Nutrition and Poverty Reduction: Lessons on Policy Change from the World Bank/UNICEF Nutrition Assessment

摘要

The global nutrition situation has improved over the last decade, but only slowly and unevenly. Malnutrition remains a formidable global development challenge. While impressive gains have been made in some regions and countries, progress has been slow in others, notably in Africa. Worldwide, over 180 million children under age five, nearly one out of three, are stunted. Malnutrition is implicated in half of all child deaths and contributes significantly to morbidity and cognitive underdevelopment. About 1 billion adults in developing countries are underweight, and an estimated 1.6 billion are anemic. They suffer from lowered resistance to infection, impaired work capacity and reduced economic productivity. In addition, there is growing evidence that fetal malnutrition has significant consequences - not only threatening survival, growth and development in childhood, but also increasing the risk of contracting various chronic diseases in later life. In spite of the magnitude of the global malnutrition problem, effective policy responses have stagnated. It was against this backdrop of relative inertia in nutrition that the World Bank and UNICEF decided in April 1999 to join forces in reviewing the agencies' ef- forts to address malnutrition. The joint assessment comprised several complementary strands of analysis, including reviews of World Bank and UNICEF portfolios, analyses of the evolution of key policy narratives, country case studies, and workshops with Bank and UNICEF staff and selected external experts. The overall aim was to provide a fresh perspective on the global effort to address malnutrition, with a particular focus on the roles of the two agencies in shaping this agenda and its implementation. The study attempted to 'get behind the headlines', to understand how policy change in nutrition happened, what influenced these processes, and what lessons can be learned from them. This paper applies lessons from the Assessment to a major policy challenge that presents itself to our field today: Will nutrition be in the mainstream of the global effort to reduce poverty, or will it be marginalized? The paper gives a brief overview of the Poverty Reduction Strategy Process (PRSP), and then argues that nutrition can feature in countries' poverty agendas if we tackle a number of issues that emerged from the World Bank/UNICEF study.