Multisectoral nutrition planning: a post-mortem

Multisectoral nutrition planning emerged in the early 1970's as a bold new approach to combating malnutrition in low-income countries. Conceptually elegant and operationally ambitious, it blossomed on paper but collapsed in practice notwithstanding vigorous promotion by international assistance agencies. This essay reviews the meteoric rise and fall of the multisectoral approach and then proceeds to examine its theoretical underpinnings. The essay concludes by identifying 12 lessons learned that, if heeded, can help the current generation of intersectoral initiatives against malnutrition to realize their potential. In retrospect, it was a mistake to assign responsibility for nutrition to economic planners and scientists who possessed little political influence or operational authority. Nutrition requires high-level political sponsorship if it is to command resources, be integrated with established ministerial responsibilities and have staying power. Nutrition planning bcame attractive to basically conservative governments anxious to accommodate international benefactors without having to accept more fundamental reforms; the analysis of malnutrition causality focused primarily on attributes of the malnourished and their families, not on the social, economic, and political order around them.     

Nutrition planning is alive and well, thank you

This article is a rejoinder to an article by John Osgood Field which discussed the failure of multisectoral nutrition planning. The author argues that, although nutrition planners may have been overly optimistic in their hopes that political systems could be made responsive to the problems, significant advances have been achieved. He outlines many of the successes of nutrition planning and the importance of multisectoral work. Malnutrition is a problem that escapes all the standard programmes, and cannot be tackled through the health and agriculture sectors alone.     

Rejoinder: nutrition planning is alive and well,thank you

This article is a rejoinder to an article by John Osgood Field which discussed the failure of multisectoral nutrition planning. The author argues that, although nutrition planners may have been overly optimistic in their hopes that political political systems could be made responsive to the problems, significant advances have been achieved. Many of the successes of nutrition planning and theimportance of multisectoral work are outlined. Malnutrition is a problem that escapes all the standard programs, and cannot be tackled through the health and agriculture sectors alone. There has been much critical thinking by many concerned people various countries. To suggest that nutrition planners moved blindly is to ignore much of the literature. A number of cautions--some of them very early--make it clear that practitioners were not oblivious to the bureaucratic constraints and political realities Professor Field now identifies. It would be cruelly wrong to suggest that no progress has been made. Nutrition planning may have borne fruit of a different sort than some of its early advocates envisioned, but there is no question that it bore fruit. The issue is whether nutrition planning has influenced the way people think about nutrition and the way they analyze problems. And about this there can be no doubt.     

Nutrition policies and programmes: a decade of redirection

This article assesses the effectiveness of nutrition programs and policies since the World Food Conference, 10 years ago. The authors perceive several distinct approaches. Just before the World Food Conference, nutrition programs had passed through an era of enchantment with technological solutions (single-cell protein, oilseed protein isolates). Supply was regarded as the problem; protein inadequacy as the crisis. None of the technological fixes had much of an impact on the malnutrition problem. This contributed to a willingness to entertain a much broader approach to nutrition. The new paradigm manifested itself 1st as a movement toward integrated nutrition planning. The national planning process was assumed to be the appropriate vehicle for applying this methodology. However, integrated nutrition planning threatened, conflicted with or at least brought pressure for change in the administrative and political reality of governmental organizations. Moreover, the nutrition community's capacity to respond to the demands flowing from the new paradigm was limited. The difficulties encountered in trying to achieve full integration led to a reexamination of working within traditional sectors but addressing the problem in several key sectors simultaneously, such as health and agriculture. The past decade also saw a move toward analyzing and improving the design and implementation of various kinds of nutrition interventions. The emphasis was on understanding and dealing with the administrative, economic and political realities of such efforts. Incorporation of consumption and nutrition considerations in the analysis and formulation of food policies in some countries is 1 of the important achievements of the past decade. This overwhelmingly economic approach focuses on pricing policies and market effects, recognizing that poverty and purchasing power are central to the malnutrition problem. Analysis of macrofood policy has filled an important void, giving a more concrete and inclusive view of food security. Nutrition progress during the next decade will require the development community to confront a changed environment and several key challenges, namely the surge of conservative politics in the early 1980s, and the severe economic problems most countries face. There is a need to be realistic about the tenacity of the problem and the multiple barriers to implementation of nutrition policies. The challenges face both national governments and development agencies. There is agreement that, during the decade since the World Food Conference, the field of nutrition has gone through a metamorphosis and that there has been progress. However, the development community still faces an unfinished nutrition agenda.     

Survey on attitudes to nutrition planning

The results of a worldwide survey of nutrition planning professionals' attitudes towards nutrition policy are presented. The objective of the survey was to determine what those involved in nutrition planning perceive to be the causes of hunger and malnutrition, and their views on the effectiveness of the programs implemented to overcome these problems. In mid-1979, a questionnaire was compiled comprising 48 questions related to attitudes towards nutrition policy, voluntary questions about social class, political classification and professional behavior and a question on perceived major impediments to solving malnutrition in the world. The questionnaire was sent to 728 professionals 87 countries; 250 replies from 55 countries; 250 replies from 55 countries were received. 44% of respondents resided in the US, 16% in Latin America and the Caribbean, 14% in the Far East, 12% in Africa and the Middle East and 13% in Europe, Canada and Australasia. Self-classification of political beliefs is the most clear cut correlate in predicting attitudes towards food and nutrition policy. There appear to be 2 clear schools of scientific/political behavior in the sample: one holds a more moderate, but generally liberal, set of views regarding the failure of modern technology in resolving world hunger and nutrition problems; a 2nd more liberal group believes political causes to be at the root of hunger. There is no single profession that can be typified as a breeding ground for nutrition planners. While the European trained and/or native group tends to be more to the left in their attitudes than their counterparts in the US, both groups are decidedly liberal and believe that social structural changes are needed to solve the problems of hunger and malnutrition in the world.     

Nutrition and national development: Establishing the connection

The three major strands of the nutrition planning literature — the socio-economic consequences of malnutrition, its determinants and characteristics, and the solutions offered to the problem — are examined by the authors and found wanting. There are serious limitations both in analysis of the problems and proposals for action in most work on nutrition policies because macro-level social, institutional, economic and political factors are neglected.     

Towards a food and nutrition policy in Tanzania

Fragments of a nutrition policy are seen throughout the different phases of Tanzania's modern history. Efforts of the pre-Independence period culminated in formation of a committee on nutrition which advocated improving food storage, food legislation and standardization, and nutrition education. After independence, an initial period of concentration on cash crops was followed by increased cooperation with the Ministry of Agriculture, and some nutritional surveys were undertaken. After the Arusha Declaration in 1967 a basic needs strategy giving greater stress to food production and adequate nutrition received emphasis, and a Food and Nutrition Centre was established with 4 departments: food science and technology; manpower development; medical nutrition; and planning and coordination. Emphasis on production is reflected in a target of reducing malnutrition by 30 to 50% in every region by 1981, and an interdisciplinary approach is being used to achieve this goal. The basic similarity in proposed activities during the various phases of Tanzania's history indicates that political will is necessary for carrying out the policies.     

The soft underbelly of applied knowledge: Conceptual and operational problems in nutrition planning

Nutrition planning features a ‘rational choice’ bias that often characterises applied knowledge. John O. Field questions this bias by exploring the softer side of success in nutrition planning efforts. He contrasts the scope of nutrition planning as understood by the international community of experts and by administrators in low income countries. He examines the politics of planning and programme implementation. Consideration of nutrition planning in an ideological and historical perspective reveals both the ambivalence of nutrition planners as agents of change and the tenuous, untested nature of nutrition planning as an approach to ameliorating malnutrition.     

Integrating fisheries,food and nutrition – Insights from people and policies in Timor-Leste

The important role of fish in food and nutrition security is becoming more widely acknowledged by the fishery sector and within food policy. Integration of fish and food policy, at national, regional or global levels, is required to ensure the contribution of fisheries and aquaculture to human health is supported through governance arrangements. We explore this aspect of food policy integration in Timor-Leste, where malnutrition is a critical health problem. Consumption of fish is low by international standards and only a small proportion of the population engages in fishing. We used a mixed method approach involving desktop policy analysis, interviews and social network analysis to explore interactions among sectoral instruments and organisations. Our results show generally good integration of food security into fisheries policies, but a lack of integration of fish into food policies. Policy network analysis revealed evidence of collaboration and cooperation between sectors, however, consideration of fish and food concerns was not well embedded across all organisations. We discuss challenges and options for future integration of fisheries into sustainable food systems in Timor-Leste and more broadly, including the need for greater political will and resources, combined with clearer targets and actions within instruments.     

Does nutrition have a place in agricultural research?

There are very few examples where nutritional objectives have made an effective contribution to planning agricultural research for developing countries. The complex nature of nutrition and the limitations of formal planning procedures help explain the failure. But most commentators ignore the personal, political and ideological factors that seriously limit the effectiveness of nutrition as a parameter for research planning. Three cases are discussed where nutrition has played a role in setting agricultural research directions, without evident nutritional impact. Conclusions are proposed for making agricultural research planning more relevant to nutritional concerns.     

Data requirements and use in nutrition planning in Costa Rica

In designing data systems for food and nutrition planning, little attention has been given to the type of data which may be needed at different stages of the planning process, ie political motivation and definition of policies, selection of programmes, geographical distribution of resources within a programme, delivery of services at the local level and monitoring of changes. The authors examine some experiences in terms of how decisions are made, available data and its use in national programmes, and the consequences relevant to the nutritional status of the Costa Rican population.     

The making of public investments: The role of champions,co-ordination,and characteristics of nutrition programmes in Mozambique

This study examines governance and institutional factors that influence how public resources are allocated for nutrition interventions in the context of a developing country—Mozambique—with very high rates of malnutrition. Based on qualitative empirical analysis building on a political economy framework, we explore the importance of two agent-centred and two investment-centred factors that determine how decisions on budget allocation to nutrition are made. The analysis finds that public decisionmakers strongly favour highly visible nutrition investments and those with a short duration between the time that spending is incurred and outcomes or outputs are achieved. Co-ordination has been quite successful among donors, and mainly of a spatial nature. Co-ordination is significantly weaker among government agencies, given the absence of fiscal tools of the co-ordinating agency, and its placement in a sector ministry rather than at a supra-sectoral level. Champions as change agents have had a truly influential role in attracting more funding to nutrition and improving its allocation. But their influence is also fleeting and difficult to sustain.     

Ethics,ideology and nutrition

What drives nutritionists in their daily work? Why do they choose nutrition and not another field? Presumably it is the appeal of working, either locally or globally, to alleviate the suffering caused by malnutrition. This article explores the political awareness of nutritionists, the political implications of their daily activities and suggests an enhanced role for nutritionists in the battle against malnutrition. The starting point for this article is the motivating principles behind individual nutritionists.     

Nutrition and the governance of agri-food systems in South Asia: A systematic review

Malnutrition is a multicausal challenge that requires multisectoral responses to make comprehensive and sustainable progress, over the long term. How is agriculture and the wider agri-food system positioned within the constellation of factors and processes that determine nutrition outcomes in different contexts and countries? What is known about the role of enabling environments and the governance of agri-food systems in driving nutrition outcomes, for better or worse? In this paper we will highlight the findings of a systematic review that focuses on this question, drawing on work from the South Asian region including research undertaken by LANSA. We conclude with a discussion of the major implications and recommendations for future policy and practice.     

Nutritional functional classification study of Panama

Despite significant progress, wide-spread malnutrition persists in Panama. This article describes a study which found that over half the malnutrition in the country is clustered in functional groups economically connected to the agricultural sector and which indicates that food availability is a serious problem for 25% of the population. Food intake deficits were equally prevalent among the urban and rural populations. Dietary composition was not seen as the principal problem; rather malnutrition problems are linked to low wages and poor access to public services. A nutrition policy for Panama must be centred first on employment and income generation, and then on extending and maintaining public health and nutrition services, particularly for the extremely poor in the central provinces. Food policy per se would not seem a priority area for public intervention.     

Sustaining healthy diets: The role of capture fisheries and aquaculture for improving nutrition in the post-2015 era

The Sustainable Development Goals (SDGs) agenda makes achieving food security and ending malnutrition a global priority. Within this framework, the importance of fisheries in local and global food systems and its contribution to nutrition and health, particularly for the poor are overlooked and undervalued. This paper reviews current fish production and consumption from capture fisheries and aquaculture, highlights opportunities for enhancing healthy diets and outlines key multi-sectoral policy solutions. Mirroring the call for a diversification of agricultural research and investment beyond a few staple grains, it is anticipated that productivity gains for a few farmed aquatic species will not suffice. Capture fisheries and aquaculture have a complementary role to play in increasing fish availability and access, and must be promoted in ways that support measurable nutrition and health gains. This paper argues that the lack of a nutrition-sensitive policy focus on capture fisheries and aquaculture represents an untapped opportunity that must be realised for ensuring sustainable healthy diets for all.     

Human rights in nutrition and nutrition in human rights

Many countries around the world are involved in nutrition planning and nutrition program implementation. This concern and activity with regard to nutrition, however, has failed to give the issue proper and adequate consideration in development plans and programs of action. The author proposes a two-pronged approach to promote nutrition as a human right. One approach is to include nutrition as a human right in educational and training programs in nutrition. Another approach is to include nutrition as a human right in educational and training programs on human rights. These approaches are described using examples from experiences in the Philippines. Families, universities, and other training institutions have roles to play in making sure that individuals and groups receive the nutrition they need. It should be stressed that nutrition is both a right and an input for development.     

Nutrition planning and food policy

The development priorities of recent years may be a cause of malnutrition amongst the poorest groups. To achieve more adequate planning, elements of an interdisciplinary approach are suggested in this article. These could be characterised as identification of risk groups, analysis of consumption patterns, continued monitoring, and understanding of the effects on individual behaviour of social, cultural, educational and economic forces.