‘Integrated nutrition programmes’ are a great idea. But do they work?

The global food crisis of 2008, influential research from the Lancet, and advocacy from a variety of NGOs have led to a recent international focus on nutrition; ensuring that children grow up to be the right height and weight, with sufficient vitamins and nutrients. DFID alone has launched at least ten large programmes in the last few years which aim to improve the nutrition of women and children.

Commendably, the development community recognises that nutritional status isn’t just determined by how much food you eat. It’s affected by whether people wash their hands, access to healthcare and other vital services, and whether the mother has the time to look after her child properly (among much more). As DFID wisely notes; “nutrition-specific interventions will only reduce global stunting by one third. The remaining two thirds will need to be tackled through nutrition sensitive development.”[1]

This all leaves me wondering how realistic it is to integrate nutrition into such a broad range of issues. From my limited experience, the most effective programmes – whatever the sector – are those that can articulate a clear strategy, direction, and goals. They know what they want to achieve, and focus their efforts. I’ve found that the limiting factor in development programmes is not money, resources or goodwill – but the quality of the management. There is a critical lack of staff with the ability to manage programmes, bringing a disparate set of activities together around a goal. Instead, large programmes often end up being a hodgepodge of things that seem like a good idea at the time, with little strategic direction or cohesiveness.

This perhaps sits uneasily with the idea of nutrition sensitive programmes. When an agricultural programme is not just aiming to boost income and crop production, but also to improve nutritional status, management is significantly more complex. New staff need to be hired, existing staff retrained, additional activities designed and managed, monitoring systems revised, and all of this brought together into a cohesive programme. Given the limitations in current management, how successfully are managers and staff really about to integrate nutrition? How about if they are also asked to incorporate climate change objectives, gender mainstreaming, HIV awareness, and child protection? Will these programmes become an integrated cohesive whole, or an unholy mess?

I have no easy or quick answer to this question; and certainly don’t want to dismiss the importance of integrating multiple sectors. So here are a couple of suggestions for ways to resolve the above dilemmas, and please add your thoughts in the comments box below.

  • Don’t do everything everywhere. Rather than trying to mainstream nutrition (or anything else) throughout the programme, pick the areas where you can make the most difference. These are likely to be the underlying causes of undernutrition. For example, are children being constantly readmitted into your supplementary feeding programme because of high rates of diarrhea? Or because mothers aren’t feeding their children at home? This will help you understand where to focus resources.
  • Wait until a programme is well established and working well before trying to integrate something new. Don’t try and integrate nutrition into a programme that is struggling anyway. Weak programmes will have enough problems doing one thing well; new initiatives can detract from rather than improve their impact.
  • Hire specialist staff. Training is a great thing. But if you’re really trying to make a difference to nutrition, your programme will need people who really understand the subject; not that guy who went to a week-long training course six months ago. That means hiring additional, qualified staff.

A rather meagre list I’m afraid! Does anyone else have any better suggestions?

[1] Scaling Up Nutrition: The UK’s position paper on undernutrition September 2011