Special focus on nutrition-sensitive programming

Editorial
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2015)), and that nutrition sensitivity means
many things to different people and agencies.
Working definitions do exist (Ruel et al, 2013):
Nutrition interventions refer to actions that aim
to change nutrition outcomes, including anthropometry,
nutritional status measured by
biomarkers, or nutrient intakes and diets and
may be nutrition-specific or nutrition-sensitive
(see Box 1). Clarity on what definitions mean
operationally can help us to plan effective programmes,
evaluate our efforts and calculate
costs in relation to benefits of this work. Based
on these definitions, key points of difference for
nutrition-sensitive action are attention to the
underlying determinants of nutrition, incorporation
of specific diet and nutrition goals and
actions, and the potential of these types of programmes
to be used as delivery platforms for
nutrition-specific actions.
It is known that programmes have more impact
on nutrition if they explicitly include a nutrition
goal or outcome objective. It is therefore
important to be explicit about any expected or
plausible pathways to effect nutrition-related
change (sometimes referred to as ‘theories of
change’); some sectors have elaborated conceptual
pathways (Herforth et al, 2015; Dangour et al,
2013; Fenn et al, 2015), but examples of impact-pathway
models for individual programme
types are few. How programmes act in different
contexts is important to investigate, as different
issues (dealt with by different sectors) are likely
to be enabling or limiting factors for the complex
causal pathway that leads to nutrition outcomes
in different situations. Unintended positive (e.g.
improved determinants of nutrition) or negative
(e.g. opportunity costs) effects may also emerge
and need to be captured. Tightly defined research
can sometimes lack broader perspectives and
flexibility to consider impact pathways, unin-
Figure 1
Benefits during
the life course
Cognitive, motor,
socioemotional
development
Benefits during the life course
tended benefits and negative consequences that
may emerge during programming if they were
not considered in the original research design,
e.g. research designed to look at the impact of
WASH interventions on diarrhoea will not accommodate
impact pathways relating to women’s
empowerment (Loevinsohn et al, 2015). A number
of research articles in this special issue explicitly
highlight that limited evidence of nutrition
impact may be due to shortcomings in design,
implementation and evaluation (Loevinsohn,
2015, Guatam et al, 2015).
e mixture of articles in this edition suggests
a number of ‘operational’ definitions or categories
of nutrition-sensitive programming, outlined
in Box 2. In order to be considered nutritionsensitive,
a minimum requirement is to align
some portion of the programme within a theoretical
causal pathway leading to diet or nutrition
impact. A nice example of this approach is reflected
in an article from Guatemala (Klein,
Framework for actions to achieve optimum foetal and child nutrition and
development (Black et al, 2013)
2015), where impact pathways informed the
qualitative study of agriculture value-chain activities
in two projects to explore impact assumptions
and investigate ways to improve nutrition
sensitivity.
Within or aside from a pathways approach,
programmes may use different instruments to
enhance their nutrition-sensitivity. ese
typically include:
• integrating and measuring nutrition goals;
• targeting nutritionally vulnerable groups;
• using conditionality to increase service use
or change behaviour;
• adding or expanding coverage of nutritionspecific
actions; and
• working with other sectors to cover more
pathways at once, or to cover more
proximate steps on a pathway.
A programme in a relevant sector, if it can place
itself on a plausible pathway to positively nutrition
impact, might be described as indirectly nutrition-sensitive
– and sometimes just doing a
good job in that one sector is enough for a particular
context. But there are ways to make these
actions even more directly nutrition-sensitive,
if the context demands it.
Obesity and NCDs
Nutrition-sensitive research:
evidence and challenges
Nutrition
Optimum fetal and child nutrition and development Nutrition-sensitive
e content of this edition demonstrates an appetite
for operational research, i.e. agencies
specificinterventions
programmes and approaches
and programmes
• Agriculture and food
• Adolescent health
Feeding and
Low burden of security
‘piggy backing’ research onto programmes
and preconception
caregiving practices, infectious diseases • Social safety nets
nutrition
parenting, stimulation
• Early child development (Mayer et al, 2015; Bonde, 2015; Oxford Policy
• Maternal dietary
• Maternal mental health
supplementation
• Women’s empowerment Management, 2015; Moyo et al, 2015; Shwirtz
• Micronutrient
• Child protection
supplementation or Food security,
Feeding and Access to and use of • Classroom education
et al, 2015; Lewis, 2015; Adamu et al, 2015;
fortification
includingavailability, caregivingresources health services, a safe • Water and sanitation
• Breastfeeding and economicaccess, and (maternal, household, and hygienic • Health and family planning O’Mahony et al, 2015). ere is a spectrum of
complementary
use of food and community levels) environment
services
practice from investigation of country-specific,
feeding
• Dietary supple-
government-supported programmes (Oxford
mentation for
Knowledge and evidence
Building an enabling
children
Politics and governance
environment
Policy Management, 2015; Shwirtz et al, 2015;
• Dietary diversifica-
Leadership, capacity, and financial resources
• Rigorous evaluations
tion
Social, economic, political, and environmental context
• Advocacy strategies
Adamu et al, 2015) to cross-country agency initiatives
(O’Mahony et al, 2015) and ACF’s nu-
• Feeding behaviours
(national and global)
• Horizontal and vertical
and stimulation
coordination
• Treatment of severe
• Accountability, incentives
trition causal analysis (NCA) approach (Gallagher,
acute malnutrition
regulation, legislation
• Disease prevention
• Leadership programmes 2015; Mutegi et al, 2015). Nutrition-sensitive
and management
• Capacity investments
• Nutrition intervent-
• Domestic resource
interventions can be complex, so producing
ions in emergencies
mobilisation
Source: Black et al, 2013
strong evidence about their effects can be difficult
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Breastfeeding,
nutrient- rich foods,
and eating routine
School performance
and learning capacity
Adult stature
Work capacity and
productivity
2
©IFPRI/Farha Khan