No Wasted Lives: Accelerating action for children with acute malnutrition

By Saul Guerrero, Nancy Aburto, Erin Body, Diane Holland, Guy Holloway, Abigail Perry and Sophie Whitney

Saul Guerrero is the Director of International Nutrition Initiatives at Action Against Hunger USA and interim Coordinator of the No Wasted Livescoalition. He previously worked for Valid International supporting the design, implementation and evaluation of community-based management of acute malnutrition (CMAM) interventions. In 2012 he co-created the Coverage Monitoring Network (CMN).

Nancy Aburto is the Chief of the Nutrition Specific unit of the Nutrition Division of the World Food Programme (WFP) based in Rome, Italy. She has more than 15 years of experience in public health nutrition.

Erin Boyd is a Nutrition Advisor at USAID/OFDA. She has overten years of experience in emergency nutrition response, covering policy, programme management, monitoring and evaluation, coordination and operational research.

Diane Holland is Senior Nutrition Advisor at UNICEF New York with a focus on scaling up programming to treat severe acute malnutrition and emergency nutrition. She previously worked in public health nutrition with non-governmental organisations (NGOs), UN agencies and in academia.

Guy Holloway is interim manager of the severe acute malnutrition portfolio at the Children’s Investment Fund Foundation (CIFF) and has extensive experience in delivering child-centred health programmes across Sub-Saharan Africa and South Asia.

Abigail Perry is Senior Nutrition Adviser at DFID.She has extensive experience in development and emergency work and previously worked in a variety of technical roles for different NGOs and as a Research Associate at University College London.

Sophie Whitney is Global Nutrition Expert for the European Commission Directorate-General for European Civil Protection and Humanitarian Aid Operations (ECHO). She has extensive experience in nutrition, having worked for over 15 years in programme design, monitoring and implementation.

In Field Exchange 53 (November 2016) colleagues from Action Against Hunger, UNICEF, the Children’s Investment Fund Foundation (CIFF), the Department for International Development (DFID), the European Commission and the United States Agency for International Development (USAID) made a collective case to scale up services to manage severe acute malnutrition (SAM) around the world. In that joint op-ed the authors recognised that “to unlock the global and national challenges we will need to bring our different skills, knowledge, geographical reach and diverse networks to bear on this very pressing problem. Only if efforts are coordinated and dialogue sustained on the opportunities and challenges we face, will we maximise the influence and impact we can leverage, and bring others on board to drive change”. 

Since then other agencies, including the World Food Programme (WFP), the innocent foundation, the International Rescue Committee (IRC) and ALIMA, have come forward to answer this call and together we have created No Wasted Lives, a coalition to accelerate action for children with acute malnutrition. 

The coalition aims to double the number of children receiving treatment for SAM to six million per year by 2020 as a critical step towards achieving universal coverage by 2030. Recognising that focusing on treatment alone will not result in the elimination of malnutrition (Sustainable Development Goal (SDG) target 2.2), the coalition also has a long-term vision of improving prevention options to reduce the number of children becoming acutely malnourished so that treatment caseloads are manageable. Over the next few years, the coalition will work towards achieving a series of outcomes, including:

• The cost of curing a child suffering from SAM reduced to US$100 or less (from the current US$150-250);
• The cost of ready-to-use foods per child cured reduced by 50%;
• New treatment approaches proved capable of reaching over 70% of cases in areas of intervention (from the current 30-40%);
• Five key high-burden countries to adopt reduction and treatment coverage targets;
• Nutrition policies of all key bilateral donors to support scale-up of acute malnutrition programming, including treatment for SAM and prevention;
• All key high-burden countries to have national nutrition policies that promote prevention of and community-based treatment for SAM; and
• New financial pledges to be made that support actions to address acute malnutrition. 

To achieve these ambitious aims and outcomes, the coalition will work on three key areas:

Advocacy agenda

The coalition will engage governments and other actors to support them in making the best decisions about prevention of and treatment for SAM. The coalition aims to facilitate the provision of evidence, intelligence and data that governments and other key actors need to make informed decisions. To this end, the coalition is currently developing a multi-year advocacy strategy supported by a US$2.3 million grant from the CIFF. 

Technical accelerator

The coalition will invest in cutting-edge ideas and bold hypotheses to drive forward global learning and action on prevention and treatment of acute malnutrition. To guide and support these efforts, the coalition has created an independent Council of Research and Technical Advice on Severe Acute Malnutrition (CORTASAM), which brings together over a dozen of the world’s leading academics, practitioners and policy-makers in this area (see article in this edition of Field Exchange). The coalition has already invested over US$8 million in operational research projects, including pilots on the integration of SAM treatment into the integrated community case management (iCCM) of childhood illnesses (Mali, Pakistan and Kenya); reduced dosage of ready-to-use therapeutic foods (RUTF) (MANGO project in Burkina Faso); simplified protocols for treatment of moderate acute malnutrition (MAM) and SAM (COMPAS project in Kenya and South Sudan, non-inferiority test in Burkina Faso); and setting up the new website The State of Severe Malnutrition (see www.severemalnutrition.org and feature in this edition of Field Exchange). The coalition is also supporting the ongoing prioritisation of research questions on acute malnutrition, using evidence gaps and opportunities for improving coverage as a primary step in the creation of a global research agenda on acute malnutrition (see article for headline findings). 

Donor forum

The coalition will convene and host a forum for traditional and non-traditional donors and governments with a view to increasing the overall amount of money available, improving coordination of existing investments, unlocking new health and long-term funding and bringing new donors and businesses to the table. This will include health/development departments of donors with prior history of supporting SAM treatment through their nutrition/humanitarian departments as well as foundations, bilateral and multilateral agencies and individual donors with no history of investing in this area. The forum will help donors align their messaging, approaches and priorities to ensure coherence. By facilitating information exchange, the coalition will encourage better integration of funding for SAM into global and domestic health budgets and will give donors, governments and service providers the best chance of driving down costs and maximising economies of scale. 

Over the coming months the coalition will work with UNICEF and its national partners in the development of regional scale-up plans for SAM management services as part of, and to complement, nutrition costed plans currently being developed in many of these countries. The UNICEF-organised multi-stakeholder meetings in East Africa (16-18 May ), South Asia (18-20 May)¹ and West Africa (19-21 June) provided the basis for these regional plans by identifying key challenges and opportunities for scaling up services across a range of contexts. The meetings brought together UNICEF country and regional office representatives and ministry of health delegates from virtually all countries in these regions. 

No Wasted Lives will continue to build on existing efforts, create and maximise synergies and bring new players on board to accelerate progress and overcome the programmatic, technical, policy and financing challenges to addressing the global burden of acute malnutrition. We have convened a coalition of partners to begin this journey but we cannot do this alone: the success or failure of this initiative will rest on our ability to engage and mobilise governments, civil society, business and other stakeholders to push this ambitious agenda.

If you or your organisation would like to know more and to explore ways to support and collaborate with No Wasted Lives, visit our website (www.nowastedlives.org) or reach out to us on info@nowastedlives.org. 

Footnotes

¹See Stunting & Wasting in South Asia – Reflections from a Regional conference  by Charulatha Banerjee, ENN Regional Knowledge Management Specialist (SUN Movement) in the region. www.ennonline.net/mediahub/wastinginsouthasia