The nutrition community needs to recalibrate global financing targets to include nutrition-sensitive interventions, according to a new report from Save the Children, a shift that could increase global funding goals from $7 billion annually to as much as $23 billion.
The $7 billion target is drawn from the World Bank’s “Investment Framework for Nutrition” report, which was released last year. But Christopher Twiss, Save the Children’s nutrition advocacy and policy adviser and one of the authors of the new position paper, said those guidelines don’t include critical multisectoral interventions in areas such as agriculture and water and sanitation, which have an outsized impact on malnutrition.
The framework – which Twiss called “hugely useful” – focuses on nutrition-specific efforts. Those alone might not be enough to reach the 2025 nutrition targets set by the World Health Assembly (WHA), which call for dramatic reductions in stunting and wasting, among other goals.
Integrating the nutrition-sensitive efforts into global funding goals will require a “paradigm shift,” he said. “We know that nutrition-sensitive interventions actually form a far greater piece of the pie that’s required than nutrition-specific ones.”
Twiss spoke to Malnutrition Deeply on the sidelines of the World Bank Spring Meetings in Washington, D.C., where Save the Children launched the report.
Malnutrition Deeply: What was the impetus to write this report? It seems like you are almost challenging the World Bank’s Investment Framework.
Christopher Twiss: I think it’s fair to say there’s not been a huge amount of work done in terms of building positions on nutrition finance in general.
Externally, even across civil society, there hasn’t been much work done in nutrition financing thus far, looking forward beyond the World Health Assembly targets. So we felt like it was a gap, and something that needs to be addressed. This is a way of starting that conversation.
In terms of challenging the World Bank’s narrative, that’s certainly not really the intention. It’s not a challenge. We really first appreciate the work that’s been done by the World Bank and Results for Development collaboratively. I think the work that they’ve done, first, was hugely useful and, secondly, took a lot of effort. And it’s hugely appreciated by the advocacy community because before that $7 billion figure was mentioned, there wasn’t anything for us to work toward.
I think now that narrative has been out there for a year, the next step needs to be taken. That $7 billion [identified in the World Bank’s Investment Framework] gets us a long way to 2025 in terms of nutrition-specific interventions. As I say in the paper, what it doesn’t really look at is any of the nutrition-sensitive interventions, since we know that nutrition-sensitive interventions actually form a far greater piece of the pie that’s required than nutrition-specific ones. So that’s the reason – well, one of the reasons – why we wrote the paper.
Malnutrition Deeply: How did you arrive at the $23 billion figure?
Twiss: The $23 billion, as it says in the paper, is actually a really rudimentary figure. It’s not really something we want to use as an ask, not something we want to particularly use for government-facing work, or World Bank-facing work in terms of what we want to push for.
The idea of it is just to say, we have this $7 billion figure and that’s what we’ve been working toward previously. But actually, even with a huge margin for error, the real figure that we’re looking at is so much bigger, and therefore we need to shift paradigm.
In terms of how we got to it, we extrapolated, basically, from the World Health Assembly targets. The four that are dealt with in the World Bank Investment Framework are wasting, stunting, anemia and exclusive breastfeeding. [This does not address the other two WHA targets – reducing low birth weight and ensuring there is no childhood overweight.]
So, for example, the WHA target on wasting is to reduce it to 5 percent. So we loosely extrapolated that figure down to 0 percent. And of course there are huge problems with that analysis because it’s much easier to reach the people to get to 5 percent than it is to reach the people to get to zero.
And then we worked with the International Institute of Sustainable Development. They released a paper indicating that there’s roughly $11 billion a year required until 2030 and nutrition-sensitive [efforts] including agriculture and [water, sanitation and hygiene] and social-protection intervention. We basically added those two things up, the extrapolation plus the nutrition sensitivity. We want the message to be that a change is required to include nutrition sensitivity, and that’s what we’re really looking for.
Malnutrition Deeply: As you know, it has been very difficult to get even to the $7 billion per year. So what would need to be done to reach these even more ambitious targets?
Twiss: There are plenty of steps that should come next. I think the key one, and one that we outlined in this paper, is just accepting that nutrition is such a multisectoral area and therefore the only way of building up an actual nuanced picture of the amount required is to pull together all the different strands, and the only way of doing that accurately is at the country level.
So what we’re looking at ideally is bringing in costed multisectoral, multistakeholder national nutrition plans in each country. The only way to make that happen is for nutrition work and those plans to be embedded in the executive of a government, so somewhere in the cabinet office or with the president or with the executive generally, because that’s the only real area that can bring together all the different ministries. And we’ve seen it in Nigeria: that’s happened. We’ve seen it in Bangladesh, for example. So I think that’s probably the way of going about something.
Malnutrition Deeply: In the paper, you also mentioned that one of the setbacks to actually thinking about nutrition funding at a global level arises because countries don’t really report their budgets well. What will be the incentive for countries to report back to global organizations such as the Scaling Up Nutrition Movement or the World Bank?
Twiss: The incentive is that at the moment we don’t have a figure for how much we really need in each country for the nutrition interventions. It’s very difficult to make a case as an advocate because we don’t know what we’re asking for.
If, at a country level, governments are able to produce a plan that says how much they need, then that will enable us to advocate for it. One of the key elements to producing a plan is identifying how much has already been spent. Activities like budget analysis are absolutely critical for that. And that really also ties into one of the other pillars that I mentioned in the paper around transparency and accountability.
It’s the joint responsibility of the country that would also at a global level make sure that aid flows and domestic resources are both tracked and accounted for. And yes, it is arduous – I don’t think anyone’s pretending that it’s not – but it’s the only real way.
This interview was edited to clarify why the policy paper was created.