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This document has been prepared by the Nutrition Advisory Service: Dominique Blariaux, Claire Chastre (team leader), Lola Gostelow, Lawrence Haddad, Cristina Lopriore, Yves Martin-Prével and Carlos Navarro-Colorado.

 

The preparation of the document has been coordinated by, and has benefited from, inputs made by representatives from Germany, Ireland, France, Poland and the United Kingdom as well as various services from the European Commission.

 

This Reference Document is intended as a resource to guide the practical incorporation of nutrition objectives into relevant sectors and different funding modalities used by the European Union (EU) — whether in development cooperation or in humanitarian response. It is targeted primarily at aid administrators working within country teams — delegations of the EU and offices of Member States.

 

The Reference Document has been structured and written in such a way that the chapters can be read independently. The only exception to this is humanitarian assistance, because there are no absolute divisions between emergency nutrition interventions and development interventions. To ensure sustainable progress on nutrition and save lives, there is a need for contiguity between nutrition emergency action and development. The critical requirement, always, is to ensure that the situation is analysed as fully as possible to determine the best course of action.

 

Chapter 1 provides an overview of the consequences of undernutrition, the scale of the problem and its causes.

Chapter 2 provides a detailed description of how nutrition benefits can be realised by adapting the design of programmes in all relevant sectors and thematic areas

Chapter 3 provides guidance on how nutrition concerns can be integrated throughout the various programming phases

Chapter 4 provides guidance for addressing nutrition through two broad categories of aid delivery methods: general/sector budget approaches and the project approach.

 

At the core of the EU Reference Document on Addressing Undernutrition in External Assistance is a call to join up action – joining analysis and evidence to action; joining different levels of causes in order to sustain improvements; joining efforts across different sectors to build coherence; joining government aspirations and efforts to external support; and joining shorter-term investments to longer-term progress.

In time, it is also hoped that this Reference Document will support on-going efforts to join up the approaches and priorities of the EU’s aid institutions across its Member States, thereby creating international momentum to combat undernutrition once and for all

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Contents

Acknowled gements 2

Abbrevia tions 5

Executive summar y 7

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Chapter 1: Introduction 11

1.1. P urpose and scope of the Reference Document 13

1.1.1. Using the Reference Document 13

1.1.2. Understanding malnutrition and undernutrition 14

1.2. Undernutrition and its consequences 16

1.2.1. Consequences at individual level 16

1.2.2. Consequences at national level 17

1.2.3. Consequences at international level 17

1.3. S cale of the problem 18

1.3.1. Fragile states 20

1.3.2. Trends 20

1.4. C auses of undernutrition 21

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Chapter 2: Improving nutrition through key thematic areas 25

2.1. Improving nutrition through health 27

2.2. Improving nutrition through water/sanitation/hygiene 28

2.3. Improving nutrition through education 29

2.4. Improving nutrition through gender 30

2.5. Improving nutrition through social protection 31

2.6. Improving nutrition through food security 33

2.7. Improving nutrition through agriculture 34

2.8. T he environment and sustainable management of natural resources 36

2.9. Improving nutrition through governance 37

2.10. Improving nutrition through human rights 39

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Chapter 3: Integrating nutrition in the programming phase 41

3.1. Analysing and understanding undernutrition in context 42

3.1.1. Is there a problem of undernutrition? 42

3.1.2. Analysing and understanding governments’ response to undernutrition 43

3.1.3. Analysing and understanding other stakeholders’ responses to undernutrition 44

3.2. Raising the national profile of nutrition 44

3.3. S haping a donor response to undernutrition 46

3.3.1. Setting priorities 46

3.3.2. Specific approaches for humanitarian response, transition situations and fragile states 48

3.4. Designing monitoring, evaluation and learning 49

Chapter 4: Nutrition in aid delivery methods 51

4.1. G uidance for addressing nutrition through general and sector approaches 53

4.2. G uidance for addressing nutrition through projects 59

4.2.1. Guidance for addressing nutrition through development projects 59

4.2.2. Guidance for addressing nutrition through humanitarian projects 61

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Annexes

Annex 1: Glossary 68

Annex 2: Countries bearing the burden of undernutrition 73

Annex 3: Indicators 75

Annex 4: Ten steps to successful breastfeeding 84

Annex 5: health-related interventions effective for nutrition 85

Annex 6: nutrition situation analysis 86

Annex 7: terms of reference for evaluating programmes for nutrition outcomes 91

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Li st of fi gure s

Figure 1: An overview of this Reference Document 14

Figure 2: An overview of undernutrition 15

Figure 3: 90% of the world’s stunted children live in 36 countries 19

Figure 4: Regional progress in addressing underweight in children 20

Figure 5: A model of the casual pathways leading to undernutrition 22

Figure 6: Nutrition framework for action 23

Figure 7: Aid delivery methods used by the European Commission 52

Figure 8: Making aid delivery methods nutrition sensitive 53

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Li st of tab les

Table 1: The disease burden and deaths associated with undernutrition 17

Table 2: Nutrition in the millennium development goals 18

Table 3: Nutrition in the donor country strategy paper 47

Table 4a: General/global approach: steps to incorporating nutrition 55

Table 4b: Sector approach: steps to incorporating nutrition 56

Table 5: Steps to incorporate nutrition aspects when preparing project support 60

Table 6: Steps to incorporate nutrition in emergency projects 62

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List of boxes

Box 1: Impact indicators potentially relevant to all aspects of external assistance 26

Box 2: Key indicators of nutrition benefits through health 28

Box 3: Key indicators for nutrition benefits through water/sanitation/hygiene 29

Box 4: Key indicators for nutrition benefits through education 29

Box 5: Key indicators of nutrition benefits through gender 30

Box 6: Key indicators of nutrition benefits through social protection 32

Box 7: Key indicators of nutrition benefits through food security and agriculture 36

Box 8: Key indicators of nutrition benefits through environment and the sustainable management

of natural resources 37

Box 9: Key indicators for nutrition benefits through governance 39

Box 10: Key indicators for nutrition benefits through human rights 40

Box 11: Introducing nutrition objectives into a national strategic framework 45

Box 12: Incorporating nutrition objectives in programming 46

Box 13: Principles of good international engagement in fragile states 48

Box 14: Sector terminology 52

Box 15: Key nutrition indicators for general and sector approaches 57

Box 16: Key issues concerning nutrition in humanitarian response 61

Box 17: Key nutrition indicators in emergencies 65