Effective international action against undernutrition: why has it proven so difficult and what can be done to accelerate progress?

The Lancet published a series of papers in 2008 to discuss maternal an child undernutrition because  “nutrition is a desperately neglected aspect of maternal, newborn, and child health. The reasons for this neglect are understandable but not justifiable.” The last paper in this series is “Effective international action against undernutrition: why has it proven so difficult and what can be done to accelerate progress?”

Summary

Many transnational organisations work to support efforts to eliminate maternal and child undernutrition in high-burden countries. Financial, intellectual, and personal linkages bind these organisations loosely together as components of an international nutrition system. In this paper, we argue that such a system should deliver in four functional areas: stewardship, mobilisation of financial resources, direct provision of nutrition services at times of natural disaster or conflict, and human and institutional resource strengthening. We review quantitative and qualitative data from various sources to assess the performance of the system in each of these areas, and find substantial shortcomings. Fragmentation, lack of an evidence base for prioritised action, institutional inertia, and failure to join up with promising developments in parallel sectors are recurrent themes. Many of these weaknesses can be attributed to systemic problems affecting most organisations working in the field; these are analysed using a problem tree approach. We also make recommendations to overcome some of the most important problems, and we propose five priority actions for the development of a new international architecture.

The Lancet, Volume 371, Issue 9612, Pages 608 – 621, 16 February 2008

Saul S Morris PhD, Bruce Cogill PhD, Prof Ricardo Uauy PhD, MD, for the Maternal and Child Undernutrition Study Group