SCN News No 36 - UNSCN

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28 FEATURES Thailand: Halved child malnutrition between 1982 and 1986 (from 50% to 25% in less than a decade) a www.unsystem.org/scn Box 2: Summary of policy instruments and success factors in three countries that have reduced child undernutrition at scale Policy instruments: • Thailand’s 2nd National Health and Nutrition Policy (1982–86) focused on targeted nutrition interventions to eliminate severe malnutrition, and behaviour change and communication to prevent mild to moderate malnutrition. • The policy used social mobilization and relied on community-based primary health care as a delivery system for nutrition and health interventions. • Health volunteers underwent extensive training and massively increased in numbers, reaching a ratio of 1 health volunteer for 20 households. • The targeted and achieved coverage was high. Success factors: • The country’s leaders had a vision of what was to be achieved and planned adequately for the scaling-up process. • Nutrition was integrated within the National Economic and Social Development Plan, and linkages between agriculture and nutrition were established, ensuring sustainability. • Social mobilization and community-level involvement were highly successful. • A strong local, action-oriented surveillance system allowed for monitoring and evaluating progress. • The country made a large investment, accounting for approximately 20% of total government expenditure on health and a similarly high percentage on education during these years. China: Reduced child malnutrition by more than half between 1990 and 2002 (from 25% to 8% in 12 years) b ; China achieved the MDG 1 in 2002 c Policy Instruments: • China pursued a successful poverty alleviation strategy along with rapid economic growth. • Effective nutrition, health, and family-planning interventions were implemented at a large scale. • China also focused on complementary interventions to address other determinants of child malnutrition, such as water and sanitation (which help reduce illness from infectious diseases) and education (between 1992 and 2005, the share of mothers who had completed middle school increased from 32% to 57% and the share of illiterate women fell from 22.5% to 7%) Success factors: • Central leadership was combined with a commitment to the process and the establishment of local government ownership • China established an effective data collection system that provides regular data for monitoring progress, and the country’s strong research institutions ensure that data and information are effectively communicated to policymakers and used for policymaking. • Strong and effective partnerships were established between the Chinese government and international partners. • The budget share of government expenditure on education increased to 20% during the 1990s, although the share spent on health was relatively low (~3–4%). Brazil: 60% reduction in child malnutrition (from 18% to 7%); and reductions in infant mortality from 85 to 36 deaths per 1,000 live births from 1975 to 1989 d Policy Instruments: • The period of sharpest economic growth and poverty reduction occurred in Brazil from 1970 to 1980, before improvements in child malnutrition and infant mortality (that is, there was a lagged response). • Coverage of safe water increased from 35% in 1967 to 80% in 1980. Sewerage coverage increased to 50% by 1980. • Immunization coverage more than tripled from 1975 to 1988; the number of physicians per 1,000 people doubled. • Major investments were made in direct nutrition inputs (food programmes ) and in social sector spending on water and sanitation, health, and education. Success factors: • Various food and nutrition programmes , including food distribution programmes (via both private and or public sector channels) and direct subsidies, were implemented; these programmes were almost entirely supported by national resources. • Food programme expenditures went from 0.06% of GDP in 1980 to 0.21% of GDP in 1989. Food- and nutrition-related expenses went from 0.16% to 0.25% of social sector expenses. • Investments in health showed an upward trend from 1975 to 1982, with lower levels in 1983–84. They further increased to a peak of US$68.73 per capita in 1989 (2.4 times the expenditures in 1975). • Spending on education increased during 1976–82. Per capita education expenditure was US$31.9 in 1982, dipped to US$24.5 in 1984, but increased again to reach US$54.8 in 1988 (a sevenfold increase compared with 1970). Since 2004 Brazil has further accelerated its nutrition policy efforts with its Zero Hunger program, and nutrition has improved significantly. That programme more than doubled food and nutrition spending between 2003 and 2007 (to about US$13 billion annually in 2007). Sources: a) Heaver 2002; Tontisirin and Bhattacharjee 2001; b) Information on China was obtained from Dr. Chen Chunming who gave the 17 th Annual Martin J. Forman Memorial Lecture, entitled: “Nutrition and Health in China -- From Science to Policymaking”, at IFPRI, Washington, DC, January 26, 2007. Available from www.ifpri.org/events/seminars/2007/20070126Forman.asp; d) Svedberg 2007. SCN NEWS # 36 back to contents
www.unsystem.org/scn FEATURES 29 Heaver R (2002) Thailand’s National Nutrition Programme: Lessons in Management and Capacity Development. World Bank:Washington, DC. (online) Hoddinott J, Haddad L (1994) Women's Income and Boy-girl Anthropometric Status in the Côte d'Ivoire. World Development 22 (4): 543–53. Katz E (1994) The Impact of Non-traditional Export Agriculture on Income and Food Availability in Guatemala: An Intrahousehold Perspective. Food and Nutrition Bulletin 15(4). Iunes RF, Monteiro CA (1993) The Improvement in Child Nutritional Status in Brazil: How Did It Occur? UN ACC/SCN country case study supported by UNICEF. A case study for the XV Congress of the International Union of Nutritional Sciences. September 26 to October 1, 1993. (online) Lagarde M, Haines A, Palmer N (2007) Conditional cash transfers for improving uptake of health interventions in lowand middle-income countries. A systematic review. Journal of American Medical Association 298(16):1900-10. Levy S (2006) Progress against poverty. Sustaining Mexico’s PROGRESA-Oportunidades program. Brookings Institution Press:Washington, DC. Loechl CU, Menon P, Arimond M, Ruel MT, Pelto G, Habicht JP, Michaud L (forthcoming) Using programme theory to assess the feasibility of delivering micronutrient sprinkles through a food-assisted maternal and child health and nutrition programme in rural Haiti. Maternal and Child Nutrition. Maluccio J, Flores R (2005) Impact evaluation of a conditional cash transfer program: the Nicaraguan Red de Protección Social. Research Report 141. IFPRI:Washington, DC. (online) Quisumbing A (2003) Household decisions, gender, and development. A synthesis of recent research. IFPRI:Washington, DC./ Johns Hopkins University Press:Baltimore, MD. Ravallion M, Chen S, Sangraula P (2007) New evidence on the urbanization of global poverty. Policy Research Working Paper 4199. World Bank:Washington, DC. (online) Rivera JA, Sotres-Alvarez D, Habicht JP, Shamah T, Villalpando S (2004) Impact of the Mexican program for education, health and education (Progresa) on rates of growth and anemia in infants and young children: a randomized effectiveness study. Journal of American Medical Association 291(21):2563-70. Rosegrant, MW, Ringler C, Benson T, Diao X, Resnick D, Thurlow J, Torero M, Orden D (2006) Agriculture and achieving the Millennium Development Goals. World Bank:Washington, DC. (online) Rossi PH, Lipsey MW, Freeman HE (2004) Evaluation: A systematic approach (7th ed.). Sage:Thousand Oaks, CA. Tontisirin K, Bhattacharjee L (2001) Nutrition actions in Thailand–a country report. Nutrition Research 21(1-2):425-33. Skoufias E (2005) PROGRESA and its impacts on the welfare of rural households in Mexico. Research Report 139. IFPRI:Washington, DC. (online) UNICEF (United Nations Children’s Fund) (1990) Strategy for Improved Nutrition of Children and Women in Developing Countries. Policy Review paper E/ICEF/1990/1.6, UNICEF:New York. von Braun, J, Swaminathan MS, Rosegrant MW (2004) Agriculture, Food Security, Nutrition and the Millennium Development Goals. 2003-2004 Annual Report Essay. IFPRI:Washington, DC. (online) von Braun J, Ruel MT, Gillespie S (Forthcoming) Bridging the gap: linking agriculture and health to achieve the millennium development goals. Wiesmann D, Schöninger I, Sost AK, Dalzell H, Collins A, Kiess L, Arnold T (2007) The challenge of hunger 2007. Deutsche Welthungerhilfe, IFPRI and Concern:Bonn, Washington, DC and Dublin. (online) Wiesmann D, Weingärtner L, Schöninger I (2006). The challenge of hunger: Global Hunger Index: Facts, determinants, and trends. Deutsche Welthungerhilfe (DWHH) and IFPRI:Bonn and Washington, DC. World Bank (2005) Repositioning nutrition as central to development. A strategy for large-scale action. World Bank:Washington, DC. (online) World Bank and IFPRI (International Food Policy Research Institute) (2007) From agriculture to nutrition. Pathways, synergies and outcomes. Report No. 40196-GLB. Washington, DC. (online) back to contents SCN NEWS # 36
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