Learning Curves

OED
March 2007

ADBInterventionsonNutrition andFoodFortification
NutritioniscentraltotheaccomplishmentoftheMillenniumDevelopmentGoals, particularlythosetoachieveuniversalprimaryeducation;promotegenderequalityand empowerwomen;reducechildmortality;improvematernalhealth;andcombatHIV/AIDS, malaria,andotherdiseases.ItisalsointegraltotheMillenniumDevelopmentGoalto eradicateextremepovertyandhunger. Thegeneraldiscussionofnutritionseeninthe1960shasbeenreplacedbynutrientspecific strategies.Fortificationhasbeenpromotedasthemostcosteffectivenutritionintervention. Incountrieswheredevelopmenthasproceededrapidly,theproblemofovernutritionis emergingrapidly,whichincreasesriskforseveralchronicdiseases. UrbanizationandincreasesinlifeexpectancyhavechangedthedemographicprofileofAsia andthePacific.Moreeffortisneededtodevelopeffectivenutritionprogramsforalltypesof nutritionrisks.
Background From1985toJuly2004,ADBfinancedinthehealth sector31regionaltechnicalassistanceprojectsrelatedto health,nutrition,population,andearlychild developmentforatotalof$32.8million.Beginningin 1996,itapprovedfiveregionaltechnicalassistance projectsfor$11.7million,outofwhich$8.8million werefinancedbytheJapanFundforPoverty Reduction,toenhancenutritionandsetthestagefor ADBinterventionsinfoodfortificationin16developing membercountries.In2004,theOperationsEvaluation DepartmentconductedaSpecialEvaluationStudyof ADBInterventionsonNutritionandFood Fortification.1Allfiveprojectswereevaluated. Bangladesh,Indonesia,KyrgyzRepublic,thePeoples RepublicofChina,andVietNamwereselectedfor detailedfieldassessments.Consultationsand interviewswereconductedwithpolicymakersand stakeholders,includingpublicandprivateentities involvedinnutritionandfoodfortification, nongovernmentorganizations,nutritioninstitutions, academics,andtheUnitedNationsChildrensFund. Deskreviewswerecarriedoutforothercountries.
Operations Evaluation Department Asian Development Bank

SummaryofFindings Thestudyfoundthat,forsomedevelopingmember countries,theregionalapproachprovidedbythe projectshadnotbeenenough.Countryspecific assistanceinintegratingnutritionplansinto developmentplans,andsupportforpilotprojects,are necessary.Technicalassistanceshouldincludeasmall investmentcomponenttoimproveeffectivenessand sustainabilitythroughdemonstration,suchaspiloting. Nutritioninterventionsshouldalsobeownedby stakeholders.Thisinvolvestailoringthemtolocalsocial conditionsbyinvolvingcivilsociety,related developmentpartners,andprivatesector representatives.Thestudyfoundalsothatpoverty reductionandstrengtheningofhealthcaresystems alonecannotsolvemicronutrientdeficiencyproblems: consumersdonotautomaticallydemandmicronutrient richfoodswithincreasedincome.Further,major constraintstoimplementingnutritionprogramsare pooraccesstoessentialservices,suchashealthand education;decliningstateofhealthservices;low resourceallocationsgiventothesesectors;andlackof povertyandnutritiondata.And,notsurprisingly,poor

6 ADB Avenue, Mandaluyong City, 1550 Metro Manila, Philippines Tel +63 2 632 4444; Fax +63 2 636 2444; evaluation@adb.org; www.adb.org/evaluation/

peopleinareaswiththegreatestriskofmicronutrient undernutritionusuallydonoteatfoodsthatcanbe fortified. Lessonsarethatmicronutrientfortificationmustbe combinedwithotherfoodsecurityandcommunity nutritioninitiatives.Also,safetynetprograms, includingrefugeefeeding,mustrespondtototal nutritionneeds,notonlycalorieneeds.Inaddition, promotionaleffortsonmicronutrientfortification shouldnotneglecttoemphasizetherecurringcostsof regulatoryandenforcementmechanisms,testing laboratories,andtraining.Thesecostsaregenerallynot integratedinshorttermassistancepackagesandneed tobetakenintoaccounttoensurethateffortsare sustainable.Moreover,nutritioneffortsshouldbe appropriatetothelevelofnutritionriskandcapacityof thecountriesinvolvedandtheirdevelopmentpartners. Nutritioneffortsshouldconsiderthefollowing: Geographicandsocioeconomicbaselinedataon malnutritionrisksareessentialfordevelopingan appropriatemixofnutritioninterventions. Periodicassessmentsofnutritionstatusand situation(e.g.,childhoodpopulationnutrition, obesity,andmicronutrientstatus)areimportant. Monitoringandriskmanagementcapacitiesof participatingcountriesmustbeimprovedtoallow increasedcoverageandsharperfocusondeliveryof fortifiedfoodsconsumedbythepoor. Appropriatetechnologiesneedtobetransferredto governments,nongovernmentorganizations,food industries,andconsumergroupstoensure successfulandsustainablefortificationprojects. Holisticsolutionsforpovertyreductionarerequired tomitigaterisksofmalnutritionbysupporting complementaryactivitiesonnutritionimprovement andempowermentofwomen. Recommendations Indesigningafoodfortificationinterventionandin calculatingthecosteffectivenessoftheintervention, ADBshouldtakeintoaccountcoststhatareoften ignored,forexample,costsrelatedtosupporting qualityassuranceandstandardization. Amodified(hybrid)modalityoftechnicalassistance thatallowssmallpilotinvestmentcomponents appearstohavepotentialinenhancingeffectiveness andensuringsustainableimpactofADB
Learning Curves available @ www.adb.org/evaluation/

interventionsonnutritionandfoodfortification. ADBshouldexplorethepossibilityofsuchmodality initsongoingefforttoenhancetechnicalassistance operations. Findingsandoutputsofthenutritionrelated regionaltechnicalassistanceprojects,andlessons fromotherADBnutritionrelatedoperations,can feedintotheupdateofADBsPolicyfortheHealth SectorortheintegratedHealth,Nutritionand PopulationStrategyplannedfor2006. ADBshouldcontinuetocatalyzenutrition developmenteffortsinAsiaandthePacific. Regionaltechnicalassistanceprojectsshouldbuild ownershipbytailoringnutritioninterventionsto localsocialconditions. Holisticsolutionsthatcanaddressandmitigate underlyingrisksforpoornutritionshouldbe promotedbysupportingcomplementaryactivities forimprovednutritionandempowermentof womeninADBsoperations. Feedback ADBManagementsResponseendorsedthe recommendationsofthestudy.Itacknowledgedthat currentprocessingandimplementationofnutrition relatedprojectsshouldtakeintoconsiderationthe recommendationsandconclusionssetoutinthestudy. Moreattentionshouldbepaidtoassessingthecostsof qualityassuranceandstandardizationwhenpreparing costeffectivenessanalysesandassessingthe sustainabilityofourfoodfortificationinterventions. TheJapanFundforPovertyReductionoffersscopefor projectsthatincludesmallinvestmentcomponents, whichareindeedconsideredessentialtoincreasethe effectivenessandimpactoftechnicalassistance.The ChairsSummaryoftheDevelopmentEffectiveness CommitteeDiscussionsexpectedADBtotakethekey recommendationsofthestudyintoaccountin(i) furtherworkinthehealthsector;(ii)thedesignof furtherfoodfortificationinterventions;and,more generally,(iii)effortstostrengthentheeffectivenessof ADBstechnicalassistance.
1

ADB.2004.SpecialEvaluationStudyofADB InterventionsonNutritionandFoodFortification. Manila. Available:http://www.adb.org/Documents/Reports/Evalu ation/sstreg200419/sesfoodnutrition.asp

Team Leader: Kus Hardjanti; Tel +63 2 632 6715; khardjanti@adb.org