Undernutrition: What Works

Undernutrition: What Works is the first part of ACF’s Zero Hunger project. What is this project all about?

The objective of this three phase project is for ACF to learn lessons from contexts which have had relative success in bringing down rates of undernutrition, and to see if policies and programmes implemented in these places are also appropriate in a case study in which undernutrition continues to be a recurring problem: Niger.  The project also looks at the regional dimensions of the fight against hunger, focusing on West Africa.

Why were the five countries featured in the report successful in reducing malnutrition rates?

The research examines five success stories – Brazil, Peru, Mozambique, Malawi and Bangladesh- which had relative success in bringing down their rates of undernutrition over the past fifteen years. Each context demonstrated, in varying degrees, a combination of six key success factors which helped bring down undernutrition; this includes strong political will, civil society participation and ownership; a multi-sectoral approach; a multi-phase approach; institutionalised coordination and continued financial investment.

Brazil’s Fome Zero programme has been praised internationally for its achievements. To what extent did malnutrition rates decrease and why was this programme so successful?

Underweight prevalence in children under five years old fell from 13 to 1.7 percent between 1994 and 2006, largely, (but not exclusively) due to the implementation of the Fome Zero programme. The success of Fome Zero lies in the fact that it is a rights-based approach, which legally binds the government to fulfill its commitments on food security. Since the early eighties, a strong civil society movement has fought for hunger issues to be central to the political agenda. The parallel promotion of health services and nutrition education packages, access to safe water and sanitation, combined with improving access to food are key to the programme’s success. Success is also related to the president’s direct involvement in planning, co-ordination and implementation.

According to your research, Malawi also proved relatively successful in reducing undernutrition. What factors contributed to this success?

In Malawi success is related to the government’s remarkable engagement and leadership on fighting hunger. Led by a few key highly motivated individuals within the Ministry of Health, engagement has led to the development and expansion of community-based management of acute malnutrition which helped the government to reach far more malnourished children, and the development of a national nutrition policy. Social cash transfer schemes and agricultural input subsidies have also been important as has an effective regional food security monitoring system. Finally, the importance of international community support cannot be underestimated.

The report challenges the common perception that high rates of undernutrition only exist in emergency settings. Why does it also persist in non-emergency settings?

Immediate causes of malnutrition are food insecurity (which includes access, availability and utilization of food), inadequate health and inappropriate care practices.  Accessing food and adequate health care are issues faced every day by many households living in the developing world, not only those in an emergency.  Difficulties are exacerbated by structural factors which people have no control over such as fluctuating food prices or the implementation of user fees for public health services. 

What can other countries learn from the experience of the featured countries?

Other countries can learn that reducing undernutrition is an attainable goal.  A combination of the six key success factors identified during this research make up an ideal ‘enabling environment’ which if in place should facilitate a reduction in rates of childhood undernutrition.

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