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Innovations in the Delivery and Scaling-up of Nutrition Interventions Marie T. Ruel, Director, Food Consumption and Nutrition Division IFPRI.

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Presentation on theme: "Innovations in the Delivery and Scaling-up of Nutrition Interventions Marie T. Ruel, Director, Food Consumption and Nutrition Division IFPRI."— Presentation transcript:

1 Innovations in the Delivery and Scaling-up of Nutrition Interventions Marie T. Ruel, Director, Food Consumption and Nutrition Division IFPRI

2 Scaling-up Scaling-up: « A combination of strategies and technologies designed to help expand programs with greater rapidity and larger scale » « Strategies to bring more quality benefits to more people over a wider range of geographical area more quicky more equitably more lastingly »

3 1: Develop a Scaling-up Plan 2: Establish Preconditions for Scaling up 3. Implement Scaling-up Process Legitimize ChangeBuild Constituency Realign/Mobilize Resources Modify/Strengthen Organizations Coordinate Action Plans & Budgets Track Performance Maintain Momentum An Overview of the Scaling-up Process Create Vision Assess Scalability Fill in info gaps Source: Cooley and Kahl 2005; MSI

4 Achieving « Scale » Achieving Scale: « Widespread achievement of IMPACT at affordable cost Impact is a function of: -Coverage -Program effectiveness (impact resulting from quality implementation and efficacy of intervention) -Efficiency (cost/beneficiary) -Sustainability – continuity/ownership -Equity – reaching the hardest to reach

5 Nutrition is not about 1 intervention/1 outcome: Determinants of child nutrition are complex Vitamin A BF Water/San Diarrhea control Agriculture Education Health systems UNICEF, 1992

6 Nutrition through the Life-Cycle

7 Improving Nutrition is Best Achieved through Cross-Sectoral Initiatives So, best results are achieved when you are able to address multiple causes of malnutrition and life-cycle approach This involves working across sectors – Scaling up nutrition as part of cross-sectoral initiatives

8 Examples of Success At National Level

9 Thailand % underweight

10 Thailand % underweight  1 st NHNP ( ): low ( 30% coverage), focus on PEM, MN, Food  2 nd NHNP ( )  Focus on behavior change + prevention  Focus on community-based PHC  Massive scale-up + training health volunteers  High coverage  Nutrition within poverty alleviation strategy  Linked to agriculture production

11 Lessons Learned from Thailand Rapid improvements in child nutrition when nutrition interventions were: –Community-based integrated PHC (from 1982) –Included in National Economic & Social Development Plan (converged with poverty alleviation strategy) –Linked with agriculture-based strategies Success factors: –Planning –Integration –Social mobilization –Local action-oriented surveillance

12 China % underweight Source: Dr. Chen Chunming, Forman Lecture 2006 China reached the MDG1 by 2002 (Svedberg 2007)

13 China: Lessons Learned Successful poverty alleviation strategy Effective nutrition/health/family planning interventions Complementary interventions: –Water/sanitation –Education (92-05: 32 to 57% moms with middle school; 22.5 to 7% illiterate) Partnerships: Chinese Gov’t, UNICEF, WB, NGOs Commitment/ownership Regular data collection; use of data for policy

14 But China has an Emerging Problem of Overweight/Obesity and NCDs Source: Dr. Chen Chunming (Forman Lecture, 2006) %  Calorie intake  Fat content of diet (oil, meat)  Physical activity (work, transport)

15 What is China doing about these New Challenges? Dietary Guidelines: (Food Guide Pagoda) –Focuses on BOTH under- and over-nutrition (e.g. limit amount of fatty meat) National Plan of Action for Nutrition (1997) –Interventions to alleviate hunger/malnutrition –Prevent diet-relatd NCDs, promote healthy lifestyles National Surveys/Food & Nutrition Surveillance System Health sector activities Plant breeding + subsidisation of vegetables Physical activity promotion/smoking cessation « Healthy Lifestyles for All » launched in 2007

16 Conclusion More complex and challenging to scale-up and integrate nutrition interventions across different sectors But pay-off is well worth it Successful experiences do exist (other examples from Latin America: conditional cash transfer programs Main challenges are NOT what to scale up, how much to scale up, but rather: How to strengthen countries commitment & capacity to scale-up and achieve scale

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18 Types of Scaling up Processes Quantitative: increase coverage Functional: increase breath and depth Political: address national level barriers to effective programs and services Organizational: increase organization’s ability to support initiative/program in effective and sustainable way (building alliances, capacity building, etc.)

19 10 issues in Scaling Up Change Capacity (financial, leadership, management, technical, community, logistical) Strategies: replication, integration, paradigm shift Impact: social, financial Sustainability: of process, of program Access Suppy/demand Cost of scaling up, maintaining scale, scaling down Resources: financing scaling up: how much/how long? Timing: when is right time? Re-assessing scale


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