The Scaling Up Nutrition Movement will focus its next phase on accelerating results and expanding its work to include fighting obesity, with a stronger emphasis on country-led ownership.
The changes are outlined in the SUN Strategy 3.0, which details how the 10-year-old, United Nations-established movement intends to continue its work to eliminate malnutrition in all its forms by 2030.
“The strategy is not a prescription for countries. The strategy is recognizing that with 62 member countries and four Indian states, we have 62 different SUN movements building from where countries are,” said Gerda Verburg, SUN Movement coordinator.
The new strategy outlines several shifts from the movement’s second-phase strategy, with a strong focus on ownership, governance, and monitoring and evaluation.
Each SUN member previously had a focal point, or a person designated as responsible for SUN activity in their country and as a liason to the wider movement. Those positions are now being shifted to country coordinators who, according to the strategy document, “will determine the institutional system that is right for their contexts, supported at the highest levels, and provide political and technical leadership for nutrition.”
“We certainly need more money for nutrition, but we also need more nutrition for the money that is being spent.”— Meera Shekar, chair, SUN’s executive committee
Meera Shekar, global lead for nutrition with the World Bank’s Health, Nutrition and Population Global Practice and chair of SUN’s executive committee, said that COVID-19 demonstrated to many nations the wider danger posed by malnutrition. It is important that all countries have the ability to develop subnational action plans, she said.
“This was our collective push that we move from an advocacy and process mode — which is what the previous strategy was — to much more focus on results and outcomes,” said Shekar said. “The strategy lays out lots of flexibility for each country to develop a plan that fits their context, with the idea being really empowering the folks who work at the lowest levels, closest to the community.”
Each country must work to determine the current state of its nutrition landscape, where improvements need to be made, how the government will work across sectors to do so, and how such efforts will be financed.
Felix Phiri, nutrition director at Malawi’s Ministry of Health, is a member of SUN’s executive committee, which led development of the new strategy. Consultations with country focal points, governments, and other partners at the SUN Global Gathering 2019 helped shape the document.
Phiri said the president of his country has “declared war” against all forms of malnutrition — recognition at the highest level of nutrition’s importance.
“SUN 3.0 is also emphasizing political leadership and government commitment, strengthening the multisectoral programming from national to community level while also looking at resources mobilization,” Phiri said. “If it’s country-led, it means countries will see where are the gaps that they want to [fill] and how do they view what countries have been doing before.”
SUN, which was created out of the U.N. in 2011, previously focused on malnutrition and the importance of ensuring proper nutrition during a child’s first 1,000 days, a period that can define health and productivity outcomes for a lifetime. But Verburg said SUN needed to expand its work.
“In more and more of our current SUN Movement countries, obesity and overweight is growing rapidly, and they also want to take into account this form of malnutrition,” Verburg said. “We see that people — especially women who have been stunted or wasted, when they come in reproductive age and they have more food available — they are more vulnearble to be obese or have overweight and give birth to an undernourished child.”
Reducing overweight and obesity also requires further engagement with the private sector, Verburg said, as well as incentivizing multinational companies and small- and medium-sized enterprises to produce more nutritious food. SUN is working with the U.N. Food Systems Summit, set to take place in the fall, on how to better hold the private sector accountable.
After a 2018 progress report found most Scaling Up Nutrition Movement countries to be lagging on key indicators, the movement is taking stock and assessing how it can use its network to spur global progress on nutrition.
It is important to be able to measure the value added by SUN, Verburg said, and what qualitative and quantitative benefits a country receives from being part of the movement, compared with seeking reforms independently. The metrics for such measurement are still a work in progress, she said.
“What is the advantage of working together and being part of a team that is really focusing on the same priorities, focusing on implementation and really scaling up, holding each other to account, encouraging each other — compared to stand-alone initiatives?” Verburg said.
There must be a shift toward results-based financing, Shekar said, and a strong incentive to improve the efficiency of current spending, given the constrained fiscal space in both national budgets and official development assistance amid the pandemic.
“We certainly need more money for nutrition, but we also need more nutrition for the money that is being spent,” Shekar said. “That means focusing on evidence, making sure that national plans are based on evidence that would lead to results, and every time going back to results on the ground: ‘What will this do? What will this spending do, in terms of results on the ground?’ We know many of the countries will be set back as a result of the COVID crisis. … But that should be further impetus for doing more.”
Phiri said Malawi has worked to ensure a diverse set of ministries — from agriculture to education to gender — have dedicated nutritionists, as does each district in the country.
“We want to have a sustained impact. We want to have nutrition as a system — not just nutrition as just nutrition, but a system at a district level all the way to communities. And what this strategy now has done is to bring more energy to us,” Phiri said. “SUN 3.0 has energized countries. … This is a game changer document. But countries have to translate it into actions. Countries have to make sure it’s making an impact.”