in elevating nutrition as a U.S. development priority. This
can be accomplished by building up the operational and
technical foundation to scale up nutrition. In order to do
this, action is needed on five fronts:
1. Developing and implementing a “whole of government”
nutrition strategy and approach that is supported by a
transparent, nutrition-specific budget across initiatives
(Feed the Future and Global Health Initiative) and accounts
(Development Assistance, Food for Peace, PEPFAR,
Millennium Challenge Corporation);
2. Strengthening nutrition leadership within the government
and improving coordination and management across
departments, offices, bureaus, and agencies;
3. Increasing and strengthening nutrition capacity at
headquarters and in U.S. government overseas offices;
4. Harmonizing interagency nutrition
operational and technical guidance; and
policy,
and
5. Monitoring, evaluating, and reporting effectively to
increase accountability.
It is important to underscore at the outset that scaling
up nutrition will depend very much on what happens in
individual countries. Strong national policies and strategies,
supported by adequate resources, effective local institutions,
and fully engaged civil society organizations, will be key
determinants of success. The recommendations in this paper
are intended to highlight ways in which the U.S. government
can become an even stronger partner in this effort. They are
not intended to take away from the work that has to be done
in country, but rather to suggest ways of ensuring that the U.S.
government is better equipped to support country-level action.
being recognized as a crosscutting issue that needs a multisectoral approach. A purely clinical, health-focused approach
to nutrition is not sufficient, nor will nutrition be improved
simply by improving the agricultural productivity and the
availability and quality of nutritious foods. According to
congressional testimony by a Bureau of Global Health
official, “One of the key lessons learned from the U.S.
government’s20… [work] in nutrition is that improving
nutrition on a large scale requires a comprehensive effort
that involves all sectors.”21 It is now an important element
of U.S. government food security and health investments,
especially in the context of two major initiatives—the Global
Health Initiative (GHI), and the global hunger and food
security initiative, Feed the Future (FTF).22,23
According to USAID Administrator Shah’s joint message
of July 3, 2012, GHI “will continue as the priority global
health initiative of the U.S. Government…and…continue to
function with a collaborative leadership structure headed by
the three core entities—USAID, CDC, OGAC … ensuring the
GHI principles are implemented in the field to achieve … (the
government’s) ambitious GHI goals. GHI country teams and
GHI planning leads will continue to work to implement GHI
strategies under the leadership of the U.S. Ambassador.”
However, the existing GHI coordinating office (S/GHI) at
the State Department will close.
GHI, coordinated by the State Department, aimed to
integrate investments in global health (including nutrition)
that are managed through the existing expertise and
programs of USAID, the Departments of Health and
Human Services and Defense, the President’s Emergency
Program for AIDS Relief (PEPFAR), the President’s Malaria
Initiative (PMI), and the Peace Corps, through a coordinated
Developing a “Whole of
Government” Nutrition Approach
The United States has a history of support for
maternal and child nutrition; this support has
been included in both maternal and child health
programs and food aid programs. Yet traditionally,
nutrition has been seen as a health issue by the
agriculture and food security sector and as a food
issue by the health sector. The lack of a constituency
within either sector has led to nutrition’s falling
between the cracks and not garnering the funding
or the emphasis needed in programming. This
is changing, however, with recent attention to
nutrition as a result of The Lancet’s series on
reducing maternal/child undernutrition and the
Scaling Up Nutrition movement. Nutrition is now
4 Briefing Paper, July 2012
Crista Friedli
Overview
Nutrition specific programs can take many different forms—coordination among agencies, bureaus and offices is essential.