Nutrition solutions “need not await economic development”
Malnutrition: what can be done? Lessons from World Bank experience, by Alan Berg (John Hopkins University Press, 1987) 120 pp.
Action to eradicate the underlying causes of poverty are important in dealing with the problem of malnutrition. However, as Alan Berg argues in Malnutrition: What can be done?, although nutrition problems are closely linked to a country’s level of economic development “nutrition improvements need not await that development”. World Bank experience suggests that efficacious and affordable measures for dealing with nutritional deficiencies are at hand. Evidence is provided by analysis of four major Bank-supported projects in Brazil, Colombia, India and Indonesia and 57 nutrition actions in other projects. For example, the Tamil Nadu Integrated Nutrition Project in India used a combination of “sensitive but practical” growth monitoring, highly selective supplementary feeding of nutritionally at-risk mothers and children, a comprehensive communications programme and rigorous management, to reduce malnutrition by an estimated 50 percent in 9,000 villages between 1980 and 1987. The author estimates that the project delivered about twice the benefit for half the cost of comparable programmes in Tamil Nadu. “This finding... suggests,” Berg writes, “that a well-managed and targeted programme is able to reduce serious and severe malnutrition more than a less-focussed programme, and at a significantly lower cost”.
Malnutrition: what can be done? cites similar World Bank experiences to challenge widely held assumptions about nutrition interventions. Large food programmes, the study found, can be targeted in ways that push costs to much lower levels than earlier programmes. There is also evidence from a large-scale Indonesian project that nutrition education alone can do much to improve nutritional status - women’s lack of schooling need not be an insurmountable obstacle. Other World Bank research has shown that vitamin and mineral deficiencies may be caused by a rapid shift from traditional, locally produced grains to polished rice and refined wheat, and that the price low-income families pay for food can be substantially reduced by increasing the efficiency of the food marketing system.
Prevention of Vitamin A Deficiency
Delivery of Oral Doses of Vitamin A to Prevent Vitamin A Deficiency and Nutritional Blindness - A State of the Art Review. Keith P. West Jr. and Alfred Sommer, with Discussion by G. Arroyave, E.M. DeMaeyer, R.P. Devadas, S.J. Eastman, K. Vijayaraghavan and V. Reddy; and an Introduction by J.B. Mason with S.J. Eastman and M. Lotfi. (ACC/SCN, Rome.)
This review, the second in the ACC/SCN’s State-of-the-Art Series, is available free of charge from the SCN Secretariat. It reviews the case for vitamin A prevention programmes, focussing on distribution of vitamin A capsules as usually the first intervention for rapid effect. Fortification and dietary modification are introduced in the discussions.
UNITED NATIONS
ADMINISTRATIVE COMMITTEE ON COORDINATION - SUB-COMMITTEE ON NUTRITION (ACC/SCN)
The ACC/SCN is the focal point for harmonizing the policies and activities in nutrition of the United Nations system. The Administrative Committee on Coordination (ACC), which is comprised of the heads of the UN agencies, recommended the establishment of the Sub-Committee on Nutrition in 1977, following the World Food Conference (with particular reference to Resolution V on food and nutrition). This was approved by the Economic and Social Council of the UN (ECOSOC). The role of the SCN is to serve as a coordinating mechanism, for exchange of information and technical guidance, and to act dynamically to help the UN respond to nutritional problems.
The UN members of the SCN are: FAO, IAEA, IBRD, IFAD, ILO, UN, UNDP, UNEP, UNESCO, UNFPA, UNHCR, UNICEF, UNRISD, UNU, WFC, WFP and WHO. From the outset, representatives of bilateral donor agencies have participated actively in SCN activities. The SCN is assisted by the Advisory Group on Nutrition (AGN), with six to eight experienced individuals drawn from relevant disciplines and with wide geographical representation. The Secretariat is hosted by FAO in Rome.
The SCN undertakes a range of activities to meet its mandate. Annual meetings have representation from the concerned UN agencies, from some 10 to 20 donor agencies, the AGN, as well as invitees on specific topics; these meetings begin with symposia on topics of current importance for policy. The SCN brings certain such matters to the attention of the ACC. The SCN sponsors working groups on inter-sectoral and sector-specific topics. Ten-year programmes to address two major deficiencies, vitamin A and iodine, have been launched.
The SCN compiles and disseminates information on nutrition, reflecting the shared views of the agencies concerned. A regular Report on the World Nutrition Situation is being issued. State-of-the-Art papers are produced to summarize current knowledge on selected topics. Research priorities for solving nutrition problems are proposed in consultation with agencies and researchers in the field. As decided by the Sub-Committee, initiatives are taken to promote coordinated activities - inter-agency programmes, meetings, publications - aimed at reducing malnutrition, primarily in developing countries.
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