Post on 04-Apr-2018
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the nutrition
barometerGuging ninl spnss undnuiin
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Front cover: A young girl and
her sister wait to be treated
for malnutrition at the medical
clinic in Hilaweyn refugee camp
in Ethiopia in October 2011.
(Photo: ja grarup/noor for
save the Childre)
Alemnesh and her daughter,
Ayal, in the Amhara region of
northern Ethiopia. Rates of child
undernutrition here are high.
(Photo: Coli Crowley/save
the Childre)
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The nutritionbaromeTer
Ggg t t tt
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Save the Children works in more than 120 countries.
We save childrens lives. We ght or their rights.
We help them ull their potential.
World Vision is a Christian relie, development and
advocacy organisation dedicated to working with children,
amilies and communities worldwide to reach their ullpotential by tackling the causes o poverty and injustice.
Published bySave the Children World Vision International
1 St Johns Lane 69 The Square, Stockley Park
London EC1M 4AR Ubridge, Middlese UB11 1FW
UK UK
+44 (0)20 7012 6400 +44 (0)20 7758 2900
savethechildren.org.uk www.wvi.org
First published 2012
The Save the Children Fund and World Vision International 2012
The Save the Children Fund is a charity registered in England and Wales (213890)
and Scotland (SC039570). Registered Company No. 178159
This publication is copyright, but may be reproduced by any method without ee or
prior permission or teaching purposes, but not or resale. For copying in any othercircumstances, prior written permission must be obtained rom the publisher, and a
ee may be payable.
Typeset by Grasshopper Design Company
Printed by Page Bros Ltd.
This report is written by Maricar Garde, Kate Eardley, Louise Holly and Lisa OShea,
with the benet o guidance on the design and methodology o the Barometer romAle Cobham. Without implication, we thank Dol te Lintelo or reviewing an early
drat. We are grateul or comments and input rom sta across Save the Children
and World Vision.
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conTenTs
The Nutrition Barometer v
Executive summary vi
Abbreviations viii
Introduction 1
2012 time or action on nutrition 1
Measuring commitments and outcomes 1
Box: Growing momentum or nutrition 3
1 The Nutrition Barometer explained 4 Box: The Nutrition Barometer and the Hunger and Nutrition Commitment Index 5
2 The ndings commitments and nutrition & child
survival outcomes 6
Highs and lows 7
Commitments matched by outcomes 7
Country case study: Guatemala 8
Country case study: India 9
Commitments higher than outcomes 7
Country case study: Kenya 10
Country case study: Aghanistan 11
Outcomes stronger than commitments 12
Box: G8 donors highlight nutrition but all short on nutrition unding 13
Political will and nancing over time 13
Box: The role o health workers in tackling undernutrition 14
3 Conclusions and recommendations 15
Appendix: Methodological notes 17
Endnotes 19
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Mother Alima Maiga with her one-year-old
daughter Fatoumata playing a hand-clapping
game during nutrition training or mothers in
Mali. The training has improved the cooking
habits o mothers with undernourished children,
resulting in weight gain or the children.
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v
The nuTriTion
baromeTer
The Nutrition Barometer provides a snapshot o
national governments commitments to addressing
childrens nutrition, and the progress they have made.
It looks at 36 developing countries with the highest
levels o child undernutrition.
The Barometer measures governments political
and legal commitment to tackling malnutrition
(eg, whether they have a national nutrition plan),as well as their nancial commitment.
Countries progress in tackling malnutrition
is measured by childrens nutritional status the
proportion who are underweight, stunted or suering
rom wasting and childrens chances o survival.
Countries are then ranked according to both their
commitments and their nutritional and child survival
outcomes, as indicated in the adjacent table. For each
category countries are divided into our groups o
nine sound (green), air (yellow), emerging (blue)and rail (red).
For detailed notes on methodology and a ull list
o indicators, see the Appendi on page 17.
Country Commitment Outcomes
Aghanistan lPOLITICAL/LEGAL
FINANCE l
Angola lPOLITICAL/LEGAL
FINANCE l
Bangladesh lPOLITICAL/LEGAL
FINANCE l
Burkina Faso l
POLITICAL/LEGAL
FINANCEl
Burundi lPOLITICAL/LEGAL
FINANCE l
Cambodia lPOLITICAL/LEGAL
FINANCE l
Cameroon lPOLITICAL/LEGAL
FINANCE l
Congo, DR lPOLITICAL/LEGAL
FINANCE l
Cte dIvoire lPOLITICAL/LEGAL
FINANCE l
Egypt lPOLITICAL/LEGAL
FINANCE l
Ethiopia lPOLITICAL/LEGAL
FINANCE l
Ghana lPOLITICAL/LEGAL
FINANCE l
Guatemala lPOLITICAL/LEGAL
FINANCE l
India lPOLITICAL/LEGAL
FINANCE l
Indonesia lPOLITICAL/LEGAL
FINANCE l
Iraq lPOLITICAL/LEGAL
FINANCE l
Kenya lPOLITICAL/LEGAL
FINANCE l
Madagascar lPOLITICAL/LEGAL
FINANCE l
Malawi l
POLITICAL/LEGAL
FINANCEl
Mali lPOLITICAL/LEGAL
FINANCE l
Mozambique lPOLITICAL/LEGAL
FINANCE l
Myanmar lPOLITICAL/LEGAL
FINANCE l
Nepal lPOLITICAL/LEGAL
FINANCE l
Niger lPOLITICAL/LEGAL
FINANCE l
Nigeria lPOLITICAL/LEGAL
FINANCE l
Pakistan lPOLITICAL/LEGAL
FINANCE l
Peru lPOLITICAL/LEGAL
FINANCE l
Philippines lPOLITICAL/LEGAL
FINANCE l
South Arica lPOLITICAL/LEGAL
FINANCE l
Sudan lPOLITICAL/LEGAL
FINANCE l
Tanzania lPOLITICAL/LEGAL
FINANCE l
Turkey lPOLITICAL/LEGAL
FINANCE l
Uganda lPOLITICAL/LEGAL
FINANCE l
Vietnam l
POLITICAL/LEGAL
FINANCEl
Yemen lPOLITICAL/LEGAL
FINANCE l
Zambia lPOLITICAL/LEGAL
FINANCE l
FAIR
S
OUND
EM
ERGI
NG
FRA
IL
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vi
2012 A CRITICAL YEAR
2012 has been a critical year or action on nutrition. In
May the World Health Assembly adopted a resolution
on maternal, inant and young child nutrition, including
a target to reduce the number o stunted children
by 40% by 2025. US President Obama, together
with the G8, Arican leaders and the private sector,
launched the New Alliance or Food Security andNutrition. Even the Olympic Games included a ocus
on nutrition, with British Prime Minister Cameron
and Brazilian Vice-President Temer hosting a historic
summit to tackle nutrition ahead o the closing
ceremony o the London 2012 Olympics. This summit
set out measures that could reduce the number
o stunted children by 25 million beore the net
Olympic Games in Rio de Janeiro, thus setting 2016
as a key milestone or reaching the ambitious World
Health Assembly 2025 target.Increased international attention on the silent crisis
o undernutrition is welcome, and long overdue.
One-third o all children under ve in developing
countries are stunted. Stunting irreversibly damages a
childs cognitive and physical potential and has lie-long
consequences or health, educational attainment and
economic productivity. In contrast with most other
child health indicators, rates o stunting are alling
too slowly, and the proportion o wasted children
(suering acute weight loss) actually rose during the
last decade.
Through initiatives such as the Scaling Up Nutrition
Movement, the UN Secretary-Generals Global
Strategy on Womens and Childrens Health
(known as Every Woman Every Child) and the
1,000 Days partnership there is growing recognition
o the importance o nutrition in achieving
Millennium Development Goals 4 and 5. Last year,
a comprehensive report on commitments to Every
Woman Every Child highlighted a lack o attention
to nutrition, describing it as a neglected area. We
now have a window o opportunity to capitalise on
increased attention on the crisis o undernutrition
and the growing political will to tackle it and to
ensure that more children get a chance to develop to
their ull potential.
GAUGING PROGRESS
In order to assess recent progress towards improving
nutrition and to help dene the critical stepsnecessary to achieve the ambitious 2025 stunting
targets, Save the Children and World Vision have
produced a Nutrition Barometer. The Barometer
provides a snapshot o governments political
and nancial commitments on nutrition in the 36
countries that are home to 90% o malnourished
children, complementing other eorts to strengthen
accountability or womens and childrens health. It
reveals that many countries still have a long way to
go to make nutrition a political priority, and then to
transorm commitments on nutrition into progress.
The Nutrition Barometer measures two dimensions
o a countrys commitment to nutrition. The rst
looks at laws, policies and other eorts at the national
level to address undernutrition. The second assesses
the resources that governments allocate to meeting
their commitments. The Barometer also measures
child survival and nutrition outcomes by tracking the
proportion o children who are underweight, stunted
and wasted. Recognising that undernutrition is the
underlying cause o one-third o all child deaths, it
also looks at a countrys progress towards Millennium
Development Goal 4 a two-thirds reduction in
under-ve mortality by 2015.
All countries eatured in the Barometer continue
to have very high burdens o undernutrition. O the
36 countries eatured, however, the countries making
most progress are Guatemala, Malawi and Peru. All
three demonstrate sound commitments, and sound
child nutrition and survival outcomes, relative to
the other countries in the group. The DemocraticRepublic o Congo, India and Yemen show the
weakest perormance, with rail commitments and
rail outcomes.
execuTive summary
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ExECUTIVESUMMARY
vii
In many o the countries surveyed, progress in
tackling malnutrition refects policy commitments.
However, some countries, such as Ethiopia, score
well on commitments but their outcomes lag behind.
This illustrates the act that it can take time or
commitments to be put into action, and or action to
be translated into outcomes. It also underscores theneed or regular monitoring o nutrition indicators.
Other countries, like the Philippines, seem to have
better outcomes even though they score lower on
commitments. This could be a result o economic
growth, rising household incomes and other social
policies that lead to improvements in nutrition across
the general population.
WHAT NEEDS TO CHANGEAll countries eatured in the Barometer need
to sustain eorts over generations. Enshrining
commitments in law will allow people to hold
their government to account and ensure adequate
investment in nutrition over time.
The Nutrition Barometer shows that, while in many
cases the level o political commitment to nutrition
is an indicator o the likely direction o nutrition
outcomes, this is not necessarily the case. In order
or nutrition outcomes to improve, there must be
ull implementation o strong nutrition strategies
that are backed up by long-term investments o
adequate nances and human resources, and sustained
political will. Regular reviews o these country-specic
nutrition strategies, along with improved transparency
and access to inormation, will enable greater
accountability in relation to the progress o national
governments in improving nutrition. Civil society has
a key role to play in the accountability process.
RECOMMENDATIONS
Holding governments to account or their
commitments on a regular basis will be critical to
reversing the unacceptably high levels o chronic
undernutrition and child mortality. By assessing
countries readiness and willingness to combine
commitments with action, the Nutrition Barometer
will contribute to eorts already underway to
scale-up improvements in nutrition.Making signicant reductions to the unacceptably
high levels o chronic undernutrition will take a
coordinated eort as we move towards the World
Health Assemblys target o 2025. The 2016 Olympics
will be a key moment to stop and check that we are
moving in the right direction.
Save the Children and World Vision call upon more
countries to demonstrate leadership on nutrition and
ensure commitments are switly translated into action.
The international community must not squander
this opportunity to address both the causes and
consequences o undernutrition, and must take the
ollowing steps:
Nationalnutritionplansshouldbecostedand
include national and sub-national targets or
improving nutrition and reducing stunting. They
must: include a ocus on reaching the poorest
children; incorporate the indirect interventions
that are the responsibility o other sectors; include
a strong monitoring ramework that sets out aregular (eg, annual) review process, with input
rom civil society and other stakeholders.
Countrieswithahighburdenofnutritionshould
increase and sustain investment in direct nutrition
interventions and in strengthening health systems
(including human resources) that are needed to
deliver those interventions.
Countriesshouldincreasethetransparencyofand
accountability or nutrition plans by making better
data available. They should ensure that there are
regular nationally representative nutrition surveys
to improve the monitoring o progress against
nutrition indicators.
Countrieswithahighburdenofundernutrition
should join the Scaling Up Nutrition Movement,
and should ully integrate nutrition into their
eorts to improve maternal and child health
through the Every Woman Every Child initiative
and through the more recent A Promise Renewed
movement (which came out o the Child Survival
Call to Action).
TheSUNmovementshouldundertakeacosting
o country plans, to be completed by the end
o 2012, while donors and other development
partners should make long-term nancing
commitments to meet any nancing gaps in
implementing ambitious nutrition plans.
Donorsshouldfulltheircommitmentsand
also use orthcoming opportunities in 2013to make urther concrete commitments to
supporting nutrition.
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viii
DHS Demographic and Health Survey
DRC Democratic Republic o Congo
EU European Union
HANCI Hunger and Nutrition Commitment Inde
HRCI Hunger Reduction Commitment Inde
ICDS Integrated Child Development Services
IDS Institute o Development Studies
MDGs Millennium Development Goals
NGOs Non-governmental organisations
SUN Scaling Up Nutrition Movement
UN United Nations
UNICEF United Nations Childrens Fund
abbreviaTions
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1
Recent decades have seen dramatic progressin child survival. The number o childrendying beore their th birthday declinedrom 12 million in 1990 to 6.9 million in 2011according to UNICEFs 2012 Levels and Trendsin Child Mortalityreport. In contrast to thisoverall positive trend, progress in reducing
childhood undernutrition has been slow. Itremains the underlying cause o more than athird o all child deaths worldwide around2.3 million in 2011.
Maternal undernutrition, long-term eposure to
a poor diet and repeated inections have also
let 165170 million children under-ve stunted,
preventing them rom reaching their ull potential.
(These are estimates rom UNICEF and the
World Health Organization.)
Stunting is a hidden problem in many populations,
and children may not appear undernourished.
However, stunting indicates impairment to both
physical and cognitive development, which can
have lietime consequences or a persons health,
educational attainment and economic productivity.
Alarmingly, the proportion o wasted children (suering
acute weight loss) actually rose in the second hal o
the 2000s.1 The recent ood crises in both west and
east Arica have highlighted the need or more eective
responses to prevent undernutrition in emergencies,
particularly in areas with recurrent ood crises.
2012 TIME FOR ACTION
ON NUTRITION
2012 has been a critical year or action on nutrition.
The US President Barack Obama, together with G8
and Arican leaders and the private sector, launched
the New Alliance or Food Security and Nutrition,aiming to take 50 million people out o poverty in
the net decade. In May, the World Health Assembly
adopted a resolution on maternal, inant and young
child nutrition, including a target to reduce the
number o stunted children by 40% by 2025. On
the closing day o the Olympic Games in London,
UK Prime Minister David Cameron and Brazilian
Vice President Michel Temer co-hosted a hunger
summit bringing together key government leaders,
the private sector, United Nations, World Bank, non-
governmental organisations (NGOs) and oundations.
Leaders attending the hunger summit took up the
baton on what we hope will be a signicant push
on hunger and nutrition. At the summit measures
were announced to reduce the number o stunted
children worldwide by 25 million by the net Olympic
Games in 2016. This would put the world on track
to achieve the even more ambitious 2025 target. The
European Commission announced that it will support
high-burden countries to reduce stunting and accept
responsibility or 10% o the overall 40% reduction
target agreed at the World Health Assembly.2 TheScaling Up Nutrition (SUN) movement3 is also
launching a revised strategy this year.
Increased international attention on the silent crisis
o undernutrition is welcome, and long overdue. But
it is not enough i we are to deliver these ambitious
targets. Countries with a high burden o undernutrition
need to demonstrate high-level leadership and ensure
that commitments are switly translated into policies
and plans, backed by additional resources and properly
implemented, to improve nutrition outcomes orchildren and their mothers.
MEASURING COMMITMENTS
AND OUTCOMES
To assess national governments political and nancial
commitments to nutrition, Save the Children and
World Vision have produced a Nutrition Barometer.
In the same way that a weather barometer measures
changes in atmospheric pressure, the Nutrition
Barometer gauges how governments are aring
in political and nancial commitments in light o
increased global attention on the issue.
inTroducTion
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THENUTRIT
IONBAROMETER
2
This frst edition o the Barometer monitors
governments political and nancial commitments to
nutrition in the 36 countries that are home to 90%
o undernourished children. Political commitment,
such as signing onto a global plan like Every Women,
Every Child or having a national plan on nutrition,
is just one step towards addressing the issue. Apolitical commitment may not always translate into
a nancial commitment. There are a number o
steps and measures that need to take place between
making a commitment, implementing programmes and,
ultimately, having an impact. The Scaling up Nutrition
(SUN) movement is a good eample o this.
This Barometer looks at the frst step o the process
towards improved nutritional outcomes. It shows that
while, in many cases, the level o political commitment
to nutrition is an indicator o the likely direction o
nutrition outcomes, this is not necessarily the case. In
order or nutrition outcomes to improve, there must
be ull implementation o strong nutrition strategies
that are backed up by long-term investments o
adequate fnances, sufcient human resources andsustained political will. Regular reviews o these
country-specifc nutrition strategies, along with
improved transparency and access to inormation,
will enable greater accountability in relation to
the progress o national governments in improving
nutrition. Civil society has a key role to play in the
accountability process, especially in acilitating the
dialogue between citizens and their elected ofcials.
PHOTO:CJCLARKE/SAVETHECHILDREN
Rani, eight, rom Punjab
in Pakistan, holding her
seven-month-old sister,
Samia. Following foods in
2011, Samia was treated orsevere acute malnutrition.
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INTRODUCTION
3
The rst 1,000 days rom conception through to
two years o age have been proven to be critical
or growth, development and lie-long potential.
Looking back over the 1,000 days rom the
beginning o 2010 to the UN General Assembly in
September 2012, there have been a number o key
events and processes that have laid the oundations
or potential unprecedented improvements in
maternal and child health and nutrition.
Momentum was galvanised early in 2010 through
the development o the UN Secretary-Generals
Global Strategy or Womens and Childrens Health,
also known as Every Woman Every Child.5 The
estimated unding gap or maternal, newborn and
child health identied in the Global Strategy
included the costs o direct nutrition interventions,
along with a target o protecting 88 million childrenunder ve rom stunting by 2015. The subsequent
launch o this Global Strategy in September the
same year garnered US$40 billion in nancial
commitments plus a large number o policy and
service delivery commitments. However, a detailed
report on commitments to the Global Strategy6
highlighted a lack o attention to nutrition,
describing it as a neglected area o the continuum
o care.
2010 also saw the launch o the Scaling UpNutrition Movement a global movement o
governments, donors, civil society, multilaterals,
private sector and other actors that aims to catalyse
and scale up current eorts to improve nutrition
or pregnant women and children under two. The
SUN movement developed a global Framework or
Action, a roadmap or implementation, and created
several taskorces to eectively spur a scaling up
o investment, advocacy and programming in
nutrition. Key donors have identied the need to
urther mobilize resources or nutrition, and nearly
30 countries with huge nutrition challenges have
signed up, keen to work with partners to increase
their nutrition eorts. The 1,000 Days Partnership,
led by the US and Irish governments, was also
launched in 2010 to bring high-level political
leadership and momentum to this movement.
Adding urther weight to the SUN movement, in
April 2012, the UN Secretary-General personally
appointed 27 senior representatives rom
governments, civil society, development agencies,
international organisations, business and oundation
to provide strategic oversight, mobilize resources
and improve accountability and coordination o the
movement. Never beore have so many leaders,
rom so many countries and elds, agreed to work
together to improve nutrition, said Secretary-
General Ban Ki-moon o the SUN Lead Group,7which is chaired by UNICEF Eecutive Director,
Tony Lake.
There has also been growing recognition o the
importance o measuring stunting as a refection
o continued, long-term eposure to poor health
and nutrition, particularly during the rst two years
o lie. This is refected by the act that stunting
was one o three outcome indicators identied
in 2011 by the Commission on Inormation and
Accountability or Womens and Childrens Healthto measure the implementation o the UN Global
Strategy. May 2012 saw agreement at the World
Health Assembly o a new target to reduce numbers
o stunted children worldwide by 70 million
by 2025.
This new global target to reduce stunting
gives greater impetus or health and nutrition
stakeholders to work together, and in particular
or urther integration between the SUN and
Every Woman Every Child movements.
GROWING MOMENTUM FOR NUTRITION
The Nutrition Barometer complements other
accountability eorts, including the work o
the independent Epert Review Group and the
Partnership or Maternal, Newborn and Child
Health.4 It will be used by Save the Children, World
Vision and other partners to acknowledge those
countries that are moving in the right direction to
reduce undernutrition, and to highlight those making
insucient progress. In uture editions, developments
on nutrition will continue to be monitored, as will
progress on other aspects o child health.
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4
The Nutrition Barometer provides a snapshoto national governments commitments andprogress in addressing nutrition and childsurvival. It analyses commitments madeby each countrys government to ghtundernutrition, and attempts to understandhow these commitments move with childrens
nutrition status and survival chances. TheNutrition Barometer builds on eistingindices such as the Global Hunger Indeproduced by the International Food PolicyResearch Institute and the Hunger ReductionCommitment Inde released by the Instituteo Development Studies.8 (For detailed noteson methodology and a ull list o indicators,see the Appendi.)
There are many diverse actors determining nutrition
outcomes. UNICEFs conceptual ramework on the
causes o undernutrition indicates multisectoral
intermediate, underlying and basic determinants
spanning ood, health and care practices.9 National-
level actors such as economic growth, social policy,
health systems and governance are signicant in
combating and addressing undernutrition. Agriculture
and ood security play a big role as well. At the
household level, income and education are two o
the key actors that aect childrens nutrition.
We know where the highest burdens o undernutritionare and their causes. One area that needs examining,
however, is how much national governments make a
commitment to address nutrition in terms o policies,
participation in global initiatives and allocation o
adequate resources to nutrition-specifc and related
interventions. The Nutrition Barometer gauges these
commitments, which are measurable and comparable
across the 36 countries that together account or
90% o the worlds undernourished children.
The Nutrition Barometer measures two dimensions
o commitment. The rst looks at laws, policies
and other eorts at the national level that address
undernutrition. The second indicates the resources
that governments allocate to see through their
political and legal commitments.10
The political and legal commitments include seven
indicators spanning economic and social rights, theright to ood, membership o SUN, nutrition-specic
commitments to the Every Woman Every Child
initiative,11 national nutrition policies and regular
monitoring o nutrition outcomes. Public ependiture
includes three indicators. Two o these are measures
o health spending, while the last looks at the
eistence o a current costed nutrition plan.
We measure outcomes by looking at three
anthropometric indicators o childrens nutrition
status and child survival. The nutrition indicatorsinclude the proportion o children who are
underweight, stunted and wasted. Recognising that
undernutrition is the underlying cause o one-third
o all child deaths, we include progress towards
Millennium Development Goal (MDG) 4 a
two-thirds reduction in under-ve mortality by
2015 in our outcomes indicators. O course,
actors beyond nutrition also contribute to mortality,
so this broadens the Barometers scope.
By providing a snapshot o country political and
nancial commitments and how they are progressing
on addressing nutrition and child survival, we aim to
stimulate a conversation about the accountability o
governments to the worlds undernourished children,
including where national governments are doing
well and where they need to do better. Through
the Nutrition Barometer, we intend to provide a
new perspective or national and global debates
about improving nutrition and reaching the stunting
reduction targets set or 2016 and 2025.
1 The nuTriTion baromeTerexplained
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1THENUTRITIO
NBAROMETERExPLAINED
5
The Nutrition Barometer complements the
orthcoming Institute o Development Studies
Hunger and Nutrition Commitment Inde.
12
Bothtools analyse country commitments and link them
with outcomes, and both look at actors deemed
important to addressing hunger and nutrition.
These include indicators such as the right to ood,
government spending on health, and national policies
to ght hunger and undernutrition. The Hunger and
Nutrition Commitment Inde (previously called the
Hunger Reduction Commitment Inde) employs
primary data to validate its assessment based on
secondary data, and looks at governance actors
that the Barometer does not include. It also
assesses commitment in developed countries
to address hunger. The Barometer considers
commitments to global rameworks such asnutrition-specic commitments to Every Woman
Every Child and membership o SUN. Both
tools look at countries with high hunger or
undernutrition burdens. In our sample, we include
the 36 countries with the highest burden o
undernutrition, while the orthcoming Hunger and
Nutrition Commitment Inde will include about
40 countries. Both Malawi and Guatemala come
among the top countries in the Barometer and
the Hunger Reduction Commitment Inde.
THE NUTRITION BAROMETER AND THE
HUNGER AND NUTRITION COMMITMENT INDEx
PH
OT
O:SIMONPETER
.ESAK
U/W
ORLD
VISION
Tony, 5, holds on to the
goat his mother received
through a community
revolving animal und.
World Visions work
in the Abim district o
Uganda has enabledmore amilies to reap
the benets o improved
income and nutrition.
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6
The fndings o the Nutrition Barometerindicate the strength o country commitments
to addressing undernutrition and theirnutrition status relative to other high-burdencountries, as shown in the fgure below.
In many o the 36 countries surveyed, commitments
to nutrition tend to mirror outcomes in nutrition
and child survival, while several cases indicate a
more nuanced relationship between commitments
and outcomes. Each country gets an overall
classication or commitments and outcomes.
In recognition o the importance o ollowing up
high-level commitments with adequate resources,
commitments are urther broken down into political,
legal and nancing commitments.
2 The findinGs commiTmenTs and
nuTriTion & childsurvival ouTcomes
FIGURE 1: COMMITMENTS AND OUTCOMES
Sound
Fair
Emerg
ing
Frail
Commitments
Frail Emerging Fair Sound
Outcomes
Ethiopia
Madagascar
TanzaniaBurkina Faso
Burundi
Nepal
Guatemala
Malawi
Peru
Niger Ghana
Indonesia
Mozambique
Uganda
Zambia
Bangladesh
Kenya
Mali
Aghanistan
Pakistan
Cambodia
Nigeria
Egypt
Iraq
South Arica
TurkeyVietnam
Democratic Republico Congo
India
Yemen
Angola
Cameroon
Myanmar
Cte dIvoire
Sudan
Philippines
Notes: Commitments reer to political, legal and nancial commitments.
Outcomes reer to nutrition and child survival outcomes.
As with any composite inde, categorisation o countries can refect either 1) consistent perormance or 2) an averageo varying perormance across indicators. For eample, Guatemalas sound categorisation refects good perormance
on child survival despite a stunting level o 48%, which is a serious national problem requiring urgent attention.
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2THEFINDINGS
COMMITMENTSANDNUTR
ITION&CHILDSURVIVALOUTCOMES
7
HIGHS AND LOWS
According to the Barometer, the countries that show
sound commitments with sound nutrition and survival
outcomes relative to the other countries in the group
are Guatemala, Malawi and Peru.
The Democratic Republic o Congo (DRC), Indiaand Yemen show the weakest perormance, with rail
commitments and rail outcomes. Outcomes or India
are dated as they are based on the National Family
and Health Survey-3 rom 200506. However, since
the country has not had a nationally representative
survey since then, these gures are still generally used.
(For more inormation about Indias perormance on
the Barometer, see page 9.)
COMMITMENTS MATCHED
BY OUTCOMES
In 13 o the countries (just over a third o the
sample) we looked at, commitments and outcomes
point in eactly the same direction. Three countries
Guatemala, Malawi and Peru have both sound
political and nancial commitments and sound
outcomes relative to the other countries in the
group in this study.
For eample, Guatemala shows ecellent high political
and legal commitments since it has signed and ratied
the Economics and Social Rights Convention, it is a
member o SUN, and it has an overarching national
nutrition policy. These political commitments are
matched by strong nancing commitments. Perhaps
due to these commitments, Guatemalas proportion
o underweight and wasted children, estimated at 13%
and 1% respectively, is much lower than most o the
other countries. However, despite strong political will
to tackle undernutrition, 48% o Guatemalan childrenare estimated to be stunted. The national data also
masks disparities across socio-economic wealth
groups. (For more inormation about Guatemalas
perormance on the Barometer, see page 8.)
Peru, among its other commitments, has been
monitoring health and nutrition outcomes regularly
with a rolling DHS. Malawi, despite its low-income
status, also comes out strongly in political, legal and
nancing commitments. This suggests that low-income
countries, as well as richer countries, can ollowthrough political commitments to nutrition with
adequate nancing.
Cambodia shows emerging commitments and
outcomes, with the Barometer indicating air
political and legal commitments that are combined
with emerging fnancing commitments. High-level
leadership, as shown by the Cambodian Prime Minister,
is key to raising the profle o nutrition as a national
development priority. The country is also developinga cross-sectoral ood security and long-term
nutrition strategy.
Weak commitments in the DRC and Yemen are
related to very poor nutrition and child survival
outcomes. While the DRC indicates emerging political
and legal commitments, it suers rom a lack o
adequate nancing rom domestic sources. The results
or both countries have to be put in the contet o
ragility and confict, which imposes heavy constraints.
Fragile and confict-aected countries are among theurthest rom achieving the MDGs, including targets
to reduce the number o underweight children. Few
ragile or confict-aected countries have signed up to
the SUN movement, indicating that urther, targeted
support may be needed to enable the involvement o
some o the highest-burden and potentially lowest-
capacity countries.
COMMITMENTS HIGHER
THAN OUTCOMES
The Barometer shows 12 countries where there
are high political, legal and/or nancial commitments
to nutrition, yet outcomes are lower. Nepal refects
sound overall commitments matched with emerging
outcomes. Breaking down Nepals commitments, we
see that the government has sound political and legal
commitments and air nancing commitments. The
governments determination to address the high rates
o undernutrition is demonstrated in the eort put
into the 2009 Nutrition Analysis and Gap Assessment.
The Multi-sectoral Nutrition Plan or Accelerating
the Reduction o Maternal and Child Under-nutrition
was nalised and approved earlier this year. The
Demographic and Health Survey or 2011 reports
a reduction in stunting rom 56% to 41% over ten
years. However, gains were not equitable across all
population groups. Much o the progress occurred in
the wealthiest quintile, while undernutrition increased
in the poorest quintile. Underweight has also,
predictably, diminished, though wasting has remained
continued on page 12
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IONBAROMETER
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It is worth unpacking Guatemalasperormance in the Barometer, whichsuggests sound commitments and outcomesor the country. While developments aroundthe right to ood, its membership o SUN,an overarching national nutrition policy andnancial allocations to health have helped
boost Guatemalas commitments to nutritionin the Barometer, the denitive impact opolicies reducing malnutrition in Guatemalais still to be seen.
The country presents a nuanced picture o nutrition
and child survival outcomes. Increases in coverage
o eective lie-saving interventions such as
immunisation, treatment o pneumonia and improved
drinking water among others have helped reduce
the countrys under-ve mortality rate (see the 2012
Countdown to 2015 report or details o coverage).Child mortality ell rom 78 deaths per thousand live
births in 1990 to 32 deaths per thousand live births
in 2010.
Nutrition, on the other hand, has not mirrored
Guatemalas relative progress in bringing down child
deaths. While acute malnutrition has allen to about
1%, 48% o children below ve years suer rom
chronic malnutrition in the country. This is the
highest stunting rate in the western hemisphere
and the sith highest in the world. The gap between
survival and chronic malnutrition has to be put in
the countrys contet.
Guatemala is a lower-middle-income country with
widespread and severe poverty. The World Bank
estimated in 2006 that hal o the population lives
below the poverty line. There are inequalities notonly across income groups but across regions and
ethnicities, with endemic poverty in the indigenous
populations. Poverty and inequality, together with
natural disasters and recent ood price increases,
uel the gap between ood availability and probable
ood requirements. Poor and vulnerable households
oten cannot aord a nutritious diet, with devastating
consequences on childrens growth. Stunting aects
long-term development and can potentially lead to
poorer schooling and earning outcomes later in lie.
While political will to address undernutrition is most
welcome, there remains a huge job or the government,
donors and other stakeholders to do to improve
childrens nutrition outcomes in Guatemala. These
commitments have to be sustained, and ollowed
through with concrete actions in the long term, in
order to bring down chronic malnutrition. Increasing
coverage o direct nutrition interventions, education
and broader social policies are just some o the
measures needed to ensure that uture generations
survive and reach their ull growth potential.
GuaTemala sTill a lonGway To Go
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Spectacular economic growth has nottranslated into better nutrition outcomes ormany o Indias children. Growth has litedmillions out o poverty but it has also beenlargely unequal, with the benefts accruing to asmall segment o the population. Many sourceso data show that almost hal its children
are underweight and stunted, and more than70% o women and children have seriousnutritional defciencies such as anaemia.
Nutrition data at the national level masks huge
disparities across states and socio-economic
wealth groups. For example, children in the poorest
households are more than twice as likely to be stunted
as those in the richest households. However, even in
the wealthiest 20% o the population, one child in fve
is undernourished. Although there are success stories
and developments in some parts o the country, whichshow what can be achieved, the Prime Minister o
India has reerred to undernutrition levels as a matter
o national shame,13 with enormous costs in terms o
health, well-being and economic development.
Indias perormance in the Nutrition Barometer
indicates both rail commitments and outcomes. Its
showing on commitments was set back by the lack
o nutrition-specic commitments to Every Woman
Every Child and not being a member o SUN as yet.
Public spending on health both as a percentage ogovernment budget and in per capita terms is low,
especially or a middle-income country.
There are signicant recent indications that
commitment to ghting undernutrition is
strengthening, including an announcement to triple
resources or the reorm o Integrated Child
Development Services (ICDS), the countrys primary
scheme to address child health and nutrition.
Implementation o the programme has been mied
across states, leading to ecellent outcomes in someplaces and poor results in others. A criticism o the
ICDS was its ailure to target children between the
ages o 0 and two years, which is the crucial growth
period. One reorm involves increasing the number
o Anganwadi [community health] workers in the
200 districts with the highest levels o undernutrition.
This could have a particular impact on increasing
interventions during the crucial rst 1,000 days, rom
a childs conception through to two years o age.
The government is also strengthening its participation
in the global stage when it comes to addressingnutrition. India co-chaired the Child Survival Call to
Action Summit in June 2012, with the USA and Ethiopia,
and the Minister or Women and Children attended the
2012 UK hunger summit. We understand there have
also been discussions around Indias engagement with
SUN during the UK Hunger Summit.
These developments are promising and, i ollowed
through and ully implemented with adequate
resources and proper oversight, can greatly help
improve the nutritional status o Indias children. Inorder to monitor the impacts o these commitments,
India urgently needs a new population-based,
nationally representative survey to check what has
happened to nutrition since 200506. The ourth
National Family Health Survey is scheduled or 2014.
District-level data collection is planned this year,
which will give a more accurate indication o where
nutrition outcomes stand at present.
india laGGinG behinddespiTe economic GrowTh
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The government o Kenya scores air in itspolicy and legal ramework or improvingnutrition and in its nancial commitments.Its nutrition outcomes, classied as emerging,are less strongly. The need or sustainedand urther action is clearly outlined by thecontinued poor nutrition status o many o
the countrys children.Over the past ew years a number o key papers
and strategies have signalled a new approach by
the government on nutrition. The rst o these
was the 2008 Food Security and Nutrition Strategy,
which sought to strengthen budgetary allocations,
involvement o the private sector, intersectoral
coordination, monitoring and evaluation systems
and stakeholder participation. In 2011 the Cabinet
endorsed the National Food and Nutrition Security
Policy, implementation o which will be guided bya National Nutrition Plan o Action (20112017),
which is currently being nalised. This Plan o Action
provides a roadmap or coordinated implementation
o nutrition interventions by the government and
NGOs across development sectors or maimum
impact. It outlines nine strategic objectives with
corresponding activities and epected outcomes,
a monitoring and evaluation approach, time rames
and estimated costs.
Despite Kenya not having ormally joined SUN yet,
elements o the movements core activities and a set
o high-impact nutrition interventions undertaken
by SUN countries are already being implemented.
Central to SUN is the engagement o stakeholders
outside o government in the planning, implementationand monitoring o nutrition policies, strategies
and plans o action to scale up nutrition. In Kenya
NGOs and UN agencies are included in the planning
committee or the orthcoming National Nutrition
Symposium, alongside various ministries, including
health and agriculture. The aim o this event, which
will be opened by the President and have regional
delegates, including the Arican Union, is to raise
the prole o undernutrition in Kenya and provide
a greater ocus on the roadmap or scaling up
the response.
Critical challenges aced by Kenya include the
need to increase the share o government budget
allocated to health and, within that, to ensure
adequate unding or direct nutrition interventions.
The current level o health spending alls ar below
the 15% o government spending agreed by all
Arican governments in 2001. In addition, signicant
improvements can be made in the coordination o
nutrition within and across government ministries,
in line with the plans or improving the institutionalramework or nutrition outlined in the National
Food and Nutrition Security Policy.
To make greater progress in improving nutrition
outcomes or mothers and children, the government
o Kenya must prioritise the implementation o
the eisting comprehensive policy rameworks or
nutrition and ood security, including the provision o
adequate nancial and human resources.
Kenya commiTmenTs noTyeT reflecTed in ouTcomes
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Despite severe security challenges, weakgovernance, limited scal resources and major
human resource limitations, Aghanistanhas made progress towards its social anddevelopment objectives over the past decade.Inant and under-ve mortality have allenrom 111 and 161 per thousand live birthsin 2008 to 77 and 97 per thousand livebirths respectively. However, Aghanistanschildren continue to suer rom high levels oundernutrition: nearly 60% o children underthe age o ve are stunted, and approimately
one-third o children are underweight.Widespread poverty and a lack o availability o
diverse and good quality ood are major causes o
undernutrition, and micronutrient deciencies in
particular. Inadequate inant and young child eeding
practices, and inectious diseases such as diarrhoea,
are also a major cause o undernutrition. Around 40%
o those admitted to therapeutic eeding units (or
treatment o severe acute undernutrition) are under
si months old, pointing to breasteeding problems as
a primary cause. Many households still have no accessto sae drinking water and still more also lack access
to improved sanitation.
The political commitment required or tackling
undernutrition is emerging. The National Public
Nutrition Policy and Strategy 200913 and the
Inant and Young Child Feeding Policy and Strategy
200913 are the governments key commitments
related to nutrition. However, to date neither policy
has been eectively implemented. To close the gap
between policy and practice, the government should
review costed plans to eectively implement the two
strategies, taking into account the need or adequate
technical and nancial donor support.
To demonstrate its leadership even urther,
Aghanistan should incorporate nutrition into its
commitment to Every Woman Every Childand jointhe SUN movement. The Ministry o Public Health
must also improve coordination with other sectors
such as the Ministry o Agriculture, Irrigation and
Livestock, Ministry o Labour and Social Aairs, and
Ministry o Education to support a multi-sectoral
approach to implementing public nutrition and
inant & young child eeding policies.
afGhanisTan some proGress,
buT undernuTriTionsTill hiGh
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There is a strong case or the countries in this
category to ormalise their commitments to
nutrition. The sustainability o these outcomes could
be improved by enshrining nutrition measures in
legislation (eg, the right to ood) to make policies,
programmes and spending less vulnerable to changes
in political priorities. Publicly made commitments
also allow stakeholders to hold the government
to account, which increases transparency andaccountability. The government o Brazil, which
saw stunting rates halved in ten years under its
Zero Hunger programme, has stated that there is
no substitute or political will and leadership and
that guaranteeing the rights to ood, education and
health were key actors in their success.18 Given the
length o time it takes to reduce levels o chronic
undernutrition, regular reviews are needed to track
progress against these commitments.
POLITICAL WILL AND
FINANCING OVER TIME
The Nutrition Barometer gauges the direction o
movement between political and legal commitments
and nutrition and child survival outcomes. In several
cases the two move in the same direction, illustrating
the importance o political and legal commitments
to nutrition and ensuring that adequate resources
are allocated to them. While political commitment
is crucial to improving childrens nutrition outcomes,
nancing has to ollow in order or sound outcomes
to come through. As seen rom the ndings o the
Barometer, it is important to eamine not just the
percentage o government ependiture allocated to
health and ideally, i this inormation is available, or
nutrition as well but also to consider the actual per
capita ependiture that this translates into.
We also see a more nuanced relationship betweencommitments and outcomes in a number o cases.
Some countries have higher commitment scores but
with outcomes lagging behind, while others seem to
have better outcomes even though they have a lower
commitments score. The ormer illustrate the act
that it takes time or commitments to translate into
good outcomes and the need or regular monitoring
o childrens nutrition status, as eplained above. The
latter could be a result o economic growth and rising
household incomes which lead to improvementsin nutrition across the general population. Other
social policies outside o the Barometer might also
be aecting nutrition. It has to be stressed, however,
that these countries continue to have very high
burdens o undernutrition and these outcomes
have to be sustained over generations. Enshrining
political commitments will allow people to hold
their government to account and setting nancial
commitments will ensure adequate unding or
nutrition over time.
2012 saw the G8 increase their ocus on tackling
undernutrition, with welcome commitments to
improving tracking and disbursements or nutritionand a call or more nutrition-sensitive activities.19
However, this must be matched by an urgently
needed increase in resources.
Some G8 members have taken strong initiatives to
tackle undernutrition and were prepared to work
together to set a global stunting target. But the G8
as a group missed the opportunity to collectively
address the chronic underinvestment in nutrition
by adopting a commitment on undernutrition to
accompany the one agreed in their New Alliance on
Food and Security, which aims to move 50 million
people out o poverty. While welcome, the G8pledge to maintain robust programs to urther
reduce child stunting would have been stronger
i accompanied by a specic target. Even with the
current poor system or tracking aid to nutrition,
it is obvious that current spending levels rom
the G8, other donors and national governments
are woeully inadequate, given the estimated
US$10.3 billion annual unding needed or direct
nutrition investment.20
G8 DONORS HIGHLIGHT NUTRITION BUT FALL SHORT
ON NUTRITION FUNDING
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IONBAROMETER
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In 2008, world nutrition eperts identied a group
o 13 cost-eective direct nutrition interventions
that include encouraging changes in behaviour to
improve nutrition; provision o micronutrients;
and treatment o severe acute undernutrition with
special therapeutic oods.21 They estimated that i
these interventions were scaled up to reach every
child in the 36 high-burden countries, approimately
25% o under-ve deaths could be prevented.
These interventions rely on a strong health system
with sucient numbers o health workers who have
the right knowledge and epertise to prevent and
treat undernutrition. However, millions o children
live out o reach o essential nutrition interventions
because there is no unctioning health service in
their communities and no skilled health workers
available to provide any orm o healthcare.
As the Nutrition Barometer shows, while many
countries have developed national nutrition
strategies, delivery o these interventions is oten
inadequate. One o the major barriers is an overall
lack o investment in health, resulting in weak human
resources and insucient institutional capacity to
plan and implement eective responses. Although
health worker density is not included in this rstedition o the Barometer, it is relevant to note
that o the 36 countries monitored, 31 have been
identied by the World Health Organization as
having a critical health worker shortage.22 Egypt,
Guatemala, the Philippines, South Arica and Turkey
the ve countries that do meet the recommended
ratio o 23 doctors, nurses and midwives per
10,000 people are all categorised as having sound
nutrition outcomes. The distribution o health
workers within a country aects outcomes; they
need to be deployed equitably across regions and
geographic areas to ensure that they reach the
poorest and most vulnerable households.
Health workers have a vital role to play in
promoting good maternal and child nutrition,
particularly during the crucial 1,000 days rom the
childs conception through to two years o age.
With the right support and supervision, well-trained
health workers without proessional qualications,
such as community health workers, can deliver
essential nutrition interventions at the local level
and help reduce inequities in the coverage o
nutrition services.
In order to ulfl commitments on nutrition and child
survival, governments must develop and implement
national plans to attract, train and retain health
workers with the skills necessary to diagnose,
prevent and treat undernutrition. Plans should ocus
on ensuring that health workers are in reach o thechildren with the greatest needs, and that health
workers working in challenging settings have sufcient
support rom the wider health service in order to
have the best possible impact on nutrition outcomes.
THE ROLE OF HEALTH WORKERS IN TACKLING UNDERNUTRITION
PHOTO:ANDYHALLFORTHEOBSERVER/SAVETHECHILDREN
Anjana (let), a communityhealth worker in a rural
district o Maharastra in
India, visits Meena and her
newborn baby.
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By constructing a Nutrition Barometer, andanalysing national governments commitmentsto and outcomes in improving nutrition, Savethe Children and World Vision are seeking tocapitalise on the current momentum aroundnutrition and contribute to a aster transitionrom pledges to implementation or results.
This picture o countries readiness and willingness
to combine commitments with action aims to help
inorm eorts which are already underway to scale
up improvements in nutrition, in line with recently
agreed global targets. Continuing and epanding these
eorts to hold all governments to account or their
own progress towards these targets (in line with their
eisting commitments) will be critical to accelerate
the current overall slow rate o progress, as will
garnering new commitments, as necessary.
It is critical that the international community doesnot squander this opportunity to address both the
causes and consequences o undernutrition. 2013 will
be a crucial year, with commitments rom both the
UK and Ireland to use their leadership o the G8 and
EU presidencies respectively to progress the nutrition
agenda and the increased international prole o the
SUN movement. Making signicant reductions to the
unacceptably high levels o chronic undernutrition
will take a coordinated, marathon eort rather
than a short sprint. All stakeholders should takeull advantage o the current momentum around
nutrition, but with a clear recognition that the interval
between commitments, ull implementation o agreed
strategies and improved nutrition outcomes requires
sustained and long-term political will and nance, and
investment in human resources.
These much-needed eorts to improve nutrition
must be punctuated with regular opportunities to
assess progress and review directions. Governments
should report regularly on nutrition spending and
develop a monitoring ramework to measure progress
towards long-term and interim nutrition targets.
This progress must be measured across population
groups, disaggregated at a minimum by wealth quintile,
geographic location and gender, to avoid national
averages that so oten mask serious inequities. As
construction o the Nutrition Barometer has shown,
it can be dicult or civil society to access key
documents and ependiture inormation in order to
hold governments to account or their commitments.
Improving transparency and access to inormation is a
key principle to ensure increased accountability to all
stakeholders, especially citizens.
We recognise that not all actors that contribute to
improving nutrition are captured by the Barometer.
Improvements in nutrition rely on unctioning health
systems, working in conjunction with education,
agriculture and social protection eorts to address
key underlying causes such as ood insecurity, lack o
access to sae water and improved sanitation.
In order to accelerate progress, Save the Children and
World Vision recommend the ollowing steps: Countriesrevisingordraftingnutritionplans
should include national and sub-national targets
or improving nutrition and reducing stunting
in line with the recently adopted World Health
Assemblys Maternal, Inant and Young Child
Nutrition Implementation Plan, with clear timelines
and details o investment required. Nutrition plans
must include a ocus on reaching the poorest
children; incorporate the indirect interventions
that are the responsibility o other sectors; and
include a strong monitoring ramework which sets
out a regular (annual) review process, with input
rom civil society and other stakeholders.
Countrieswithahighburdenofnutritionshould
increase and sustain investment in direct nutrition
interventions and also in strengthening health
systems including human resources needed to
deliver those interventions.
Countriesshouldincreasethetransparencyofand
accountability or nutrition plans by making betterdata available. They should ensure that there are
regular nationally representative nutrition surveys
to improve the monitoring o progress against
3 conclusions andrecommendaTions
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IONBAROMETER
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nutrition indicators. Large-scale surveys such as
the Demographic and Health Survey and Multiple
Indicator Cluster Survey should be conducted at
least every our to ve years, alongside national
surveys, to strengthen monitoring.
Countrieswithahighburdenofundernutrition
should join the SUN movement, and ully integrate
nutrition into their eorts to improve maternal
and child health through the Every Woman Every
Child initiative, and the more recent A Promise
Renewed movement that came out o the Child
Survival Call to Action.
TheSUNmovementshouldundertakeacosting
o country plans, to be completed by the end o
2012; donors and other development partners
should make long-term nancing commitments to
meet any nancing gaps in implementing ambitiousnutrition plans.
Donorsshouldfulltheirexistingcommitments
and also use orthcoming opportunities in 2013 to
make urther, concrete commitments to support
nutrition. Specically:
The UK should use its convening power as
Chair o the G8 to ensure increased resources
or nutrition and agriculture, to ll the undinggap, and take concrete steps to address the
major threats to progress, such as increasing
volatility o ood prices.
The Irish government should use its EU
presidency to push or the EU to produce
a roadmap on how it will reach its recently
announced 10% share o the global stunting
reduction target, in addition to convening a
high-level conerence on the impacts o climate
change on nutrition.
PHOTO:ALBERTYU/WORLDVISION
A girl in Cambodia gets
a nutritious meal. Many
children in Cambodia
are still undernourished
but political attention to
nutrition is growing.
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Constructing the Nutrition Barometer isairly similar to constructing an inde. Thekey aspects o the methodology are designingthe Barometer, selecting the indicators andweighting them. Designing the Barometerrequires an understanding o actors thataect nutrition outcomes. This also needs to
be considered in light o the diverse natureo the group o 36 high-burden countries.
Many actors aect childrens nutrition, including
economic growth, wealth distribution, government
commitment, social policies, direct nutrition
interventions, and education and care. Our Barometer
ocuses on measures that a government has publicly
committed to, and which stakeholders can thereore
hold them to account or. Given the diversity o the
countries in the sample, we needed to set criteria
that objectively gauge commitment and at the sametime allow us to nd comparable indicators across
the countries.
The Barometer includes commitments disaggregated
by political and legal commitments and by nancing
commitments and outcomes. We look at the
commitments separately and in their entirety. What
ollows is a detailed eplanation o how the indicators
were devised.
1) POLITICAL AND LEGAL
COMMITMENTS
The ollowing questions aim to measure a
governments political commitment to promoting
nutrition through: protecting citizens rights to a
decent standard o living, including the right to ood;
committing to global initiatives such as Every Woman
Every Child and the SUN movement; instituting a
national nutrition policy; and regularly monitoring
nutrition outcomes.
The data or this section are rom web pages o
the UN Treaty Collection, Every Woman Every
Child, SUN, UNICEFs Child Ino, Demographic and
Health Surveys and the Multiple Indicator Cluster
Surveys. Data on the right to ood is rom Knuth
and Vidar (2011),23 brieng notes rom the UN
Special Rapporteur on the Right to Food and the
right to ood website o the Food and Agriculture
Organization. National nutrition policies are rom
various sources. Full details can be ound at www.
savethechildren.org.uk/resources/online-library/
nutrition-barometer
IsthecountryasignatorytotheEconomicand
Social Rights Convention? Has it signed or ratied
the optional protocol to the Convention?
Istherighttofoodenshrinedinnational
legislation either eplicitly or implicitly (eg, in the
Constitution or as a state directive)?
IsthecountryamemberofSUN?
Hasthegovernmentmadenutrition-specic
commitments to Every Woman Every Child? Isthereacurrentnationalnutritionpolicyor
ramework or nutrition targets (either as a
stand-alone document or part o a broader
development plan)?
HastherebeenaDemographicandHealth
Survey / Multiple Indicator Cluster Survey /
comparable national nutrition survey in the past
ve years? For countries with older surveys, is
there a new survey in progress?
2) FINANCING COMMITMENTS
The ollowing questions determine each governments
nancial commitments to nutrition by looking
at its spending on health and whether there is a
costed current nutrition plan. Government health
spending is measured in two ways: as a percentage
o total government spending and in per capita
terms, recognising that low-income countries might
do better in the ormer and worse in the latter,
compared to middle-income countries (and viceversa). A current costed nutrition plan indicates a
governments intentions to spend on nutrition-specic
interventions, or which it can be held to account.
appendix:meThodoloGical noTes
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IONBAROMETER
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Data on the share o government budget that is spent
on health relate to 2010, collected rom the World
Development Indicators. Figures or government
health spending per capita are rom the World Health
Statistics 2012. Whether or not a country has a
costed nutrition plan comes rom various sources.
(For country sources, see www.savethechildren.org.uk/resources/online-library/nutrition-barometer)
Whatpercentageofgovernmentbudgetgoes
to health?
Howmuchisgovernmenthealthspending
per capita?
Isthereacurrentcostednationalnutritionplan?
3) OUTCOMES
The ollowing indicators refect childrens nutritionstatus and their survival chances. The outcome
indicators are rom UNICEFs Child Ino website,
which compiles data rom the Demographic and
Health Survey, the Multiple Indicator Cluster Survey
and comparable national surveys. These were
supplemented by the Demographic and Health Survey,
Multiple Indicator Cluster Survey and national surveys
released in recent months. Progress towards MDG 4
is rom the 2012 Countdown to 2015 report.24
Whatistheproportionofunderweightchildren?
Whatistheproportionofstuntedchildren?
Whatistheproportionofchildrensuffering
rom wasting?
HowhavecountriesprogressedtowardsMDG4?
We assess commitments and outcomes using the
Borda scoring system, where countries are given
scores based on their rank. As many o the variables
are ordinal in nature, we chose the Borda scoring
system over an additive system.25 The seven indicators
or political and legal commitments are given equal
weights and scored between 0 and 1. We sum upthe gures and the 36 countries are then ranked
according to their total score in the political and legal
section. The country that comes out best receives
a Borda score o 36. The one that comes out worst
gets a Borda score o 1.
The health and nutrition nancing indicators are
scored between 0 and 1 and are given equal weights
(ie, the two health ependiture health indicators have
a weight o 1). To normalise the nance ependiture
gures between 0 and 1, we rank countries rom best
to worst with the best receiving a score o 1. For the
nutrition costing variable, a country gets a score o 1
i it has a costed current nutrition plan. I it does not,
it scores 0. The scores or the three indicators are
totalled and countries are then ranked rom best to
worst with the country with the best score receiving
a Borda score o 36.
Outcome indicators are scored between 0 to 3 and
given equal weights. To normalise the anthropometric
variables, we rank countries based on theirproportion o underweight, stunted and wasted
children, with the country having the least proportion
receiving a score o 3. For the child survival outcomes,
a country is given the lowest score o 0 i it has made
no progress towards MDG 4 and the highest o 3 i
it has already achieved this. The scores or the our
indicators are summed up and countries are ranked
rom best to worst with the best-scoring country
getting a Borda score o 36.
At the end o the eercise, each country has a scoreor political, legal and nancing commitments and
outcomes or nutrition and child survival. The score
or the political, legal and nancing commitments are
totalled to produce the overall commitment score.
Countries are then ranked rom best to worst and
divided into quartiles. The rst nine countries are
classied as having sound commitments, the net
nine as having air commitments, the third nine as
having emerging commitments and the bottom nine
as having rail commitments. Outcome scores are also
ranked rom best to worst and countries are again
divided into quartiles o sound, air, emerging and rail
outcomes. The results o the Barometer or the
36 countries are shown on page v.
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19
1 Child Development Inde 2012: Progress, Challenges and Inequality, Save
the Children 2012
2 Andris Piebalgs European Commissioner or Development Intervention
at the Global Hunger Event, London, 12 August 2012 http://europa.eu/
rapid/pressReleasesAction.do?reerence=SPEECH/12/575
3 The Scaling Up Nutrition (SUN) movement was launched in 2010. SUN
brings together governments, including nearly 30 high-burden countries,
donors and other stakeholders committed to scaling up nutrition and
ghting hunger. See www.scalingupnutrition.org or urther details.
4
For more inormation on the independent Epert Review Group seehttp://www.who.int/woman_child_accountability/ierg/en/
For more inormation on the Partnership or Maternal, Newborn and
Child Health see http://www.who.int/pmnch/en/
5 The Global Strategy or Womens and Childrens Health is being put
into action through the Every Woman Every Child initiative. For more
inormation, visit www.everywomaneverychild.org
6 PMNCH (2011) The PMNCH 2011 Report: Analysing Commitments to
Advance the Global Strategy for Womens and Childrens Health http://www.
who.int/pmnch/topics/part_publications/2011_pmnch_report/en/inde1.
html
7 UN Secretary-General Appoints 27 Global Leaders to Head Worldwide
Eort to Address Child Malnutrition, press release, United Nations,
New York, 10 April 2012 http://www.scalingupnutrition.org/wp-content/uploads/2011/05/120410-SUN-Lead-Group-release-SG-Appoints-27-
leaders-to-head-SUN.pd
8 Save the Children is one o the partners o the IDS or the Hunger
Reduction Commitment Inde.
9 UNICEF, The State of the Worlds Children 1998 http://www.unice.org/
sowc98/silent4.htm#gure5
10 The Hunger Reduction Commitment Inde (HRCI) includes the two
categories. For urther reading see the HRCI 2011 report by Dol te
Lintelo and Lawrence Haddad et al at http://www.hrcinde.org/.
11 Launched by UN Secretary-General Ban Ki-moon during the United
Nations Millennium Development Goals Summit in September 2010,
Every Woman Every Child aims to save the lives o 16 million women and
children by 2015. It is an unprecedented global eort that mobilises andintensies international and national action to address the major health
challenges acing women and children around the world. The eort puts
into action the Global Strategy or Womens and Childrens Health, which
presents a roadmap on how to enhance nancing, strengthen policy and
improve service on the ground or the most vulnerable women and
children. For more inormation, visit www.everywomaneverychild.org.
12 The HRCI will be launched as the HANCI in the coming months. Save
the Children is one o IDSs partners or the HRCI and HANCI.
13 Child malnutrition in India a national shame Manmohan Singh,
11 January 2012, Reuters website http://in.reuters.com/article/2012/01/11/
child-malnutrition-in-india-a-national-s-idINDEE80A03F20120111
14
The UK Prime Minister and Vice President Michel Temer o Braziljoint statement on maternal and child undernutrition, 12 August 2012,
Number 10 website http://www.number10.gov.uk/news/pm-and-vice-
president-michel-temer-o-brazil-joint-statment-on-maternal-and-child-
undernutrition/
15 Data rom Egypt Demographic and Health Survey 2008
16 Department o Social Development, South Arican Social Security
Agency and UNICEF (2012) The South African Child Support Grant
Impact Assessment: Evidence from a survey of children, adolescents and their
households. Pretoria: UNICEF South Arica
17 Egypts Progress Towards the Millennium Development Goals 2010
report, downloadable at http://www.euromedale.org/node/13940
18 See note 14.
19 G8, Camp David Accountability Report; Actions, Approach and Resultshttp://www.state.gov/documents/organization/189889.pd
20 World Bank (2006) Repositioning Nutrition as Central to Development: A
strategy for large-scale action, Washington DC
21The Lancet, Maternal and Child Undernutrition, Special series, January
2008
22 World Health Organization (2006) World Health Report 2006: Working
together for health
23 L Knuth and M Vidar (2011) Constitutional and legal protection of the right
to food around the world, Rome: Food and Agriculture Organization
24 Countdown to 2015 (2012) Building a Future for Women and Children:
The 2012 Report
25 This is ollowing the model o the Hunger Reduction Commitment
Inde.
endnoTes
7/30/2019 Nutrition Barometer
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