

January 2011

Prepared by France, Germany, Ireland, Poland, the United Kingdom and the European Commission

Acknowledgements

This document has been prepared by the Nutrition Advisory Service: Claire Chastre, Lola Gostelow, Dominique Blariaux, Yves Martin Prével, Carlos Navarro, Lawrence Haddad and Cristina Lopriore.

The preparation of the document has been coordinated by, and has benefited from, inputs made by representatives from France, Germany, Ireland, Poland and the United Kingdom as well as various services from the European Commission.

In light of the experience in drafting this Reference Document, modifications and adaptations will be made as and when necessary. To help with this work, comments, questions and suggestions are welcomed and should be sent to EuropeAid at the following email address: DEVCO-Nutrition-Support@ec.europa.eu

This and other related documents can be downloaded from: http://capacity4dev.eu/topic/fighting-hunger

Table of contents

acknowledgements i

ABBREVIATIONS ii

executive summary iii

introduction iv

chapter 1: introduction 1

1.1 purpose and scope of the reference document 2

1.1.1 Using the reference document 3

1.1.2 Understanding malnutrition and undernutrition 3

1.2 UNDERNUTRITION AND ITS CONSEQUENCES 5

1.2.1 The consequences at individual level 5

1.2.2 Consequences at national level 6

1.2.3 Consequences at international level 6

1.3 THE SCALE OF THE PROBLEM 7

1.3.1 Fragile states 8

1.3.2 Trends 8

1.4 CAUSES OF UNDERNUTRITION 9

CHAPTER 2: IMPROVING NUTRITION THROUGH KEY THEMATIC AREAS 14

2.1 IMPROVING NUTRITION THROUGH HEALTH 16

2.2 IMPROVING NUTRITION THROUGH WATER/SANITATION/HYGIENE 17

2.3 IMPROVING NUTRITION THROUGH EDUCATION 18

2.4 IMPROVING NUTRITION THROUGH GENDER 19

2.5 IMPROVING NUTRITION THROUGH SOCIAL PROTECTION 19

2.6 IMPROVING NUTRITION THROUGH FOOD SECURITY 21

2.7 IMPROVING NUTRITION THROUGH AGRICULTURE 23

2.8 THE ENVIRONMENT AND SUSTAINABLE MANAGEMENT OF NATURAL RESOURCES 24

2.9 IMPROVING NUTRITION THROUGH GOVERNANCE 25

2.10 IMPROVING NUTRITION THROUGH HUMAN RIGHTS 27

CHAPTER 3: INTEGRATING NUTRITION IN THE PROGRAMMING PHASE 29

3.1 ANALYSING AND UNDERSTANDING UNDERNUTRITION IN A CONTEXT 30

3.1.1 Is there a problem of undernutrition? 30

3.1.2 Analysing and understanding governments’ response to undernutrition 31

3.1.3 Analysing and understanding other stakeholders’ responses to undernutrition 32

3.2 RAISING THE NATIONAL PROFILE OF NUTRITION 32

3.3 SHAPING A DONOR RESPONSE TO UNDERNUTRITION 33

3.3.1 Setting priorities 34

3.3.2 Specific approaches for humanitarian response, transition situations and fragile states 35

3.4 DESIGNING MONITORING, EVALUATION AND LEARNING 37

CHAPTER 4: NUTRITION IN AID DELIVERY METHODS 39

4.1 GUIDANCE FOR ADDRESSING NUTRITION THROUGH GENERAL AND SECTOR APPROACHES 41

4.2 GUIDANCE FOR ADDRESSING NUTRITION THROUGH PROJECTS 47

4.2.1 Guidance for addressing nutrition through development projects 47

4.2.2 Guidance for addresssing nutrition through humanitarian projects 48

ANNEX 1: GLOSSARY 53

ANNEX 2: COUNTRIES BEARING THE BURDEN OF UNDERNUTRITION 59

ANNEX 3: INDICATORS 61

ANNEX 4: TEN STEPS TO SUCCESSFUL BREASTFEEDING 69

ANNEX 5: HEALTH-RELATED INTERVENTIONS EFFECTIVE FOR NUTRITION 70

ANNEX 6: NUTRITION SITUATION ANALYSIS 71

ANNEX 7: TERMS OF REFERENCE FOR EVALUATING PROGRAMMES FOR NUTRITION OUTCOMES 76

list of figures

Figure 1: An overview of this reference document 3

Figure 2: An overview of undernutrition 4

Figure 3: 90% of the world’s stunted children live in 36 countries 8

Figure 4: Regional progress in addressing underweight in children 9

Figure 5: A model of the casual pathways leading to undernutrition 11

Figure 6: Nutrition framework for action 12

Figure 7: Aid delivery methods used by the European Commission 40

Figure 8: Making aid delivery methods nutrition sensitive 41

LIST OF TABLES

Table 1: The disease burden and deaths associated with undernutrition 5

Table 2: Nutrition in the Millennium Development Goals 6

Table 3: Nutrition in the donor country strategy paper 34

Table 4a: General/Global approach: Steps to incorporating nutrition 43

Table 4b: Sector Approach: Steps to incorporating nutrition 44

Table 5: Steps to incorporate nutrition aspects when preparing project support 47

Table 6: Steps to incorporate nutrition in emergency projects 49

LIST OF BOXES

Box 1: Impact indicators potentially relevant to all aspects of external assistance 15

Box 2: Key indicators of nutrition benefits through health 17

Box 3: Key indicators for nutrition benefits through water/sanitation/hygiene 18

Box 4: Key indicators for nutrition benefits through education 18

Box 5: Key indicators of nutrition benefits through gender 19

Box 6: Key indicators of nutrition benefits through social protection 21

Box 7: Key indicators of nutrition benefits through food security and agriculture 24

Box 8: Key indicators of nutrition benefits through environment and the sustainable management of natural resources 25

Box 9: Key indicators for nutrition benefits through governance 27

Box 10: Key indicators for nutrition benefits through human rights 28

Box 11: Introducing nutrition objectives into a national strategic framework 33

Box 12: Incorporating nutrition objectives in programming 33

Box 13: Principles of good international engagement in fragile states 36

Box 14: Sector Terminology 40

Box 15: Key nutrition indicators for general and sector approaches 45

Box 16: Key issues concerning nutrition in humanitarian response 48

Box 17: Key nutrition indicators in emergencies 51

Abbreviations

AAP Annual Action Programme

BMI Body mass index (see glossary)

CSP Country Strategy Paper

DAC Development Assistance Committee (of OECD)

DALY Disability Adjusted Life Year (see glossary)

DHS Demographic and Health Surveys

DCI Development Cooperation Instrument

DG Directorate-General of the European Commission

DG DEVCO Directorate-General of EuropeAid Development Cooperation Office

DG ECHO Directorate-General for Humanitarian Aid and Civil Protection

EEAS European External Action Service

EC European Commission

EDF European Development Fund

EU European Union

FAO Food and Agriculture Organisation of the UN

GAM Global Acute Malnutrition (i.e. moderate + severe)

GBS General Budget Support

MAM Moderate Acute Malnutrition

MDG Millennium Development Goals

MICS Multiple Indicators Cluster Surveys

MS Member States of the EU

NIP National Indicative Programme

NSA Nutrition Situation Analysis

OECD Organisation for Economic Cooperation and Development

PAN Programa Articulado Nutricional, (National Programme in Peru)

PCM Project Cycle Management

PFM Public Finance/Financial Management

PROGRESA Programa De Educación, Salud y Alimentación, (National Programme in Mexico)

PRSP Poverty Reduction Strategy Paper

SAM Severe Acute Malnutrition

SBS Sector Budget Support

SPSP Sector Policy Support Programme

SWAp Sector-Wide Approach

TAP Technical and Administrative Provisions

UNDAF United Nations Development Assistance Framework

UNICEF United Nations Children’s Fund

WB World Bank

WHO World Health Organisation

Executive Summary


Bachari and his friend, Maman, are both three, but

malnutrition when he was a baby has left Bachari

(right) severely stunted.

Source: Amadou Mbodj – Save the Children (Running on Empty)

Introduction

Undernutrition is the biggest development challenge facing the world1. It is both a consequence and a cause of poverty; it affects child and maternal survival and is detrimental to the well being of populations. The knock-on economic costs of undernutrition have been estimated at 10 % of individuals’ lifetime earnings2 and at 2 % to 8 % of a nation’s GDP.3

Yet undernutrition can be prevented, so that individuals do not become underweight, too short for their age (stunted), dangerously thin (wasted) or deficient in vitamins and/or minerals. The current reality4, however, is that:

  • A third of children aged below five years in low/middle-income countries (around 195 million), are stunted.

  • A third of the world’s stunted children aged below 5 years live in fragile or conflict-affected countries.

  • About 75 million (13 %) children under five years of age in low/middle-income countries are wasted, 26 million severely so.

  • 19 million babies a year start life with a low birth weight due to poor growth in the womb.

Only by tackling undernutrition might there be a realistic chance of achieving several of the Millennium Development Goals by 2015:

  • to eradicate extreme poverty and hunger (Goal 1)

  • to reduce child mortality (Goal 4)

  • to improve maternal health (Goal 5)

as well as

  • to achieve universal primary education (Goal 2)

  • to promote gender equality and empower women (Goal 3) and

  • to combat HIV/AIDS, malaria and other disease (Goal 6).

Improved nutrition can drive economic growth. Equitable economic growth, which benefits the poorest, can, in turn, significantly help improve nutrition. However, countries and development actors need to, first, create a policy environment geared to addressing undernutrition, and, second, invest in a coherent package of measures.

The EU’s Reference Document on Addressing Undernutrition in External Assistance seeks to help transform aid programmes so that they can achieve real progress in preventing undernutrition. A thoughtful approach is required, based on evidence and sound understanding of the context. Nutrition-specific objectives need to be incorporated in the design of assistance programmes – whatever the sector or aid modality – thereby seeking and measuring specific results on nutrition. Tackling undernutrition thus becomes the responsibility of all - not just left to technical experts.

Understanding Undernutrition

There are numerous possible causes of undernutrition, as depicted in the conceptual framework below.

Rectangle 2

Short-term consequences:

Mortality, morbidity, disability

Long-term consequences:

Adult size, intellectual ability, economic productivity,
reproductive performance,
metabolic and cardiovascular disease


Line 24Line 25

AutoShape 7AutoShape 8AutoShape 9AutoShape 15Line 20Line 21Line 28Line 29Line 30Line 31Line 32Line 33AutoShape 3AutoShape 4AutoShape 5AutoShape 6AutoShape 10

Maternal and child undernutrition

AutoShape 14AutoShape 16Line 17Line 18Line 19Line 22Line 23Line 26Line 27

Source: Based on UNICEF, 1990: Strategy for Improved Nutrition of Children and Women in Developing Countries; and adapted in the Lancet Series (2008).

  • Immediate causes relate to the individual level and have two dimensions: dietary intake and health status. This distinction emphasises the limitation of ‘hunger’ to denote undernutrition, for hunger may or may not be a cause of undernutrition.

  • Underlying causes operate at household and community levels. They comprise three categories: household food security, care for children/women and health environment/ health services. Income poverty underpins all three.

  • Basic causes include a range of factors operating at sub-national, national and international levels, ranging from natural resources, to social and economic environments to political events.

The various determinants of undernutrition can act in synergy so that one cause influences others. Given this complex interplay, a multi-sectoral approach is required to act on multiple determinants and prevent/address long-term undernutrition. This is also true in humanitarian contexts, although assistance tends to prioritise life-saving interventions focused on immediate and underlying causes.

Tackling Undernutrition

The Reference Document on Addressing Undernutrition in External Assistance provides a detailed description of how nutrition benefits can be realised by modifying the design of programmes in all relevant sectors and thematic areas – from health to governance, education to gender – and by choosing appropriate indicators to monitor progress.

Assistance through sectors that are not the traditional focus of nutrition action can bring about significant achievements in reducing undernutrition. For example, evidence from 63 countries shows that:

At the underlying level of causes:

  • 43 % of the total reduction in undernutrition came from improvements in child care as represented by women’s education (female enrolment at school);

  • 26 % came from increases in per capita food availability;

  • 19 % came from improvements in the health environment (access to safe water); and

  • 12 % came from improvements in women’s status (female to male life expectancy).

At the basic level of causes:

  • 50 % of the reduction in undernutrition came from increased per capita national income

Undernutrition needs to be understood as a multi-sectoral concern that requires a multi-sectoral response. Yet, responses have traditionally been single-sector and single-level, with inadequate emphasis on addressing the underlying and basic causes. Significant and sustained progress to improve nutrition cannot be achieved unless appropriate actions are put in place to address these determinants.

Such breadth of response can lead to a lack of clarity regarding how nutrition should be overseen and managed by government. In the absence of a consistent institutional ‘home’ for nutrition, coherence is built through strong and senior government leadership, which can oversee and coordinate the work of individual line ministries and departments. Donor support is undoubtedly critical to the success of such governance efforts.

Any cooperation strategy in the field of maternal and child undernutrition must take into account the nature of the problem, the commitment of the government, the strengths and weaknesses of the different sectoral or thematic interventions of the government and the strategies of other stakeholders. A basic starting point is nutrition-sensitive national policies that encourage a multi-sectoral approach to addressing chronic and acute undernutrition.

Having nutrition in a national plan or strategy provides legitimacy and enables donors to channel support. The type of support will depend on the outcomes of various analyses examining the extent of the undernutrition problem and the priorities and responses of key stakeholders. Typical investments are summarised below.


Aid Delivery Methods

Different aid delivery methods can be used to fund nutrition-sensitive assistance. The choice of method needs to be considered in light of context-specific institutional funding opportunities – whether project, sector or general approaches.

Each aid delivery method offers a fresh opportunity to introduce and embed nutrition-related concerns and factors. The process of working through each method tends to include several key steps that are common to all methods, as summarised below:

Group 48

Emergencies

In contrast to most development situations, emergencies often have a very strong emphasis on undernutrition. The challenge therefore is not to integrate nutrition but to manage the responses, act on results and demonstrate the impact more consistently. Furthermore, nutrition concerns in emergencies are often superimposed on pre-existing undernutrition, in particular stunting, which is rarely prioritised. In this way emergencies offer an opportunity to start tackling underlying causes with a view to long-term outcomes.

The key challenges in addressing undernutrition in emergencies are:

  • Responding to early warning indicators;

  • Promoting quality management of undernutrition in emergencies through evidence-based decision-making and implementation;

  • Building an evidence base in research priorities, including field-appropriate methods to assess the impact of action;

  • Ensuring a holistic and meaningful impact on undernutrition;

  • Measuring impact in relation to nutrition and mortality in emergencies;

  • Strengthen national capacity;

  • Ensuring more sustained support from development actors for tackling undernutrition.

Experience has demonstrated the need to maximise sustainable, inter-sectoral support for undernutrition over the longer term, and not to simply isolate efforts within a humanitarian response.

A Call to Joined-Up Action

Such joined-up thinking is at the core of the EU Reference Document on Addressing Undernutrition in External Assistance − joining evidence to action; joining different levels of causes in order to sustain improvements; joining efforts across different sectors to build coherence; joining government aspirations and efforts to external support; and joining shorter-term investments to longer-term progress. In time, it is also hoped that this Reference Document will support on-going efforts to join up the approaches and priorities of the EU’s aid institutions across its Member States, thereby creating international momentum to combat undernutrition once and for all.

CHAPTER 1: Introduction

Undernutrition kills more than three million children every year. For those who survive, it can have irreversible consequences on their physical growth and mental development. This in turn undermines virtually every aspect of economic and human development. Up to 8 % of GDP can be lost as a result of undernutrition.

Yet undernutrition is wholly preventable, and there is sound evidence on the measures likely to have the greatest impact. International assistance needs to be planned comprehensively so as to use all possible avenues to prevent and mitigate the very serious consequences of undernutrition.

Current international concern and the increasing commitment shown means that its time to harness the potential to combat undernutrition. At the L’Aquila Summit in 2009, Heads of States called for increased support for food and nutrition security outcomes. The World Health Assembly adopted a specific resolution on infant and young child feeding5 calling for nutrition policies to be pro-poor, focus on people with specific nutritional requirements and be rooted in a multi-sectoral approach.

The European Union has recently adopted several policies reflecting its increased commitment to fight undernutrition. Through different avenues, the Global Health, Food Security and Food Assistance Communications take the first steps towards a common framework for the EU and its Member States in combating malnutrition. More importantly, individual countries have launched their own programmes and strategies.6 This document is in line with these and highlights concrete steps to translate the political commitments into action and measurable impact.

The term undernutrition encompasses a range of conditions that are due to insufficient food intake and repeated infectious diseases. Individuals may be underweight, too short for their age (stunted), dangerously thin (wasted) or deficient in vitamins and/or minerals (micronutrient malnutrition).

Undernutrition is closely associated with food insecurity and hunger, but is distinct from them. Undernutrition is a physical outcome; food insecurity describes the socio-economic circumstances whereby individuals or households are unable to access enough quality food for an active healthy life. Hunger is a term used to describe estimates in the deficit of food intake for population groups – regardless of whether there is evidence of undernutrition.

1.1Purpose and scope of the reference document

The purpose of this reference document is to help transform aid programmes so that they achieve real progress in this area. The key is to incorporate nutrition-specific objectives into their design and to monitor progress with nutrition-specific indicators.

This reference document is intended as a resource to guide the practical incorporation of nutrition objectives into relevant sectors and different funding methods used by the European Union (EU) – whether in development cooperation or in humanitarian response.

The reference document is targeted primarily at aid administrators working within country teams - delegations of the EU and offices of Member States. It seeks to complement and extend existing efforts by Member States. In addition, it is anticipated that the discussions likely to emerge from the guidance here may prove of use to national counterparts and other stakeholders.

No nutrition expertise is assumed, or required, to apply the guidance.

1.1.1Using the reference document

Users are likely to focus on the specific sections that are most relevant to them. For this reason, the reference document has been structured and written in such a way that the chapters can be read independently. The only exception to this is humanitarian assistance, because there are no absolute divisions between emergency nutrition interventions and development interventions. To ensure sustainable progress on nutrition and save lives, there is a need for contiguity between nutrition emergency action and development. The critical requirement, always, is to ensure that the situation is analysed as fully as possible to determine the best course of action. Thus, all sections have been written with all types of operational context in mind. Occasionally, specific pointers are given regarding nutrition in emergencies.

Figure 1: An overview of this reference document

Throughout the document, the core text is accompanied by the following additional information:

case studies, highlighted in orange boxes or available on the web

practical tips and guidance

critical questions to consider

sources of further information. A list of references is available in a web link.

Text in italics denotes direct excerpts from references cited.

1.1.2Understanding malnutrition and undernutrition

‘Malnutrition’ encompasses both undernutrition and over-nutrition (obesity). Although there are serious public health concerns about the increasing levels of obesity around the world, and the pressure this puts on health systems, the imperative to act on undernutrition remains even greater, hence the focus of this reference document.

Undernutrition is defined7 as the outcome of insufficient food intake and repeated infectious diseases. Undernutrition describes a range of conditions: it includes being underweight for one’s age, too short for one’s age (stunted), dangerously thin (wasted), and deficient in vitamins and/or minerals (micronutrient malnutrition). There are several ways of assessing undernutrition, typically with body measurements such as weight, height or arm circumference (anthropometry).

A full explanation of terms is given in the glossary in Annex 1. Figure 2 provides a simplified summary of the types of undernutrition.

Figure 2: An overview of undernutrition

While it is recognised that nutrition is important throughout a person’s life, the most vulnerable and critical period is during pregnancy and from birth to two years of age. This is when undernutrition can cause long-lasting health and developmental consequences (as described below), unless it is reversed at this stage. This period is therefore the priority. It offers a crucial window of opportunity to ensure that the right conditions are in place for optimal growth.

Making the period from pregnancy to two years of age a core priority implies seeking and measuring results of actions specifically for this group/period. However, this does not need to be at the exclusion of other groups of concern. It is not, necessarily, a targeting criterion because actions targeted at households, communities or nations can also result in improved nutrition for pregnant women and children under the age of two years (see Section 1.4). Along the same lines, interventions could be extended to children under the age of five when undernutrition is responsible for high mortality rates amongst these older children.

The period from pregnancy to 24 months of age is a crucial window of opportunity for reducing undernutrition and its adverse effects 8



Скачать документ

Похожие документы:

  1. The Roles of Aid in Politics

    Документ
    ... aid motivation by McKinlay and Little, and Maizels and Nissanke for Germany, France, Japan, theUnitedKingdom, andtheUnited States, found that the ... vision into anintegratedapproach to North-South relations. The gap between rhetoric and policy ...
  2. Wiki cites sm debate '11

    Документ
    ... Ambassador (27 January2011, Lord (Christopher) Patten, Former European Commissioner for ... were also anintegral part of the rhetoric of ... France, GermanyandtheUnitedKingdom, other states such as India, Iran, Pakistan andTurkey have joined the ...
  3. The law faculty of masaryk university international private law the department of international and european law dissertation thesis

    Документ
    ... an exception. The Appellate Body concluded that the Enabling Clause became anintegral part of the ... aid. In June 2000, theEuropeanCommission signed ... byFrance, Germany, Luxembourg, Portugal, UnitedKingdomand Hungary. 443 Done mainly byFrance ...
  4. The post-staples state the political economy of canada’s primary industries

    Документ
    ... . Clausen, Scott and Mary Louise McAllister. "AnIntegratedApproach to Mineral Policy ... the middle to northerly reaches, the major beneficiaries proved to betheUnitedKingdomand ... Act" Prepared for the Royal Commission on Renewing and Strengthening ...
  5. The main objectives of this Report

    Документ
    ... in the EU bytheIntegrated Pollution Prevention and Control (IPPC) Directive (EuropeanCommission, 1996), throughthe application of anintegratedapproach, the ...

Другие похожие документы..