What's next for global nutrition efforts after ICN2

Over 2,200 delegates attended last week’s Second International Conference on Nutrition in Rome 22 years after the first edition in 1992.

As expected, government representatives gathered at the U.N. Food and Agriculture Organization’s headquarters in the Italian capital endorsed the political document known as the Rome Declaration and a framework for action to guide their future efforts in fighting global malnutrition.

But aside from the official items on the agenda, what buzz topics took center stage at the conference, what do experts now view as the main nutrition challenges, and how must we reform food systems to feed a growing world population more efficiently? In an exclusive interview, we asked Francesco Branca, director of the Department of Nutrition for Health and Development at the World Health Organization.

Here are a few highlights from our conversation with Branca about what’s next after ICN2.

The Rome declaration states that international cooperation and official development assistance for nutrition “should support and complement nutrition strategies, policies and programs.” This sentence is quite general. What does it mean in practical terms? What are the key areas to which ODA should be channeled?

In general there is a problem of counting that ODA and the way we count ODA in nutrition is very inaccurate.

Specifically in nutrition?

Specifically in nutrition. There are other areas that are better tracked. This one is not tracked [well] because we don’t know which programs, which investments to count. What is it? Do you count only the direct nutrition interventions?  How do you count those interventions, in agriculture for example, that are supposed to have an impact on nutrition? Do you count them or you don’t? There has been an effort in that direction by some development actors to try and measure in a better way this ODA. Having the numbers right is quite important because countries have been making pledges and it’s important to be able to accurately track.

It is not sufficient to have ODA. ODA has to match local resources. We really need a major scale up of investments and that can only be accomplished by a combination by endogenous and outside investments.

We would like to see that all women in reproductive age are really reached by interventions, and in that improving their vitamin and mineral status. It is very simple and it is very cheap intervention — there’s no reason not to have that. We would like to see the management of acute malnutrition better, with a greater coverage. We only have 1 child in 10 reached by adequate interventions. We would like to see universal health coverage. We would like to see water and sanitation programs really scaled up. There are areas that require greater investment.

Maybe we would like to see a different way to invest. There’s in an investment in agriculture … but what are the objectives? Are the commodities produced by those investment adequate for the local and global supply? Food security has been mainly looked at from the point of view of the amount and of the energy, but not from the quality and the diet diversity, vitamins and minerals — type of nutrients really assessed. Probably, those agricultural interventions should be aimed at filling the nutrient gaps rather than creating new accesses in some areas.

Do you think the ICN2 outcome documents will have an impact on the work of WHO, like for instance reorienting your nutrition strategy?

Certainly WHO is at the service of its member states, so a political document like this will certainly have an influence on what we do and obviously there is a need for greater clarity on how certain policies and programmes need to be delivered. There are questions. …

For instance?

For instance, being clearer about what actions need to be done in agriculture, in the whole description of which value chain need to be acted upon. It would require some greater analysis and attention, describing the nutrients gaps and finding the adequate tools to measure the nutrient gaps so that then adequate policies can be established. There’s work to be done in terms of finding the right solutions and the right operational details for some of those policies, the adequate delivering channels for certain direct interventions. We know what to do, but sometimes we don’t know how to do it.

For example, if we want to reach all women with iron and folic acid, how do we do that? Why have certain programmes not been efficient? Is it because we didn’t have enough supply, or maybe because we used the health service as a delivery platform and maybe that’s not the best way to do it because of the efficiency of the health service itself? Maybe using schools, instead, would be a better way. We are looking into that, going from a daily supplement of iron and folic acid — which maybe women don’t like to take or the health services are not able to distribute — to a system which is a weekly iron and folic acid supplementation in schools for adolescent girls or maybe delivered through the mosque every week. It’s something we need to do better.

Looking better on how to deliver interventions to be able to achieve this universal coverage of not only health, but nutrition coverage, too.

How are you trying to engage private sector in a different way?

WHO has been looking into engagement with private sector now recently more and more. Of course, it is difficult because … there are a lot of firewalls that need to be established. We prefer to talk about the dialogue, we prefer to talk about consultations, exchanges of information. We don’t have direct collaboration, but it is not necessarily WHO that has to have this collaboration. It can be done at local level, at country level and this collaboration can prove useful. We are now in a world that talks more and more about multi-stakeholder partnerships, they are difficult structures to establish, but of course … we’ve been hearing about the need to have adequate risk assessment and management tools, too.

There are rumors pointing to an attempt to make some organizational adjustments within the U.N. system on nutrition management, and the Rome Declaration also calls for the U.N. system to work better. What are the main challenges you are facing, and how does WHO plan to address them?

We have been working more and more with the [global coordinating platform] and with the Renewed Efforts Against Child Hunger initiative at the country level. REACH somehow needs to be scaled up. We need to work together at country level, in all countries. We are thinking of some organizational arrangements that will allow us to actually scale up our collaboration at country level, probably with different organizations. Some organizations have more people on the ground than others, so making sure that everybody is working effectively together in all countries … will require some additional [efforts]. We have some models of cooperation which we can replicate. We need to do more joint programming. One of the challenges is funding — we need to have some joint funding that will help us. At the same time we need to make sure that at the global level we are going to be able to follow up on ICN2 and on policy harmonization … As the nutrition profile is increasing, we’ll have to do more of that … We are at the moment working on a UN global nutrition agenda to at least put down these concepts.

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