If development in Africa is to achieve the purpose of Sustainable Development Goal 2 and "leave no one behind," it is imperative that national governments translate international commitments to the right to food, children's rights and recent commitments to nutrition into actions for impact. While there has been some reduction in micronutrient deficiencies (except for iodine) in Malawi, South Africa and Zambia over time, the rate of reduction has been suboptimal despite national universal supplementation programs and rollout of fortification programs. The progress is uneven and way off target for some nutrients. While there is ample international evidence that these interventions should hypothetically produce better results, little evidence exists to explain why they perform so poorly and how to initiate policy change to address their shortcomings.

Improving nutrition requires multi-sectoral national policies and programs. Getting multi-sectoral policy issues on the agenda and through the policy cycle requires a number of essential elements. A recent study that forms part of the USAID Innovation Lab for Food Security Policy investigated the drivers of change for micronutrient policies. The comparative review of three case studies of micronutrients policy processes in Malawi, South Africa and Zambia (respectively, Babu et al. 2016; Haggblade et al. 2016; Hendriks et al. 2016) set out to identify what drives, prevents and delays policy change; how to motivate and initiate change processes; and who the best partners are to set change in motion in the nutrition policy cycle. The case studies used the Kaleidoscope Model for Food Security Policy Change to analyze policy reforms over time and across the countries (see Resnick et al., 2017).

The results indicate that salt iodization has successfully reduced deficiency levels. Vitamin A fortification and supplementation have had limited success, primarily due to implementation challenges. Biofortification offers population-wide opportunities for enriching the nutritional value of foods.

We found that the common drivers of policy change in nutrition included: a sound and accessible global knowledge base (such as the Lancet series best practice papers); a call for action (World Summit on Children in 1990 and their associated National Plans of Action) and international targets (WHA nutrition targets and SDGs); and national leadership and champions with the support of development partners. Some areas that differed in the policy processes in the three countries, leading to different policy outcomes (including the possibility of no policy), were seen in: the level of engagement of various stakeholders, program design, funding considerations (donor, public or private), the institutional and regulatory infrastructure and long-term investment in sustainable solutions.

In conclusion, the role of international attention, focusing events and guidelines on best practice are essential in initiating national policy reform in nutrition. Sustaining the momentum is dependent on donor support, coordination of a wide range of stakeholders and implementing partners, including the private sector. Due to nutrition being a public health issue, recognition of this sets in motion policy change. Credible evidence and knowledge is crucial to all elements of the cycle.
 

This article was written by Sheryl L Hendriks, Suresh C Babu and Steven Haggblade and published on USAID's AgriLinks, 23 May 2017.