To the WHO Executive Board Members representing at the 146th Session, 3-8 February 2020:
Make 2020 the Year the World Reverses Malnutrition Trends!
World Vision together with global nutrition partners calls on ministries of health to make commitments to the 2020 Nutrition for Growth process. Specifically, we believe it is ministries of health' full responsibility to ensure comprehensive delivery of essential nutrition actions through the health system.
We call on the World Health Organization Secretariat to prioritize nutrition and the 2020 Nutrition for Growth process in the 2020 World Health Assembly, and to provide constructive support to member states to develop their commitments and plans. Together, we must all commit to making 2020 the year we reverse malnutrition.
2020 is an important year for nutrition, marking the mid-term review of the Decade of Action on Nutrition, the debut of the Decade of Action on the SDGs, and the third iteration of the Nutrition for Growth (N4G) Summit. Nevertheless, nutrition is at risk of losing traction and falling off the agenda as a global health priority, and we must use this year to focus on the World Health Assembly (WHA) Global Nutrition Targets, and reinvigorate a public health approach to nutrition. The Tokyo 2020 N4G summit represents an unprecedented opportunity to bring together countries, donors and partners to present clear commitments and demonstrate progress towards the WHA Targets, and the Sustainable Development Goals.
The Tokyo N4G summit is a critical moment for human development in 2020, alongside GAVI replenishment, UNFCCC Conference of Parties 26, and the continued drive to achieve Universal Health Coverage (UHC). Nutrition is essential to further the returns achievable through investments in each of these initiatives, and crucial to unlocking the health, development and economic potential of millions of people worldwide.
While achieving these nutrition goals is a multi-sector responsibility, the health sector plays a critical role in implementing essential nutrition actions. To ensure these actions are delivered through the lens of UHC – equitable, affordable, and delivered with quality – ministries of health must take a leading role, making bold political and financial commitments to nutrition through the 2020 N4G process, and ensuring that nutrition is fully integrated into national UHC policy and plans.
The rationale for investing in nutrition is clear:
- UHC cannot be achieved without ensuring everyone has to access to quality nutrition services.
- Malnutrition in all its forms increases the risk of disease and death. More than half of deaths in children under 5 years of age and one in five adult deaths worldwide can be attributed to malnutrition.
- The cost of addressing malnutrition and nutrition-related diseases is significant, but losses to the wider economy are even larger, amounting to almost US$ 3.5 trillion annually.
In 2019, the World Health Organization (WHO) led the development of the UHC component of the N4G commitment framework and published the Nutrition in UHC policy brief. The expert advisory group assembled to develop the UHC commitments recommends six overarching commitments:
- As part of national health plans and UHC roadmaps, fully integrate priority actions and interventions to prevent and treat malnutrition in all its forms, including WHO’s Essential Nutrition Actions and the World Bank’s Essential UHC and Highest-Priority Package lists of interventions involving nutrition, into the package of quality essential health services to improve overall health and well-being for people across the life-course, with a focus on the most deprived and marginalized, tailored to the health needs of the population and country context.
- Ensure that nutritionists, health workers and non-health workers whose work involves nutrition are properly trained on and supported in the integrated delivery of quality priority nutrition actions across the life course and that they receive integrated supportive supervision and mentoring that builds their capacity to deliver these interventions.
- Ensure that nutrition is systematically and equitably included in health sector budgets as part of an integrated approach to UHC, with an emphasis on the inclusion of essential nutrition actions in the package of primary health care quality essential health services, accessible to all and with a focus on all forms of malnutrition.
- Ensure universal access to essential, quality-assured, effective, safe and affordable nutrition-related health products through the health system.
- Ensure that health information systems track the coverage and quality of essential nutrition actions, the burden of malnutrition in different population groups, and the risk of nutrition emergencies – as well as ensuring local capacity to use this information effectively.
- Integrate nutrition actions into the package of essential health services as part of national health plans and UHC roadmaps and ensure these are aligned with national multi-sectoral nutrition plans as part of a ‘health in all policies’ approach with nutrition at the heart of it.
National ministries of health have the decision making authority to make all of these commitments a reality.
While these proposed commitments are bold and comprehensive, the Director General’s Maternal, Infant and Young Child Nutrition Biennial Report – being reviewed during the WHO Executive Board meeting – indicates that progress remains slow and concludes that “in the absence of a substantial scale-up in response actions, it is likely that the 2025 targets will not be met, and neither will the targets under Sustainable Development Goal 2, target 2.2 on ending all forms of malnutrition by 2030.”
Acknowledging the lack of progress on the WHA global nutrition targets and the momentous opportunity presented by the 2020 N4G Summit, we call on the Member States to prioritise nutrition at the 146th WHO Executive Board meeting and the 73rd World Health Assembly by:
- Calling for nutrition to be prioritized in the draft Operational Framework on Primary Health Care, which will be presented at the 73rd WHA – ensuring Member States receive concrete guidance on integrating essential nutrition actions across the six pillars of the health system.
- Ensuring an official high-level session to review global nutrition status and actions needed to accelerate progress on nutrition during the 73rd World Health Assembly.
- Calling for the WHO Secretariat to prepare a concrete plan for how they will support Member States to make meaningful and comprehensive commitments relating to nutrition in UHC at the 2020 Nutrition for Growth Summit.
- Calling for the WHO Secretariat to prepare and launch its own organizational N4G commitment during the 73rd WHA.
 Nutrition in universal health coverage. Geneva: World Health Organization; 2019 (WHO/NMH/NHD/19.24). Licence: CC BY-NC-SA 3.0 IGO: https://www.who.int/publications-detail/WHO-NMH-NHD-19.24
 We strongly recommend a specific emphasis on implementation of the seven steps of the UNICEF/WHO Global Breastfeeding Collective Call to Action.