Chapter Nine

111

Making Nutrition
Good Politics:
The Power of Governance

Stuart Gillespie
Senior Research Fellow, Poverty, Health and Nutrition Division, International Food Policy
Researc Institute (IFPRI)
CEO of the Transform Nutrition Research Program Consortium
Currently based in Brighton, UK

“There is no sea more dangerous than the ocean of practicalpolitics – none in which there is more need of good pilots and of asingle, unfaltering purpose when the waves rise high.”
Thomas Henry Huxley – physiologist, anatomist, anthropologist and early champion of Darwin’s Theory of
Evolution, (1825–1895)

Key messages•	Undernutrition has certain features which
necessitate a strong focus on governance.
•	Progress in reducing undernutrition
cannot be sustained where governancesystems are weak or absent.
•	As governance relates to power, capacity,commitment, accountability andresponsiveness, it is crucially important for
all levels of action, not just the policy level.
•	Strong leadership – in the form ofambassadors championing the politicalcause, as well as more midlevel, lateralleadership to facilitate intersectoral
action- is fundamental to success.
•	Governance can be measured andmonitored using innovative new tools andindices, with the results used to name,shame and praise.

112

What is good governance, and why is itneeded for nutrition security?
The concept of governance has many definitions.
Governance can be defined with regard to institutional
structures, relationships between actors and/or organizations,decision-making processes, and incentives. It involves thecapacity to act, the power to act and the commitment to act. It
requires accountability, responsiveness and transparency.
Essentially, good governance refers to the effective, efficient,accountable exercise of public authority for the provision of apublic good.
The challenge of undernutrition has several features which
require strong systems of governance to successfully
address it.
First, the nature of the problem itself. Undernutrition isneglected because it is invisible, it is not infectious (unlike
HIV, for example), it requires several actions to beundertaken by many actors in several unconnected sectors,
and at different levels, it is difficult to measure success andto attribute impact to any one decision or action (unlike forexample vaccinating a child against a disease), and thebenefits of improving nutrition often take longer than apolitician’s time in office to fully manifest themselves. These
unique features generate a lack of commitment,
accountability and responsiveness to act, which – linked
with the major challenge of limited leadership, strategic andoperational capacity – all combine to fuel the political
economy of undernutrition reduction.
The second fundamental rationale for a strong focus on
governance is the type of action that is needed to ensure
nutrition security.
Globally the challenge of overweight and obesity is
growing but accelerating the reduction of undernutrition
remains the major challenge in many countries. In thesesituations, ensuring nutrition security requires action on
three broad fronts.
First, there’s a need to enhance and expand the quality andcoverage of nutrition-specific interventions. Second,
maximizing the nutrition-sensitivity of more “indirect”
interventions, such as agriculture, social protection, waterand sanitation etc., And third, there is a need to cultivateand sustain enabling political and policy environments fornutrition. This third level – which largely relates to global andnational governance – has been relatively neglected to date.

Chapter Nine | Making Nutrition Good Politics: The Power of Governance | Stuart Gillespie

113

At this third level, the challenge is to understand how
high-level political momentum can drive action to reduce
undernutrition, and what needs to happen to turn thismomentum into results on the ground. How to ensure thathigh-quality, well-resourced direct (nutrition-specific)
interventions are available to those who need them, andindirect (nutrition-sensitive) actions (e.g. agriculture, social
protection, water and sanitation) are re-oriented to support
nutrition goals? These three levels of complementary action
correspond broadly to the three levels of causes ofundernutrition – immediate (individual) level, underlying(household, community) level and basic (national andglobal) levels.

But governance is not only an issue for policy andpoliticians. It is a key cross-cutting issue at all three levels ofaction described above. This is because direct interventions
can fail to scale because of weak incentives, institutions andinfrastructure, indirect interventions are often underleveraged
for nutrition because of commitment and coordination
failures, and the environment for nutrition is more often
disabling due to the invisibility of undernutrition and weakleadership from the state and civil society.
The need for good governance to ensure nutrition security
is thus incontestable. Sustained progress is simply notpossible where governance systems are weak or absent.

Why is it so important now?
Yet the focus on governance has only emerged in recent
years as two types of gaps or disconnects have emerged.
First, the disconnect between the strong evidence of thedamage caused by malnutrition, on the one hand, and therelative inertia with regard to action, on the other. So much
more is now known about the drivers of undernutrition andthe serious and enduring consequences of undernutrition, thebenefits of acting to reduce undernutrition, and the costs ofinaction and/or poorly designed and implemented responses.
Second, the disconnect between sustained economic growthof several high-burden countries and their failure to makesignificant inroads in addressing undernutrition. This has
been seen most dramatically in South Asia, though there are
now signs of positive change in some countries (such as
Nepal, and Bangladesh – see case study). As their nations
grow economically, governments need to decide how
important it is that their children grow. They may have thepower and capacity (including financial resources) to act,but often they don’t act (or not at the scale required)because they lack commitment.
Commitment has been likened to a political will to act – andthis does not fall from the sky, it needs to be created. As James
Grant, the former Executive Director of UNICEF said:“Each of the great social achievements of recent decades
has come about not because of government proclamations,but because people organized, made demands, and made it
good politics for governments to respond. It is the political
will of the people that makes and sustains the political willof governments.”
This then throws the spotlight on accountability andresponsiveness of political systems, how power is distributed,
and how equitable societies and political systems are. Are
governments held accountable for their actions or theirfailure to act? Are they responsive to changing situations,especially in context of humanitarian crises.
Politics and policy processes are now firmly embedded in theagenda of both research and action. No longer is the political
economy of nutrition viewed as an impenetrable “black box”.
Nutrition advocates or champions, adept at navigating andshaping policy arenas, are emerging. More policy research is
being done on these issues – often with multidisciplinary teams– to shine a light on success or failure and what drives it. We
know a lot more now about the pathways and dynamics ofchange, the key levers and catalysts, and what drives success or
failure (see “further reading”).

Chapter Nine | Making Nutrition Good Politics: The Power of Governance | Stuart Gillespie

Proportions of countries reporting the content of policies, by WHO region

Policies in all four nutritionareas (undernutrition, obesity,
infant and young child nutrition,
vitamins and minerals)
Undernutrition

AFR(n=22)

AMR(n=24)

EMR
(n=8)

EUR
(n=44)

SEAR
(n=8)

WPR
(n=17)

Total(n=123)

67

63

50

11

75

71

46

90

92

88

82

65

88

76

55

88

71

51

100%
50%
0%
100%
50%
0%

Underweight

88

63

7

90

71

63

7

67

63

7

88

71

50

90

79

50

23

88

76

59

81

58

38

5

88

76

81

92

75

91

57

83

63

89

62

67

50

71

79

63

100

100

100

86

96

75

55

81

83

50

45

100%
50%
0%
100%
50%

90

0%

Low birth weight*

100%
50%
0%

Maternal undernutrition

100%

0%

Obesity and diet-related NCDs

27

90

0%

Wasting

63

100%
50%

Stunting

114

46

100%
50%

75

100

88

88

78

94

75

0%

Child obesity

100%
50%
0%

Adult obesity

63

100%
50%
0%

86

63

66

75

94

73

100

94

85

88

88

76

88

76

66

100

82

73

100%

Diet-related NCDs

50%
0%Infant and young child nutrition

100%
50%
0%

61

100%

Breastfeeding*50%0%Complementary feeding*

100%
50%
0%

International Code ofMarketing of Breast-milk
Substitutes

100%
50%
0%

Source: WHO’s
WHO’s Global
Globalnutrition
nutritionpolicy
policyreview
review
Source:

100

67

100

50

Chapter Nine | Making Nutrition Good Politics: The Power of Governance | Stuart Gillespie

115
AFR(n=22)

AMR(n=24)

EMR
(n=8)

EUR
(n=44)

SEAR
(n=8)

WPR
(n=17)

Total(n=123)

AFR

African Region

AMR

Region of the Americas

EMR

Eastern Mediterranean Region

EUR

European Region

SEAR South-East Asia Region
WPR

100%
50%

90

83

75

0%

11

88

82

88

59

63

53

58

100%
50%

81

0%

38

25

33

38

Vitamin A supplementation
for children
37

100%
50%

81

0%

34

100%
50%
0%

71

67

86

75

63

21

13

71

63

75

95

96

25

2

75

53

88

71

40

100%
50%
0%

5

50

100%
50%
0%

43

22

50

47

75

76

88

88

66

75

88

60

100%
50%

9

0%

50

27

50

20

25

2

13

5

50

16

75

100%

88

57

63

100%

0%

47

37

33

58

29

27

100%

Nutrition and infection*

81

67

0%

38

41

46

100%

Trade

50%
0%

29

63

13

7

25

53

29

100%

Gender

50%
0%

38

5

42

88

29

26

71

50

100%
50%
0%

Underlying causes andindirect actions

Conditional cash transfers

50%

50%

Zinc supplementation
for children

Food aid

88

100%

0%

Iron and folic acidsupplementation for women

Food security

90

0%

50%

Iron and folic acidsupplementation for children

48

100%

50%

Vitamin A supplementation
for women

Food fortification

0%

50%

Western Pacific Region

Vitamins and minerals

62

92

Source: WHO’s Global nutrition policy review

Vulnerable groups

38

11

88

Chapter Nine | Making Nutrition Good Politics: The Power of Governance | Stuart Gillespie

Age-standardized prevalence of overweight and obesity in adults 20+ years of age by
WHO region. 2008
AFR

Obesity, BMI ≥ 30
Pre-obesity, BMI = 25.0-29.9
Male

AFR

SEAR South-East Asia Region

EMR

WPR Western Pacific Region

Eastern Mediterranean Region

5.3

17.6
11.1

19.4

8.3

0%

18.6

10%

20%

Male

AMR

30%

10%

20%

80%

90%

100%

60%

70%

80%

90%

100%

60%

70%

80%

90%

100%

39.1

35.2

30%

40%

50%

28.7
24.5

26
27.3

18.7

0%

10%

20%

Male

30%

40%

50%

20.4

Female37.9

23.1

Both sexes

28.1

21.9

0%

Male

1.7

Female3.7

Both sexes

2.7

10%

32.9

20%

30%

40%

50%

60%

70%

80%

90%

100%

20%

30%

40%

50%

60%

70%

80%

90%

100%

30%

40%

50%

60%

70%

80%

90%

100%

40%

50%

60%

70%

80%

90%

100%

10
12
11

0%

10%

Male

5.1

20.8

Female6.8

18

Both sexes

5.9

19.5

0%

Male
Global

70%

31.5

13

FemaleBoth sexes

WPR

60%

26.7

Male

SEAR

50%

29.7

0%

EUR

40%

23.5

FemaleBoth sexes

EMR

European Region

AMR Region of the Americas

FemaleBoth sexes

AFR

African Region

10%

20%

10

Female23.8
14

Both sexes

21.1

12.1

0%
Source:policyreview
review
Source:WHO’s
WHO’s Global
Global nutrition
nutrition policy

116

10%

22.4

20%

30%

Chapter Nine | Making Nutrition Good Politics: The Power of Governance | Stuart Gillespie

117

Policies, coordination mechanisms and stakeholders, interventions and surveillance incountries with high and low levels of stunting. Data are presented as the percentage of total
number of countries in each group.
Countries withstunting ≥ 20% (n=27)

Policies

Countries with policy documents addressing stunting

Countries withstunting < 20% (n=16)

96

69

96

69

Countries with the following related issues addressed in these documents:
Breastfeeding
Complementary feeding

93

69

Low birth weight/Maternal undernutrition

93

63

Vitamin A supplementation for children

31

85

Food fortification

74

Iron and folic acid supplementation for children

70

44
56
25

41

Zinc supplementation for children
Food security

38

81

Conditional cash transfers

38

37

Coordination mechanisms and stakeholders
Countries with coordination mechanisms addressing stunting

67

31

Countries where these coordination mechanisms can assign responsbility to stakeholders

63

31Countries where these coordination mechanisms can assign budgets

19

Countries with stakeholders addressing stunting

75

89

Interventions being implemented by stakeholders*Countries implementing the following relevant interventions:
Promotion of breastfeeding

3 93

Communication or counseling for improved complementary feeding

15

Vitamin A fortification or supplementation

15

94 6
75 13

81
19

78

Fortification of wheat flour

37

Zinc supplementation for children

14

Iron supplementation for children

11 30

Fortification of complementary foods

13

11

19

38

12

13
30 14

70
45

Most MIYCN interventions relevant to specific situational contexts**

50

30

11 19

Most MIYCN interventions relevant to all contexts**

17

22

13

18

Monitoring and surveillance
Countries measuring children’s height

63

89

Countries with recent data (within past 2 years)

30

Countries conducting surveys every 1-2 year or more often

26
100%

19
6
0%

100%

Note: * For interventions, the darker area indicates implementation at national scale, the lighter area indicates implementation at subnational scale, andthe full bar implementation at any scale (national or subnational). ** This refers to a majority of maternal, infant and young child nutrition (MIYCN)
interventions relevant to please all contexts or in specific situational contexts as identified by Bhutta et al. (2008) and listed in Table 4.

Chapter Nine | Making Nutrition Good Politics: The Power of Governance | Stuart Gillespie

What are the core drivers and ingredients of good governance?
At the time of the 2008 Lancet Nutrition Series, thegovernance of the international nutrition system was said tohave been fragmented and dysfunctional. Since then, a
process of reforming UN institutional architecture has been
underway, and the Scaling Up Nutrition (SUN) Movement
has emerged with a core focus on galvanizing national andcountry-led action (see box).
The global architecture is now characterized by an array of
governments, NGOs, international and regionalorganizations, donors, foundations, research organizations,academia and private foundations and companies.
Compared to five years ago, there is much more coherence
and complementarity in the way these different actors andorganizations interact.
But the SUN Movement will ultimately only realize its true
potential through its application in each country. This will
require the maintenance of support and consensus amongst
all SUN stakeholders, and strong country-level ownership.

Strong leadership – in the form of ambassadors
championing the political cause, as well as more mid-level,
lateral leadership to facilitate intersectoral action – isfundamental to success.
In terms of institutional arrangements, nutrition is an issue
that needs an executive body, ideally linked to the Prime
Minister’s office, and a coordinating body that ensureshorizontal (cross-sectoral) and vertical (national to district)coherence in action.
These two bodies need to ensure accountability andresponsiveness through regular collection and managementof key data on nutrition trends and changing drivers,
ensuring the quality and appropriate scale-up of direct
nutrition interventions (targeted to the 1,000-day windowof opportunity), maximizing the nutrition-sensitivity ofwider development programs (especially agriculture andsocial protection), and mobilizing and managing capacityand financing to sustain all these efforts.

United Nations headquarters
Source: http://www.panoramio.com

How is governance measured and monitored?
Governance is key for all stages in the policy process – fromagenda-setting, to policy formulation, program planning,
implementation, monitoring and evaluation. It is fundamental
for creating and sustaining commitment but also crucially forconverting such commitment into real impact on the ground.
Different challenges emerge at this point. The quality, intensity,and equity of implementation may not be as easily tracked as
the existence of a plan or a legal framework, as shown by alandscape analysis. Understanding whether and how wellpolicies are actually implemented and legal instruments are

enforced will require different measures and different
perspectives, including importantly those of nutritionallyvulnerable populations themselves.
In 2012, WHO introduced a comprehensive “‘LandscapeAnalysis” mapping tool in order to assess nutrition
governance in different countries. If a country has most or
all of the following indicators in place, they could be
described as having ‘strong’ nutrition governance, and goodreadiness to accelerate action in nutrition: political

118

Chapter Nine | Making Nutrition Good Politics: The Power of Governance | Stuart Gillespie

119commitment and awareness of nutrition, focused policies
and regulation at a central level, with supporting plans andprotocols at subnational level, resource mobilization at
central level and budget provision at subnational level,
coordination of nutrition activities at all levels, involvementof partners, support to districts and facilities, trained staff
with appropriate skills at all levels, capacity and motivationof staff, quality of services and follow up, management,
information systems and supplies in place, and community
engagement strategies.
The SUN Movement has a simple four indicator system totrack country-level progress, including existence of amulti-stakeholder platform, coherent legal and politicalframework, alignment of policies and programs around acommon results framework, and mobilization and trackingof financial resources.
Innovative tools are increasingly available to stimulate andbuild commitment and accountability. For governments anddonors, for example, a Nutrition Commitment Index has
been developed by the Institute of Development Studies forcross-country and country-specific comparisons over time.

This measures political commitment to tackle
undernutrition in 45 developing countries by focusing on aseries of policy, legal and spending indicators. The first
analysis in early 2013 generated some interesting results –for example, some of the poorest developing countries areshowing the greatest political commitment to tacklingundernutrition, e.g., Malawi and Madagascar, while
economic powerhouses such as India and Nigeria are failingsome of their most vulnerable citizens. The index not onlyshows that low wealth is no barrier to committed action, it
also highlights that sustained economic growth does notguarantee that governments will prioritize undernutrition
reduction. This may help explain why many countries in
sub-Saharan Africa and South Asia remain blighted by highlevels of hunger and undernutrition. In naming, shaming
and praising, such tools can be very powerful.
This is quite possible at more decentralized levels too – ICTbased monitoring systems, social accountability mechanisms,
and community-based tools such as community scorecards,
have all been shown to promote accountability and to
improve the provision of direct public services.

Definitions and ingredients of good governanceIn possibly the first statement defining “governance”, in
1999, the World Bank defines national governance as:“the traditions and institutions by which authority in a country is
exercised. This includes the process by which governments are
selected, monitored and replaced, the capacity of the government
to effectively formulate and implement sound policies, and therespect of citizens and the state for the institutions that govern
economic and social interactions among them.
(Source: Kaufmann, D. and Kraay, A. (2008) Governance Indicators: Where
are We, Where Should We Be Going? The World Bank Research Observer 2391), 1–30.)“Governance is….the exercise of economic, political, andadministrative authority to manage a country’s affairs at alllevels. It comprises mechanisms, processes, and institutions
through which citizens and groups articulate their interests,
exercise their legal rights, meet their obligations, andmediate their differences.”(Source: Governance for Sustainable Human Development: A United Nations
Development Program Policy Document, 14 April 2005)“Good governance refers to governing systems which arecapable, responsible, inclusive and transparent. All
countries, developed and developing, need to work
continuously towards better governance.”(Source: Helen Clark, Administrator of the UNDP, Fourth United Nations
conference on the Least Developed Countries High Level Interactive Thematic
Debate on Good Governance at All Levels, Istanbul, 11 May 2011)

President Obama at the G8 Summit At Lough Erne
Source: WPA Pool (GETTY)

Chapter Nine | Making Nutrition Good Politics: The Power of Governance | Stuart Gillespie

Hunger and Nutrition Commitment Index (HANCI) Scores

Country
HANCI
1 Guatemala
240
2 Malawi
220
3 Madagascar
213
4 Peru210
5 Brazil
210
6 Philippines
205
7 Indonesia
204

Low commitment

Moderate commitment

High commitment
HRCI
109
105
101
105
96
100
90

NCI
131
115
112
105
114
105
114

Country
HANCI
8 Gambia
201
8 Tanzania
201
10 Burkina Faso 198
10 Ghana
198
12 Bangladesh 190
13 Mozambique 186
14 Vietnam
179
14 Rwanda
179
16 Mali
177
17 Zambia
176

HRCI
71
91
104
94
74
68
86
90
104
74

NCI
130
110
94
104
116
118
93
89
73
102

Key
High commitment >201

Low commitment 132-175

Medium commitment 176-201

Very low commitment <175

Hunger Reduction Commitment Index(HRCI) Scores

120Country
HANCI
18 Nepal
175
18 Cambodia
175
20 Uganda
173
21 Senegal
172
22 China
168
23 South Africa 167
24 Niger162
25 Ethiopia
160
26 Sierra Leone 147
26 Pakistan
147
26 Benin147
29 India
138
30 Nigeria
135
31 Cote d’Ivoire 132

Very low commitment
HRCI
50
87
81
89
103
105
72
96
59
63
54
67
55
45

NCI
125
88
92
83
65
62
90
64
88
84
93
71
80
87

Sub
indices

Hungerreductioncommitment
High commitment

Very low commitment

Nutrition Commitment Index (NCI) Scores

High commitment

Very low commitment

NCI
45
75
68
47
34
96
53
69
28
63
51
33
47
50

ThemesIndicators

Legal
framework

4

Policies &programs

4

Publicexpenditures

2

Legal
framework

1

Policies &programs

10

Publicexpenditures

1

HANCI

Nutritioncommitment

Key

HRCI
78
47
46
65
70
8
48
28
64
26
35
47
29
24

The structure of the HANCI
Index

Key

Country
HANCI
32 Togo123
33 Cameroon
122
34 Kenya114
35 Liberia
112
36 Lesotho104
36 Afghanistan 104
38 Mauritania
101
39 Yemen
97
40 Sudan92
41 Myanmar
89
42 Burundi
86
43 Angola80
44 Congo,DR
76
45 Guinea Bissau 74

Source: www.hancindex.org, June 2013

Chapter Nine | Making Nutrition Good Politics: The Power of Governance | Stuart Gillespie

Landscape Analysis:

Insufficient progress

On track

Country progress in reaching MDG1 nutrition target

No progress

121

PRSP*

UNDAF**

Nutrition
Governance

Afghanistan
Bangladesh
Cambodia
Ghana
GuatemalaIndonesia
MalawiPeru
TurkeyViet Nam
Côte d’Ivoire
DRC
Egypt
Ethiopia
India
Iraq
Kenya
Mali
Mozambique
Myanmar
Nepal
Nigeria
Pakistan
Philippines
UgandaUnited Rep. of Tanzania
ZambiaBurkina Faso
BurundiCameroon
Madagascar
Niger
South Africa
Sudan
Yemen

Source: *Poverty Reduction Strategy Papers; **United Nations Development Assistance Framework“Assessing countries’ commitment to accelerate nutrition action demonstrated in PRSPs, UNDAFs and through nutrition governance.” Engesveen et al (2009) SCN NEWS 37

Chapter Nine | Making Nutrition Good Politics: The Power of Governance | Stuart Gillespie

How does the SUN Movement work?
The Movement recognizes that malnutrition has multiple causes. That’s why it requires people towork together across sectors to put nutrition into all development efforts.
Nutrition-specific interventions: Support for exclusive breastfeeding up to 6 months of age andcontinued breastfeeding together with appropriate and nutritious food up to 2 years of age,
fortification of foods, micronutrient supplementation, treatment of severe malnutrition
Agriculture: Making nutritious food more accessible to everyone, and supporting small farms
as a source of income for women and families

Clean Water and Sanitation: Improving access to reduce infection and disease

Education and Employment: Making sure children have the energy that they need to learn
and earn sufficient income as adults

Health Care: Improving access to services to ensure that women and children stay healthy

Support for Resilience: Establishing a stronger, healthier population and sustained prosperity
to better endure emergencies and conflicts

And at the core of all efforts, women are empowered to be leaders in their families andcommunities, leading the way to a healthier and stronger world.

Source: TBC

122

Chapter Nine | Making Nutrition Good Politics: The Power of Governance | Stuart Gillespie

123

Case study
What worked: Thailand’s big pushThailand outlined their first multi-sectoral nutrition policy
in 1977, under the national economic and social
development plan (1977–1982). One of the early key
messages was that malnutrition should not be perceived as
simply a health problem, but should be regarded also as asocial and economic problem with human impact. The
policy stated that investment in nutrition would not be ashort term ‘fix’, but a national investment for intermediateand long-term growth. In addition, it was agreed that“nutritional literacy should be an integral part of planningand implementing nutrition programs.”
Establishing a multi-sectoral policy and plan was the firstand major step in nutrition improvement efforts. The
challenge was then to implement the program in an
integrated manner. The fifth national development plan,
Thailand’s “Poverty Alleviation Plan (PAP)” was aspearhead of the rural development program, focusing on
poverty stricken areas. Nutrition programs were employed
as stopgap measures to relieve the most severe forms of
malnutrition until systematic solutions could bring about
long-term, sustainable improvement.
The PAP was one of Thailand’s first efforts to bring about
effective and efficient infrastructural reforms conducive torural development. Effective organizational structure andmanagerial mechanisms to coordinate and integrate
multi-sectoral efforts at various administrative levels andwithin the communities was critical. Four major
ministries, i.e., Health, Agriculture, Education, andInterior (Community Development Unit), were involved
and streamlined the integrated budgetary allocations totarget poor villages. Each ministry also strengthened theintra-sectoral collaboration among its various departments
or divisions.
PAP employed four key programs, namely, (1) Rural Job
Creation to create jobs for rural people during the dry
season so that they remain in the communities andparticipate in community development; (2) Village
Development Projects included village fish ponds, water
sources and other development projects to improve
economic status and household food security; (3)Provision of Basic Services, i.e., health facilities and healthservices; and (4) Agricultural Production Programs
including nutritious food production (e.g., crops for
producing complementary foods), upland riceimprovement and a soil improvement project.

Income generation and household food security were thedirect benefits.
During the five years of PAP, 32 development projects
were implemented in 12,562 poor villages in 38 provinces.
By 1986, 550,000 village primary healthcare volunteers
were trained, covering almost every rural village in the
country. Nutrition activities were integrated within the
PHC with other health services. The PHC movement
mobilized the community to address malnutrition. It wasrecognized that successful nutrition programs should not
be centrally planned and made into ready-made packages.
Rather, they should serve as guidelines.
Another major breakthrough in nutrition governance wasthe adoption of the Basic Minimum Needs (BMN)
approach in village-based social planning, empoweringvillagers in decision making using BMN indicators inproblem identification and prioritization. This was a key
contributor to reduction in malnutrition.
In nutrition governance, policies such as primary
healthcare and poverty eradication are as relevant as foodand nutrition policies. Community-based nutritionintervention programs have a better chance ofsustainability if the people themselves become agents ofchange and if certain elements are in place: community
organization for planning and management; community
manpower development based on appropriate technology
and information and a viable self-perpetuating community
financing scheme.
(Source: Abridged from Keynote Talk on ‘Thailand’s Community-Based
Nutrition Improvement’ by Pattanee Winichagoon, at the ‘Leveraging
Agriculture for Improving Nutrition and Health’ International Conference,
2011, Delhi, India)

Chapter Nine | Making Nutrition Good Politics: The Power of Governance | Stuart Gillespie

Case study
Scaling up nutrition in Bangladesh
There has been rapid economic growth and substantial
poverty reduction in Bangladesh over the past two
decades. Poverty rates declined by 8 percent between 2005
and 2010, per capita GDP doubled from 1990 to 2010,
and agricultural growth averaged 3.3 percent, due toimpressive gains in rice yields (FAO 2012). In line with theMillennium Development Goals (MDG), current estimatessuggest that Bangladesh has achieved a 50 percent
reduction in undernourishment, will achieve the same forunderweight, has achieved the required child mortality
figures, and will achieve the target for maternal health. It
has also performed well in terms of nutrition
improvements, particularly in the 1990s. While progress
reduced between 1999 and 2004, it improved again fromthen onwards.
There are other figures released, highlighting the various
success stories. For example, literacy rates for young

124

females aged 15–24 years are said to have doubled, risingfrom 38 percent in 1991 to 77 percent in 2009. Also thecoverage of vitamin A supplements for children is now
nearly universal, the use of oral hydration salts has
increased, and there has been a substantial rise in
exclusive breastfeeding during the first six months of life,
from 43 percent in 2007 to 64 percent in 2011. There
have been several government initiatives that have helped
to arrive at these figures, with research and surveys toidentify where continued development is needed.
For example, it is acknowledged that nearly one third of
women in Bangladesh are undernourished still, and there
are challenges regarding population growth, cropvulnerability, poverty and natural resources. Malnutritionin Bangladesh costs an estimated US$1 billion a year inlost economic productivity, there are known to be
widespread vitamin A, iron and zinc deficiencies, andcases of anemia remain strong in groups of young
children, adolescent girls and pregnant women.
As a member of the Scaling Up Nutrition (SUN)Movement, the Government of Bangladesh (GoB) is
recognized for its commitment to improving nutrition.
Various initiatives have been launched since 1995, withthe current Health, Population and Nutrition Sector
Development Program planned to run until 2016, at
which point it will be reviewed and updated.
The GoB has mainstreamed nutrition within the existing
health system, with improved access to nutritioninterventions for those in remote areas. There is a strong
focus on the first 1,000 days of a child’s life througheducation and support, with infant and young childfeeding schemes throughout the country, as well as
substantial investments in agriculture and health.
Specific programs operated by the GoB include theVulnerable Group Distribution (VGD) and Vulnerable
Group Feeding (VGF) schemes, which distribute fooditems at subsidized rates, based on a rationing system. The
VGF program helps those who find it difficult to meet thebasic needs for survival, providing food to low-income
groups, and VGD promotes self-reliance amongst women.
A school feeding initiative has also been started in poor
areas with help from the World Food Program, providing
high-energy biscuits to children.
Source: The Hunger And Nutrition Commitment Index (HANCI 2012):
Measuring the Political Commitment to Reduce Hunger and Undernutrition in
Developing Countries, Dolf te Lintelo, Lawrence Haddad, Rajith Lakshman
and Karine Gatellier, Institute of Development Studies, UK, April 2013

Chapter Nine | Making Nutrition Good Politics: The Power of Governance | Stuart Gillespie

125Case study
Global governance: the rising of the SUN

improvement in nutrition, health and development.

A number of factors served as background to thelaunching of the Scaling Up Nutrition (SUN) Framework
and Roadmap in 2010. These factors include therecognition of the importance of early childhood
nutrition, the increased political support for nutrition as
being central to development strategy, and theacknowledgement that a wide range of stakeholders,
including governments, civil society and the private sector,
needed to collaborate if significant advances in improving
nutrition were to be achieved.

SUN represents an unprecedented opportunity for
coordination, collaboration, cross-learning and advocacy
to catalyze sustainable nutrition gains at national andglobal levels. Membership of the SUN Movement implies anational commitment to address undernutrition. By July
2013, SUN had grown to include 41 countries committed toscaling up direct nutrition interventions and advancing
nutrition-sensitive development, including 18 of the 31
highest burden countries.

The SUN Movement is founded on the principle that all
people have the right to food and good nutrition. It unites
people – from governments, civil society, the UN, donors,
businesses and researchers – in a collective effort toimprove nutrition.
Following on from the publication of the SUN Framework
and Roadmap in 2010, the US and Irish governments
committed, in September 2010, to promote the SUN atinternational level. By the end of 2012, 33 countries had
made a commitment to implement the principles andassociated programs of the SUN. The Global Movement is
supported by a series of Networks, including a Country
Network, Civil Society Network, UN System Network,
Donor Network and a Business Network. In April 2012,
the UN Secretary-General appointed a SUN Lead Groupof 27 high-level leaders charged with improving
coherence, strategic oversight, resource mobilization andaccountability across the Movement.
The key focus of the SUN must be at the national level ofthe 33 countries committed to the Movement. A particularfocus of the Movement is aimed at reducing the level ofstunting in these countries. The early indication is that the
average annual rate of reduction in stunting in the 33
SUN countries is 1.8%. It is hoped that operational
research such as the RAIN project in Zambia – see box– will provide policy insights which can accelerate
progress in reducing stunting.
The SUN Movement is defined as “a country-led, global
effort to advance health and development through improved
nutrition.” Not a new institution, organization or fund, SUN
is a shared approach that supports the implementation of
direct nutrition interventions, while also looking to address
the underlying causes of malnutrition and engage themultiple sectors that could contribute to an overall

In broad terms, the roles and responsibilities of “SUN
members” are first, that countries are in the lead and must
work to establish coordinated national plans of action,
allocate national resources to nutrition and foster a policy
environment supportive of nutrition goals. Second,
supporters align with this approach by committing toback country-developed plans and build coordination andalignment to leverage resources, knowledge and capacity
in a more effective and efficient manner.
The intended “value-added” of the SUN approach is tocreate a platform to bring governments, businesses andother entities together, both globally and nationally, tofind new opportunities to advance nutrition bydetermining best practices, tracking the effectiveness ofefforts, promoting cross-sector learning and strengthening
the enabling environment – and ultimately by aligning
stakeholders behind a shared goal. A strength of the
movement is the depth of expertise and experience
represented by the more than 100 organizations andentities that have endorsed the SUN Framework. The
collective ability, resources and reach of these supporters
has the potential to impact far more communities andnations than any one group could alone. Working toward
a common goal through a shared platform such as SUN,
stakeholders have an opportunity to maximize theeffectiveness of actions and investments.
As it reaches its third birthday, the SUN Movement is wellaware that it needs to progressively increase the focus on
results on the ground. The success of high-level discourseand commitments made by politicians from the podium
can only be judged by their impact on the lives ofnutritionally vulnerable young children and women.
For more, please see: www.scalingupnutrition.org

Chapter Nine | Making Nutrition Good Politics: The Power of Governance | Stuart Gillespie

126

The SUN approachhipards
Stew msent
orernm al Platf
v
o
G
n
atio
of N

Within eachcountry a
SUN Focal Point
is identified

Focus on People’s rights

Action atcountry
level
Country support
and capacity
development
Globalfunctions
Financing
pathways
Governance

NGOs

Civil
SocietyBusiness
Community

Government(lead)UN
SystemDonorsResearch
Community

Country
governments
lead national
efforts to scale
up nutrition

The multi-stakeholder
platform

The Focal Point brings people together in a
multi-stakeholder platform

Works to align andcoordinate action
across sectors

Technical
Community

HealthWomen’s
Empowerment
Education

Multi-sector,
multi-stakeholder
platform

These efforts are underway in all SUN countries
using a unique approach that works for each country
Together the combined efforts of all countries
make up the core of the movement:

The SUN Country Network

Source: TBC

SocialProtection
Agriculture
Development& Poverty
Reduction

UnitedNations
Government
Partners

Civil
Society
DonorsBusinessChapter Nine | Making Nutrition Good Politics: The Power of Governance | Stuart Gillespie

127

My personal viewStuart Gillespie

Senior Research Fellow, Poverty, Health and Nutrition
Division, International Food Policy Research Institute (IFPRI)
CEO of the Transform Nutrition Research Program
Consortium. Currently based in Brighton, UK

In the last five years momentum has
been building and malnutrition is
finally being taken seriously as amajor development challenge. At longlast there is a degree of harmony withregard to the scaling up of nutritionspecific and nutrition-sensitive
actions, driven and supported byenabling political and policy environments. Various
actors and organizations are converging on the core
challenge and developing partnerships andcollaborations. The energy of the SUN Movement –which would probably not have survived ten years ago– is driving this momentum and raising the stakes. As
the political and multisectoral nature of the challenge
is taken on board, issues of governance become evermore prominent.
Research is more operational and more policy-relevant
than before. In the past, nutritionists did their research,made recommendations and then implored politicians todo the right thing. More often than not, it didn’t happen.
Now, there is a new focus on opening up the black boxof “political will” to better understand (and ultimately
shape) governance and policy processes, to makenutrition outcomes, and the policy pathways that lead tothem, more visible.
In reality, political will is a political choice – to act toensure children grow healthily, or not to act. New tools
and indices and greater access to information for more
stakeholders will help to continue to shine a light on
governance systems at different levels. In this way,political leaders will increasingly be held to account if
they choose not to act, and they stand to reap therewards if they do.

Further reading
Gillespie S, Haddad L, Mannar V. The politics of
reducing malnutrition: Building commitment andaccelerating impact. Maternal and Child Nutrition.
The Lancet Series, 2013.
Pelletier DL, Frongillo EA, Gervais S et al. Nutrition
agenda setting, policy formulation and implementation:
Lessons from the mainstreaming nutrition initiative.
Health Policy Plan 2012;27:19–31.
Garrett JL, Natalicchio M. Working multisectorally
in nutrition: Principles, practices, and case studies.
IFPRI research monograph, 2010.
Gillespie SR, McLachlan M, Shrimpton, R.
Combating malnutrition: Time to act. Washington
DC: World Bank, 2003.
Mejia Acosta A, Fanzo J. Fighting maternal and childmalnutrition: analysing the political and institutional
determinants of delivering a national multisectoral
response in six countries. A synthesis paper. Brighton,
UK: Institute of Development Studies, 2012.