Goals & Objectives

There is enough evidence linking nutrition and good maternal and child health (MCH) outcomes; however, nutrition has been poorly integrated with MCH activities in most countries. It is important, therefore, to converge the nutrition agenda in selected countries with the MCH agendas towards the achievement of MDGs 1, 4 and 5. The Mainstreaming Nutrition Initiative (MNI) was formed last year with support from the World Bank by ICDDR,B in Bangladesh in collaboration with other partners including Cornell University, the Aga Khan University, and the Partnership for Maternal, Neonatal and Child Health.

The key objectives of the Initiative are: development of effective policies for mainstreaming nutrition, assisting countries in implementing programs at scale, and global advocacy for the mainstreaming process. The Mainstreaming Nutrition Initiative has identified four key strategic objectives in order for nutrition to be effectively mainstreamed into health sector policies and programs and for nutrition related goals to be achieved. These are:

1. Effective policies and programs must be developed;

2. Policies and programs must be implemented at sufficient scale and quality to produce measurable impacts;

3. There must be an effective alliance at country level to provide leadership, mobilize support and expertise, and oversee the nutrition agenda over the long term.

4. There must be effective strategic leadership and management capacity at country level to assess country needs, plan a comprehensive nutrition strategy, and oversee the implementation of critical nutrition actions.

Key nutrition priorities for achieving the MDGs

Shift from a curative to a preventive focus. The majority of the world’s children are born healthy, and maintenance of adequate child growth is an excellent indicator of good health. Mothers and program workers who strive for adequate child growth each month can prevent childhood malnutrition and illness. Few well-nourished children die from communicable diseases, however, as children slip into moderate or even mild degrees of malnutrition, the risk of death from illness increases. Therefore, preventing even mild and moderate malnutrition- which account for the vast majority of all malnutrition- will lead to large reductions in child mortality.

Focus nutrition interventions from pregnancy through two years of age. The best window of opportunity for addressing malnutrition lies between pregnancy through two years of age. Actions targeted over two years of age, such as school feeding programs, are likely to have little impact on reversing the damage to brain development, stunting, or to impact on the link with NCDs established in the early years. Many programs target all children under five, overloading health workers and community volunteers and diluting efforts to prevent malnutrition during the critical first two years of life.

Move from a vertical to an integrated approach to caring for children. Most programs focus on an isolated area of child health, such as breastfeeding or the major childhood illnesses. A more comprehensive approach for improving nutrition outcomes includes: (1) incorporating growth promotion with growth monitoring, (2) improving maternal knowledge and care during pregnancy and infant feeding and care practices, such as exclusive breast feeding and adequate and timely complementary feeding and (3) micronutrient supplementation.

Seek solutions to faltering growth first with the family and within the community. Providing food has been the conventional treatment for malnutrition. Countries spend millions of dollars on food aid with little impact on nutrition or health. There is a place for food aid, particularly in emergencies. However, the accumulating body of evidence suggests that with the proper guidance, the majority of families can meet the nutritional needs of their young with their own resources. The kind of guidance that makes the difference in whether or not a child gains adequate weight from one month to the next may be for example, a recommendation about the number of times he or she is breastfed during the day and night. It could mean teaching a mother that she must give her child two more spoonfuls of rice at each meal or half a tortilla twice a day. The changes needed at this age are small (about 300 kilocalories per day) and within the reach of the majority of families. Of course, individuals or families cannot manage some problems alone. The involvement of the broader community usually results in locally viable solutions. Again, the problem may not be lack of food or absolute economic constraint, but the need for child care while a mother goes to work. As a solution, the community might offer organized child care. In many instances, it is not feasible or affordable for families to travel to the nearest clinic for monthly weight monitoring or at the onset of illness. Therefore, health maintenance must be brought to the community level. Community members can be trained to weigh children, detect adequate or inadequate changes in weight, diagnose any problems, and make decisions about what action should be taken. They can also counsel mothers and help them improve their child’s growth.