What does nutrition-sensitive programming mean for WFP?

By Kathryn Ogden, Geraldine Lecuziat, Mutinta Hambayi, Quinn Marshall, Ali Elnawawi and Josephine Lofthouse (WFP nutrition team, Rome)

The WFP team acknowledge colleagues from IFPRI (Deanna Olney, Aulo Gelli, and Lilia Bliznashka) who supported the development of the programme impact pathways and seven opportunities. (Technical report: Making WFP’s Programmes More Nutrition-Sensitive).

Background

The new nutrition policy[1] of the World Food Programme (WFP) articulates its role in supporting governments to achieve Sustainable Development Goal (SDG) 2. It emphasises the need to integrate nutrition across WFP’s work in order to address the multiple burdens of malnutrition facing vulnerable groups. The potential impact of nutrition-sensitive programming in WFP is significant: WFP served 76.8 million people in 81 countries in 2015 (WFP, 2015), many of whom were in hard-to-reach places. The policy has three key messages:

• WFP can make a significant contribution to eliminating of all forms of malnutrition through nutrition-sensitive programming.
• Both nutrition-specific and nutrition-sensitive interventions are key in accelerating progress towards ending malnutrition in all its forms.
• Humanitarian nutrition-specific responses will remain a central feature of WFP’s work but are to be reinforced with nutrition-sensitive approaches.

This new policy reflects key changes in the global context. The 2013 Lancet Nutrition Series showed that implementing large-scale, proven, nutrition-specific interventions alone will only reduce stunting by 20% (Bhutta et al, 2013), leaving an 80% ‘black box’ which can only be addressed through nutrition-sensitive programming. We now know that one in three people globally is malnourished (IFPRI 2016), while 138 of 140 countries with data are facing single or multiple burdens of stunting among children, anaemia among women of reproductive age, or overweight among women (IFPRI 2016). Lastly, diet is the number one driver of the global burden of disease (Forouzanfar et al, 2015). WFP’s nutrition policy puts forward an integrated approach to nutrition that aims for adequate and healthy diets for vulnerable groups of all ages.

Nutrition-sensitive programming in WFP

Many of WFP’s programmes target poor and nutritionally vulnerable individuals and households and address immediate determinants of nutritional status (e.g. diet), as well as underlying determinants such as household access to food and care practices. WFP has identified four key programme areas that address some determinants of malnutrition:

• General food assistance.
• School meals, which reached 17.4m children in 2016.
• Smallholder agricultural market support programmes, which support smallholders to gain access to formal markets.
• Food assistance for assets, which addresses immediate food needs through cash, voucher or food transfers while promoting the building or rehabilitation of assets that will improve long-term food security and resilience.

A nutrition-sensitive food assistance for assets programme might, for example, build latrines or water points as the community asset; a school meals programme may involve building kitchen infrastructure or latrines; or cash transfers may be conditional on attending health centre check-ups. Improved water, sanitation and hygiene practices, care practices and knowledge may also be part of these programmes; all will be supporting improvements in dietary diversity and nutritional outcomes. In addition, through its partnerships with governments and others, WFP improves the enabling environment through supporting nutrition governance and policy formulation, multisector coordination, and better targeting, analysis and monitoring.

A nutrition-sensitive programme can also be used as a platform to scale-up nutrition-specific actions that address the immediate determinants of malnutrition. National social protection programmes, which are implemented on a large scale and target the most vulnerable people, also represent an important opportunity for delivering nutrition-sensitive programming.

For WFP, this means an organisational shift, broadening our nutrition focus beyond traditional treatment and prevention programmes beyond calories to nutrients. Programme colleagues will need support and guidance to do this.

Unlocking WFP’s potential: Guidance for nutrition-sensitive programming

Recently released WFP guidance, developed in partnership with IFPRI, aims to demystify what nutrition-sensitive means practically for WFP’s country office programmes. Programmes are encouraged to articulate how their interventions will influence nutrition outcomes by developing programme impact pathways which include inputs, activities and outputs and identify enabling and constraining factors and the means of addressing them. The guidance develops a set of minimum requirements (see Figure 1). Seven opportunities to increase nutrition-sensitivity across programmes have been identified (see Figure 2). The process to design nutrition-sensitive programmes is structured around four key steps following the logic of the project cycle:

1. Understanding the nutritional situation for vulnerable life cycle groups and the drivers for malnutrition.
2. Formulating and jointly planning the programme strategy across WFP sectors and key stakeholders and targeting nutritionally vulnerable groups.
3. Selecting key opportunities to enhance nutrition-sensitivity of the programme.
4. Measuring and monitoring progress and tracking unintended positive and negative effects.

Coordination and collaboration with government, partners and other sectors are essential within each step. WFP engagement with governments includes advocating for inclusion of nutrition-sensitive actions in national and/or sector strategies and developing joint annual action plans, facilitating links across ministries, and contributing to coordination platforms and fora.

Figure 1: Minimum requirements for nutrition-sensitive programming