Briefer on the

Nutrition Barometer: Gauging National Responses to Undernutrition

Malnutrition is the underlying cause of one-third (or around 2.3 million) of the 6.9 million children below age five dying each year.
To address malnutrition, the World Health Assembly (WHA) set a global target to reduce the number of stunted children by 40% or 70 million by 2025. US President Barack Obama, together with G8 and African leaders and the private sector, launched the New Alliance for Food Security and Nutrition, aiming to take 50 million people out of poverty in the next decade. In addition, the hunger summit hosted by UK Prime Minister David Cameron and Brazilian Vice President Michel Temer announced measures to reduce the number of stunted children worldwide by 25 million by 2016. The European Commission has also declared its commitment to support high-burden countries to reduce stunting and accept responsibility for 10% of the overall 40% reduction target agreed at the WHA. To understand the efforts needed to reach the WHA targets, the Nutrition Barometer measures for the

first time political and economic commitments to tackle children malnutrition in a group of 36 highburden countries, together with how these countries are doing in meeting the challenges of nutrition and child survival. These 36 countries, including the Philippines, account for 90% of the worlds undernourished children. 1 The Barometer also measures the scale of the problem by looking at childrens
nutritional status the proportion that are underweight, stunted (low height-for-age) or wasted (low weightfor-height) and these childrens chances of survival. 2 The political and legal commitments are measured through seven indicators on economic and social rights, the right to food, membership in the Scaling up Nutrition (SUN), nutrition-specific commitment to the Every Woman Every Child initiative, national nutrition policies and regular monitoring of nutrition outcomes. Public expenditure indicators measure health spending and the existence of a current costed nutrition plan. Countries are then ranked separately according to both their commitments and their outcomes. For each category, countries are divided into four groups of nine and the groups are categorized as sound, fair, emerging and frail.3 Effectively, the Nutrition Barometer measures nutritional status and commitment to address undernutrition relative to other high burden countries. As with any index based on nationallevel data, it masks varying performance of countries across indicators, as well as inequality within countries. The Philippines manages to show strong outcomes despite frail commitments relative to the 35 other high burden countries. Based on the 2011 survey of the Food and Nutrition Research Institute (FNRI), 20.2% of children under 5 years old are underweight for their age while 33.6% and 7.3% are stunted and wasted, respectively. The Philippines is also on track in meeting the MDG target on child mortality. The Philippines, being a middle income country, has a higher per capita income than the rest of the group, which has resulted in improved nutrition status of the general population and consequently, relatively better outcomes. While rising household incomes may improve the nutrition status of the general population, it does not mean improved nutrition for all children, especially those living in the poorest households. In order to accelerate progress, Save the Children and World Vision recommend the following steps: Nutrition plans should include targets to improve nutrition and reduce stunting in line with the recently adopted World Health Assemblys Maternal, Infant and Young Child Nutrition

Implementation Plan, with clear timelines and details of investment required. Increase and sustain investment in direct nutrition interventions and strengthen health systems including human resources needed to deliver those interventions. Extensive dissemination of the results of the nutrition surveys Adopt the SUN framework, and fully integrate nutrition into efforts to improve maternal and child health through the Every Woman Every Child initiative, and the more recent A Promise Renewed movement that came out of the Child Survival Call to Action. Cost nutrition plans; donors and other development partners should make long-term financing commitments to meet any financing gaps in implementing nutrition plans. Donors should fulfill their existing commitments and also use forthcoming opportunities in 2013 to make further, concrete commitments to support nutrition. Specifically: o The UK should use its convening power as Chair of the G8 to ensure increased resources for nutrition and agriculture, to fill the funding gap, and take concrete steps to address major threats to progress such as increasing volatility of food prices. o EU to produce a roadmap on how it will reach its recently announced support to highburden countries to reduce stunting and accept responsibility for 10% of the overall 40% reduction target agreed at the World Health Assembly, in addition to convening a highlevel conference on the impacts of climate change on nutrition.

The 36 high burden countries are Afghanistan, Angola, Bangladesh, Burkina Faso, Burundi, Cambodia, Cameroon, Cte d'Ivoire, Democratic Republic of the Congo, Egypt, Ethiopia, Ghana, Guatemala, India, Indonesia, Iraq, Kenya, Madagascar, Malawi, Mali, Mozambique, Myanmar, Niger, Nigeria, Nepal, Pakistan, Peru, Philippines, South Africa, Sudan, United Republic of Tanzania, Uganda, Viet Nam, Yemen, Turkey, and Zambia. 2 The sources of information are from official reports and represent the most recent available and comparable data (as of publication) on the key indicators outlined. For the indicators for the political and legal commitments, the information comes from the UN Treaty Collection, Every Woman Every Child, SUN, UNICEFs childinfo.org, Demographic and Health Surveys, and the Multiple Indicator Cluster Survey. Information about the right to food is from Knuth and Vidar (2011), briefing notes from the UN Special Rapporteur on the Right to Food and the Food and Agriculture Organisation. National Nutrition polices are from various sources. The data on public health spending are from 2010 and collected from the World Development Indicators, government health spending per capita is from World Health Statistics 2012. The existence of government costed nutrition plans are from a variety of sources more details are available on the website. The nutrition outcome indictors are from UNICEFs childinfo.org, Multiple Indicator Cluster Survey, Demographic and Health Surveys and comparable national surveys. Progress to MDG4 2015 is from the 2012 report from Countdown to 2015.
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Commitments and outcomes are assessed using the Borda scoring system. The seven indicators for political and legal commitments are given equal weights and scored between 0 and 1. The country that comes out best is receives a Borda score of 36 and the one that comes out worst gets a Borda score of 1. Outcome indicators are scored from 0 to 3 and given equal weight. We rank countries based on their proportion of underweight, stunted and wasted children with the country having the least proportion receiving a score of 3. For the child survival outcomes, a country is given the lowest score of 0 if it has had no progress towards MDG 4 and the highest of 3 if it has already achieved this. The scores for the four indicators are summed up and countries are ranked from best to worst with best country getting a Borda score of 36. Countries are then ranked from best to worst and divided into quartiles. The first nine countries are classified as having sound commitments, the next nine as having fair commitments, the third nine countries as having emerging commitments and the bottom nine as having frail commitments. Outcome scores are also ranked from best to worst and countries are again divided into quartiles of sound, fair, emerging and frail outcomes.