SCN News No 36 - UNSCN

www.unsystem.org/scn FEATURES 47
survey respondents was in fact the bickering among ourselves and our lack of consensus on priorities. That
same finding was identified prominently by OPP respondents in the survey 10 years ago (Table 2).
This time, infighting and the absence of consensus on priorities was cited (from among 13 options) as the
main disappointment or negative factor by more than a quarter of the respondents, with this figure increasing
to 44.4% among the 90 international agency respondents (three times higher than their second ranking disappointment).
The finding supports the compelling plea for consensus made at the 33 rd SCN Annual Session
by then-World Bank Senior Vice President Jean-Louis Sarbib, and his argument that the absence of consensus
has reduced our credibility and, in turn, has constituted a primary constraint in our efforts to advance nutrition
(Sarbib 2006). Some of this need for consensus was also highlighted in the new Lancet series (Morris
et al 2008), and examples of infighting with serious consequences abound, e.g. one nutrition project blocked
because it was to be run by the Department of Social Welfare rather than the Department of Health; another
blocked because it might divert field staff from an agency’s family planning priority.
When asked to identify the primary substantive limiting factor where malnutrition rates have not fallen significantly,
i.e., comparing the three primary determinants of malnutrition in the UNICEF causality model, food
insecurity was ranked highest (53.2%), followed by inadequate caring practices (28.4%), and then inadequacies
in health services, hygiene and sanitation (18.4%.) (The percentage of OPP respondents – those on or
closer to the front lines -- listing inadequate caring practices as a primary limiting factor (36.8%), was more
than double that of RTT respondents (16.6%).) Clearly, however, the balance of attention here, as on several
other issues raised in the survey, will have to be responsive to the specific primary limiting factors facing individual
countries and regions.
When asked to rank the population groups deserving primary attention in future nutrition interventions, “under
twos” ranked highest, with 67.4% selecting this group as their first or second priority – suggesting that the
compelling evidence on the importance of addressing the needs of this group is now getting through, especially
among those dealing with operations. If the very young miss the boat during the first two years, they
miss it for life, and are likely to suffer the consequences throughout their lives (Victoria et al 2008, World
Bank 2006). Pregnant women ranked second with 49.1%.
The “under five” age group, which not too many years ago was the reflex reaction answer to such a question and
would then have been first, has diminished in importance, especially among those closer to the action. Worthy of
note are the considerable differences between the OPP and RTT in responding to this under five group (35.0%
versus 50.4%, respectively) and also in the school age group (10.1% versus 17.5%, respectively).
When asked about the balance of attention that should be given to under versus over-nutrition in developing
countries in the next 10 years, the overall tally indicated preference for a three-to- one balance (75% to 25%)
in favour of undernutrition, with nearly two- thirds of program operations and policy respondents (65.1%) supporting
that position.
When asked if nutrition should maintain its own identity and institutionalization, as opposed to being encompassed
by larger health sector or MCH programs, nearly four out of five respondents (79.2%) agreed, with
more than half of these agreeing strongly. This level of agreement is substantially higher than the 54% who
indicated that opinion to the same question in the survey 10 years ago. Whereas 20% disagreed strongly a
decade ago, now only 2.4% do. It might be argued here that nutrition professionals are seeing increasing evidence
of nutrition activity being marginalized when absorbed into broader health sector programs, and that
they do not like what they see.
Relatedly, when asked if the best means of addressing malnutrition problems in developing countries is
through inputs which are solely nutrition/MCH-based, as opposed to multisectoral, 56.8% disagreed or disagreed
strongly (32.4% agreed or agreed strongly with the rest remaining neutral). The nutrition community
clearly would choose to have an independent identity in its programmatic activity, but would wish its efforts in
such programs to be multisectoral.
When respondents were asked specifically if they agreed that growth monitoring and promotion is not an effective
means of facilitating nutrition improvement at the community level, 63.8% disagreed or disagreed
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