13. Recent Trends and Innovations in Development Assistance for Health

In most countries, nutrition has not become a visible issue on the national political agenda, because nutrition advocates have not succeeded in linking improved nutrition with political and economic goals or in creating popular demand to eliminate malnutrition. In Bangladesh in the early 1990s, the United Nations Children's Fund and the World Bank joined forces to present a case to the government showing how the country could not achieve its economic goals unless it reduced malnutrition. This effort persuaded the government's financial planners that funding a national nutrition program was a good investment, and the government approved a new nutrition project in 1995.

However, the issue is not just how to build initial commitment, often the main focus of organizations such as the World Bank. Commitment can be fragile, and the issue is how to broaden and maintain commitment and complement it with systematic investments in institutional capacity development. The first nutrition investment in Bangladesh was completed in 2001. Children's nutritional status and households' health-seeking behaviors improved substantially in project areas, and malnutrition rates declined. A follow-on nutrition investment was approved, but because of weak government commitment, it is struggling in the challenging policy environment in which the social sectors operate. The Ministry of Health has not assigned high priority to the program, and conflicts between the government and the NGOs involved in community activities have complicated the situation. Contradictory messages from donors and frequent changes in leadership within the government have added to the challenge.

More recently, donors and advocates for nutrition within the government have proposed that nutrition activities that build on earlier successes be included in the Health, Nutrition, and Population Sector Program, which is scheduled to be finalized and approved in early 2005.

In contrast, in Thailand, building commitment for nutrition was achieved during the 1980s and nurtured with little external support. Government-sponsored efforts through studies, workshops, and media outreach generated commitment for nutrition by building broad consensus (in the government, NGOs, and the private sector) on the benefits of nutrition—not as a welfare issue, but as a human development issue. This initial commitment was sustained by ensuring that policy statements were closely linked to national investment plans, by building strong technical and managerial capacity for nutrition in the country (often by means of external aid), and by linking those actions with a strong buy-in and demand from communities. Malnutrition rates in Thailand declined from 51 percent in the early 1980s to 18 percent in 1990 and continue to fall.

Source: Heaver 2002.