Special focus on nutrition-sensitive programming

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Field Article . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Box 1 The Nutrition Links Project is testing the effect of integrated agriculture and nutrition strategies on livelihoods, nutrition and health status of infants in Ghana’s Eastern Region. Logistic regression was used to determine relationships between infant nutrition (exclusive breastfeeding, diet diversity, Hb
Field Article . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Box 3 A three-step approach was identified by the SUN Movement Secretariat as a way to report on nutrition-relevant allocations in national budgets. The process includes: Step one – identifying nutrition-relevant budget allocations through a key word search. Step two – clearly assessing which budget allocations are specific to nutrition, which allocations are related to nutrition, and those which are unrelated to nutrition. Step three – attributing a weighting of the allocated budget to programs that are specific to nutrition (100%), such as a national nutrition programme in the budget; and a reasonable allocation to programmes that are related to nutrition (e.g. 25%), such as social safety net and early child development programmes. For more information, including tools, visit: www.scalingupnutrition.org/resources-archive/ financial -tracking-resource-mobilization/budget-analysis Box 4 The three-step approach to budget analysis (SUN Movement) EVIDENT partnership The Evidence-informed Decision-making in Nutrition and Health (EVIDENT) partnership is a global hub of North-South partners aiming to enhance evidence-informed decision-making and policy-driven research in health and nutrition. The network addresses the priority concerns and questions of decision-makers from low- and middle-income countries by providing reviews of evidence, health technology assessments and locallyappropriate guidance, and by facilitating the translation of evidence into policy. It aims to meet local needs and to avoid unnecessary duplication of research. EVIDENT encompasses all issues that are at the forefront of global nutrition and health policy: stunting, underweight, maternal and child health, micronutrient deficiencies, obesity and non-communicable diseases (e.g. heart disease, cancer, diabetes, hypertension, etc.). EVIDENT runs courses on evidence-informed decision-making (e.g International Course in Evidence-Informed Nutrition, South Africa, 2015; and Translation of Evidence into Country based Recommendations, Ethiopia, 2015), is developing a series of guidelines (Stakeholder Mapping and Engagement, Identifying and Prioritising Questions), and shares key relevant resources. Partners include: Ethiopian Institute of Public Health; Ethiopia Institute of Tropical Medicine; Belgium (coordinating body); Makarere University, Uganda; National School of Public Health, Morocco; NICE International, UK; North- West University, South Africa; University of Abomey-Calavi, Benin; University of Ghana, Ghana; University of Ghent, Belgium; University of Sheffield, UK; Sokoine University of Agriculture, Tanzania; and Royal Tropical Institute, the Netherlands. EVIDENT is supported by a number of external scientific experts in knowledge management and health technology assessment. For more details, include course locations and dates, visit www.evident-network.org based on the provisions in the budget statement (Laar, Aryeetey, Akparibo & Zotor). In Ghana, nutrition-specific services are administered by the Nutrition Department, a sub-unit of the Ghana Health Service. Because the Nutrition Department has a low level of power within the Ghana Health Service, it does not receive adequate budgetary allocation. Nutrition-sensitive spending is distributed through other agencies (local government and rural development; water, works and housing; food and agriculture; and gender and social protection ministries; etc). e actual spending on nutrition by these sectors to increase the nutrition sensitivity of their programming is almost negligible. A key outcome of this study is that nutrition budgets should not be embedded in the total health budget as this diminishes their priority. Research influencing policymakers e research activities described above are expected to feed into the national plan to address malnutrition through the SUN multi-stakeholder platform. In Ghana, this platform – the Cross Sectoral Planning Group (CSPG) – has been in existence since 2012 following Ghana’s commitment in 2011 to scale up effective nutrition interventions towards reducing stunting among young children. e CSPG is coordinated by the national development planning commission and convenes working groups that include government (health and non-health sectors), UN agencies, business sector, bilateral development partners, academia and civil society. All these partners are contributing to implementing a national nutrition policy; this has been prepared and awaits completion of a costed budget prior to government endorsement. e working groups include resource mobilisation, policy development and review, capacity-building and research, monitoring and evaluation, and advocacy and communication. e plans of the CSPG are intended to be operationalised through the support of the National Nutrition Partner Coordination (NaNuPac), another multi-stakeholder platform that predates the CSPG. e NaNuPAC is <strong>focus</strong>ed on implementation aspects of nutrition service References African Journal of Food, Agriculture, Nutrition and Development, Volume 12 No. 1 (2012) ENAM Supplement. www.ajfand.net/Volume12/No1/index1.html Aryeetey, R et al. Baseline Household Agriculture and Child Nutrition Linkages in the Nutrition Links Project. April 2015 The FASEB Journal vol. 29 no. 1 Supplement 585.17. www.fasebj.org/content/29/1_Supplement/585.17. See also: Nutrition Links – Building Capacity for Sustainable Lives in Ghana, April 2015 The FASEB Journal vol. 29 no. 1 Supplement 898.18. FAO, 2015. State of food insecurity in the world. www.fao.org/hunger/en/ Ghana Nutrition Improvement Project (GNIP). www.ajinomoto.com/en/activity/csr/ghana/ Ghana Statistical Service, 2010. Population and housing census. www.statsghana.gov.gh/docfiles/2010phc/Census2010_Summary_report_of_final_results.pdf Ghana Statistical Survey, 2014. Demographic and Health Survey 2014. www.dhsprogram.com/publications/publication-FR307-DHS-Final-Reports.cfm delivery, while the CSPG concerns policy and strategic planning. e NaNuPac is convened by the Ghana Health Service. e findings of the various studies indicated above need to be contextualised in the implementation of the national nutrition policy. e ENAM project has demonstrated the role of community mobilisation and the use of nonformal systems to enhance nutrition of families and particularly young children. e Nutrition Links project in the Eastern region is seeking to improve nutrition and livelihoods of poor and vulnerable families in the Upper Manya Krobo district using improved agriculture, business and health services. e current study will provide insight and useful lessons on how different government and non-government agencies can work together with traditional leaders and communities to improve nutrition. e findings from the market-based initiatives are likely to identify the roles and pathways by which private sector participation in nutrition can be maximised. All these findings, however, need to be plugged into a national nutrition evidence system that allows for reviewing not only the quality of the studies but the strength of the evidence from the studies. e University of Ghana is currently engaged in an international network seeking to support national efforts to set up a mechanism for evidence-informed priority-setting and decision-making (see Box 4). e aspiration of the CSPG is ultimately to coordinate local research so that it meets the needs of decision-makers. Ideally, the research should be relevant to ongoing programmes and eventually, when pulled together, should guide decisionmaking at the CSPG and NaNuPAC levels. In conclusion, the nutrition-sensitive research activities indicated above make important contributions towards nutrition outcomes. It is important to actively engage with other sectors beyond those in health as part of efforts to improve nutrition. It is essential that nationallydriven research is coordinated and applied to enable evidenced country policy. For more information, email Richmond Aryeetey at raryeetey@ug.edu.gh. Institute of Development Studies. www.ids.ac.uk/publication/markets-for-nutrient-rich-foods-policy-synthesis-from -three-country-studies Laar A, Aryeetey RN, Akparibo R, Zotor F. Ghana SUN Academic Platform. Nutrition sensitivity of the 2014 budget statement of Republic of Ghana. Proc Nutr Soc. 2015 Nov;74(4):526-32. Epub 2015 Aug 5. Marquis et al, 2015. Journal of Nutrition. www.jn.nutrition.org/content/early/2014/12/10/jn.114.194498 Marquis et al [1]. Global Livestock CRSP. Research Brief 08- 01-ENAM. Marquis et al [2]. Global Livestock CRSP. Research Brief 08- 03-ENAM. The Nutrition Links Project is a collaboration between University of Ghana, McGill University and World Vision International with funding from the Department of Foreign Affairs, Trade and Development (DFATD), Canada. www.mcgill.ca/cine/research/building-capacity-sustainable-livelihoods-and-health-ghana UNDP, 2015. MDG report for Ghana. www.gh.undp.org/content/dam/ghana/docs/Doc/Inclgro/ UNDP_GH_2015%20Ghana%20MDGs%20Report.pdf . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
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