Thin on the Ground

By Louisa Gisling, SC UK

Questioning the evidence behind World Bank-funded community nutrition projects in Bangladesh, Ethiopia and Uganda, key findings of the Save the Children UK report, Thin on the Ground, were presented at the UN Standing Committee on Nutrition meeting in Chennai, India in March 2003.

The report was written by Save the Children UK to publicise the findings of a study into the effectiveness of nutrition projects funded through World Bank IDA loans. All the projects use the growth monitoring and promotion approach as one of their key components. The study showed that because of problems with both the design and implementation of these projects, it is extremely unlikely that they can be really effective in addressing problems of malnutrition in the poorest countries.

In Bangladesh, Save the Children UK conducted a cross-sectional survey comparing areas included in the project with non-project areas. This investigation cast doubt on the effectiveness of the project and found no difference in the rates of malnutrition between project areas and non-project areas despite six years of implementation. The survey also showed that growth monitoring charts were poorly understood by mothers and that supplementary feeding had limited effectiveness, especially for very young children.

In Uganda, no evaluation of the project's impact over the past four years has been made public. In spite of this, plans to open up new areas to the project are being discussed. In Ethiopia, Growth Monitoring and Promotion (GMP) is a high-risk intervention, since the strategy has never been evaluated in such a resourceconstrained environment and in the absence of a functioning health system. In all three countries, the per capita cost of the projects exceeded per capita investments on health services.

The report calls on the World Bank, and other donors, to cease opening up new areas to the projects until independent reviews have been completed, to explore the cost-effectiveness of alternative approaches to malnutrition, and to increase accountability in the design, monitoring and evaluation of projects.

The report has already stimulated a lively controversy. SC UK have posted the report on http://www.nutritionnet.net, to promote a transparent and wide-ranging debate on this issue within the professional nutrition community. There are clearly different experiences and professional opinions in relation to large scale nutrition programmes. We need to capture and analyse this range of experience to help establish how best to tackle the enormous problems of malnutrition in the poorest countries.

For further information or comment, contact Anna Taylor, Nutrition Adviser, Save the Children UK tel: +44 (0)207 716 2016 email: A.Taylor@scuk.org.uk