Update on Scaling up Nutrition (SUN) and the ‘1000 Day’ movements

By Tom Arnold and David Beckmann

Tom Arnold is CEO of Concern Worldwide and David Beckmann is President of Bread for the World.

Recognised globally as non-governmental organisations (NGOs) committed to the eradication of hunger and actively engaged in the development and roll-out of the Scaling Up Nutrition (SUN) Movement, Bread for the World and Concern Worldwide participated in the September 2010 1,000 Days: Change a Life, Change the Future Call to Action event. This joint U.S.- Irish government initiative drew attention to the irreversible impact of maternal and child undernutrition during the critical 1,000 day window of opportunity, from pregnancy to the age of two years, and also saw the launch of the SUN Roadmap. The 1000 Days partnership marked the beginning of 1,000 days of concerted action and focus on undernutrition in the 1,000 days between September 2010 and June 2013.

As panelists at the 1,000 Days meeting, Bread for the World and Concern Worldwide committed to hosting a follow up meeting nine months later, in June 2011, to strengthen the voice of civil society in the global effort to scale up nutrition and to sustain political commitment and energy to address maternal and child undernutrition.

What is SUN?

The 2008 food price crisis propelled food and nutrition security toward the top of the global political agenda. This year also marked the publication of an influential series on maternal and child undernutrition in the British medical journal The Lancet. The five-part series drew attention to the scientific evidence on how undernutrition contributes both to infant and child mortality, and to the long-term irreversible effects on the development of children. The series underscored the critical importance of nutrition from pregnancy through a child's second birthday, the so-called 'window of opportunity'. A series of high impact and cost effective interventions were identified. Consequently, governments around the world, donors, and multilateral institutions began to reassess their food and agriculture policies and programmes with priority to the most vulnerable. This renewed focus gave rise to the SUN movement.

The 1,000 Days partnership supports the SUN movement and its principles by drawing attention to and galvanizing action during the critical 1,000-day 'window of opportunity' and by helping to identify and meet measurable benchmarks in improving maternal and child nutrition.

The SUN Road Map envisages three to five years of intensive effort for SUN, which draws on sustained commitment of a broad range of stakeholders at local, national, regional and international levels. The SUN movement is a collective effort to support governments as they invest in policies and actions to improve maternal and child nutrition from conception until a child reaches the age of two years. SUN is not a new institution, initiative, or financial mechanism, but serves as a catalyst for joint work and to bring organisations across sectors together to support national plans to scale up nutrition interventions. The aim is to achieve this by helping ensure that financial and technical resources are accessible, coordinated, predictable, and ready to go to scale.

The SUN movement recognises that successful, sustainable efforts to improve nutrition must be anchored at the national level, with national-level actors 'owning' and leading tailored efforts to address undernutrition. The SUN movement is built on the engagement of countries affected by a high burden of undernutrition. National-level leadership coordinates both national and international efforts through coordination of national multi-stakeholder platforms, participation/input into the global SUN Transition Team and Country Partner Reference Group (please see below). The SUN movement commits to aligning financial and technical support with these country plans.

A number of developing countries have already begun to scale up actions on nutrition at the national level, and are known as 'early riser' countries. These include Bangladesh, Burkina Faso, Ethiopia, Ghana, Guatemala, Lao PDR, Malawi, Mali, Mauritania, Nepal, Niger, Peru, Senegal, Tanzania, Uganda, Zambia and Zimbabwe.

The foundation for the SUN movement is the SUN Framework¹. Finalised in April 2010, it outlines the core priorities, elements, and actions necessary to reduce malnutrition. From these, countries can build and tailor their national plans. The SUN Roadmap² transforms the Framework into action by identifying principles and strategies for increasing support to countries as they scale up nutrition efforts across a range of sectors. The SUN Roadmap encourages a coordinated approach among national leaders and stakeholders to harmonize actions and make the overall effort more effective.

Priority nutrition interventions

The SUN movement supports government's implementation of nutrition, in particular focusing on 13 evidence-based direct nutrition interventions, and supporting the prioritisation of nutrition and gender-sensitive approaches to policies in sectors such as agriculture, social protection, health and water and sanitation.

The 13 direct nutrition interventions fall into three general areas of investment:

• Behaviour change interventions that include promotion of breastfeeding, appropriate complementary feeding practices (but excluding provision of food), and good hygiene, specifically hand washing.
• Micronutrient and de-worming interventions that provide a range of supplements for children under the age of five years, pregnant women and the general population
• Complementary and therapeutic feeding interventions that consist of provision of vitamin- and mineral-fortified and/or - enhanced complementary foods for the prevention and treatment of moderate malnutrition among children 6-23 months of age.³

SUN recognises that sustainable progress in nutrition requires looking beyond 'traditional' nutrition activities. Because the effects of undernutrition reach across sectors, efforts to improve nutrition should also engage multiple sectors, for example, by:

• Bundling direct nutrition interventions with services or actions from other sectors at the time these are delivered.
• Incorporating nutrition from the beginning of a development effort by assessing potential nutrition impacts as part of the planning phase.
• Including nutrition indicators in the list of desirable outcomes of a range of projects and policies.

Some notable achievements have been made in several of the 'early riser' countries. For example, Malawi is developing and rolling-out a wide range of key SUN interventions including:

• Micro-nutrient supplementation and fortification
• Behaviour change interventions such as the development of infant and young child feeding counselling cards, child health days and consumer education
• Promotion of optimal pre- and post-natal nutrition
• Capacity building in nutrition and therapeutic feeding.

In addition, nutrition policy and strategy plans are to be reviewed in August 2011 and a Nutrition Act is to be finalised in 2011. Malawi is planning a national launch of the SUN movement for the end of July 2011 which will be called 1,000 Special Days, to focus attention on stunting. The national launch will be followed by launches in all four regions and it is anticipated that the movement will have reached all households within six months. In addition to the national launch, Malawi will hold a technical workshop to share experiences with the other early riser countries.

Resources necessary to scale up nutrition

Nutrition must be prioritised and funded at the international, national, and local levels. Success of programmes will require commitment and support first and foremost by developing country governments. The cost of scaling up the 13 direct nutrition interventions outlined above is estimated to be at least U.S. $11.8 billion annually⁴. It is estimated that households will contribute $1.5 billion of this. SUN's recommendations may sometimes require a shift in approach and alignment of existing resources rather than new programming and funding, for example in relation to nutrition sensitive approaches to development efforts. As country plans are developed, stakeholders engaged in the SUN movement will work with country officials to determine how to best align resources and programmes behind these plans.

Who supports SUN?

SUN is an open global movement that brings together broad constituencies of all interested stakeholders in a partnership through which collective efforts are harmonized in support of country plans to improve nutritional outcomes. In country actions are being supported by a 12 member provisional SUN Transition Team chaired by the Special Representative of the UN Secretary General for Food Security and Nutrition, David Nabarro. This is composed of cross-sector, multi-partner leaders from developing and developed countries, non-governmental organizations (NGOs), the private sector, academia, and the United Nations system.

The SUN Transition Team is informed by two reference groups: an Country Partner Reference Group, with representatives from countries now working to scale up nutrition, and a U.N. Reference Group. The Transition Team provides guidance to six task forces that provide the technical expertise and tools to support efforts to scale up nutrition at the national level. These task forces include: national capacity building, advocacy and communications, civil society mobilization, donor coordination, private sector engagement, and monitoring and evaluation. Each task force focuses on specific key elements, building a foundation for SUN by mobilising the support of stakeholders, developing useful resources, and ensuring SUN sustainability in these areas. The task forces focus is on developing in-country capabilities, strengthening the engagement of civil society, of development partners, and of the private sector, monitoring progress, and supporting effective communications and advocacy activities.

At the national level,'early riser countries' appoint a high level Government Focal Point and establish multi-stakeholder and sectoral platforms to ensure effective and coordinated efforts. These platforms work to identify gaps and prioritize actions through regular mapping and stocktaking of on-going food and nutrition security interventions.

1,000 Days/SUN movement meeting June, 2011

A follow-up meeting of 1,000 Days/SUN stakeholders was hosted by Concern Worldwide and Bread for the World on 13th June 2011 in Washington DC⁵. Attended by more than 170 international organizations representing international NGO's, early riser civil society and government representatives, donors and academia, it aimed to build on the political momentum behind 1,000 Days. It highlighted the progress made nine months after the launch, as well as some of the challenges to scaling up efforts and implementing proposed solutions, such as mobilizing resources, building capacity, and developing champions and strong leadership on nutrition.

One of the examples of progress shared was that of Zambia. In Zambia, the National Food and Nutrition Commission (NFNC), under the authority of the Ministry of Health, has been appointed by Government as the focal point for SUN. Essential nutrition actions are being promoted such as Infant and Young Child Feeding, micronutrient control, and crop and dietary diversification. In February 2011 a high level food and nutrition forum 'Accelerating Nutrition Actions' was convened. The importance of scaling up nutrition within the window of opportunity has been incorporated into the draft National Food and Nutrition Strategic Plan 2011-2015. Efforts to establish a multistakeholder forum have been accelerated with meetings held between key government ministries, various committees and technical working groups are in place and a mapping exercise for SUN has been initiated. In addition, the Ministry of Agriculture and Cooperatives (MACO) are reviewing their operational guidelines to make them more nutrition sensitive.

The meeting's keynote speakers are an indication of the high level of international commitment to SUN and 1,000 Days. They included Maria Otero, U.S. Under Secretary of State for Democracy and Global Affairs; Kevin Farrell, Irish Hunger Envoy; David Nabarro, Special Representative of the U.N. Secretary- General for Food Security and Nutrition; and Robert B. Zoellick, President of the World Bank. In addition, Hillary Rodham Clinton, U.S. Secretary of State; Andrew Mitchell, U.K. Secretary of State for International Development; and Melinda French Gates, Co- Chair of the Bill & Melinda Gates Foundation, prepared video addresses to the participants.

The morning session included a moderated panel discussion featuring representatives from partner nations and civil society groups. The afternoon session consisted of four concurrent working groups which focused on advocacy and communications, capacity-building, implementation of SUN at the country level, and linkages with other sectors, such as health, agriculture, and education. The working groups were a central and fundamental part of the meeting since they set aside time for participants to share their experiences and convey their perspectives on a variety of issues as SUN progresses. Some of the key themes that cut across the working groups included the importance of a multi-stakeholder effort at the country level, engaging civil society and the private sector, the need for training at all levels of government, especially on how to coordinate and program across sectors, strengthening local capacity and institutions, and continuing to build the evidence base for nutrition programming.

Participants discussed a proposed joint declaration urging national governments to prioritise maternal and child nutrition in their development plans and calling on both national governments and the international community to make more financial resources available for early nutrition. The declaration will also be used as an advocacy tool to raise awareness and engage other civil society partners in the SUN movement, particularly in the run-up to the September 2011 U.N. General Assembly and the 2011 G-20 summit in November.

Civil society organizations from SUNs 'early riser' countries met again on June 14th to work with SUN's task force on civil society to strategise and plan the actions needed to advance SUN at the country level. The civil society meeting challenged the group to galvanise action and hold stakeholders accountable. Stories of success, learning and challenges were shared by the 'early riser' countries with much discussion on the means to mobilise civil society around the issue of nutrition and raise awareness among the public. Each country delegation spent time identifying priority actions and needs. There was a strong sense of commitment to translate the global momentum to action at national and local levels.

Over the next few years, sustaining political commitment, building capacity and coordination will be crucial for scale up of nutrition interventions. The main investors in efforts to scale up nutrition must be the governments of the countries facing the most severe undernutrition problems. The support from other key stakeholders is crucial to their success. Though many high-level global and national champions are speaking passionately, this work still lacks adequate resources, and this must be redressed. The global community and national governments must build on existing momentum by learning from and multiplying the good initiatives that have already emerged at the country level. Documentation of best practices and their scale-up, as well as the implementation and application of these lessons learned, are critical. Those working on SUN issues must also collectively hold one another to high standards. Tackling, and ultimately eradicating undernutrition, will require all stakeholders joining together and playing their part. We know what needs to be done, and the time to act is now.

For more information, please visit: www.thousanddays.org and http://www.unscn.org/en/scaling_up_nutrition_sun/sun-road-map.php

¹http://siteresources.worldbank.org/NUTRITION/Resources/281846-1131636806329/PolicyBriefNutrition.pdf

²http://un-foodsecurity.org/sites/default/files/SUNRoadMap_English.pdf

³Susan Horton, Meera Shaker, Christine McDonald, Ajay Mahal, Jana Brooks Krystene. Scaling Up Nutrition: what will it cost?, 2009

⁴Susan Horton, Meera Shaker, Christine McDonald, Ajay Mahal, Jana Brooks Krystene. Scaling Up Nutrition: what will it cost? 2009.

⁵www.bread.org/meeting