Building commitment and capacity for nutrition: Time to act

Global and national momentum to address the challenge of malnutrition has never been higher, and the knowledge now exists to build commitment and to convert it into enduring impacts, according to the authors of the fourth paper in The Lancet Series on maternal and childhood malnutrition.

"With sound evidence and dynamic leadership, underpinned by strengthened institutional capacity, a lasting political commitment can be forged, generating lifelong benefits for millions of women and children currently at risk of illness or death arising from malnutrition,"* says Stuart Gillespie, a lead author of the paper.

The authors emphasise that political leaders and policy makers need to prioritise investment in nutrition, focusing investment on the nutrition-specific interventions supported by the best evidence, as identified in the second Series paper, and maximising the nutrition-sensitivity of national development processes, as outlined in the third Series paper.

According to Lawrence Haddad, another lead author, "Framing of undernutrition reduction as an apolitical issue is myopic and self-defeating. Political calculations are at the heart of effective coordination between the many different sectors and organisations which need to be engaged and committed to undernutrition reduction."*

"While the developments of the last five years have shown us that political commitment to nutrition can be developed in a short time, this commitment must not be squandered. Now is our crucial window of opportunity to scale up nutrition."*

Examining the controversial role of the private sector in improving nutrition, the authors note that trust in the private sector has been badly eroded by continuing violations of the breast milk substitute marketing code, yet there is now "substantial potential" for the private sector to contribute to the acceleration of improvements in nutrition. However, efforts to realise this potential have been hindered by a lack of credible evidence, as well as a lack of accountability and appropriate regulation, and addressing these issues will be essential if the private sector is to be effectively and appropriately engaged.

In recent years, some countries have achieved a rapid and substantial reduction in their burden of malnutrition, showing that, with concerted action, undernutrition rates can be tackled. In Ethiopia, for example, there have been considerable improvements in recent years to maternal and child health nutrition.

In a Comment accompanying the Series, Ferew Lemma, of Ethiopia's Ministry of Health, and Joan Matji of UNICEF Ethiopia, outline how this has been achieved, largely through a concerted, country-led, and community-focused set of actions and service expansions, which have resulted in the child mortality rate halving in just over ten years, and accelerated rates of undernutrition reduction.

In another Comment, Anna Taylor, Senior Nutrition Adviser to the UK's Department for International Development (DfID) and co-authors reiterate the findings of Dr Gillespie and co-authors, writing that: "Everyone is part of the solution. Governments need to lead; businesses need to identify how to improve nutrition through their business models and employment practice; civil society organisations need to help citizens to drive transparency and accountability; and the scientific community needs to keep us focused on evidence about what works. Policy commitments, capacity strengthening, and targeted financing are all essential."