KATHMANDU, Nepal — The Scaling Up Nutrition Movement is in introspection mode. It has grown in the nine years since its inception — it now reaches 61 countries and four Indian states — but it has also witnessed its scope expanding, and the movement must now confront the changing definition of malnutrition, including whether and how it will respond to overweight, obesity, and other increasingly urgent issues of overnutrition.
While its 2018 progress report found most SUN countries to be lagging in key indicators, the movement is now taking stock and assessing how it can use its network to spur global progress on nutrition ahead of the Tokyo Nutrition for Growth summit in 2020.
At a global gathering in Nepal this month, the SUN Movement Secretariat, SUN Movement Lead Group, SUN government focal points, country delegations, members of parliament, SUN business network members, and members of civil society met to discuss progress in fighting global malnutrition. SUN is conducting a strategic review to determine how its third phase should be structured.
“The movement is really a collection of at least 61 different country movements, each with their own personality, each still driving towards better nutritional outcomes, but doing so in a way that makes sense to them.”— David Nabarro, former coordinator, the SUN Movement
“We are in the middle of an independent strategic review to sort out where the power of the SUN Movement lays when it comes to dealing with all forms of malnutrition,” SUN Movement Coordinator Gerda Verburg told Devex.
“If we spread too much, we might lose focus as SUN Movement, and our focus first and foremost needs to be on the first 1,000 days,” she said, referring to the critical period in each child’s life from conception through their second birthday.
Focus on: Improving Nutrition
Verburg said that moving forward, the global nutrition movement must concentrate on how nutrition can be linked to universal health coverage, how food systems can be structured to ensure they benefit both planet and people, and how to promote urgent and effective action on nutrition in conflict-affected and fragile states. The Japanese government is also focusing on those three themes as it prepares to host 2020’s Nutrition for Growth summit.
That recurring event, the first of which was held in London in 2013, is led by a partnership of the governments of the United Kingdom, Brazil, and Japan. It aims to create opportunities for nutrition stakeholders to come together and build momentum for global pledges on nutrition outcomes.
Promoting a multisectoral approach
SUN was created out of the United Nations in 2010 to promote a multisectoral approach after a recognition that the world was behind when it came to meeting malnutrition reduction goals. It was then spun off into a movement with its own secretariat, a structure that gives it independence but can also create ambiguity when it comes to targets and accountability.
In joining, countries commit to developing or revising national nutrition policies, forming multistakeholder platforms that engage multiple government ministries, and appointing a SUN focal point who ensures a whole-of-government approach and coordinates with external actors.
David Nabarro, who served as SUN’s first coordinator before Verburg took over in 2016, said it was purposefully structured as a movement to ensure that diverse actors: governments, the international system, and civil society — and different sectors such as health, agriculture, and education, could work together as equal stakeholders. He said the continuation of the country-first structure of SUN, shepherded by the secretariat, is necessary for real progress on malnutrition.
“The movement is really a collection of at least 61 different country movements, each with their own personality, each still driving towards better nutritional outcomes, but doing so in a way that makes sense to them,” Nabarro said.
“We need to get the ownership right at the community level.”— Gerda Verburg, coordinator, SUN Movement Coordinator
These better outcomes depend on securing high-level political commitments that put nutrition on the national agenda at the highest level, SUN participants say. Former Tanzanian President Jakaya Kikwete said his government was successful in putting nutrition at the heart of his country’s development plan, a recognition of the importance of a multisectoral approach. He also said that although finance ministers control national budgets, support from a head of government can convince the finance ministry to allocate appropriate funds for nutrition.
“We need to secure buy-in for finance ministers to ensure increased domestic investment,” Kikwete said. “I believe from my own experience that if the president, prime minister [are] ready, the minister of finance will certainly fall in line.”
While these high-level commitments are necessary for budgetary and political buy-in on nutrition, SUN countries say that they would also like more support on a local level. Throughout the global gathering, many delegates said they wanted to engage regional-, municipal-, and community-level officials in nutrition work but were unsure of how to do so in the context of the movement.
“They can support us with the multisector platforms that function better and strengthen work on the subnational level,” said Juan Carlos Carías Estrada, Guatemalan food security and nutrition secretary. He said that those working in local communities know best what their specific challenges are, but they need access to tools and information systems to solve them.
Verburg acknowledged the need for extending the influence of the movement down to the community level and said this is something that is being considered as the third phase of the movement is being designed.
“The implementation needs to be done bottom-up, at the community level,” Verburg said. “Why? It’s new and therefore quite difficult. We need to get the ownership right at the community level.”
Joining the SUN Movement is voluntary, and no country is expelled for not meeting indicators, making it difficult to determine what being part of the movement means if each nation is not beholden to its nutrition commitments. But members said that being a part of the movement provides an incentive to make progress because it provides access to high-level figures such as Verburg to put pressure on governments to prioritize nutrition. Countries can request visits or letters from her to the government requesting stronger national commitments.
“If you stay just alone in your country and you report just at the country level, it’s different. If you know you have to be named or shamed at the global level, you have a different perspective. It’s key for us also to have this type of international, global pressure on our governments,” said Abdoulaye Ka, SUN focal point for Senegal. “We need to find a way to increase this type of pressure.”
This accountability is vital if nutrition progress is going to continue, Nabarro said. Globally, most countries are not on track to meet the World Health Assembly’s 2025 targets or the Sustainable Development Goals by 2030.
“Measuring and being transparent about results is actually an essential part of working within the movement,” Nabarro said.
At the recent global gathering, countries and other delegates were not afraid to share their own experiences on scaling nutrition interventions or to express skepticism — including about the role of the private sector in improving global nutrition. Many said they want to see more action from global food companies, particularly when it comes to overnutrition. As access to junk food grows in low- and middle-income countries, so has the double burden of malnutrition — populations simultaneously suffering from stunting and obesity.
“There’s still huge distrust [of the private sector],” said Shawn Baker, director of nutrition at the Bill & Melinda Gates Foundation. “I don’t think we could have had this level of frank debate going back 10 years ago, because there is a sense of we are all in this together, we are trying to find solutions.”
SUN was designed to operate in three phases, the first of which laid the groundwork for scaling nutrition efforts while the second built-out movement structures as more countries elected to join. The last phase will begin in 2021.
An independent evaluation process is underway, led by Deborah Rugg, executive director of the Claremont Evaluation Center. Her team of eight consultants will produce a report of recommendations on the structure, governance, and hosting arrangements of SUN, and determine what skills and capacities are needed to make the efforts fit for purpose.
The team is conducting case studies to see how different countries have fared to determine what pieces of the current structure are working well and what needs to be improved. They have also conducted interviews with the SUN Movement Executive Committee, the movement’s various networks, government focal points, and global-gathering country delegations to gather feedback.
“The point of the illustrative case studies is to learn what is and isn’t working, and, if we’ve missed opportunities, what we do about that,” Rugg said.
Members of Rugg’s team will consolidate the themes and issues they recognize into a draft report which will be submitted to the executive committee in January but will not be made public. The final report will be given to SUN as the movement designs the third phase, according to Rugg.
Given that the movement is nearly 10 years old, Rugg said, it’s only natural that participant countries and nutrition advocates have different ideas about where SUN should go in the future.
“It would be nice to have people have a little bit more of a sense of what the SUN Movement is and what the role is and where it should be going,” Rugg said.
“In the beginning it was OK, because the movement was trying to bring in everybody, it could be everything to everybody — ‘just join our fray.’ And now 10 years in, ‘But what are we actually a part of?’ And then now with the vision for the future, ‘What are we a part of but [also] where are we going and why?’ It’s hard.”
Momentum to Tokyo
Verburg also used the global gathering as an opportunity to hear directly from government focal points and delegations, holding 40 bilateral meetings to discuss progress and support needed for the future. She said she’s seen notable improvements since the last global gathering, with many more SUN countries now possessing national nutrition plans and having SUN focal points with political convening power in their governments.
More and more frequently, Verburg hears from countries that they want to “own the process.”
Using next year’s Nutrition for Growth summit to spur momentum on nutrition progress is key, Verburg said.
“Nutrition for Growth is a milestone for the SUN Movement and all the different stakeholders. And this milestone feeds into the next phase of the SUN Movement because making a commitment is one thing but … these commitments need to be measurable, they need to be ambitious but not stupid. I mean, realistic” Verburg said. “It’s a catalyzer but a lot of work.”
Editor’s note: SUN facilitated Devex’s travel to the SUN Global Gathering. Devex retains full editorial control and responsibility for this content.
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