Remarks by USAID Administrator Dr. Rajiv Shah at the Change a Life, Change the Future Roundtable in New York City

Tuesday, September 21, 2010
1,000 Days: Change a Life, Change the Future Roundtable

Other participants in the panel:
Anthony Lake, Executive Director of the United Nations Children's Fund; Peter Power, Irish Minister of State for Overseas Development; Beverly ODA, Canadian Minister of International Cooperation; Andrew Mitchell, British Secretary of State for International Development; Kristalina Georgieva, European Commissioner for International Cooperation, Humanitarian Aid and Crisis Response; Dr. Margaret Chan, Director-General of the World Health Organization; Tamar Atinc, World Bank Vice President for the Human Development Network; Josette Sheeran, Executive Director of the UN World Food Program

MR. LAKE: I’ve been asked first to call us to order, and then secondly to offer a few words of context before we get to discussions, I hope, in more detail on breastfeeding, on nutritional supplementation, on Vitamin A, on hand washing, et cetera.

First, I would like very much to thank the governments of Ireland and the United States for calling attention to the issue of nutrition, which has been for much too long under-discussed and overlooked, and to thank the Secretary General for his leadership, and all of our partners here and all of you in this room who are doing so much every day on this issue.

So to set the context, let me ask each of you to make with me a leap of imagination. I want you to imagine a judge sitting in a courtroom and before him is brought a newborn baby, and the judge sternly looks over the bench, and without hesitation, condemns that infant to death or to a life sentence of learning challenges and poor health and diminished potential. Now, can you do it? No, of course not. It’s unimaginable. But that is exactly what is happening everyday to millions of children in the world’s poorest places and hardest to reach communities. Through inaction, through inattention, through simple ignorance of the irreversible effects of undernutrition, we are slamming down the gavel, like that judge, on these children’s capacity to learn, to grow, and to thrive. And it makes me angry.

And we know that the burden of undernutrition and the stunted physical and cognitive development that it causes falls overwhelmingly on the world’s poorest communities and poorest countries perpetuating an intergenerational cycle of poverty and despair. In fact, UNICEF recently released a report that shows that poor children in developing countries are twice as likely to suffer from stunting as children from richer households in those countries.

Just look at a country like Niger, nearly half of all the children in Niger suffer from stunting – nearly half of the children; that’s 1.5 million children experiencing irreversible harm that will diminish their development and undermine the strength of their society. Half a million of those children are suffering from acute malnourishment, and 100,000 of those children are in severe and critical condition. Without immediate intervention, most of them will almost surely die. That is a tragedy. That is an outrage. But it hardly makes the papers. Can anyone doubt if there were a sudden outbreak of cholera or the death toll of a natural disaster of some sort that most people would pay attention?

The stakes of malnutrition could not be higher. And nutrition, like education, like clean water, like health care, cuts across our ability to achieve all of our development goals, not just MDG-1. But rather than contemplate the consequences of failure, we should be looking at the enormous opportunities that this presents and seizing those opportunities. That is what the 1,000 Days approach is all about and it’s also the purpose of the SUN framework, guidelines our partners and we have developed for the most effective ways to scale up nutrition and implement those policies in the places where the highest burden of stunting is taking place.

But to make this work, we need a new commitment to coordinate our efforts across the sectors, working in partnership with governments and the private sector across the UN, throughout civil society, and most importantly at the country level, to scale up nutrition.

This event is the start of that process. And we need to commit ourselves to giving every child the best possible first thousand days. The first thousand days are a window of opportunity to give every newborn baby the chance to grow and to thrive. The first thousands days in which we can save millions of children from lives of disability, disadvantage and despair, a thousand days to help break the cycle of poverty, build stronger societies and a more equitable world. That is what we are working toward and I look forward to hearing from all of my colleagues on this panel who are doing so much every day to save so many lives. Thank you Raj. Thank you. (Applause.)

ADMINISTRATOR SHAH: Thank you, Tony. And it is wonderful to have UNICEF led by someone with so much commitment and compassion on this particular issue, but on the much larger set of issues that affect child welfare around the world.

That’s – it’s quite a challenge, and the task this morning has been laid out quite clearly by Secretary Clinton and so many other distinguished panelists this morning who highlight the convergence that this meeting essentially represents – a convergence of strategy, of evidence, of political will, and most notably perhaps of business partnerships and of new ways of delivering what we all know we need to deliver to children in that first thousand days by a unique set of new partnerships.

And so perhaps we might start this panel, and we’ll introduce panelists as we go to protect our limited time and allow us all to hear from their great insights, with someone who really represents, perhaps one of the most important interventions that’s been made over the last decade, in bringing the international business community, large food companies, and perhaps most notably, small, local producers of packaged and processed foods into the problem-solving around nutrition and micro-nutrients in particular.

So, Jay Naidoo, who is the chair of the board at the Global Alliance for Improved Nutrition, will be our first speaker and will have the opportunity to share today some of the things you’ve learned and some of the things you think can be achieved. And as you do that, you may want to address the item on David Beckmann’s wonderful list, which I thought was easy to remember and important for all of us on how important a few specific micro-nutrients can be if delivered at scale to everyone in the population through the basic food system.


MR. NAIDOO: Thank you very much, Raj, for this opportunity. And firstly, as an antiapartheid activist, I understand more than anything else how important international solidarity was in our struggle to defeat a very brutal system. It was your individual and collective actions that supported us inside the country to win our battle against a very brutal system and to introduce democracy.

That’s – the second lesson I want to talk about is as a part of the Mandela cabinet, we had great intentions to solve the problems of poverty and inequality. And yes, we’ve done remarkably well in introducing political democracy, in having economic growth, and also, in a sense, of creating a grant system that reaches 40 million people in our country. But malnutrition has not changed in our country, even with economic growth and political democracy. So the decision today to launch this 1,000 Day campaign to build a global movement to deal with the challenges of malnutrition in a targeted way, I think, is a phenomenal step for all of us to take. And to do it in the context of the SUN agreement – this global agreement about scaling up nutrition – is a remarkable first, which creates this convergence that Secretary Clinton talked about, and I think that’s what is a great impetus for what we want to do. And hopefully, we’re going to create new bureaucracies around this global agreement. But it strengthens our individual capacity to coordinate and to do the right thing.

In terms of the poor, who we are addressing at the bottom of the pyramid, while 70 percent of poor people that we encounter will buy this food from private sector company, either the global companies or small companies and small producers of grain at a town or national or regional level. That is the reality. With the migration to the cities, this is where people, poor people are buying. They’re buying their food from the private sector.

So to build a sustainable business model is to see how we can work with that private sector and we do today with over 600 companies from the largest companies to the smallest companies, to look at sustainable models of how they can produce foods that are nutritious that are affordable, and that are accessible. And we’ve had remarkable success. And one of the most cost-effective ways of doing it, as again many of the speakers have elaborated here, is the science is there, the solutions are there. That, with the addition of micro-nutrients and targeting pregnant mothers and children under two – that thousand-day period – we can save lives of millions of children who today die of preventable causes which are indictment on all of us. And so today for me, the issue is about human rights. It is a human rights abuse to say that a child could die because we haven’t taken the appropriate action.

But central to this issue is also the rights of women. Without the rights and empowerment of women we will not succeed, because if you take Africa as an example, 80 percent of food that poor people consume are produced by women. They own 1 percent of the land and they access 10 percent of agricultural extension services. Without putting women at the center of our fight against nutrition, we cannot hope to succeed. And so it is critical that we look at the issue of leadership, which is political leadership. Do we have the political leadership to go beyond these glorious surroundings that we are sitting in today, and get into the field to do what is the right thing?

Do we have the ownership that we are going to give to people that they control their destinies and not us that are sitting in institutions? It’s about the best practice with a local execution. It’s about ownership. We owned our struggle against apartheid, that’s why we defeated it. And this is what we’ve got to do. It’s about – the third thing is about partnerships; it’s about smart partnerships. And it’s about not saying that we are excluding anyone. Anyone with a contribution should be part of the solution. And we’re looking at solutions.

The fourth is about measurable milestones that we set ourselves. And I’m glad that we’ve done that in this period. So the last point is about values. Do we care that children are dying needlessly?

Thank you. (Applause.)

ADMINISTRATOR SHAH: Thank you very much, Jay. And it’s exciting to hear the challenge and also to recognize the great progress that GAIN has made in bringing so many diverse types of actors into helping to solve this problem.

Now that we are joined by Minister Lopes, we’d like to turn to her to offer really some profound and important insights on the tremendous gains that have been made in Brazil, in particular, through a range of policy innovations, working with a broad range of private sector and NGO organizations as well as effective government service delivery that has perhaps been one of the global leaders in hunger performance and in reducing child malnutrition at a very, very large and impressive scale. And so hopefully we will be able to take from you your insights and learn your thoughts.

Before we do that, so that everyone can enjoy her comments and appreciate that, if you want to take a moment, you should have at your chairs translation headphones and, I believe, Channel One will be the English channel. So we’ll just give you a moment to do that and then – Minister Lopes, thank you for joining us today.

MINISTER LOPES: (In Portuguese.) (Applause.)

ADMINISTRATOR SHAH: Thank you, Minister Lopes. It’s tremendous to hear about how the integration of policy, political will, program activity, and pure effort have resulted in a 50 to 60 percent reduction in child stunting. And I think we do all seek to learn and share those learnings as broadly as possible and through all of our programs and partnerships through the 1,000 day movement.

Next, I’d like to ask Dr. Jagadish Chandra Pokharel, the vice chairman of the National Planning Council of Nepal, to share comments on the tremendous activity that’s been taking place in Nepal. There has recently been a joint donor assessment, a national, multi-sectoral program and a series of other efforts that you and your colleagues have championed. And we would appreciate hearing how that is progressing and what you think we can take away as learnings from your experience. Thank you.

DR. POKHAREL: Thank you, Mr. Shah. First of all, I would like to thank Secretary of State Mrs. Clinton and Mr. Martin and both the governments for taking this very important initiative. And I thank the organizers, particularly the USAID, for giving me this opportunity to share with you what we have been doing in Nepal. Nepal has been very much on track in terms of achieving MDGs and even on the nutrition part, we are doing more or less okay on the micro-nutrition part. But when it comes to macro-nutrition, we are not doing well.

So the government has approached this – the issue of food and nutrition in three ways: One, in the production side basically focusing on agriculture, increased food production, and second, on the access part that’s basically increasing access to market and also access to the food distribution to the communities and areas where it is difficult to reach for the food. And then the use part which is more related and a bit complex and it enters up to the individual and out-source (ph) level.

So there are three areas that we are focusing. On the health and treatment part, we are doing fine. So with the micronutrients, the treatment, education, counseling, immunization, that part we are doing fine. Of course, we have campaigns such as breastfeeding and others and educating the mothers. On the production side, of course, we need to do more because still – because the food production, the deficiency is there.

So we want to have more focus on this and that will mean both research and development in the agriculture sector – more food production, and then linking this production with the market. So that means increased transport network to areas which are still inaccessible in most of the month of the season, and also the immediate food supply chain that needs to be increased. So for both immediate hunger – addressing the hunger and then more sustained – the food security for both, we need to have increased transport network. That’s one of our strategies that we are using.

And then there is an issue in the utilization of food. It is more complex – it’s more complex. One is the preparation of food and then distribution of food. It’s not only distribution geographically or among the households, but within the households also, who gets how much food. So the nutrition issue is more of a social – has more of a social dimension when it comes to her children and particularly children of different gender. That is an area which is getting attention from our side.

Who is our partner? Of course, international donor partners, they are there for the resources and also technical backstopping in terms of (inaudible). We do have private sector communities and local government who actually implement. So we – in the next days, what we are doing is we are sort of coordinating the effort to be more focused on the nutrition and food security.

So the National Planning Commission under my chairmanship, there is a steering committee which coordinates national strategy for food security and nutritional plan and we are also working together with donor partners to come up with proposal for accessing the global fund. We expect that all donor partners, in some way, accept to be coordinated. The USAID, World Bank, United Kingdom, and the DFID, and of course, the World Food Program are all our partners and we expect you to be partner in this 1,000 Days initiative. And may I also reiterate our government’s commitment for 1,000 Days initiative. Thank you. (Applause.)

ADMINISTRATOR SHAH: Thank you, Dr. Pokharel. We appreciate hearing particularly how that effort really started with significant focus on agriculture and productivity, but evolved quickly to include health interventions and social safety net types of interventions. And I look around and see Josette Sheeran and so many others here who have made a compelling case over the years that it really does have to be across all of those sectors in order to get the statistical improvements we want to see at scale.

Speaking of statistical improvements at scale, it’s a pleasure to ask Dr. Mary Shawa from Malawi to share her experience. She is the prime secretary for nutrition and HIV/AIDS in the Office of the President. And perhaps as you share your thoughts, you could also describe Malawi’s recent experience, which has been tremendously successful with agricultural production improvements and have those improvements translated into significant reductions in child malnutrition and in progress against the first thousand days. Thank you.

DR. SHAWA: Thank you very much. Let me start by saying that suppose a bus full of children had an accident and six of them died, or a bus full of women had an accident and 57 percent of them died. Definitely, we are going to have an inquiry. Unfortunately, these are the figures that kill our children and women due to malnutrition. There is no inquiry. Then something needs to be done. I’m glad that we have the 1,000 Days today, and I’m also glad that we are finally launching this summit (ph), because we are what we eat. Whether you like it or not, what you put in your mouth is what makes you who you are.

Having said that, in 2004, Malawi’s malnutrition situation was so bad. In fact, in a room like this one, 50 percent of the people here would be severely malnourished and bones walking. I’m talking about (inaudible), your children. When we came to children, it was 60 percent stunted. And you are looking at almost 6 percent wasted and at 4 percent underweight. So imagine it was a nation on the verge of disappearance. Secondly, iron deficiency, Vitamin A deficiency, and (inaudible) deficiency was the order of the day. So in the same year, the president of Malawi declared malnutrition a crisis, and made it a point that he was going to champion and take the lead in the fight against malnutrition. And he is the minister responsible. Having done that, he made it a point that the agriculture subsidies are distributed to the poorest of the poor farmers. The results are every household that got agriculture subsidy annually, the children are gaining one centimeter in their height. And therefore, stunting has gone down from 60 – 53 percent to 35.8 percent. But it’s still high. Wasting has gone down to 1.3 percent, underweight to 14 percent.

Having said this, what I want to say is, malnutrition in Malawi is considered a cross-cutting issue, which brings onboard everybody from the economic background, social, cultural, political, and biomedical. And therefore, (inaudible) partners and donors have joined hands with the Malawi Government, but it’s not all of them. It’s a few. All I want to say is I’m calling up on all of us to join hands with Malawi, to join hands with all the other member states that have high levels of malnutrition to make sure that you assist us to do a country analysis and develop a program around the SUN, around the 1,000 Days.

Secondly, I want to ask you to help us to rapid scale up the programs so that we can eliminate malnutrition. And thirdly, for the sake of Malawi, we are putting down our own national funding basket. We want to invite you to join us in the national nutrition funding basket. For us to eliminate malnutrition, it is the oldest challenge that the global has known, but action has taken too long. And this is what I wanted to contribute. Thank you. (Applause.)

ADMINISTRATOR SHAH: Thank you. Thank you for that outstanding contribution, Dr. Shawa, and I think one of the things that we have, in this community in particular, talked about now for years is developing mechanisms that allow for directly supporting country-owned plans and country leadership. And I think so many of our panelists today, but Malawi in particular, has demonstrated the value of that, certainly when, in 2004 and ’05, when some of these plans and proposals were being proposed, they did not have the complete consensus support of the international community. And your leadership has changed the way people think about how these problems are fundamentally solvable, so we applaud your great, great leadership.

And consistent with our theme of great leadership, I’m pleased to introduce Director General Elias Sory from Ghana. He is the director general of the Ghanaian Health Service. And Ghana, of course, in this set of meetings this week, has garnered appropriate attention for being one of the African – Sub-Saharan African countries on track to meet the Millennium Development Goals, and particularly MDG-1. We are curious to hear from you about how the help system in Ghana is taking specific, unique actions to really better target and better achieve improved nutrition outcomes during the first thousand days.

MR. SORY: Thank you very much. I think one major thing we have considered is looking at or imagining Ghana being free of malnutrition. If we are free of malnutrition, we know how our children will live; they wouldn’t die. Our – the level of mortality will decrease. We know that our women who are struggling now with maternal mortality – and we know that malnutrition is similarly contributing towards maternal mortality. Bleeding is a major concern. And women with anemic before getting to pregnancy is more than likely to die than a person who was not anemic.

And therefore, our nutrition program, which is that – Imagine Ghana Free of Malnutrition – is on three major pillars. One, a multisectoral action starting from the community; two, the national level community, knowing quite well that when you look at the personnel who work within the communities and who can do something about it, workers that are critical – the teacher, the health worker, and the extension officer – indeed, you’ve got much of the forces with national directions to interact with the communities. They will be educating the communities on what to do. They will be looking at school health and making sure that the school children are well taken care of. If it comes to the district assembly, they will be looking at food security and ensuring that the production of food becomes a major concern, and at national level we will be looking at making sure that the policies and plans are well articulated.

The second area – second pillar I talk about is that of really harnessing and improving on the new intervention that we have – we all know here and we’ve talked about: health promotion, making sure that all our hospitals are baby-friendly and that breast – exclusive breastfeeding is articulated well, making sure that food, indeed, supplementation is carried out, and these days, we make sure that we have two or three times a year education in the community that is mounted and supported by both partners and our national government, in ensuring that food fortification is carried out. We know quite well that anemia is a problem, and if we could get bread, for instance – that is now becoming a staple food – if we can get iron into bread, many people will get an iron supplementation in order to make sure that we don’t have anemia.

And lastly, we want to look at the partnership. We’ve talked about partnership here, and the concern all of us have is whether or not it’s being given to Africa and to Ghana, for instance, so that we can work together in order to decrease malnutrition. In fact, this is an opportunity using this program to ensure that our partnership is on strong grounds to help Ghana and Africa reduce malnutrition.

Thank you. (Applause.)

ADMINISTRATOR SHAH: Thank you. And that’s a great description of the contributions of the health sector in this space and toward solving this problem. I’d like to conclude this part of the panel and turn it over to my colleague Minister Power with just two quick concluding comments. The first, is that Secretary Clinton in the earlier panel noted that this really was not just about us coming together and acknowledging that we are converging around this problem, but also about doing things differently in concrete terms, with a clear calendar and our own 1,000 Days to hold ourselves accountable.

And today, we’ve heard from the Brazilian experience around political will and policy leadership; in Nepal and Malawi, bold leadership in agriculture and true production done often in a way that created new ways of thinking for the global and international community. And in Ghana, really realigning the tremendous capability of community health workers to specifically target, identify those at-risk households, mothers, and children, and design the kinds of interventions from educational support to supplementary feeding that can target and achieve outcomes in those specific settings.

One of the things we need to hold ourselves to at the – in the United States, at USAID, and others is taking these learnings on board and then doing things differently. And one of those things the Secretary highlighted earlier today is to shift from essentially providing services through parallel delivery systems to supporting the leadership of those of our colleagues on this panel today that have identified a future where they can actually solve this problem at scale.

With that, I’d like to turn this over to Minister Peter Power who is the Irish Minister of Development and absolute leader in this field. The Irish Hunger Taskforce and the great leadership from Concern and so many others in Ireland who have really helped over the last several years create the opportunity for us to all be here today. And today’s pledge of 20 percent of your development budget being focused on this specific goal is a tremendous demonstration of leadership. So I’ll turn it over to you and then I think we’ll have comments from some of our colleagues and the audience as well.


MINISTER POWER: Thank you very much, Rajiv. And on behalf of Irish Aid, could I welcome everybody here today? I suppose this is the business end of our meeting this morning, to quote Secretary Clinton. And this is the part of the meeting that puts the meat on the bones. And without a doubt, the people in this room as I look around, the real leaders, the real implementers of the Scaling Up Nutrition roadmap and framework, you are the people who, also on the political side, will look to to implement the initiatives and the objectives and the ambitions which we have set out here today. So you’re all extremely welcome.

As Minister Martin mentioned earlier on, it is two years since Ireland had our own dialogue on hunger and food security culminating in the launch of the Irish Government’s Hunger Taskforce which was launched here in New York and the United Nations two years ago. Since then, we have designated the fight against hunger and food insecurity, a cornerstone of our aid program.

Undernutrition of pregnant women and children over the age of two is identified as a very key priority of our hunger reports. And it is this priority which brings Ireland here today in partnership with the United States. To address the problem of undernutrition, it is clear to us in Ireland that we must work together to ensure that food and nutrition constantly stays at the very top of the international agenda, or, to quote a Hunger Taskforce report, that hunger includes security and nutrition, meets the absolute priority that it deserves.

The SUN roadmap, I believe, gives us an excellent framework for supporting the highest-burdened countries in their efforts to address the problem. For Ireland’s part, we strongly support the work of Malawi and we’re delighted to welcome Dr. Shawa here today. Indeed, in my own visits to – visit to Malawi, I was able to meet with you and see it firsthand, the absolutely fabulous leadership which she and her entire government are showing right throughout Malawi, and I visited the delta region where I saw the Scaling Up Nutrition roadmap actually in operation on the ground in various areas. The challenge now, of course, is to really scale up that right throughout Malawi and right throughout many other countries in which we have a partnership with.

The African Union has been an inspiration in all of this work, as also has the great leadership, as demonstrated by President Obama in the L’Aquila Food Security Initiative, their own principles, the UN high-level taskforce, the Special Representative on Food and Nutrition, David Nabarro, who I see in the audience here with us today. So all of you are playing a key role. All of you are the people who we look to to implement this roadmap.

Ladies and gentlemen, translating this dialogue into action is the primary goal of both Administrator Shah and I at this roundtable today. And for that, we are truly grateful for your presence. So it’s my duty now to call on contributions from some key international, political, and multilateral actors who contribute to this discussion.

And I’d like to begin with, if we can bring the microphone, to Ms. Beverly Oda, Canada’s Minister for International Cooperation. And I think all of us in this room are very familiar with the key role that she has played in advancing the global fight against under nutrition. And as many of you will know, Canada is really a global leader in micronutrient investments.

And we very much look forward to hearing from Minister Oda now. Thank you very much for take the podium.

MINISTER ODA: Well, thank you very much. And I’d like to thank the leadership shown by Secretary Clinton and Minister Martin for convening this entire session, and of course, our colleagues and panelists today. I want to also thank the many panelists who have presented with us the challenges they faced and the progress they’ve made.

Canada is strongly committed to nutrition and it’s a critical part of our food security strategy, one of Canada’s key priorities. It’s also integrated into our children and youth strategy, as is maternal health. At the 2010 G-8 Summit, Canada championed the Muskoka Initiative to improve maternal, newborn, and child health, and we place nutrition as a key pillar in this initiative. The thousand day focus must be an integral part of our work in maternal and child health, as it is in meeting so many other MDG goals. This builds on Canada’s ongoing support as leading supporters of micronutrients, such as the vitamin A distribution.

This leadership we have to demonstrate and continue to demonstrate. The global community has worked hard to bring consensus to the areas of nutrition, preparing the Scaling Up Nutrition framework and the recently announced SUN roadmap. This consensus recognizes that nutrition needs to be better integrated in development efforts. It recognizes that the investments in nutrition can have catalytic impact on making progress towards reaching MDGs.

Canada is committed to working collaboratively with our partner countries, other donors, and relevant stakeholders to ensure that we can focus on a common set of goals and that we abide by the aid effectiveness principles. We talk about leadership, and today, this morning, I would like to acknowledge the leadership given by those countries that have developed nutrition strategies and have taken action.

While we’ve made some progress in both treating undernutrition and better integrating nutrition initiatives with other interventions, much remains to be done. As Secretary Clinton has said this morning, our resource commitments are important; they’re very important. But we know that outcomes and results are the key. This means accountability and fulfilling commitments. And it also means we as donor countries should be accountable for the results that we achieve with our investments.

Now is the time to accelerate our efforts and be willing to find innovative ways to address this challenge. Increasing the nutritional value of our food programs, introducing different crops into our agricultural projects, or adding micronutrients to diets as well as to our immunization programs would incrementally accelerate the impact of these programs for the undernourished in developing countries.

We must support agencies and organizations such as the World Food Program, the WHO, UNICEF, and many others who are seeking new innovative ways of addressing these challenges working closely together. We must support their efforts. We must also find ways to fuse the power of partnership and leverage expertise, research, resources from a variety of stakeholders including the private sector. Canada acknowledges the critical role of the private sector. And we know that by working in partnership with them, we can combat malnutrition. Canada also continues to support this kind of innovative approach, by partnerships, by breaking down the walls between vertical approaches. And in fact, Canada also will continue to support Canada’s micronutrient initiative, a worldwide global leader.

I want to tell you just about one project. It is salt iodization, where the Micronutrient Initiative works in Senegal with the World Food Program to process and iodize salt. This women’s cooperative is now iodizing salt and providing iodized salt not only to Senegal, but to several other Western African countries. Imagine the impact of this for the women, for the health, and for the community at large.

I’d also, in conclusion, like to say we are willing to work with you. We are seeking to maximize our investments. And we know that without addressing micronutrients and undernutrition, we will not accomplish the goals we’ve set out. Thank you. (Applause.)

MINISTER POWER: Thank you, Minister Oda. Your contribution is most welcome. I think everybody in this room is aware of the fabulous leadership of yourself and, indeed, Canada, especially the area of research into micronutrients and the critical part and role that plays in the whole nutrition program.

Ladies and gentlemen, it is now – gives me great pleasure to introduce Andrew Mitchell, the brilliant secretary of state for international development. He has shown great leadership before he became secretary of state for international development over many, many years in this whole area. He has a particular specialty in the area of maternal and child health. And of course, we all know of the inextricable link between MDG-1 and MDG-4. So your contribution, Andrew, is one that we’re very much looking forward to. Please come to the podium. (Applause.)

SECRETARY MITCHELL: Well, Raj, Peter, thank you very much. You said my contribution was being much looked forward to. I promise it will be very brief at any rate. I want to congratulate the American Government and the Irish Government on this initiative today. I want to particularly underline the importance of the road of the private sector that was set out in the first session, and I want to salute the work that Maria and the Nike Foundation are doing. In Britain, we love them so much that she has the basement to my department in Whitehall for her use. (Laughter.)

And I finally, want to say a particular thank you to Tony for what he said in this session. I wish to return briefly to what he said because I think it’s extremely important. I take as my text the comment by the Irish foreign minister and the comment that Peter made. The point that the Irish foreign minister ended on was saying that the issues we’re addressing today are the most serious, but the least addressed. And the point that you, Peter, made was that we have to translate these grand plans into action on the ground, and that is my message today. The issues we are discussing are extremely important and in my view they are not sufficiently understood by the media and the wider world.

The effects of severe malnutrition in the first thousand days of a child’s life are absolutely fundamental to that child’s life chances. We have some reasonably good evidence of what works. We know about the importance of breastfeeding. We know about the importance of sanitation – very basic things like, washing your hands. We know about the critical importance of diet, of unfortified food. We know about zinc supplements and we know the two, particularly from the work that the World Bank and the British Government are doing in South Asia – how all these important points come together.

But before brief messages, I want to give now, firstly, that there needs to be more work done on the nutrition leaders group. The British Government will serve on that group in order to assist; we’re not there yet. More work needs to be done on that. Secondly, in terms of the transition team, I think we need to freshen up the UN Standing Committee on Nutrition to make it more effective. Thirdly, we need an absolute focus, as my colleague Bev Oda has just said, on the results. We need to ensure that we can demonstrate to hard-press taxpayers who are funding some of this work, as well as to the civil society in the countries where we’re trying to help people, that we’re actually getting real results for the money that we are spending. And I hope that the World Bank, which will obviously be reluctant to embrace this, will look as part of IDA-16 to see whether or not they can incorporate these results in what they’re doing. I think it’s very important that we, all of us, hold ourselves to account for what we’re trying to do. And fourthly and finally, I think there are knowledge gaps and the British Government will fund research over the next five years, specifically on this subject, to try and assist. And I announced that program and that commitment to research today.

Now, the point I want to end on is this: There are a lot of grand words today at this meeting, but today, as we all know, there are women and children who are dying in Niger and Chad, as Tony so eloquently said, coming today, a silent emergency, a distant emergency – I don’t know what you call it – but that is what is happening. I had an opportunity to talk to Foreign Minister Kouchner about this some time ago. I know that the French Government are looking to see what they can do to help in an area with which France has very close contacts. My department and the British Government are doing everything we can to help, particularly on issues of nutrition for women and children in Niger and Chad. But those are the challenges we face – making these words meaningful today when women and children are dying needlessly in Niger and Chad. We have the power to prevent this and we should do this. And I invite everyone here today to ensure that we match these fine words with the actions we are taking on the ground in these vital matters.

Thank you very much. (Applause.)

MINISTER POWER: Thank you very much, Andrew. Britain’s renewed commitments to research and technology and innovation is most welcome. It is one that is shared by Ireland. Technology, science, innovation will ultimately be the key to unlocking this very, very difficult issue. So we very much welcome your contribution, Andrew.

Ladies and gentlemen, I now would like to turn to Ms. Kristalina Georgieva, the European Union commissioner for international cooperation, humanitarian aid, and crisis response. And I think both Administrator Shah and myself would like to acknowledge the very, very strong steps which the European Union has taken recently, especially in the formulation of a new EU policy framework to assist developing countries in dealing with food security and humanitarian crisis.

Commissioner, you have the floor.

MS. GEORGIEVA: Thank you very much. We started with pictures today, and I want to bring two that are very vivid in my mind. One is my granddaughter Ivana (ph) just born three weeks ago, a healthy seven pounds, 3.5 kilos baby. (Laughter.) And the other one is a severely malnourished little baby girl, 17 days old at that time, Lori (ph) quite so in Niger. She only had the chance to live because of the nutrition center that together, with the World Food Program, we support there.

For my granddaughter, born in the poorest member country of the European Union, but still in the European Union, nutrition, healthcare, and, in the future, education are birth rights, and they should be the same for Lori (ph), but they are not. And this is why it’s so important that we are here today, and this is why, on behalf of the European Commission, I want to very strongly and wholeheartedly support the 1,000 Days initiative and take my intervention to share with you two things: What we have done so far and what we intend to do next.

We have taken three very important steps. One, we track our support for nutrition. Today, it stands at 517 million Euros, and of course, we want to see this well integrated in everything else we do. Second, we have changed our food assistance policy to shift away from in-kind assistance to cash and vouchers, so we encourage production and private sector agriculture in countries, and in this way we contribute to long-term security. Three, we have focused on fragile states, because we know that under nutrition among kids under two is twice as severe there than it is in the rest of the developing world.

Looking forward, we will introduce a new policy framework to strengthen our focus on child malnutrition – child nutrition, with four goals. One, to promote the comprehensive approach. A lot has been said it is nutrients for kids, but it is also access to safe water and sanitation and maternal health. Two, to advance accountability for results by tracking not just the money we spend, but the outcomes we receive for this as a result of this money. Three, to empower partner countries which have made nutrition a priority in their development policies because of the significance to reach the MDGs. And four, to seek solutions bottom up, putting both resources and responsibilities in the hands of mothers, local community leaders, local healthcare providers.

One final remark, strong and accountable leadership at home and international level is crucial, and this is why I strongly support the nutrition leaders forum and wish it success. And I will be here next year to be held to account for what we have done to meet the objectives we commit to.

Thank you. (Applause.)

MR. POWER: Thank you very much, Kristalina for traveling so far to be with us here today. Of course, the European Union as the world’s biggest donor is going to be a really key actor in keeping nutrition at the very top of the international agenda, so we very much welcome your contribution.

I would now like to turn to Ms. Margaret Chan, the World Health Organization executive director. Of course, good nutrition is an absolute prerequisite to childhood good health, so your contribution is very welcome here today, Margaret. Thank you.

MS. CHAN: Thank you so much. This is a very tough act to follow. I’ve never attended such an inspiring session. All protocols observe. So that saves a lot of time. (Laughter.) I know we are running out of time. (Applause.)

We have heard all the arguments, all the science, what needs to be done, the power of partnership, public-private partnership, the power of civil society, women, governments, everything. There’s nothing you can disagree, coming from all the interventions from the different sessions, but I just would like to do one thing that is politically correct – to thank the organizers, U.S. and Ireland and all the rest. Then I’ll do something that is politically incorrect towards the end – (laughter) – before you kick me out. (Laughter.)

But I have to say you are shining a spotlight on an area which is very much neglected, and I want to thank you. And this spotlight will bring hope to many people, women and children included. Why do I say that? This is a golden opportunity for your investment not just in health and in education, but in all MDGs. This is an investment with high payback for a lifetime.

I just want to remind you that neglect of nutrition in the first 1,000 days will cause a lot of irreversible damage both in physical health, and what is even more devastating is the mental health. That will compromise your investment in education. Don’t talk about bringing girls and children to school if you can’t even give them the right mental capacity to start with to benefit from the educational system. So your investment in this is an investment of a lifetime.

Now, we talk a lot about country ownership, country leadership. We must walk that talk. We haven’t done too well. WHO is committed to work with all our partners, to support ministries of health, development, education, to bring together the country policy strategy and planning, and identify gaps and also prioritize investment. And I would urge donors and partners to support that country capacity, leadership, and ownership. Without ownership – let me put it this way – if the countries don’t own it, you own it. You are a just visitor. You are not a resident. So if you don’t hold them to account, they don’t have to be held responsible. And if they are not responsible, they don’t have to deliver results.

Talking about results, which is so important, and WHO is very honored and privileged to be asked by Mr. Secretary General, under his global strategy for women and children, to facilitate a process to develop mechanisms whereby we can track your commitments, track your promises and hold you to account. We would take this on seriously. Please come along with us on this journey to report progress on results on your money, on your investments so that you can go back to Congress and parliaments and give us more money to do the job at the country level.

On that, I thank you for this opportunity to share with you my comments. (Applause.)

MINISTER POWER: Thank you very much. Margaret, I didn’t hear anything really politically incorrect in your statement. (Laughter.) What we did get from you is passion and real leadership, and that’s what’s needed more than anything else. And of course, we all know that research is increasingly showing that it is nutrition, micro-nutrients, Vitamins A, D and E. They’re -- that’s the food that unlocks the neuropathways. It opens up the brain and allows young children to learn, and that’s why it is – concentration in this focus is absolutely necessary.

I’m now going to turn to Tamar Atinc, the vice president of Human Development Network, at the World Bank. In introducing Tamar, I’d like to take the opportunity to acknowledge the World Bank’s consistent leadership in bringing attention to the issue of maternal and child undernutrition and calling for large-scale global action. That’s what we need.

Before I call you, Tamar, can I just convey on behalf of the Administrator Shah his apologies that he had signaled before our meeting that he had to leave at 11:30, but is very, very happy with the way that this roundtable has developed, and no doubt will be in contact with you in due course. Thank you very much, Tamar.

MS. ATINC: Thank you, Minister Power. The World Bank warmly welcomes this initiative and enthusiastically embraces the results focus that Secretary Mitchell has challenged us to adopt. Make no mistake – no resistance here.

I would like on behalf of President Zoellick to express our appreciation for the leadership provided by Secretary Clinton, the U.S. Government, Minister Martin, the Government of Ireland, and of course, Secretary General Ban Ki-moon in this important agenda.

The short film that we watched earlier this morning and the many speakers that we have heard from later on have all vividly and powerfully spoken to the fact that malnutrition, especially in early life, causes permanent damage to human capital. And as Minister Kutesa of Uganda noted, “Malnourished children grow up to be less productive adults.” We estimate a 2 to 3 percent loss of GDP in developing countries with the highest burden of maternal and early childhood undernutrition.

So we have here a vicious cycle where poverty causes malnutrition and malnutrition perpetuates poverty. And unless this cycle is broken, we will not achieve sustained economic growth and poverty reduction or attain the MDGs. The World Bank is deeply committed to scaling up its investments in nutrition. Already, we’re the second largest financial contributor next to USAID for malnutrition investments.

As we scale up our investments, though, we are firmly positioned to take a multi-sectoral approach to improving nutrition, not just through direct or nutrition-specific investments, but to Vitamin A supplements, deworming, and breastfeeding promotion, but also by promoting nutrition-sensitive investments that include nutrition across a multiplicity of sectors: food security and agriculture, social protection, health, education, water supply and sanitation, as well as by addressing cost-backing issues like poverty reduction, gender equality, governance and accountability, and state fragility.

As you may know, the Bank was one of the initiators of the Scaling Up Nutrition, SUN, framework that has now been endorsed by over 100 partners. And we stand firmly behind the principles of the framework. Key among these principles are those that all donors adopted in Paris and Accra: country ownership and leadership -- we’ve talked quite a bit about this today -- and donor harmonization so that we can leverage greater impact on the nutrition of women and young children from our collective efforts and reduce inefficiency and transaction costs.

We at the World Bank are determined to help countries reduce malnutrition rates, especially focusing on children under two years of age and women. We are also determined not to add to these transaction costs. We will coordinate our actions with all partners, work together at the country level so our countries can focus on the issues that matter the most, implementing the high-scale, the high-quality, large-scale programs that Secretary Shawa of Malawi talked about. And we are ready to hold ourselves accountable, much like the rest of the donor community. Thank you.


MINISTER POWER: Thank you very much, Tamar. And the World Bank’s commitment to scaling up its investments in Scaling Up Nutrition is most welcome, and thank you very much for joining us here today.

Ladies and gentlemen, invited speakers, I would like to thank our entire panel here on the top table and those who have come to the podium to speak here today. Your contributions have been exceptionally welcome. But this is a global problem and it requires global solutions, and that’s why we are imploring everybody to scale up and step up to the challenge of undernutrition and hunger.

And because the challenge is truly global, I think it is only right and fitting that our final speaker to wrap up at this particular roundtable and discussion should be leader of the World Food Program Josette Sheeran, who has shown great leadership and commitment for many years in this whole area.

Josette, you are extremely welcome. Perhaps you would conclude our deliberations today. Thank you. (Applause.)

MS. SHEERAN: Well, thank you so much, Peter. As has been pointed out, two years ago, we had the devastating evidence put forward that if a child below the age of two does not have adequate nutrition, the damage is irreversible. It was then that we entered into what I call the burden of knowledge. We know, that just deprived of a minute amount of a micronutrient, that we’re condemning a child to a life that will be less with no chance of full recovery.

It was asked today, do we care? And I’ve been asked to try to sum up what we have. I think we can leave this meeting affirmatively saying yes. In fact, I think we’ve made some history here. I guarantee you two years ago, if you met with a group of nutritionists and said their cause would be taken up by three foreign ministers and the secretary general of the United Nations, they wouldn’t believe it. In fact, they wouldn’t even believe that they would be meeting with the development ministers and the ministers from nations, let alone what the World Bank has helped do – bring finance ministers into this equation and others. I think we are witnessing a revolution in the approach to undernutrition.

I just want to say we have together not only foreign ministers who understand that if we’re talking about a world of peace and stability, an issue like undernutrition actually is at its core, but also development ministers here like Raj Shah and Peter and Andrew Mitchell and Beverley Oda, and Kristalina who are not business-as-usual leaders. And we’ve heard from leaders from countries. I will say that what Brazil is doing in their Fome Zero program is so revolutionary, transforming the face of undernutrition. What we’re seeing in Uganda and Ghana and Malawi is inspiring all of us. And I was just in Uganda, in fact, and this is one of the ready-to-use foods. This one happens to be from Pakistan, one that we use there, but five different ready-to-use foods that take post-harvest production often lost at 40 percent, transform it into powerful nutrition-packed material. These types of products are revolutionizing.

But then we saw the private sector here and pace-setters like Tom Arnold and Jay and David and others. Just two things: One, the burden of knowledge requires that tribes that don’t trust each other, don’t speak the same language, and have never worked together come together. Among them, the food crowd, the health crowd, agriculture, human rights, child’s rights, private sector, business, government, and scientists. None of us can do it alone. So here is the challenge.

But I, again, want to thank the United States and Ireland for bringing us all in one room and also those who have led the SUN project. I will say, if you look at what the United Nations is doing, you have seen a transformation, and Tony and Margaret and I just launched in Pakistan something called a survival strategy that makes sure we’re using the strengths of our three agencies on undernutrition to help an extremely malnourished 20 million people hit with that tragedy. We’re seeing new ways of doing business that we’ve never done before. And I just want to think Denise Coitinho with the Standing Committee on Nutrition. She, again, is a real leader for change.

So I think all the necessary elements are in place. I leave here deeply inspired. We – there will be an event in Egypt and I don’t know if the Egyptian Government is here, but the first lady, Suzanne Mubarak, will host a follow-up meeting to look at best practices and nutrition for school children in February and other events will follow, I know.

SUN, Scale Up Now, this report is available. David Nabarro has put it outside. But look at – we have never seen organizations of this scale come together. So please get your copy. Oh, okay, the yellow one. I have an old one. See, it’s already moving. First thing is building consensus, check that box; it’s happened. It wasn’t true 24 months ago. Second is getting commitment, and we’ve seen today powerful commitment from nations that can make a difference and from organizations that can implement the difference. And third, execution, and that’s the phase we’re in now, but we have every reason to be hopeful that we have the tools and the new strategies in ways to do business.

So, thank you. And again, I want to thank the development ministers, Beverley Oda, and Peter, you, and Raj and Kristalina and the ministers from the developing world. You’re the ones that can really put power behind our wings on all of this. Thank you.


MR. POWER: Ladies and gentlemen, that concludes our formal proceedings. I think we would all agree that Josette has pulled all the threads of our discussion together very admirably. Thank you very much, Josette. On behalf of everybody on the top table here, I would like to thank everybody in the room for your exceptionally kind attention and quietness right throughout these proceedings. Thank you very much, indeed. (Applause.)

InterContinental Hotel, New York City

Last updated: June 01, 2012

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