Nutrition Advocacy Process: Using PROFILES and Nutrition Costing - Kavita Sethuraman

1. 1
Nutrition Advocacy Process:
Using PROFILES and Nutrition Costing
Kavita Sethuraman, PhD
Food and Nutrition Technical Assistance III (FANTA) Project

2. Presentation Outline
• Nutrition Advocacy Terms and Steps in
Process
• Examples of Results from Various Countries
• New PROFILES Models
• Coming Soon…
2

3. Nutrition Advocacy Terms
and Steps in Process
3

4. What is Nutrition Advocacy?
4
• Planned and deliberate process to ignite social
change for movement toward greater political
and social commitment to improve the
nutrition situation
• Promotes accountability for nutrition and
strengthens nutrition governance
• Defined and shaped by specific country context
• Can support a country at any stage of
commitment

5. What is PROFILES?
5
• An evidence-based tool to support nutrition advocacy
• Consists of a set of computer-based models that calculate consequences if
malnutrition does not improve over a defined time period and the benefits
of improved nutrition over the same time period, including lives saved,
disabilities averted, and human capital and economic productivity gains
• Based on reduction in the prevalence of several nutrition problems, such as
iron deficiency anemia; low birth weight; vitamin A deficiency; iodine
deficiency; suboptimal breastfeeding practices; and childhood stunting,
underweight, and wasting
• Requires current country-specific nutrition data that are identified and
agreed upon in collaboration with stakeholders in country
• Results can be used to engage government and other high-level
stakeholders in a collaborative nutrition advocacy process
• Works to identify, prioritize, and advocate for evidence-based actions to
reduce malnutrition

6. Nutrition Problems Addressed in PROFILES and
the Benefits of Their Reduction
PROFILES also estimates economic productivity losses if there is no change in the nutrition situation.
6

7. What is Needed for PROFILES to Calculate
Estimates?
7
• Data Sources (i.e., what sources of information
do we use?)
• Time Period (i.e., what time period should we
base the estimates on? Does it need to
correspond to national vision documents? How
much time do we need to see real change?)
• Targets (i.e., what should be our goal with
regard to prevalence for the given time
period?)

8. What is Nutrition Costing?
8
• Estimates costs of implementing a comprehensive set of
nutrition programs in a country or prioritized geographic area
over a specific time period
• Complements PROFILES estimates (PROFILES does not
calculate costs)
• Involves a collaborative process to:
– Identify an appropriate structure for the nutrition program
– Select interventions and activities
– Determine a management structure
– Select an approach to service provision
– Identify inputs and obtain unit costs

9. How are PROFILES and
Nutrition Costing Results Used?
9
• PROFILES and Nutrition Costing estimates are the
cornerstone of this nutrition advocacy process
• Using a consensus-building approach coupled with
systematic planning with government and
nongovernment stakeholders, country teams
develop nutrition advocacy plans and targeted
materials to disseminate PROFILES and Nutrition
Costing results to key audiences

10. What Are the Steps in the
Nutrition Advocacy Process?
10
• Step 1: Convene multi-stakeholder core working group and
conduct stakeholder meeting
• Step 2: Conduct a PROFILES workshop to develop estimates
and share preliminary results
• Step 3: Develop nutrition costing estimates and share
preliminary results
• Step 4: Conduct a Nutrition Advocacy Planning workshop to
develop a National Nutrition Advocacy Plan and
corresponding nutrition advocacy materials
• Step 5: Conduct sub-national nutrition advocacy planning and
development of materials, as needed

11. Examples of Materials Developed During
Nutrition Advocacy Process
• Final PROFILES Report
• Final Costing Report
• National Nutrition Advocacy Plan
• Nutrition Advocacy Materials Targeted to Key
Audiences (e.g. policymakers, media, private
sector, civil society, etc.)
• District-level Nutrition Advocacy
Implementation Plans
11

12. Bangladesh PROFILES
and Costing Report
12

13. Ethiopia Nutrition
Advocacy Plan
13

14. Nutrition Advocacy Materials Targeted
to Key Audiences
14

15. Nutrition Advocacy Process in Summary
PROFILES and Nutrition
Costing are helpful in
situations where:
Advocacy processes for nutrition need to:
Tools such as PROFILES
and Nutrition Costing
provide:
• The prevalence of
many forms of
malnutrition are high
• Investment,
commitment,
governance, and
accountability for
nutrition is low
• Nutrition services are
fragmented and not
holistic
• Be based on a sound understanding of the
current country context for nutrition (scale
of problem, visibility, commitment,
investment, and accountability)
• Be systematic, planned, and deliberate,
involving key stakeholders and targeting key
audiences
• Be part of a collaborative effort at the
country level including multiple stakeholders
(government and nongovernment)
• Be multisectoral, obtaining buy-in of
stakeholders across sectors
• Target key audience segments that are
influential and that can promote
accountability and good governance
• Insight for action
• Consensus building
and a shared vision for
nutrition (“one voice”)
• Accountability and
goal setting for
investment in nutrition
across the lifecycle,
including services
along a continuum of
care for the prevention
and treatment of
malnutrition
15

16. Illustrative Timeline for
Nutrition Advocacy Process
Months 1-2
Form a core
working group
Months 3-4
Hold a multi-
stakeholder
meeting and
PROFILES
workshop; present
preliminary results
and begin
nutrition costing
consultations
Months 4-7
Conduct
nutrition
advocacy
planning
workshop(s)
Month 6-7
Present nutrition
costing preliminary
results
Months 8-12
Finalize PROFILES and
nutrition costing reports
Finalize nutrition advocacy
materials
Conduct nutrition advocacy
activities as determined in
country

17. Countries FANTA has Conducted Nutrition
Advocacy Process Since 2010
17
PROFILES and
Nutrition Costing:
• Bangladesh
Nutrition Costing:
• Guatemala
PROFILES:
• Uganda
• Ghana
• Ethiopia
• Haiti
• Tanzania
• Malawi

18. Examples of Results
18

19. Nutrition Situation Among Children Under 5
Uganda
(2011)
Ghana
(2008)
Bangladesh
(2007)
Ethiopia
(2011)
Haiti
(2013)
Tanzania
(2011)
Malawi
(2010)
Percent -2 SD (z-score)
Stunting
(chronic
malnutrition)
33 28 43 44 22 42 42
Underweight 14 14 41 29 11 16 17
Wasting
(acute
malnutrition)
5 8.5 17 10 5 5 4
Source: Demographic and Health Surveys
19

20. Stunting
Lives Saved
~160,000
~17,000
~150,700
~9,000
Wasting
Lives Saved
~150,000
~28,000
~108,000
~3,800
Bangladesh
2011–2021
Ghana
2011–2020
Saving Lives by Reducing
Chronic and Acute Malnutrition
20
Ethiopia
2012-2025
Haiti
2013-2022

21. Stunting
Lives Saved
~118,700
~120,600
~97,700
Wasting
Lives Saved
N/A
N/A
N/A
Tanzania
2014-2025
Uganda
2013-2025
Malawi
2015-2030
Saving Lives by Reducing
Chronic and Acute Malnutrition
21

22. Saving Lives and Preventing Disabilities
Maternal
Deaths
Averted
Iron deficiency
anemia
~6,000
~4,700
~6,400
~1,300
Perinatal
Deaths
Averted
Iron deficiency
anemia
~150,000
~32,000
34,000
~4,000
Infant
Deaths
Averted
Low birth weight
~230,000
~14,000
~57,700
~7,400
Child
Deaths
Averted
Vitamin A
deficiency
~50,000
~25,000
~106,500
~5,100
Permanent
Disabilities
Averted*
Iodine deficiency
~2,000,000
~700,000
~7,000,000
~90,700
Bangladesh
2011–2021
Ghana
2011–2020
* Cretinism and mild to severe permanent brain damage prevented
22
Ethiopia
2012-2025
Haiti
2013-2022

23. Saving Lives and Preventing Disabilities
Maternal
Deaths
Averted
Iron deficiency
anemia
~6,600
~15,500
~6,200
Perinatal
Deaths
Averted
Iron deficiency
anemia
~19,700
~72,700
~22,600
Infant Deaths
Averted
Low birth weight
~25,800
~20,500
~22,800
Child Deaths
Averted
Vitamin A
deficiency
~61,000
~101,900
~27,700
Permanent
Disabilities
Averted*
Iodine deficiency
~236,500
~869,800
N/A
Tanzania
2014-2025
Uganda
2013-2025
Malawi
2015-2030
* Cretinism and mild to severe permanent brain damage prevented
23

24. Infant Lives Saved
Infant Lives Saved Related to
Improved BF Practices
Uganda (2013-2025) 101,100
Tanzania (2014-2025) 85,500
Malawi (2015-2030) 81,400
24

25. Economic Productivity Gains That Would Result from
Reduced Micronutrient and Chronic Malnutrition
Bangladesh
2011–2021
US$
Ghana
2011–2020
US$
Ethiopia
2012-2025
US$
Haiti
2013–2022
US$
Iodine
Deficiency
900 Million 300 Million 2.9 Billion 34 Million
Anemia 1 Billion 350 Million .5 Billion 37 Million
Stunting 13 Billion 500 Million 5 Billion 218 Million
25

26. Economic Productivity Gains That Would Result from
Reduced Micronutrient and Chronic Malnutrition
Uganda
2013-2025
US$
Tanzania
2014-2025
US$
Malawi
2015-2030
US$
Iodine
Deficiency
75.9 Million 479.1 Million N/A
Anemia 108.8 Million 381.7 Million 170.6 Million
Stunting 1.7 Billion 3.9 Billion 1.8 Billion
26

27. Human Capital Gains That Would Result from
Reduced Chronic Malnutrition
Equivalent School Years of
Learning Gained
Uganda (2013-2025) 19.8 Million
Tanzania (2014-2025) 24.7 Million
Malawi (2015-2030) 18.2 Million
27

28. 28
Cost Centers
Scenario 1 Scenario 2
US$ (Mn) USD (Mn)
Direct costs
SBCC and community nutrition promotion 260 260
Management and coordination 53 53
Systems strengthening 102 102
Micronutrient supplementation 449 449
Targeted food supplementation - 434
Management of SAM in children 435 435
De-worming 4 4
Total 1302 1736
Indirect costs through Public-Private Partnership
Food Fortification 441 441
Estimates of Cost - Bangladesh 2011-2021
Source: Nutrition Costing for Bangladesh (2011) conducted in conjunction with PROFILES.

29. Results from Nutrition Costing in Guatemala
• Found an investment gap for 2013 in the amount of
Q1,196.5 million (about U$ 150 million) given that
the government’s investment in nutrition for that
year was Q637.2 million (about U$ 80 million) - one
third of what was required.
• If sufficient annual resources are not made available
to achieve nutrition goals, the budget shortfall for
nutrition is predicted to grow.
• 77% of the total funds for nutrition should be
allocated to nutrition-specific services.

30. 1,420
1,566
1,723
1,893
2,065
2,233
2,407
2,619
2,858
637 665 694 724 754 784 815 848 882
1834
2037
2255
2495
2740
2986
3242
3538
3869
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
2013 2014 2015 2016 2017 2018 2019 2020 2021
Funding needed for Nutrition-Specific Interventions
Current projected budget allocation for nutrition
Total funding needed for nutrition-specific interventions and immunizations and water surveillance
FundingGapforNutrition
Funding Gap At The National Level in Guatemala For
Nutrition Interventions: Projected Budget versus Funding
Needed by Year

31. Usingtheestimatesforadvocacy
Created a multisectoral advocacy
strategy and implementation plan
with key stakeholders
Disseminated PROFILES and
costing final results in June 2012
Developed targeted materials and
conducted advocacy efforts with
20 members of parliament,
including the chief whip; 20 high-
level GOB policy makers; 30 CSOs;
15 development partners; and
several representatives of
political parties.
Worked with each audience to
move the nutrition agenda
forward through discussions and
roundtables
OutcomeHighlights
Within GOB, cost estimates
guided national budget
allocation for nutrition for
the next 5 years
Raised the visibility,
commitment, and
accountability for nutrition
in Bangladesh among GOB
and development partners
Parliamentarians requested
to join nutrition task force
after discussions
Bangladesh Advocacy Work with Gov’t
31

32. Usingtheestimatesforadvocacy
Held trainings with media houses
targeting media gatekeepers
(editors and newsroom leaders)
and journalists to strengthen
understanding of nutrition issues
and investigative reporting skills
Created training modules, fact
sheets, and a handbook for media
Developed a fellowship program
for journalists
Conducted media outreach
including organizing two talk
shows highlighting nutrition
issues that candidates in the
upcoming election should be
focused on
OutcomeHighlights
Resulted in a marked increase in
the amount of news coverage,
especially in-depth reports and
features, of nutrition issues as
well as in the quality of reporting
(i.e. clarity and readability)
19 percentage point increase, on
average, in coverage of nutrition
after the intervention
Articles that were considered
clear and compelling to read rose
from about 1% to about 70%
Of the 565 articles considered
very clear and compelling to read
during the follow up monitoring,
345 of them were written by
journalists trained by FANTA
Bangladesh Advocacy Work with Media
32

33. Usingtheestimatesforadvocacy
Convened multisectoral national
task force
Launched PROFILES results and
held advocacy activities with key
audiences
Developed advocacy materials
focused on nutrition and sectors
and also targeted to media, CSOs,
donors, policymakers, district
level officials, faith leaders, and
community-based services
officers
Created nutrition advocacy
training for district-level officials
to help them develop advocacy
implementation plans and talking
points
OutcomeHighlights
Culminated in the development
and adoption of a multisectoral
Uganda Nutrition Action Plan
operationalized by the Office of
the Prime Minister
Worked with policymakers to
contribute to the Food and
Nutrition Bill
Developed a budgeting tool for
districts to allocate funds for
nutrition programming
10 districts are now implementing
their advocacy plans to support
integration of nutrition into sector
work plans and budgets
Uganda Advocacy Work
33

34. New PROFILES Models
34

35. Examining the Relationship Between Suboptimal
Breastfeeding (BF) and Child Mortality:
A New Model Within PROFILES
• Suboptimal BF practices result in more than 800,000 child deaths
annually (Black et al. 2013).
• New model shows benefits of optimal BF practices on reduced child
mortality
• Uses coefficients (on increased mortality risk due to suboptimal BF)
from peer-reviewed literature and country-specific BF information
• Calculates proportion of child mortality (among children 0–5 months
and 6–23 months) related to suboptimal BF
• New model used in Tanzania, Uganda and Malawi
• In Tanzania, for example, improving BF practices would save ~86,000
children’s lives by 2025
35

36. 36
Estimating the Effect of
Suboptimal Breastfeeding
Practices on Child Mortality:
A Model in PROFILES for
Country-Level Advocacy

37. Examining the Relationship Between Stunting and
Human Capital (Learning Ability):
A New Model Within PROFILES
• Childhood stunting is associated with developmental delays
• New model estimates human capital losses in terms of reduced learning
ability related to stunting
• Uses coefficients (estimating deficits in learning ability related to
stunting) from peer reviewed literature and country-specific stunting and
education information
• Unit of measurement is “equivalent school years of learning” - aggregate
of deficit or gain in children’s learning ability across all years when a child
is supposed to be in school according to a country’s education policy
• New model has been used in Tanzania, Uganda and Malawi
• In Tanzania, for example, more than 24 million equivalent school years of
learning would be gained related to a reduction in stunting by 2025
37

38. 38
The Effect of Chronic
Malnutrition (Stunting) on
Learning Ability, a Measure
of Human Capital: A Model
in PROFILES for Country-
Level Advocacy

39. Examining the Relationship Between Suboptimal
Breastfeeding (BF) and Overweight/Obesity in
Childhood: A New Model Within PROFILES
• As of 2014, as many as 41 million children under 5 worldwide are
overweight or obese – More children are affected in LMIC than high-
income countries
• New model shows benefits of optimal BF practices on reduced
overweight/obesity among children
• Uses coefficients (on increased risk of overweight/obesity due to
suboptimal BF) from peer-reviewed literature and country-specific BF
information
• Calculates country-specific estimates of children 48-59 months who are
likely to become overweight/obese related to suboptimal BF
• New model will be used this year in Kenya and Zambia
39

40. Coming Soon
Web-Based Manual for Country-Level Nutrition
Advocacy using PROFILES and Nutrition Costing
including detailed information on each step of the
nutrition advocacy process:
• Step 1: Convene multi-stakeholder core working
group and conduct stakeholder meeting
• Step 2: Conduct a PROFILES workshop to develop
estimates and share preliminary results
• Step 3: Develop nutrition costing estimates and
share preliminary results
• Step 4: Conduct a Nutrition Advocacy Planning
workshop to develop a National Nutrition Advocacy
Plan and corresponding nutrition advocacy materials
40

41. This presentation is made possible by the generous support of the American people through the support of the Office of
Health, Infectious Diseases, and Nutrition, Bureau for Global Health, U.S. Agency for International Development (USAID) under
terms of Cooperative Agreement No. AID-OAA-A-12-00005, through FANTA, managed by FHI 360. The contents are the
responsibility of FHI 360 and do not necessarily reflect the views of USAID or the United States Government.
Thank You
For more information, contact:
Kavita Sethuraman, PhD
Food and Nutrition Technical Assistance III Project (FANTA)
FHI 360
ksethuraman@fhi360.org
For more information on the FANTA Project or PROFILES and
Nutrition Costing, please visit www.fantaproject.org.
41