26 May 2015

FANUS 2015: African Nutrition at the Crossroads. But which one?

For the past day I have been attending the Federation of African Nutrition Society  (FANUS) conference in Arusha, Tanzania.  

The Conference is called “African nutrition at the crossroads”.  The question is, what does that mean?

Here are some potential meanings:

*Just as progress is being made on reducing stunting rates, overweight and obesity are increasing rapidly on the continent.   Africa’s choice?  How much effort to expend on preventing overweight, obesity and the related NCDs at risk of diluting the effort to reduce undernutrition? This is somewhat of a false (budget) choice because many of the nutrition related NCD choices are about policy rather than spending.  And the rise of nutrition related NCDs means an even greater focus on African food systems - they are at the heart of all forms of malnutrition reduction.  Again, no tradeoff there, just a strengthening of emphasis on health and nutrition.

*The commitment to reduce undernutrition on the continent is high—but will this be translated into actions and impact?  This will be harder than building commitment (which was not easy!)—the temptation to give up in the face of difficulties must be resisted. Budget allocations to nutrition need to be increased.  Frontline nutrition workers need to be hired.  The coverage of programmes needs to be expanded and monitored.  
*Economic growth is strong in many African countries.  Their Ministers of Finance face a decision: invest in the productivity of the next generation so that the coming demographic transition can be a demographic dividend or invest in unsustainable short term fixes that are electorally attractive?

*The MDGs applied to all low and middle income countries, but were mainly focused on Africa.  This will not be the case for the Sustainable Development Goals.  Africa’s voice will be diluted in the SDGs unless the countries become more active in shaping the agenda, and nutrition--represented so poorly in the latest publicly available SDG drafts—desperately needs African outrage to move nutrition higher up that agenda.

Many other regions are at these crossroads, but it seems to me that the consequences of taking the wrong paths are intensified in Africa.  Africa has more time than Asia to deal with nutrition related NCDs and it needs to use that time well.  Africa faces more challenges than other regions in terms of low nutrition budget allocations and the low number of frontline nutrition workers, but these are also opportunities—the case for increasing the allocations has never been stronger, especially from such a low base.  Tax revenues are growing more rapidly in Africa than elsewhere, partly because from low levels, and decisions made around how to spend those taxes will be difficult to undo in later years.  Finally, Africa has a lot of moral authority to exert its influence over the SGDs—African countries are affected more than other regions by the actions of the high income countries (think climate) so African countries can use that authority to raise the profile of nutrition within the SDGs.

All of these crossroads are presenting themselves to African decision-makers—those within and outside nutrition. The consequences of getting it wrong have never been higher.  But so too the benefits of getting it right. 

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