International Development Sub-Committee on the Work of the Independent Commission for Aid Impact
Oral evidence: ICAI’s review on assessing DFID’s results in nutrition, HC 1213
Wednesday 24 February 2021
Ordered by the House of Commons to be published on 24 February 2021.
Members present: Theo Clarke (Chair); Sarah Champion; Chris Law; Kate Osamor.
Questions 1 - 35
I: Wendy Morton MP, Minister for European Neighbourhood and the Americas, Foreign, Commonwealth and Development Office, and Darren Welch, Director of Global Health, FCDO.
II: Dr Tamsyn Barton, Chief Commissioner, ICAI, and Jonathan France, Review Lead, ICAI.
III: Dr Agnes Kalibata, UN Special Envoy for the 2021 Food Systems Summit, Martha Nyagaya, Kenya Country Director, Nutrition International, Callum Northcote, Senior Nutrition Policy and Advocacy Adviser, Save the Children, and Simon Bishop, CEO, Power of Nutrition.
Witnesses: Wendy Morton MP and Darren Welch.
Q1 Chair: I welcome our first panel of witnesses for the Sub-Committee’s evidence session on ICAI’s review of DFID’s results in nutrition. We are delighted this morning to be joined by Wendy Morton, a Minister at the Foreign, Commonwealth and Development Office. Can I turn to you first, Minister Morton? How are the UK’s aid nutrition priorities going to be reviewed in the light of the DFID-FCO merger?
Wendy Morton: First of all, let me thank the Committee for inviting me today. Obviously, the Foreign and Commonwealth Office merged with DFID earlier in the year, but the creation of the new FCDO really does enable us to unite the development work with diplomacy in one Department. As you will be aware, the Foreign Secretary is focused on health. We have a new global health directorate, which is headed by Darren Welch. This is the first time that all the teams working on health will be united in one directorate. We really expect that this will bring a greater impact and efficiency in our work on health. That includes nutrition. It is important to recognise that the nutrition team is continuing in the new organisation to do the work that it was doing.
Q2 Chair: What steps will you be taking to protect the global nutrition budget going forward?
Wendy Morton: When it comes to future funding, you will be aware that the UK has played a pivotal role in securing increased investment in nutrition since hosting the 2013 Nutrition for Growth summit. We are working closely with the Government of Japan to ensure that the 2021 Tokyo Nutrition for Growth summit is a success. We have invested at least £3.7 billion to tackle malnutrition since that 2013 summit. Between April 2015 and March 2020, we reached 55.1 million young children, women and adolescent girls with nutrition support. It is important to note that, as part of our Covid-19 response in 2020, we maintained support for vital services to prevent and treat malnutrition in a range of countries, including Somalia, Ethiopia, Zambia and Yemen.
Looking forward, which was where your focus was, we will build on this investment. We are directing our technical, financial and diplomatic expertise, thinking about the new FCDO, to support partner Governments to strengthen their own policies and systems. We will also leverage the range of investments we make in different sectors to address malnutrition and drive action, accountability and food systems to enable more people to access nutritious diets. We will give priority to reforming how acute malnutrition is addressed by driving innovation in financing and supporting Governments to adapt their own approaches, particularly in those countries that are facing recurrent climate-related crises as well.
There is a lot of work going on. We are also currently undertaking a rigorous internal prioritisation process, as I know the Committee will be aware of, in response to the spending review announcement. I cannot give you any details at this stage about our future funding, but we will provide an update on the implications of this process for any Nutrition for Growth commitment and our funding nutrition as soon as possible.
Q3 Sarah Champion: Good morning, Minister. I wonder whether you could tell us what work, if any, the FCDO is doing with the Department for Environment, Food and Rural Affairs to improve initiatives for sustainable agriculture in developing countries.
Wendy Morton: I will set out some of the work that we are doing in terms of support for agriculture and access to healthy and sustainable diets. That is the important link. We absolutely agree that enabling people to access the right type of food is just as important as having the quantity of food available.
We are focusing on three dimensions. First, our research investment is helping to develop more nutritious and climate-resilient crop varieties. Secondly, we are adapting how we invest in agriculture and private-sector development to improve nutrition. Thirdly, we are supporting Governments to strengthen their policies and promoting accountability by businesses to improve diets. It is a three-step approach.
As part of that, we are a major supporter of the development of biofortified crops by HarvestPlus and the International Potato Centre. We know that biofortified varieties of maize, beans and these sorts of crops that are rich in nutrients have been developed in collaboration with research institutes across Africa and south Asia. We are also working on the adaptation of agriculture and private-sector programmes. Our commercial agriculture for smallholders and agribusiness programmes helps strengthen production of nutritious foods. This is helping the production capacity of smallholders in Malawi as well.
There are many other examples. There is AgDevCo, which is an impact investor that we are working with to improve production of foods in Rwanda, Mozambique, Tanzania and Zambia. We are also supporting the innovative Food Cities 2022 initiative, which is working in countries such as Bangladesh, Malawi and Uganda. There is also the support for the Access to Nutrition Initiative, ATNI. We are working and liaising very closely with DEFRA, as you would expect, on the national food strategy.
Hopefully I have given you a flavour—that was not meant to be funny—or a sense of the breadth of work that we are doing. If it would be of interest, I could ask Darren Welch, who is on the panel with me, to comment a little bit more on the national food strategy.
Q4 Sarah Champion: It would be of interest. To continue the pun, you have provided us with a whole meal of information there, Minister. Can I ask a very specific thing? Are the seeds for the biofortified crops that you are talking about more expensive? Are they F1? Can farmers use them to reproduce their own crops next time? I would hate for us to encourage people to use crops that they cannot afford.
Wendy Morton: That is a really important point. I might need to ask Darren to comment on the specifics of the cost. The important thing here is about working with farmers and producers on the ground to produce food that is nutritious but affordable. It is also about that sustainability piece. I will defer to Darren on the actual costings, if that is all right with you, and perhaps he can pick up on that national food strategy point as well.
Darren Welch: There is a lot of food for thought this morning, to continue the metaphors. The important point in the question that the Minister makes is about the cross-Government approach to our work on global health and nutrition more generally. We are obviously working very closely with DEFRA, but also with DHSC, on the broader span of our global health initiatives. As the FCDO represents all the Government’s policies overseas, the creation of the new merged Department enables us to be even more influential in how we interact with Governments around the world.
The national food strategy is important because what we import, the standards, the regulatory requirements, and the markets we create and trade into are very important for many of the countries we want to help. Getting that right and having an international development lens on our national strategy is very important. That is why I am attending regular meetings over at DEFRA to try to influence the way the national food strategy work is developing.
On the specific question about costs of biofortified foods, I am afraid we do not have the answer to that right now. If you indulge us, we will come back to you on that. There is no reason to expect it all to be more expensive, but we will confirm that shortly.
Q5 Kate Osamor: What steps are you taking to implement ICAI’s recommendations, especially when you are working with other Departments?
Wendy Morton: I can touch on it broadly, Kate. If you want me to go into specifics about any of the six recommendations, I am happy to do so. The important thing to recognise is that, overall, it was a positive report in terms of the nutrition results and the work that we have achieved. Obviously, we always know that we can do more. It is an important part of the work that we are doing. It is fair to say that we are making good progress on the actions that we committed to taking in our response. In all cases, we should complete the work that we committed to undertake for each of the recommendations by September 2021.
We are currently reviewing the best practice relating to recommendations 1, 3, and 5 on results measurement, reaching the most marginalised and improving access to healthy diets. We have already taken steps to strengthen citizen feedback and promote the convergence of programmes; those are recommendations 4 and 6. Options for strengthening the results methodology and standardising reporting have been developed as well, which is recommendation 2. They will be implemented once we have agreed a way forward on our results work. Hopefully, that sets out what our position is in relation to each of the six recommendations.
Q6 Kate Osamor: Minister, you are right to say in your response that the Department has done very well. Given the changes that are upon you—and you have not been able to tell us what these changes will look like or how they will impact on various programmes—how are you going to ensure that the great work you have already done withstands that and does not deteriorate, putting the most marginalised families in the worst predicaments?
Wendy Morton: I know that the Committee wants to draw me on financial commitments, and you know that I cannot do that. There is a big reprioritisation going on. As I set out in some of my opening responses, the new FCDO is very much a merger of development and diplomacy working really closely together. The work of the nutrition department continues, as I set out earlier. It is also important to recognise that nutrition feeds into many other elements of work that we are doing, and in particular the work around ending preventable deaths of children, mothers and new-borns.
Q7 Kate Osamor: Nutrition is not really just about money; it is about the well‑being of many nations. The Committee is not trying to draw you out; we just need to know that you are rooting and fighting for those people who need the Department to do that. It is not about whether money is sliced away and given to diplomacy; it is about ensuring that everyone we are committed to can eat and feed themselves.
Wendy Morton: The important thing to recognise here is that our approach to nutrition, moving forward, will be an integral part of our broader work to end preventable deaths of mothers, new-borns and children by 2020. While we will not have a stand-alone nutrition strategy, we will publish an action plan on our commitment to ending preventable deaths this year. You said that it was not just about money. It is about that holistic picture here. The action plan will prioritise three really key areas of nutrition. This will build on the investments and results that we have achieved over the past decade.
There are three parts to this. If I can just briefly set them out, that might be helpful. First, we will continue to promote the integration of highly cost-effective nutrition services into health. This includes services such as breastfeeding support and treatment for acute malnutrition because we know that these services play an important part in reducing mortality and averting malnutrition. We are trying to prevent some of the further challenges and problems later in life and downstream. We are going to pay particular attention to how the multilateral system can improve how nutrition services are delivered as part of health systems strengthening, which is important too.
Secondly, we will focus on enabling more women, adolescent girls and young children to access nutritious diets. This is going to link to the work being done across the FCDO to support stronger food systems, particularly in the face of climate change, and leveraging our funding in areas such as climate adaptation. It will also consider the role of the multilaterals and the development of finance instruments.
The third point is about continuing to support the empowerment of Governments to lead their own efforts to address malnutrition. This is about that longer-term sustainability piece. It also reflects some of the points that were raised in the ICAI report. I is also really important to note that our support for technical assistance and advocacy has generated wider impacts.
Finally, it is important to remember that we will continue to deliver humanitarian nutrition response. This will include making sure that women and children in countries at risk from famine are able to access the life-saving services to treat acute malnutrition. Hopefully, that gives you a bit of a flavour of what the Department’s priorities going forward are in that nutrition space, linking in with EPD as well.
Kate Osamor: Thank you, Minister. I appreciate your response.
Darren Welch: It is important to remember that neither DFID nor the old Foreign Office had a global health directorate. This is genuinely something new that has been built, which shows the importance that our Ministers are attaching to global health, for good reasons at the moment.
We are not going to be really credible on global health unless we have a strong offer on nutrition. We have a great foundation to build on; that has been recognised by ICAI and the Committee. We want to build on that. We may do things in slightly different ways. As the Minister has said, we may look at integrating work on nutrition into what we do on ending preventable deaths and the TA we provide to our partner Governments. It is a really important part of our work towards universal health coverage as well.
We can do more with businesses, too. We know that the foods that businesses produce are not always nutritious. In one study, only a third were found to be up to the standards we want for a nutritious diet. Working in different ways with business, we can also drive higher standards. There are a lot of opportunities and there is a good foundation for us to work on. It might just look a bit different from what we have become used to.
Q8 Chris Law: I have a question for Minister Morton. We have not talked so far about the impacts of Covid-19. What impact has the pandemic had on the delivery of the UK’s nutrition programmes and global food security generally?
Wendy Morton: That is a really important question. We know that people who are malnourished are more likely to be severely affected by Covid-19. The impacts of Covid-19 are threatening to reverse the gains that we have made in reducing malnutrition. That is why, since the very early stages of the pandemic last year, we have emphasised the importance of maintaining services to prevent and treat malnutrition. We have prioritised nutrition support in a range of countries as part of our Covid-19 response. That includes Somalia, Yemen, South Sudan and Ethiopia.
We have focused particularly on strengthening the monitoring of the impacts of Covid-19 on nutrition. This includes compiling evidence of disruptions to key services and food consumption patterns. If you have the strong evidence base, you know where to target and build on. We have also adapted our support to the Access to Nutrition Initiative to monitor the responses by the business community to address nutrition issues in the face of Covid-19. We have also worked with humanitarian actors to improve surveillance in high-risk countries so that action can be taken.
We have also worked with our partners to adapt how nutrition issues are addressed when faced with Covid-19. I can share an example of that with you. Our support to UNICEF has enabled it to help countries modify how acute malnutrition is treated to reduce the risk of transmission of Covid-19. We have worked with Nutrition International and the Scaling Up Nutrition Movement, which helps enable Governments to access tailored advice on how to protect and support good nutrition as part of their own pandemic response.
Q9 Chris Law: You are right that there has clearly been a disruption. It is good to hear about some of the assessments being made by the UK. The estimate is that between 2020 and 2022 there will be an additional 9.3 million children under five with wasting disease, an estimated 2.6 million additional children with stunted growth, and 168 deaths of children under five due to malnutrition, after decades of steady decline. What further resources are going to be committed by the UK Government, particularly to achieve the global nutrition targets of SDGs 2 and 3?
Wendy Morton: Covid-19, as you rightly recognise, has highlighted some of the challenges we face. Acute malnutrition is estimated to have increased by 14% by the end of 2020 as a result of the indirect impacts of Covid-19. Many countries, including those with a high malnutrition risk, have faced significant disruptions to key nutrition services such as breastfeeding support and delivery of vitamins. As I have explained, because of the reprioritisation process that we are going through internally, I cannot set out any more detail at the moment. As soon as I can, I will certainly come back to you on that.
This is also about looking at the nutrition piece holistically. I have linked it in with the work that we are doing on EPD and where we are giving support to Governments to increase that longer-term sustainability piece.
Q10 Chris Law: Thank you. How will the FCDO improve its approach to reaching the most vulnerable in hard-to-reach areas? It was identified as an area for improvement in the ICAI review.
Wendy Morton: Our focus obviously remains on vulnerable people. The important part here is working around universal health coverage as well. In terms of what we are doing coming out of Covid-19 and our work on nutrition, our focus on global health and humanitarian assistance will ensure that we continue to prioritise reaching people who are affected by malnutrition. Our work on famine prevention will mean that support is prioritised to those parts of the world where malnutrition is particularly severe. Our focus on strengthening health systems will help address malnutrition and improve delivery of essential nutrition services. The other important part to remember is that our continued support for social protection will be invaluable for reaching many of those who are at risk of malnutrition.
Q11 Chris Law: Moving on to the integrated review, I know you have said you cannot let us know just now what future financial commitments there will be. Am I right in saying that we should accept that there will be decisions that will affect areas of focus on the FCDO’s nutrition efforts as a result of the integrated review?
Wendy Morton: I have explained the position in terms of spend and funding. The full conclusions of the integrated review will be announced in March. I am not in a position to comment on any of the outcomes at this stage. I can say that the IR will define the Government’s ambition for the UK’s role in the world and the strategic aims for our national security and foreign policy. It will also importantly outline the way in which the UK will be a problem-solving and burden-sharing nation. It will set a strong direction for recovery from Covid-19, both at home and overseas, so that we can work together to build back better. I am not in a position to comment on any of the specifics. We will all have to wait and see.
Q12 Chris Law: That is fine. Thank you for that. Does the shift towards the Indo-Pacific region—and this is one that concerns all of us—mean that there will be less of a focus on core development efforts such as nutrition programmes in Africa?
Wendy Morton: This is an area that is often raised and is of interest to people. We have been very clear when it comes to our focus on the Indo-Pacific and the work that we are doing that we will align our work around where it needs to be strategically. There will be some focus on the Indo-Pacific, but importantly there will remain a focus on Africa. It is important that we do not lose sight of that in all that we are doing as we come through the various reviews.
It is about focusing on where the UK’s development, security and economic interests align. It is also about considering the needs, including levels of poverty, and the ability of countries to fund themselves. We are really making sure that every penny that we spend on ODA goes as far as possible and has the greatest impact that we are able to achieve; hence it includes the Indo-Pacific region and Africa.
There are no decisions yet in terms of individual counties or sectoral budgets. That process is ongoing as we go through this internal business planning process, which will then start to allocate the ODA budget across both the priorities and the geographies. Again, we are going to have to wait a little bit longer, but it will hopefully be soon.
Q13 Chris Law: You have answered my next question, which was about countries. In response to recommendation 2 made by ICAI, the Government say they are carrying out a number of reviews and reassessments aimed at improved data gathering, but no dates have been attached. Can you give us some idea of the target dates for completing each of these actions on data?
Wendy Morton: Our aim is to work through all the recommendations by September 2021, broadly speaking. In terms of that one, I might need to just go back and check for something a bit more specific. In terms of the broader adoption of all the recommendations, we have made great progress on them and September 2021 was very much our target.
Q14 Chris Law: DFID’s nutrition policy unit is highly regarded, and I hope it will continue. That is my next question, really. Will the FCDO maintain a dedicated unit with the technical expertise of the former DFID team?
Wendy Morton: Darren touched on this very eloquently before. This is the first time we have really had a single global health team. It is working across both directorates. We expect this to bring a bigger impact and efficiencies to the work we do in health; that includes nutrition. The nutrition team is continuing to do the work that it is doing. No decisions have been taken as to the implications for specific teams as we go through the prioritisation process. The team is continuing to do the work that it does.
Q15 Chris Law: I have one last question—I know you have had quite a few from me.
Wendy Morton: That is all right.
Chris Law: The progress made in tackling malnutrition over the years is largely down to the UK’s historic leadership as host of the first Nutrition for Growth summit in 2013, which you pointed out earlier. With the next summit due to be held in Tokyo in December, will it not be embarrassing if the UK makes a miniscule pledge due to the merger and extreme budget cuts? Allies such as Japan, the US and Canada are rallying around to prevent the worst effects of Covid on malnutrition.
Wendy Morton: When it comes to Nutrition for Growth and funding, it is important to recognise that we have already exceeded our commitment to invest £2.13 billion in nutrition-sensitive programmes between 2013 and 2020. To date, we have spent £2.7 billion on this type of programme. The next update in terms of a nutrition-specific spending target will be published in June 2021. As I have said, I cannot make a further commitment while the internal process is ongoing. When it comes to Nutrition for Growth, as I noted last December, when I spoke at Canada’s year of action event, we remain firmly committed to the Nutrition for Growth process. We are continuing to work really closely with the Government of Japan on preparations for the 2021 summit. We will be reviewing options for any new Nutrition for Growth commitment once the business planning process is complete.
Chris Law: Thank you, Minister. That is much appreciated.
Darren Welch: We are very fortunate to have a fantastic nutrition team. The Committee recognises that they do amazing work. We are really appreciative of all of their efforts and how they have enabled the UK to show that leadership. We hope that they will continue to support us in doing that as we move towards the important nutrition events over the course of the year. We have a world Food Systems Summit coming up. We have Nutrition for Growth. There are lots of opportunities for us to set out what our approach is going to be. As I said before, that may look a bit different, but that should not be read as any lessening of our ambition in this area.
Q16 Chair: Minister, I had an additional question. We all know how important it is to feed children in order for them to be able to attend school and concentrate in class. Given the Prime Minister’s commitment to a girls’ education strategy, can I ask how nutrition will feed into that, given the important connection of nutrition to education?
Wendy Morton: That is another really important point. The Prime Minister is committed to 12 years’ education for girls. I know this is a topic that is of particular interest to you, Chair. This highlights that, when it comes to nutrition, it is much more than nutrition. For girls to go to school, they do need access to nutrition. It is like the links to WASH. It is part of the importance of getting girls not just into education, but back into education.
We know that, as a result of Covid, so many children and young girls have dropped out of education. It is important that we get them back. As the Committee will be aware, the UK is a real global leader when it comes to girls’ education. We know that, for children to learn, they need the right diet. They need the right nutrients.
The other important thing to remember is that we know that malnutrition disproportionately affects women and girls. Not only does it prevent them from attending school, but it hinders the potential of those who get to school. It is not feasible to integrate nutrition activities in all our education programmes, but we have promoted it wherever possible. As an example, our programmes in Ghana have provided nutrition training on locally available food to adolescents. That is one way in which we can link nutrition in with education.
Q17 Chair: You talked about the impact of Covid-19 on global health and food security. I wanted to pick up on a specific angle, which is about humanitarian support to refugees. I have visited several refugee camps and seen the food distribution networks with the World Food Programme and other British NGOs working on the ground. Could I ask how Covid-19 is impacting on food distribution in refugee camps and what we are doing to address nutrition, given how challenging it will be for refugees and displaced persons in the challenging context of today?
Wendy Morton: I visited a refugee camp some time ago, although I have to admit it was pre-Covid. When it comes to our work in humanitarian assistance, it is important to recognise that, last year, the Prime Minister appointed Nick Dyer as our famine envoy. I must admit that the humanitarian response is more under one of my colleagues’ briefs than mine, but I recognise the importance of our humanitarian response, access to refugee camps, and nutrition and supply of food there.
Darren Welch: On that last point, we announced £180 million specifically for famine-related support along with the appointment of Nick Dyer in his role. We are acutely aware of the need to get services in for some of the most marginalised people, including refugees. Last week, the Foreign Secretary chaired the UN Security Council open debate. He talked about getting Covid vaccines into refugee camps and called for global ceasefires. Reaching those refugees and marginalised people is very much part of our work on global health.
Chair: Thank you very much to Darren and the Minister for joining us this morning.
Witnesses: Dr Tamsyn Barton and Jonathan France.
Q18 Chair: I am delighted that Tamsyn Barton from ICAI has joined us this morning. Dr Barton, if I could start with you, you awarded a green-amber rating for this review. Could you tell us why ICAI decided to award this overall score?
Dr Barton: A green-amber score represents good achievements in many areas and partial achievements in others. It is indeed a good score overall—it is very rare for a full green score to be awarded. The basis for this is that this was a results review. Sometimes in the past, ICAI has been critical of the way that the Government have used their results claims and whether they have been able to substantiate them. In relation to this review, we found that the Government had been too conservative. They had surpassed their target and had sometimes underestimated their achievements. Broadly speaking, we were happy with that, although of course we always find areas for improvement.
It was particularly pleasing for us that ICAI had done a review in 2014 and the Government had clearly taken on board what we had said. They had adjusted their results methodology so that it was much more meaningful. We could meet people on the ground who explained that they were doing their work better and more impactfully because they were focusing their results in a different way with different levels of intensity. Those were some of the more pleasing areas.
It was also a very evidence-based approach. A lot of the approach was derived from important research published in the Lancet. Use of knowledge of what works and succeeds is always important for us in ICAI. We also noted the success of some of the work with Governments. We were able to see that Governments had really taken on board nutrition as a priority and that was making a difference on the ground. All of that needed appreciating, as did the work in very difficult contexts.
The area where we thought there was only partial success, as you have just been hearing, was reaching the most marginalised. I will give you an example of who the most marginalised are. It might be pastoral or nomadic communities, as we saw in Ethiopia. It is very challenging to reach them; we recognise that. Nevertheless, that means that the Department needs to redouble its efforts.
Reliable data is a huge challenge for Governments. If you have social protection systems, for example, you know who is disabled. That data should be usable when it comes to nutrition programmes, but that is the challenge of joined-up Government and different Ministries. The real challenge for achieving results is different Ministries working together on what we call convergence and more high-intensity interventions. Overall, we would like to give credit to the Government for what they have done, and particularly their global leadership since 2013.
Q19 Chair: Are you satisfied with the Government’s response?
Dr Barton: The written management response that they provided within six weeks of the review was one of the more pleasing that we have received. It had a lot of specific actions that they were going to undertake, which we will be able to check in our follow-up review. It was particularly good on the first two recommendations to do with the results methodology and the statistical expertise. We are definitely pleased with those responses.
I also listened very carefully to what the Minister was saying and heard a lot of very useful reassurances there. One of the areas where we felt that they needed to be stronger was working with the private sector in a food systems context. That is really very challenging. Frankly, profits are much more easily made in selling biscuits than they are in sorghum, for example. It was good to hear that there is going to be a new focus on this. Looking at the agriculture programmes that were supported by the Department at the time of our review, the majority were focused on increased household consumption, whereas we need more focus on nutritious food, a reduction of stunting and dietary diversity. We are going to look at that particularly carefully.
The other thing that we may want to talk about more later is that the responses were not completely specific in relation to funding for nutrition. That obviously did not come as an official management response, but we were listening carefully to what the Minister said. It seems as though we will have to wait to hear what the decision is as to how much this will continue to be a priority.
Q20 Chair: Could you tell us a bit more about some of the standout successes that you saw in the review? What were the areas of most concern to ICAI?
Dr Barton: Some of the easiest areas to recognise as successes are where it is particularly challenging for food to reach people who are very undernourished. In our reviews in normal times—and luckily we were able to undertake the field visits before Covid–19—we try to make sure that we do not just go to the nearest places, but that we find out whether aid is getting through in the most difficult circumstances.
We went on a very long journey with many hours of travel by vehicle and boat and reached a very remote island. It was really impressive to find out that, in the floods, when it was impossible to get to this island by boat, sufficient food had been delivered by helicopter. It had frankly been lifesaving and had made an enormous difference. If you meet people who have been saved in such circumstances, that is obviously impressive and memorable. We saw many examples and we met many mothers who told us about their children being saved. Those are the kinds of dramatic lifesaving results that one can intuitively understand.
As you will know, what really counts is up-front investment to prevent these emergencies taking place, or even the long, drawn-out emergencies of continual undernutrition. You heard in the last session that Covid-19 is only making that more challenging. The standout successes were a lot to do with the community-based work of volunteers in ensuring that those most in need, on a continual basis, received support.
If you take a very simple point, research has found that the biggest determinant of nutrition over time and a healthy life is birth weight being high, but birth weight will not be high if you have undernourished mothers. It is enormously important in these small, village-level groups that there is good information and sufficient priority given to good nutrition for adolescent girls and mothers, pregnant women and so on. We also witnessed that kind of community-level work, which I would say was a success. It happened on my visits to Zambia, but my colleagues saw impressive work in Ethiopia as well. I would pick on those as the areas of success.
I should mention the work of the Scaling Up Nutrition movement, where the UK support has been very important. It was very visible in those countries where it was having an impact, such as Zambia, that there was a high level of mobilisation. We were quite impressed to meet a committee that had a huge number of permanent secretaries from different Departments working together on nutrition; everybody knows that is very challenging.
You could also see mobilisation at the community and district levels, right down to the most junior officials, including even the volunteers at village level. That kind of mobilisation is very important because, for nutrition, you cannot just work in a health context. Everything can be wiped out if water, sanitation and hygiene are not provided. You need social protection programmes to work, so it involves cross-Ministry collaboration. That is always a real challenge to support. Credit to the UK for where we could see they had, particularly through the SUN movement, succeeded in generating that.
Q21 Sarah Champion: Your report shows that DFID was fantastic on nutrition. How successful do you think it will be following the creation of the FCDO? Do you have any concerns about that?
Dr Barton: Any merger or machinery of government change carries transaction costs. A lot of time and energy is always devoted to setting up the new systems and structures. That, of course, could be mitigated if the new arrangements are better. There are ways in which we have heard encouraging indications. In the last session, we had Darren Welch, the director in the new global health directorate. There was not a directorate focused on health before in the Department for International Development. That could bring an appropriate level of focus on nutrition, given how important that is in a health context. That is definitely encouraging.
We have also seen in the new structure that there is a directorate devoted to research and evidence. That is very encouraging because it needs an evidence-based approach to succeed, although obviously we will have to see how well that directorate works with the geographical directorates on delivery. Ideally, the delivery and evidence DG will work effectively.
The other potential advantage with the merger is bringing in diplomatic heft to the picture, which is always particularly useful in the run-up to summits. Obviously, the hope is still that the delayed Nutrition for Growth Summit will happen at the end of the year. To the extent that diplomats can be involved at a country level, the role of the ambassador in supporting this agenda can always make a bigger difference than just the staff focusing on the development.
In principle, all those things could be positive, provided that the new structures do not deprioritise. In the last session, you were all asking probing questions about whether there would be geographical or thematic priority shifts. The jury is still out on that.
Q22 Sarah Champion: Jonathan, do you have any thoughts about the merger and how it might impact on nutrition?
Jonathan France: One thing that has worked particularly well is the central gathering of evidence under DFID and now FCDO. That is the ability to gather strong global evidence from London, share it and trickle it down to country-level nutrition programmes. The combination of central programmes and bilateral country nutrition programmes working in synergy was a key strength under DFID. Providing that those types of arrangements can continue, I would expect the nutrition programmes to continue to be successful. It will require, of course, choices to be made about what to fund and what not to.
Q23 Sarah Champion: That is the next logical question. Should nutrition programmes be protected in the recently announced ODA cuts?
Dr Barton: Obviously, what the priorities are is a ministerial decision. It goes without saying. ICAI can only comment to the extent that our evidence is relevant on that. There are a number of perspectives from which nutrition looks like a priority. If a child is insufficiently nourished in their early years, in particular in the first 1,000 days, that has a negative impact on their cognitive development that can never be repaired. Whether you are looking at it from a rights-based perspective or an economic perspective, it is very damaging. There is a really strong case for investment focused at that stage of life and everything that influences it.
Apart from that, it is noteworthy, as we have just heard, that the UK has invested very significant funds in this since 2013. There is obviously a risk that, if there are cuts in this area, that might take the foot off the pedal and be seen as a signal by others at a time when donors are moving to other priorities. The Covid situation could lead to prioritisation either way. There are very good reasons for prioritising nutrition in times of Covid. On the other hand, a lot of the focus is going on much simpler, more straightforward measures such as vaccine delivery. Broadly speaking, I would say there is a strong rights-based and investment case for protecting nutrition investment at a time of cuts.
Jonathan France: A further area of real strength of the nutrition programming was the work with country Governments. In Ethiopia, for example, it is one of the policy areas where ICAI has perhaps seen closer working with Governments. DFID, now FCDO, was gradually handing over more and more responsibility for the delivery of nutrition services to the Ministry of Health in Ethiopia. Year on year, we have seen increased domestic financing for nutrition within countries such as Ethiopia.
That journey is not quite complete, and it does need to be completed. Once that happens, the UK will see the best value for money from that investment in nutrition through continued working with country Governments. That would be part of the rationale for continuing with the programme.
Q24 Sarah Champion: That was going to be my next question, Jonathan. From a taxpayer’s point of view, does investment in nutrition represent good value for money?
Jonathan France: Absolutely. As Tamsyn pointed out, nutrition is a fundamental prerequisite for good-quality education and a healthy workforce. As we have seen during the past challenging 12 months, it is a prerequisite for resilience against infectious diseases. Investments in nutrition absolutely deliver good value for money.
As I alluded to, the joint work with overseas Governments, which seems a particular feature of nutrition programmes, also helps to deliver good value for money. Ultimately, it is more sustainable. It would perhaps allow the FCDO to pull back and focus on those most in need, and the most marginalised women and girls, for example, once Governments take responsibility.
Q25 Kate Osamor: I just wanted to pick up on something Jonathan was speaking about, on the way the previous Department, DFID, worked and secured political commitments and strengthened national systems. How will the new Department, the FCDO, work to ensure that the effectiveness of the political commitment that was previously there continues?
Dr Barton: There are some potential advantages, provided that that is what happens in practice and those are the priorities, in the way that ambassadors are involved at country level. It needs top-level commitment in Government for nutrition to be prioritised. I noticed that the Institute of Development Studies had just published some research looking at the impact of the Government of Tanzania really focusing on nutrition over the last few years. It is really encouraging in this area that you can see improvement at country level in those countries that have really focused on it. Tanzania was one of them. It is going to be enormously important that that continues, there is close working between the donors supporting it, and donors co-ordinate rather than undermining each other in supporting the Government to do this.
It also needs quite a lot of technical support. One of the areas of most importance that we touched on in our review was this issue of data and statistics. Some of the most important, not necessarily glamorous, work that the former DFID did, which we hope will continue in the FCDO, is that support to good statistical systems. It will allow you to ensure that, for example, disabled people are reached by these programmes. It is not straightforward at all, even with modern IT. We see that even in the UK, so imagine how difficult it is in Zambia.
Jonathan France: Another area that is very important is the co-ordination and co-operation with other donors in country. The day-to-day work makes these programmes successful. Nutrition is an area where we probably see more of that than in some other policy areas. The challenge to make nutrition programmes as successful as possible is to co-ordinate with other donors so that their programmes are impacting on the same vulnerable populations, tackling different sides of the coin in terms of malnutrition. The Global Nutrition Report talks about the importance of equally tackling food systems and health systems. This is a huge, comprehensive challenge. FCDO can only deliver on it through good co-operation with other donors. For me, that is a key part of the work going forward and, again, something where diplomacy can help.
Q26 Kate Osamor: The review recommended that the FCDO should improve its work on making sustainable and nutritious diets accessible to all. From your findings, do you have any clearly defined ways in which the Government could do this?
Dr Barton: One of the most striking things to us was the work in agriculture. As mentioned, it is a challenge to work across sectors. That is even the case within the Department in the UK, let alone in developing countries. Whereas health was front and centre, social protection was closely concerned, and water, sanitation and hygiene were the next most integrated, the real challenge was reaching agriculture. I think I mentioned earlier that, when we reviewed the commercial agriculture programmes, it was clear that nutrition was not really mainstreamed to the extent that would make a difference. The focus was just on increasing household consumption. That is important, but not nearly as important as ensuring that there is dietary diversity and a real focus on tackling stunting and wasting.
The Minister mentioned examples of programmes that, in her view, offered the potential for this. We are aware of some of them, but it is certainly not the majority from the review we looked at. That is the kind of area where, in our follow-up, we would really want to see evidence that there is a much more focused approach on nutrition in agriculture.
Jonathan France: I have two points. As we have mentioned, the work around food systems is quite nascent. There is a lot more work to be done, working in co-operation with country Governments, on setting standards and guidelines, for example around healthy diets and influencing national agriculture policies. That is one area where FCDO could exert influence.
Secondly, we saw some promising progress in use of DFID/FCDO’s private sector development funds, so the award of grants and loans to early-stage nutritious food businesses. This is a good example of where two different objectives or aims of FCDO can come together and be mutually supportive. The challenge is to scale up those nutritious food businesses. Through working with organisations such as CDC, there is obvious potential to strengthen the supply side within food systems.
Q27 Kate Osamor: What do you see as the impacts of Covid-19 on the UK’s nutrition programmes, positive and negative?
Dr Barton: It has to be said that we were only taking into account the impact of Covid-19 right at the end of our evidence gathering. At the time we were doing our field visits in January, it was not evident what a huge impact it was going to have. We made sure to catch up with some of the country programmes in June and July, before we published, to check whether there were dramatic changes that we should be aware of. It was reassuring to hear that work was continuing, albeit with much more limited monitoring than in the past, which obviously does not give the reassurance to know what is happening to UK aid and, more importantly, what is happening more broadly out in the field.
There is no question that Covid has hugely disrupted mobility of goods and people. In the end, that changes the balance, so the purchasing power of people is reduced. Their livelihoods are hit directly and their access to food is, broadly speaking, reduced. There are huge differences in how that impacts, depending on what measures the Government took to combat the spread of Covid-19 and how evident it is that the disease has spread.
Probably the biggest impacts we have seen so far are to do with measures to contain the disease and reductions in mobility. In general, it has probably put the focus more on health. Specifically, because those who are undernourished suffer worse, the case for investment in nutrition is, if anything, stronger, as you heard earlier. There were estimates. These are always estimates that are quite difficult to rely on, but, nevertheless, those best placed to estimate them, such as the FAO, were suggesting that anything up to 130 million people could be undernourished as a result of Covid-19.
Unfortunately, looking into 2021, whereas we may see things improving in Europe, it is not at all clear that we will not see things getting much worse in the developing world. Africa has been relatively less hit so far than Asia and Latin America. If the disease has a much more major impact and needs bigger containment measures, it is of concern to ensure that nutrition is not lost sight of in the context of how Covid hits, and that the focus on something easy, such as vaccination, important as that is, does not absorb all the energies. Otherwise, many people could be left behind as a result.
Jonathan France: We know that many African countries have been slightly less worse hit than the UK because of their younger populations. In countries such as Zambia, they have been able to maintain some nutrition services, but inevitably there has been disruption. Much of the nutrition services is based on face-to-face contact, for example community health workers going to villages and training women and young women on infant and child feeding practices. Some of that inevitably has been disrupted. Ground will need to be made up, particularly as things begin to open up slightly this year. Progress needs to be regained.
Q28 Chair: Tamsyn, you talked first about the need for donors to co-ordinate on this issue and the importance of top-level commitments from the UK Government. You talked about leadership by the UK in this area. Do you have any specific examples of how the UK leading on nutrition has impacted on other donors and encouraged other countries to step up their commitments to increase support in developing countries on nutrition?
Dr Barton: You heard that it was the UK that, in 2013, hosted the Nutrition for Growth summit, which really spotlighted the issue. It still looms large, as we found in our travels, hearing from other donors, even though, quite rightly, the UK has passed the baton to others. Japan is expected to host the summit later this year, which is unfortunately delayed. One thing is the global level. That has been very visible. I hope the merger will help with even more diplomatic effort.
It was striking to us to see, at the country level, the extent to which the UK’s role was often helpful in piloting innovative approaches, but working in a way that brought other donors on board and divided labour between them appropriately. Some donors pursue their agenda without so much considering how it will be, because it is less visible. They are more interested in their domestic profile and how they work together well with others in country. It will be very important that the UK continues to work in the way that we saw as being very effective in both Zambia and Ethiopia, where we were able to look at it in more detail.
One of the other key areas, as Jonathan mentioned, has been this investment in the Scaling Up Nutrition movement and the investment in the Technical Assistance for Nutrition. That is the more technical aspect to supporting Governments. The UK investment in that has been significant, but the Government have been successful in getting others on board as well. Those are areas where they deserve credit.
We have criticised them for being insufficiently focused on marginalised groups, which is a continual theme for ICAI, because we want to hold the Government accountable for high standards. Other donors felt that the UK was better and setting a good example in this respect, certainly in relation to geographical targeting. It was in itself interesting that the then-DFID, at the time of our fieldwork, was often seen as a leader and a model in the way of approaching this from an evidence-based perspective and focusing on the most marginalised.
Jonathan France: I will expand on some of those examples. In Zambia, we attended a meeting of the National Food and Nutrition Commission. This was in the central Parliament building. It was hugely impressive that they had representatives from all the different Government Ministries within Zambia to consider the implications of nutrition, for agriculture, health, employment and skills, for example. This type of cross-Government commitment had been facilitated and catalysed by DFID/FCDO. I do not think this would have happened without DFID’s nutrition programmes. Political commitment is the first step to increasing financing for nutrition.
In Ethiopia, it was slightly further down the line. Again, with the assistance and influence of DFID, they had set up a specific unit in the Government called the Seqota declaration. This is designed and set up to target very specific pockets of malnutrition and areas of Ethiopia that are most in need with concentrated support. Again, it is highly unlikely that that would have happened without FCDO and DFID’s influence in this policy area.
We saw other examples in Nigeria, where certain aspects of nutrition services have been integrated into the basic healthcare budget, again following the work and efforts of DFID. As Tamsyn said, there are lots of great examples at the country level, alongside the global influencing role.
Chair: Thank you very much.
Witnesses: Dr Agnes Kalibata, Martha Nyagaya, Callum Northcote and Simon Bishop.
Q29 Chair: We will now turn to our third and final panel of witnesses. My question is to all of you, but I will start with Simon Bishop from Power of Nutrition. Could I ask you to respond to what you have heard from the Government and ICAI this morning?
Simon Bishop: I am very happy to do that, and thank you very much for inviting me today. The first thing we have to recognise is that we should celebrate success, with a decade of amazing leadership from the British Government on nutrition. It is in that context that we are deeply concerned about the potential impact of cuts that are likely to come in the weeks ahead, potentially to nutrition. I hope you will give me an opportunity today to make the case for why those cuts are not smart. In fact, they are the opposite of smart. I am not a supporter of any cut, but if you have to make them, make smart cuts. I hope you will allow me to make the case for that.
It was very welcome to hear Minister Morton talk about the Government’s commitment to working with the Government of Japan to make sure that Nutrition for Growth is a success. There is a recognition that if any progress is going to be made on the manifesto commitment to reduce preventable maternal and child deaths, nutrition has to be at the heart. There is a potential impact on millions of the world’s poorest children and young mothers from cuts that are likely to come in the weeks ahead.
I am five weeks in, in my new role as CEO of Power of Nutrition. I am very proud to be CEO of that organisation, which was co-founded by DFID in 2015 and continues to be at the heart of the British Government’s nutrition investment. It means I am a bit new, so I apologise in advance if technically I am not quite up there yet, but I hope you will forgive me for that.
Callum Northcote: I agree with what Simon has just said about the implications for the cuts. Focusing slightly differently, there were a lot of positives and reflections on the good work that has been done from both the Minister and the ICAI team, yet we still do not have the clarify on the specifics moving forward. That remains our concern, certainly on the financing side, but also on the frameworks that are in place within Government.
We heard from the Minister this morning that there is not going to be a stand-alone nutrition strategy but part of an ending preventable deaths framework. That is slightly concerning. A stand-alone strategy is really useful and important for an issue that is so cross cutting and needs that top-down focus. We still do not really have clarity on the level of commitment we are going to see, in terms of a reach commitment again. Are we expecting to see the UK Government pushing forward with top-line indicators that will allow us to impact on a strategy for ending preventable deaths? There are lots of positives, lots of good words, but we still really need that detail and clarity.
Chair: Dr Agnes Kalibata, I am delighted that you have joined us today as the UN’s special envoy. Thank you for taking the time.
Dr Kalibata: If I might go straight to the question you are asking, to respect time, there is a lot at stake now. If I just talk about the number of children who are dying, the global hunger index indicated that, in 2018 alone, we lost 5.3 million children before they were five years old from malnutrition-related causes. The United Kingdom has provided a lot of leadership. The previous panel was talking about how you all led in the Nutrition for Growth summit. When Covid is at its height, when the world and everybody is suffering, this is not the time to abandon multilateralism, your place as the United Kingdom in the world, and what you have been standing for and representing.
We have millions of people who are suffering, who had jobs and have lost jobs, even in your country, the United Kingdom, and other developed ones. Think about what is happening in some of these economies that are much weaker. If I speak now from a food systems perspective, you are signed up to SDG 2. You are very far from coming through on SDG 2 and the SDG on nutrition.
My appeal to you all is to go back to that reason we come together as a world. We have an opportunity to show leadership. This is not the time for the United Kingdom to drop its leadership in the world. I do not think it would be the right thing to do. The rest of the world needs you. I know you have lots of challenges internally, but that is not a good reason to drop everybody else for your challenges. What happens when you need us tomorrow? You will come back. That is the way I would look at it.
Chair: Martha Nyagaya, thank you for joining us from Kenya.
Martha Nyagaya: I have heard lots of very inspiring statements and encouraging words from the Minister. The first one is that we are currently undertaking a rigorous internal prioritisation process. Given the report from the review and recommendations and the fact that this report is generally accepted, I am sure that prioritisation is going to take into consideration the most relevant interventions, the multisectoral nature of interventions and the integration required at various levels. About the future funding that will be provided, even though there are no real commitments at this time, as long as those points are taken into consideration and the rigorous internal prioritisation listens to the voices from the ground and the recommendations from the review, we are confident that the UK will be in a good place to provide the right interventions at the right time.
I also heard that, in the future, work on nutrition will be an integral part of broader work to end preventable deaths for mothers and children. That means the right targets, an integrated approach and a broader framework that looks at food systems and nutrition, rather than a siloed approach, which is also very welcome.
The third one, if I remember well, is that there will not be a stand-alone nutritional strategy, but an integrated strategy that looks at the key elements of an overall strategy for addressing malnutrition, as well as the system, capacity, governance and co-ordination issues. This is also a very welcome approach from a ground perspective. There is also the fact that the UK will continue to deliver humanitarian nutrition responses while simultaneously building resilience. If we continue to deliver humanitarian responses without building the required resilience, we will spend so much money continuing to give people fish, rather than teaching them how to fish in future.
The recent DFID/FCDO merger and the proposed budget cuts pose a real threat to the UK’s leadership in nutrition. The UK has played a critical role, particularly in Kenya and globally, as a leading investor, a thought leader and a convenor. If I get a chance, I will give you examples of how that has happened in Kenya. This is actually a worry for some of us on the ground. The UK has also brought a critical focus on low-cost, high-impact interventions that we focused on. We are hoping that the UK’s 2013 N4G commitments and the upcoming N4G commitments will focus on the critical things we are looking at, not just funding commitments but impact commitments, financial commitments and leading us towards the road to self-reliance, mobilising Governments in Africa to commit, as well as the policy commitments.
Q30 Chair: What do you view as the main challenge to achieving the sustainable development goal of no hunger?
Simon Bishop: It is hard to say that there is one main challenge. As we have seen on this call, it is about global leadership and leadership at the national level as well. It is about ensuring that the interventions we provide are value for money and are reaching the hardest to reach. Fundamentally, money is at the heart of this—it is not all about money, but money is incredibly important. We know that, in order to deliver the sustainable development goals, we need trillions, not billions.
Specifically in the nutrition sector, we know that the funding gap globally annually is $7 billion. One report says that, with the impact of Covid, that will rise to $8 billion, yet we have a fraction of that coming into the sector. This is where we need to galvanise global commitments to try to tackle that chronic underfunding in the nutrition sector globally. That is where the year of Nutrition for Growth that we are in now, culminating in that summit in December, is so important. It is also why the British Government’s level of financial commitment to nutrition is so critical, not only that it is their own amount and that they do not cut that, but that their global leadership gets other Governments to come in as well. That is why it is so critical that nutrition spending is protected in the weeks ahead, as we see likely cuts in the UK Government’s aid budget.
Callum Northcote: Probably the biggest issue with this is the complexity. When we think about hunger or nutrition, to some people it means health services. To some people it means food. To some people it means money in the pocket to be able to afford to buy things. It is all of these things. That can be really beneficial when that is done well. Equally, it can lead to a situation where everybody thinks somebody else is doing it. The biggest challenge to achieving this is getting those sectors working together.
To come back to what the UK can do on this, it reverts to that need for a top-level policy position or indicators that allow and force a policy focus from health services, from agriculture work, through economic development work, so that nutrition and hunger are sufficiently prioritised within each individual section, working towards a top-line reach indicator or target, which shows that this is the impact that is being had. The complexity is in itself part of the problem, but it is equally the way we can have the solution, if we are able to force the sectors to think together more comprehensively.
To reiterate Simon’s point as well, one of the issues will now be, with budget cuts and implications at a macroeconomic level across the world, if leaders on specific issues step back. In this area, the UK is one of those leaders. It will be a real big stress to the infrastructure if, at that time of most need, the UK decides to step back slightly.
Dr Kalibata: Like everybody else, I do not think there is a simple and easy answer. One thing that stands out for me is the fragility of the whole food system today and the fact that part of how we produce food is contributing to climate change. Climate change itself has made the food system so fragile and difficult to work with, especially for communities that depend on agricultural systems for food and nutrition. The number one thing we must do is to come through on dealing with the issue of climate change.
The number two thing we must do is to come through on the issue of adaptation to climate change. There are already communities that are living in situations where climate change is a reality for agricultural systems. These communities are always one season away from hunger and malnutrition. Not being able to deal with this problem is a major challenge.
The third thing, which many people have also referred to, is the ability to work together as institutions. There is so much on the ground. Here in Africa, you see so many institutions, including ones from the United Kingdom, that are trying to do real good work. Our ability to come together, work together and co-ordinate better is critical, supporting Governments. Many previous witnesses have talked about this. You are working with people in other places, supporting Governments and Government plans, and helping them have the leadership that they need and the right level of capacity so they can come through on their own programmes. The UK Government have been working in partnership with other people.
The programme we are implementing here at AGRA is just one of those where the UK Government look at a gap and fill that gap, versus other partners. We need to see more of that. The United Kingdom is investing in trade and opening up regional trade and resilience for local value chains here in Africa, working with us at AGRA. It is building on work that is already being done on the production, market and sales sides by other partners, such USAID and the Bill & Melinda Gates Foundation. On the resilience side, it builds on the work that is being done by BMZ. On the programme, the partnership and the cultural transformation, it has these five partners.
The critical thing here is that we stop duplication in the same areas, but also build on each other’s capabilities and take every donor further by showing that we are building on everybody’s strength. Doing more of this, recognising that it is not so much a need of resources as how we bring those resources together, is going to be extremely important. Of course, in that whole context, the UK’s leadership and resources will still be important. Being able to fill those gaps and bring strength where you have great strength is still going to be important to ensure that other partners come through.
Martha Nyagaya: I agree with all that: from Simon governance, from Callum complexity, and from Agnes partnerships. The main challenge for me is that we all recognise that we need to link health, nutrition and sustainable food systems, including climate. I do not see steps at various levels of linking those two, of establishing a real integrated approach, of speaking to each other, of working together, of discussing designs of integrated programmes, from the donor level to the country-level policy, to the community level. How do we ensure that this conversation happens and we start taking immediate steps? My main challenge is how we start taking steps to link health, nutrition and sustainable food systems, to address the complexities, governance issues and required partnerships, and to stop implementing these programmes in a siloed way.
Q31 Kate Osamor: Welcome, witnesses. I want to pick up on what Martha was talking about. What should donors such as FCDO be doing to improve the sustainability of nutrition programmes to ensure that their success is not wasted?
Martha Nyagaya: I will give you an example of a DFID-funded programme that is being supported in Kenya. We call it the DRM approach. We have a Technical Assistance for Nutrition programme that is funded by DFID. It seeks to improve the capacity of scaling up nutrition in countries to design, deliver and track the progress of nutrition programmes. The purpose of this is to generate and learn from this kind of work. It helps us overcome the gaps in capacity.
With this grant, we have taken advantage of the fact that we now have a devolved system of government and the counties have autonomy to decide where to put money. We used this to provide a fiscal space analysis of where we can get integration. Devolution provides a platform where all the sectors are governed somewhere at the subnational level. It also provides us with a platform where we can start integration of policy around the different sectors that need to be addressed under nutrition.
We are calling it a domestic resource mobilisation approach. We have identified the significant financing gaps. We have identified devolution as a key driver of the road to self-reliance. We have also identified a number of leverage opportunities from the various sectoral programmes, particularly nutritional sensitive, that are working in the health sector.
With this, it is important that we have one policy document, one action plan that defines what each sector should do. The action plan is costed. It is a five-year plan. It ensures country ownership because all the sectors are brought together to develop this county nutritional action plan that is multisectoral. It has a results measurement framework. It also defines targets aligned to national and global targets. When we go, we endorse policies, programmes and targets at a national level, N4G, World Health Assembly, but we do not come back home to translate what that means strategically at subnational level. That is what that grant has helped us to do.
On a matched funding arrangement, we mobilise political and financial commitment to this action plan. We provide support while we gradually withdraw, as the county government takes on implementation of this programme. We implement by strengthening county systems and structures to actually implement their own action plan, as we support systems and structures. That is not only to monitor programme progress, but to track financial commitments, as well as effective utilisation of resources.
Simon Bishop: I will also use an example of a programme we run in Rwanda. This is a programme backed by FCDO, as well as the Children’s Investment Fund Foundation and the Gates Foundation, and we are working with the global financing facility and co-financing with the World Bank to raise about $116 million towards this programme. Critically, building on Martha’s point, this is about Government ownership. This is something that the Government of Rwanda are fully involved in, own and believe in. That is critical for long-term sustainability.
Something else that is important for sustainability is focusing on what works. We know that is best-practice interventions, but there is also a cash transfers element to this, which makes it efficient. We are now digitalising it as well. All the beneficiaries’ records and how we work with them will be digital, which helps with a more efficient programme but also long-term sustainability.
Building on Martha’s point, this is a programme that looks at nutrition, but it is fully integrated with a social protection programme. You are stretching the nutrition across other areas. It is focused on the poorest in Rwanda, which means you will probably maintain that long-term Rwandan Government buy-in, because that is a priority for them.
The other thing on sustainability is that so much of this is about social norm change. It is particularly about working with women and girls, their role in societies, and making sure that changes, particularly when they are discriminated against. If they change their behaviour, if the society around them changes behaviour when it comes to nutrition and attitudes towards breast feeding, for example, you will see long-term sustainable change.
Callum Northcote: Martha and Simon shared really helpful country examples. From a more general perspective, off the back of what they have said, one of the things that is most important in this long-term sustainability piece is supporting technical assistance. In particular for nutrition, it is things around supporting the SUN movement. It is supporting civil society organisations as well in implementing countries. That is always something that can help long-term sustainability. It is aligning with country and national priorities.
We have heard this morning and seen in the ICAI review that the UK has been good at this in lots of ways. There are elements that it is good at in its own right, but it always refers back to the need for a strong basis. Being known as an excellent deliverer of programmes and a policy leader in this space allows the UK to step slightly further and enable sustainable conversations to become more sustainable, essentially. The grounding in the experience and the expertise that the Department has is crucially important as the strong baseline.
One thing that could potentially undermine the sustainable work that has been happening, and looking at transferring ownership or delivery of programmes, is a lack of communication about cuts moving forward. It is fair to say that, from the broad range of NGOs I have spoken to, there is still more than a bit of a lack of clarity about the direction and what that will mean for individual programmes. If we are going to see large reductions, particularly towards the end of project cycles, that could be the optimal point where those transfers start to take place. That could really damage the long-term sustainability of some older programmes that are moving out of FCDO delivery and more towards national ownership. It is definitely relying on that experience to build off of, but there are concerns in the immediate phase for the future.
Dr Kalibata: I look at the sustainability of programmes from the perspective of the ability to build local capacity and opportunities. In terms of the ability to build local capacity, some of the previous speakers have talked to this already. There is an opportunity to ensure that there is capacity to have information, correct data and use that information for planning. There is an opportunity to have capacity to be agile around policies and look at the policies that need to change, and when. What problem are you dealing with today? How is it changing and how do you ensure that you are on top of that policy environment, so that it gives you the solutions you want? There is then the capacity to get these programmes to be implemented. That is the local capacity issue. That capacity exists and is built in the programmes that we are putting in place.
To me, all that is to one major end, the end being local opportunities and ensuring that those local opportunities thrive. Through many of the UK programmes you have done in the past, but also now, there has been a lot of support to private sector initiatives, local SME capacity here in Africa. We have a programme with the FCDO on supporting local SMEs that provide job opportunities but also focus a lot on ensuring that they are dealing with nutritional products. One very good example is Africa Improved Foods, where the UK Government have significantly invested through CDC but also through AgDevCo. Africa Improved Foods is a wonder, by the way. This builds on local efforts and local government leadership, but also partnerships, as we were talking about earlier.
They are producing stuff that was being imported from France before, which did not ensure that farmers were producing. Farmers produce for this company. They all go to farm knowing that they have a market. These farmers who are producing for this company are able to buy back the product, which is rich in nutritious stuff that is good for their children. They are also able to buy eggs and stuff like that that they need. For me, that is sustainability. These investments that we make now in these types of farms or companies, local SMEs, become sustainable.
We must also have the environment, the type of agility, that allows other businesses an opportunity to come in and focus on the challenges of the day. Building local capacity, in terms of strengthening Governments’ own capacity, but also strengthening private capacity, is important. The UK Government have already been investing in these areas. These areas are very critical.
Q32 Kate Osamor: Simon, what is the importance of improving the quality of nutrition, rather than just the amount?
Simon Bishop: We need to focus on both; it is not one or the other. The fantastic thing about nutrition is that we know what works in terms of quality and which interventions are most effective. There is a huge amount of evidence about that, whether that be providing vitamin or mineral supplements, encouraging exclusive breastfeeding for six months and a wide range of other interventions. That allows us to marry the quality and the quantity together.
One key thing Power of Nutrition does is to try to bring together a diverse range of organisations—implementors, donors, UNICEF, the World Bank, the domestic Governments, wonderful NGOs—to run scalable programmes based on proven, value for money and evidence-based interventions. Having your cake and eating it is always the holy grail for international development, but where so much of international development struggles is in having the quality and the quantity.
Q33 Kate Osamor: Callum, how best can nutritional quality be improved over the medium and long term?
Callum Northcote: This follows on nicely from Simon’s points there. It is really important, when we talk about nutrition, to recognise that hunger, nutrition and food security are all related but different topics. We need to constantly make sure that, when thinking about medium and longer-term responses to nutrition, we focus on, in particular, that nutritional element and it is not overlooked. It can be much easier to move towards thinking about calories as solving a solution, or a crop solving a solution.
We know this in ourselves, in our own diets. We know that we need a diverse range of nutrients in order to be able to grow, develop and maintain our focus. If we had skipped breakfast this morning, we might feel hungry, but if we skipped breakfast for the first 1,000 days of our life we would not have grown to the full potential that we could have grown to.
When we are thinking about specific focuses that we would look at, we would want to draw particular focus on things like treating micronutrient deficiencies and preventing them through, potentially, supplements and fortifying foods, and deworming where necessary. We definitely need to be thinking about infant and young child feeding and prioritising that in particular. That includes prioritising, protecting and promoting breastfeeding and relevant complementary feeding as appropriate.
Although we think about acute and chronic malnutrition, or stunting and wasting, as being separate, they have a reinforcing effect on each other. We need to think about responding to, preventing and treating wasting when we see that occur, particularly in crisis situations. We are seeing the predictions that are coming for an additional 9.3 million wasted children because of the coronavirus pandemic. We need to be combining those things all together.
Moving forward with the UK, our concern is that, while we really welcome the initial comments it has made around famine prevention and response, we want to make sure that nutrition is sufficiently included within that and we are thinking about the nutritional elements. If we do not do that in the short term, we risk turning a short-term acute crisis of hunger into long-running malnutrition issues. That then creates further problems down the line. If we respond comprehensively in the immediate term, it might cost more, but it will save a lot more in the longer run.
Q34 Kate Osamor: Dr Agnes, you rightly said that tackling climate change is a top priority. Is there a risk that action to combat global heating will threaten the sustainability of food supply?
Dr Kalibata: When you look at what is happening right now from a climate change perspective, if I might tell you my own take on this, the only reason I am with the Food Systems Summit is because, from 2013, I have seen farmers, from season to season, reeling from one climate change event to another. These were farmers who had very good profitability and were already beginning to move out of poverty. I saw them go back into poverty and have challenges of feeding their children.
In the first place, we should not be talking about nutrition as an aid programme. The reason we are talking about nutrition as an aid programme is the failed performance of sectors that are responsible for feeding people, including the agricultural sector, with an inability to produce and produce sufficiently. People have predicted failures in the system that will happen. Sometimes I look at it and people say, “By 2050, maize yields will reduce by 12%”. The truth is that, today, some farmers have 100% loss of yields. It depends on which part of the world you are living in. In the part of the world I live in, farmers are losing everything. Farmers are going back into situations where they need Government support to be able to feed themselves and their families. Crop insurance is one of the biggest-growing businesses today because there is an opportunity now to step in and do something.
The Food System Summit was launched from this perspective, recognising very clearly that our systems for producing food are failing in a number of ways. The most critical part of the failure is that we are impacting climate change. In addition, climate change is impacting how people produce food and access nutrition. That is worsening the whole problem that we are trying to deal with in zero hunger and other SDGs.
Without going into the detail of the numbers, right now we are living the nightmare of climate change. We want the world to fix that. We are prepared to do our part, in terms of what we could do. For example, Africa contributes 4% to climate change. We will do whatever we can to reverse that, but we also need that to stop from everybody else. One thing I keep saying is that each of us needs to recognise that whatever we do impacts so many other people in other parts of the world. We need to think that when it comes to climate change.
Let me end on this. Because I am now talking to you all from a UK Government perspective, I am a little disappointed with the lack of enthusiasm from the UK Government for the Food System Summit. I have not seen the level of enthusiasm. I appreciate the enthusiasm I have seen around reduction of carbon and stuff like that, but the agricultural sector contributes 30% to carbon. Honestly, if we do not pique enthusiasm around this Food System Summit and be part of ensuring that the food system we share for the future is about reducing the impact on climate change as well, what are we doing? Basically, I want you all to have the same enthusiasm that we have for all the other sectors, recognising that the Food System Summit brings all these things together. It is an opportunity to also reduce emissions from that part of the world and ensure that climate change can get to zero eventually.
Martha Nyagaya: I want to reiterate a few things that Callum has said, to put this in context. There is the food summit, food security, farming and nutrition. Food access or availability does not automatically translate to good nutrition. The terms “food security” and “nutrition security” are used interchangeably when talking about the coming of malnutrition, the hunger crisis and hunger. As we know, they are linked but different concepts, yet yield different outcomes. The lack of distinction between these two concepts is causing key donors, including the UK Government, to prioritise food security interventions sometimes in their response, resilience building and recovery plans, without fully understanding the threat of malnutrition.
There are different types of malnutrition, as Callum has mentioned. There is acute malnutrition, chronic malnutrition and hidden hunger. In the situation in Kenya for example, you will find an obese mother and a stunted child in the same household. Nutrition and food security approaches should be complementary, and we must also intervene at the right time and target the right populations. There are areas of heightened nutrition needs, such as the pregnancy period, the child growth period and the ECD period, where available foods cannot provide required nutrients. For example, a pregnant woman will need more iron. A woman of reproductive age will need more iron, and therefore will require complementary supplementation to address those needs.
We must look at all the key elements of an overall strategy for addressing malnutrition, particularly in most of Africa where we are now seeing the triple burden of malnutrition. There is stunting, wasting and an increasing prevalence of overweight and obesity. As Agnes has said, this will include looking at how food systems shape diet choices and diet quality. The subsystems include the production systems. Are they diversified? Are they responding to nutrition needs? They include the food storage, transportation and trade systems and the food transformation systems. They are adding more sugar and more salt. There are urbanisation issues, food retail and provision systems issues, and safety issues.
We need to understand how the food systems will shape diet choices and quality, with the consumer at the centre, because there is preference, women’s workload and gender issues. It is a broad perspective with a lens that is centred on the consumer to ensure that, when we look at how food systems shape diets, we are looking at quality across all the subsystems that drive choices and quality.
Q35 Sarah Champion: Dr Agnes, what are your goals for the Food System Summit?
Dr Kalibata: Let me start with this one clear goal. My first goal is to ensure that we all understand what is at stake. The food system is contributing 30% to carbon emissions. We must fix that because climate change is impacting us.
Secondly, we must ensure that as many people in the world understand what is at stake here. I brought this to you and I am going to take it to everybody.
Thirdly, because of the fragility of our food system, we are not able to come through on SDGs. The food system impacts nearly everything across the 17 SDGs, so we are not able to come through on SDGs. That is why it was launched. It was launched with the recognition that, because it impacts all these SDGs, if we do not do anything differently, we will not be able to come through. We could do things differently, if we start looking at all the issues we need to bring together: environment; food and agriculture; waste and how we manage waste; resilience and how we need to manage resilience; and adaptation for people who are facing threats; but also improving livelihoods, especially in the face of Covid. If we bring those things together, we might be able to come through on zero hunger by 2030.
If we do the things we want to do from a perspective of saving the environment, we might be able to come through on biodiversity and climate change. For me, first, it is really taking this into the public and making sure all of us understand what is at stake. Secondly, it is about ensuring that we understand the need to act now. We have structured the food system so that we have global dialogues, with conversations going on globally. At country level, we have dialogues going on so that countries understand from their own local context the challenges for our food systems. They understand that, first and foremost, it is within them. They have the ability to fix some of those problems before they bring the biggest problems to the summit.
Thirdly, we have conversations happening in action tracks that are based on the key objectives of the summit—around hunger and nutrition, western consumption behaviour, emissions, resilience and livelihoods. In those areas, we have teams working on what we are calling game-changing ideas or solutions, which are going to be put forward. Those are going to be some of the solutions we use to help countries think through how they want to contribute towards coming through on 2030. My goal is that we change the trajectory of how we come through on 2030. Right now, we are completely off track. If we do some of those things right, we might be able to come through on some of our goals.
Chair: Thank you very much to all of our witnesses for coming today.