Landscape anaLysis: Strengthening Global Nutrition Investment

The human and economic costs of undernutrition are staggering. Undernutrition affects an estimated 2 billion people worldwide and is responsible for 3.5 million preventable child deaths each year. It is a major impediment to economic growth and development, contributing to losses in a countrys GDP of as much as 2-3%. Ultimately, without accelerated action to improve nutrition, achieving the Millennium Development Goals will be impossible for many countries.
Over the last few years, there has been a growing consensus that improving nutrition is central to the success of other global health and development priorities. The Scaling Up Nutrition (SUN) movement and the 1,000 Days partnership have coalesced unprecedented international resolve to tackle the problem of undernutrition by underscoring the need for: Committed collaboration across health and development sectors; and New and better investment from public, private, and civil society actors in donor countries, as well as in lower and middle income countries. Both efforts aim to address the large gap that exists between current funding levels for nutrition and what is required to implement a series of proven, highly effective interventions and enable scale-up of solutions. Bridging this funding gap and translating international resolve into results requires an understanding of the landscape of potential partners and resources that can be mobilized to improve nutrition. The purpose of this brief is to contribute to that understanding by providing an overview of nutrition investment and donor engagement trends in Europe and the United States, as well as recommendations for mobilizing resources and commitments.

KEY FINDINGS
Leveraging existing investments in health and development sectors can help bridge the funding gap. Nutritional status affects and is affected by overall health status, as well as agricultural, economic, and social conditions. However, nutrition outcomes are not commonly considered as impact measures across broader health and development programs, such as those in food security and agriculture; water, hygiene and sanitation; maternal and child health; and social protection. Existing resources in these programs can be better targeted and realigned to support improved nutrition. Stronger bilateral and multilateral donor commitment to nutrition is needed. Though donor governments and multilateral organizations have increasingly made nutrition a priority, there is still a need to enshrine commitments to nutrition within clear strategies and policies, increase funding levels, and to target investments more effectively for nutrition outcomes. The private sector is critical to improving nutrition at scale, but meaningful engagement has been limited. There is a legacy of mistrust between the nutrition community and the private sector that has impeded constructive engagement. In this way, the significant skills and resources of the private sector, including unique product research and development capabilities; technical skills and expertise in distribution; and demand creation, have not been fully utilized to address the problem of undernutrition. Private philanthropy is a significant untapped funding opportunity for nutrition. This is especially true in the U.S., where philanthropic giving is estimated at close to $300 billion annually. Nutritions share of the large infusion of private funding for global health and development within the last decade has been relatively modest.

RECOMMENDATIONS
Advocate for donors to prioritize nutrition within policies and budgets. Leverage U.S. government investments in health, food security, and food aid by championing greater integration and harmonization. Push for strong financial commitments from European donors. Target the European Commission to develop a nutrition policy. Target investments in the 1,000 day window from pregnancy to age two for maximum impact. Strengthen agriculture and nutrition linkages in partnership with the private sector. Engage the private sector across the food value chain. Analyze where opportunities exist along the continuum of growing, producing, processing, transporting, and marketing foods (i.e., the food value chain) to improve nutrition. Use value chains as roadmaps for private sector engagement in order to mobilize resources for systemic solutions, rather than project-based efforts. Use public-private partnerships to leverage the knowledge, skills, and resources of the private sector, especially in the production, distribution, retailing, and marketing of food. Continue to build the evidence base for advocacy. Strengthen the evidence base across agriculture-nutrition-health intersects. Build evidence of private sector and public-private partnership impact. Develop a strong messaging strategy to drive advocacy and funding. Use clear, simplified messaging to communicate the problem of undernutrition and its solutions. Messaging should connect with audiences emotionally as well as intellectually; improving nutrition can be positioned as both a moral and economic imperative. Set bold programmatic and funding targets to help galvanize activists; drive large-scale awareness and fundraising campaigns; and attract greater international commitment.

CONCLUSION
Undernutrition is too large and complex a problem for any one sector to solve unilaterally. Greater commitment from government, business, and civil society is needed to implement nutrition solutions at scale. Sustainably addressing undernutrition will also require working across an array of programs within various global health and development sectors. Within this context, there is great potential in the U.S. and Europe to mobilize new partners and resources for improving nutrition. What is needed now is urgency and action to direct this potential and momentum into scalable progress to end undernutrition.
The summary report is available at: www.ThousandDays.org/resources

KEY REFERENCES:
Food and Agriculture Organisation, 2010: The State of Food Insecurity in the World: Addressing Food Insecurity in Protracted Crisis. Bryce, J., D. Coitinho, I. Darton-Hill, and P. Pinstrup-Andersen, 2008: Maternal and Child Undernutrition: Effective Action at National Level. The Lancet, 371; 510-26. Butta Z.A, T. Ahmed, R.E. Black, et al., 2008: What Works? Interventions for Maternal and Child Undernutrition and Survival. The Lancet, 371; 417-40. Horton, S., M. Shekar, C. MacDonald, A. Mahal, J.K. Brooks, 2010: Scaling Up Nutrition: What Will it Cost? The World Bank. The Center on Philanthropy, 2011: Giving USA 2011: The Annual Report on Philanthropy for the Year 2010. Giving USA Foundation.

This brief is informed by two independent studies commissioned by the Bill & Melinda Gates Foundation. conducted separately by ccs and the London school of Hygiene & Tropical Medicine, the studies examined the donor and partner landscape in the U.s. and europe, respectively, for improving nutrition throughout the world.