Global Nutrition Report

This Global Nutrition Report (GNR) is the first in an annual series. It tracks worldwide progress in improving nutrition status, identifies bottlenecks to change, highlights opportunities for action, and contributes to strengthened nutrition accountability. The report series was created through a commitment of the signatories of the Nutrition for Growth (N4G) Summit in 2013. It is supported by a wide-ranging group of stakeholders and delivered by an Independent Group of Experts in partnership with a large number of external contributors. 

The GNR assembles copious country-level data and other information and highlights the experiences of a large number of countries from Africa, Asia, Europe, Latin America and the Caribbean, North America, and Oceania.  It  measures progress that each country is making towards the World Health Assembly (WHA) nutrition targets (wasting, anaemia, low birth weight, stunting, breastfeeding and overweight); for this first edition, it was only possible to assess country progress on meeting four of the six WHA indicators (stunting, wasting, overweight, and anaemia). It also presents data on the overlap between nutrition problems, e.g. stunting and wasting, stunting and obesity. The Report goes further than the WHA targets, bringing together 70 nutrition indicators in country-by-country profiles in the following areas: nutrition outcomes, determinants, programme coverage, resources and political commitments.  It tracks the specific Nutrition for Growth (N4G) commitments made in London in June 2013.

Some of the report’s key findings are as follows.

Investments in nutrition have high returns. Newly calculated benefit-cost ratios for scaling up nutrition interventions in 40 countries (median 16:1) are highly competitive with investments in roads, irrigation, and health. 

All countries in the world (with the exception of two), that collect nutrition data experience stunting, anaemia, or adult overweight. Multiple burdens of undernutrition and overweight/obesity are the "new normal"; most countries experience some combination of under-five stunting, anaemia in women of reproductive age, and adult overweight.

The world is not on track to meet any of the six WHA nutrition targets. Globally, little progress is being made in decreasing rates for anaemia, low birth weight, wasting in children under the age of five, overweight in children under five years, and in increasing exclusive breastfeeding rates.  More progress has been made in reducing stunting rates in children under five, but not enough to meet the global target under current projections. 

Despite a poor global picture, on a country-by-country basis, many countries are making good progress in improving nutrition outcomes.

• Of the 99 countries for which data are available, 68 are on course for at least one of four WHA global targets (31 are not on course for any). 
• Out of 109 countries that have data on stunting of children under age five, 22 are on course for meeting the WHA target.
• Out of 123 countries with data on wasting of children under age five, 59 are on course to meet WHA targets. Out of 107 countries with data on overweight of children under age five, 31 are on course. 
• Only 5 out of 185 countries with data on anaemia are on course for anaemia reduction. 

There is great potential to learn from country experiences, but it is not being exploited because of a lack of country case studies that examine the wide range of factors affecting progress.  There are plenty of examples of country-level progress from which to draw inspiration and insight; the GNR makes particular reference to experiences from the Indian state of Maharashtra (where indications are that stunting has declined in under 5’s by 10 million), Bangladesh, Brazil, and the United States.

Coverage of nutrition-specific interventions – and national coverage data - is low.

Many countries have national coverage data for only three of the 12 key nutrition-specific interventions (vitamin A supplementation, zinc treatment for diarrhoea, and universal salt iodisation). Given the lack of progress on wasting rates, the lack of coverage data for programmes to treat moderate and severe acute malnutrition (MAM and SAM) is a major concern. Geographic coverage is poor, even in countries with very large burdens of SAM. Direct coverage estimates are needed to properly assess people’s access to treatment for both MAM and SAM.

Estimates of undernourishment based on food supply are decreasing but remain high. Access to improved water and sanitation services is steadily improving, although large coverage gaps remain in Eastern, Western, and Middle Africa for water and in Southern and South-Eastern Asia and most regions of Africa for sanitation. Trends in female secondary education enrolment are positive for all regions, although the rate is still just 50% for Africa. Health services are still lacking in Africa and Asia. 

The GNR presents data on government expenditures on the related sectors of agriculture, education, health, and social protection; this varies between and within regions.  Social protection spending¹ is increasing rapidly in many African and Asian countries.  Evidence is limited on how to make interventions that address underlying determinants more nutrition sensitive. The report offers some ideas for agriculture, social protection, education, health, and water, sanitation, and hygiene. 

The vast majority of countries do not currently track their financial commitments; spending by donors is clearer than spending by countries. The GNR reports committed² and disbursed³ funding by donors for which data were available. Multi-year commitments may be made in one year but disbursed over several years. There is some variation in how disbursements are reported⁴.   Between 2010 and 2012, commitments from 13 donors on nutrition-specific interventions rose by 39%, and disbursements rose by 30%. Nutrition-sensitive donor commitments declined by 14%, but nutrition-sensitive disbursements for the 10 donors that reported data increased by 19%. The percentage of official development assistance disbursed to nutrition in 2012 was just above 1%. 

The Scaling Up Nutrition (SUN) process score approach⁵ was noted for being a participatory measurement process that stimulates reflection among stakeholders on how they can strengthen coordinated action on nutrition. Reporting on the 2013 N4G commitments was challenging; the assessment will be strengthened in 2015.

Actions are identified to strengthen accountability in nutrition – civil society actors, national evaluation platforms, community feedback mechanisms and national and international nutrition research programmes all have a role. 

There are many gaps in data on nutrition outcomes, programmes and resources.

Ensuring all countries can report on the WHA indicators is a priority for governments and UN agencies. Data gaps may be holding back action on anaemia, overweight/obesity, and low birth weight. Gaps holding back scale up and context specific interventions include data on countries’ capacity to implement and scale up nutrition actions, programme costs, and financial resource tracking. Not all data gaps need to be addressed by new data, but by better utilisation of existing data.

Almost all countries suffer from high levels of malnutrition. The GNR calls for countries to make a common cause and exploit opportunities to learn from each other. 

To access the report and related resources (including 12 technical notes, datasets, country profiles, interactive data maps) visit: http://globalnutritionreport.org/?

Technical Note 1 provides all data sources and definitions used for the indicators in the Country Profiles and detailed description of some of the data and indicators used.

¹ Government outlays on social protection include expenditures on services and transfers provided to individual persons and households (e.g. sickness and disability, old age, survivors, family and children, unemployment, housing, social exclusion) and expenditures on services provided on a collective basis (e.g. government policy, legislation and standards for providing social protection, applied research and development) (Source: UN Statistics Division, www http://unstats.un.org/). Source of GNR data: International Food Policy Research Institute (IFPRI). Statistics of Public Expenditure for Economic Development (SPEED) 2014.

² For all donors, commitments represent the total amount reserved by a donor, backed by the appropriation or availability of the necessary funds, to provide a specified amount of resources for the benefit of a recipient country, agency, or non-governmental organisation.

³ Australia, Canada, EU, France, Germany, Ireland, Netherlands, Switzerland, UK, US, Bill and Melinda Gates Foundation, Children’s Investment Fund Foundation, World Bank.

⁴ For example, the EU 2012 total disbursement figure represents all disbursements made against their 2012 commitments, regardless of the year in which they are disbursed. All other donors have reported their disbursements against commitments made in current and previous years.

⁵ http://globalnutritionreport.org/files/2014/11/gnr14_tn_n4g_11sun_secretariat.pdf