During its most recent (26th) session, the SCN decided to place the Advisory Group on Nutrition (AGN) in abeyance for one year. During this year an appointed Interim Programme Steering Committee (IPSC) has taken on the reform measures for restructuring the SCN. IPSC members were invited to provide their views on the triumvirate nature of the SCN.
Partnerships in Eliminating Malnutrition
Life, sometimes unfortunately, is never simple. Neither are solutions. This applies no less to the solutions for malnutrition. Malnutrition includes undernutrition, overnutrition and micronutrient malnutrition, but even these distinctions are blurred as it becomes ever clearer that nutritional insults suffered at one point in a life, can have long-lasting effects, even into the next generation. Nevertheless, we all still look for simple solutions, and should continue to do so. The prevention and control of micronutrient deficiencies appears comparatively simple, with dear ways of addressing them with quick and tangible results. It has been argued that the vastly increased attention to micronutrients over the last decade, largely donor driven, reflects disenchantment with the lack of success in addressing the hydra-headed protein-energy malnutrition challenge. The complexity of the underlying and basic causes and effects of malnutrition means we must also use a broader framework such as that developed by UNICEF [see ACC/SCN NPP No. 16, p.54]. Another recent major step has been to address the non-biological determinants of malnutrition through a "human rights' framework [see SCN News No. 18]. It is another milestone that virtually all affected nations attending the major international fora of the 1990s [The World Summit for Children, the international Conference on Nutrition, and the World Food Summit] accepted three universal goals: the elimination of vitamin A deficiency, iodine deficiency disorders and the substantial reduction of iron deficiency anaemia. Much progress has been made, but goals set for the year 2000 will not be achieved. It is now important to see what the successes and failures have taught us as we move to adjust. In the last year, there has been re-affirmation that a single 'magic bullet' approach - however tempting for practitioners and policymakers alike - is not enough.
The other thing we have learned is that partnerships are not only a more effective way of working, but are in fact, simply a necessity. It is tremendously encouraging that the UN in general, and the current ACC/SCN in particular, recognize this tenet. The IPSC is composed of representatives of the key UN agencies (ably chaired by the World Bank), but also has representation from the bilateral funding agencies, and rotating representation from the NGO community. The new leadership of WHO has actively embraced the need for other partnerships from 'civil society', including international and national NGOs, and also for developing new relationships with the private sector so that they, and the more affluent world in general, share more of the global burden of disease and malnutrition.
The challenge now, is to leverage the added benefit of different groups working toward common goals, while not losing the special expertise, leverage, influence or skills of the separate partners. It is quite dear that the UN agencies have a critical role to play in acting as one voice (which is what the ACC/SCN is designed to promote globally, and what the UN Development Assistance Framework - (UNDAF) - promotes at the country level). Neither the bilateral agencies nor the NGOs have power similar to the UN agencies in terms of opening up governments to necessary action. Nevertheless, they cannot do this alone (and increasingly do not want to). Governments must be full partners - both in countries where malnutrition levels are high, as well as in those that must be the providers of added resources. The wealthier countries must allow global structures that facilitate countries, and the international community, to help themselves. It is now totally accepted that community involvement is a prerequisite to successful interventions (although still not always acted upon, or given appropriate budgeting). The private sector also has an important role to play, particularly regarding pharmaceuticals, vaccines, and food fortification. Like all the partners, they bring both strengths and weaknesses (profit inevitably conflicts with disease intervention approaches at times).
The recognition given to NGOs by this ACC/SCN Chairman, Dr Richard Jolly, is encouraging, and will be mutually useful in reaching common goals. Without a broad range of NGOs applying their flexibility, experience, and local knowledge to these nutrition problems, the goals will simply not be reached. Partly because of some of these characteristics, and partly due to the extreme diversity of NGOs - from single issue lobby groups (such as WABA), to national NGOs, large and small, International NGOs/PVOs (such as Helen Keller Worldwide), to more technically/academically oriented groups (such as IUNS) - the NGOs, as a whole, are difficult to define and organize. And this is probably how it should be - a relatively independent voice is always important - both within an organization but also in a grouping of partners. This should not be seen as a threat. Getting the international nutrition community to agree to a common approach and goals during this decade has been a major achievement of the UN agencies involved in food, nutrition and development. While retaining their special role and mandate, the UN agencies' other major achievement toward realizing these goals, has been the increasingly welcome recognition of the vastly synergized strength of all partners working together. The Advisory Group on Nutrition (AGN) has had great impact by serving as the independent external voice and third arm of the triumvirate structure of the SCN, and has stimulated much necessary debate within the international nutrition community. It is the hope, and expectation, of many NGOs that their partnership with the SCN will also grow and even be loosely formalized, in a way that does not reduce independence but ensures that all our strengths are brought to bear on the multitudinous problems. One challenge is to show NGOs not currently involved in the ACC/SCN, that reaching their objectives can be facilitated by strengthening these sorts of partnerships. Similarly, the special responsibilities and roles of the UN agencies should not be diluted. The ACC/SCN is providing leadership to the rest of the UN and its many willing partners on how we can all maximize our impact and contribution. It will be interesting to see how the challenge is met in the 21st century. However it develops, it is dear we will be looking at a mix of interventions and a mix of partners. It is critical we succeed.
Ian Darnton-Hill, Helen Keller Worldwide, New York, NY 10006, USA; Fax 212 791 7590; email:firstname.lastname@example.org