undernutrition as one of the key measures of overall progress
in these sectors.” The 2010 SUN Road Map identified priority
areas in which to mainstream nutrition; they included
agriculture, education, social protection, and health.36
At the Sixty-Fifth Session of the World Health Assembly,
held in Geneva, May 21–26, 2012, member states adopted
for the first time six global nutrition targets as part of a
Comprehensive Implementation Plan on Maternal, Infant,
and Young Child Nutrition. The first target is a 40 percent
reduction in the global number of stunted children younger
than 5 by 2025. Achieving this goal will require a concerted
effort by countries, donors, and program implementers to
scale up both the nutrition-specific interventions identified
by The Lancet and the Copenhagen Consensus and nutritionsensitive development efforts.
When considered together, these global efforts reflect a
historic tidal change in political will, promoting increased
donor support and larger investments in nutrition to
improve maternal and child nutritional status and reduce
nutrition-related mortality. A number of initiatives are
assisting countries in scaling up nutrition-specific and
nutrition-sensitive programming. Since 2008, the U.N.
Renewed Efforts against Child Hunger and Undernutrition
(REACH) initiative has served as a catalyst for scaling up
multi-sectoral (agriculture, health, education, etc.) nutrition
interventions through country-led plans and activities along
with the coordinated action of U.N. agencies, civil society,
donors, and the private sector. The U.S. government’s Feed
the Future (FTF) (2010) and Global Health (GHI) (2009)
initiatives share a goal of reducing child undernutrition by
20 to 30 percent in assisted food-insecure countries.37
There is strong agreement on the cost-effective and proven
direct, nutrition-specific interventions and how to bring
them to scale. However, very few international organizations
or donor governments have clear working definitions that
specify which actions are considered nutrition-sensitive,
and there is no standard definition across organizations
and donors. Organizations tend to define nutrition-sensitive
in the context of their own programs. Now, with increased
nutrition programming, it is important to make sure that
efforts are aligned and coordinated and that all stakeholders
have a shared understanding of how to scale up nutrition.
Coordination is particularly important when it comes
to integrating nutrition into multi-sectoral programming.
Lawrence Haddad, director of the U.K.-based Institute of
Development Studies, notes that the challenge is that each
agency is using different ways of classifying and reporting on
which indirect actions are nutrition-sensitive and which are
not.”38 Without a standard definition, it has been difficult to
build the evidence base for what works and what does not—
which is important when setting funding priorities—or to get
an accurate measure of the efforts made so far to scale up
and their impact. Additionally, with little guidance on how to
design and implement a multi-sectoral approach to nutrition,
inconsistencies in implementation add to the complexity of
measuring the impact of a particular intervention. We hope
this paper will contribute to a broader discussion about these
issues and encourage experts to develop working definitions
Case Study: Orange Sweet Potato and Nutrition-Sensitive Development
Orange-fleshed sweet potato (OSP) is the first biofortified
crop to be released commercially. It has been bred to increase the
amounts of Vitamin A available to those who have micronutrient
deficiencies. This is the case in most of Africa, where the
prevalence of vitamin A deficiency is high; traditional white and
yellow potatoes contain little of this important micronutrient.
Lessons learned from OSP delivery can be applied to scale up other
biofortified crops to ensure that target groups (primarily women
and children) are consuming adequate amounts of vitamins and
minerals to improve their nutritional status.39
The International Food Policy Research Institute (IFPRI) found
that for a strategy—in this case, crop biofortification—to become
viable, the costs of delivering nutrients through crops must be
lower than the costs of nutrition-specific interventions such as food
supplementation and fortification. It also found that educational
components such as behavior change communications need to
focus on key messages related to OSP, not on other messaging
such as general nutrition or improving farming practices. Using
4 Briefing Paper, November 2012
the World Bank’s Disability-Adjusted Life Years (DALYs) as
a measure, this agricultural nutrition-sensitive program was
considered highly cost-effective.
Other nutrition-sensitive activities contributed to the success
of OSP and helped improve nutrition. These included efforts to
define gender roles in production, consumption, and marketing;
well-focused nutrition messaging; and consideration of how
to brand OSP to differentiate it from traditional potatoes and
encourage a growing number of producers to accept the product.
Complimentary activities included sanitation/hygiene and
education.
The agriculture sector needs to assume more responsibility for
improving nutrition, and “better nutrition through food” needs to
be a core component of global research and product development.
Existing frameworks such as SUN and the Comprehensive African
Agriculture Development Program (CAADP) can be an important
means of mainstreaming nutrition-sensitive programs to build
successful indicators, measures, and outcomes.