The document discusses how the Essential Nutrition Actions (ENA) framework could support the Scaling Up Nutrition (SUN) Movement in scaling up proven nutrition interventions. It outlines five key tasks for the SUN Movement: 1) reaching women and children at broad scale with ENAs; 2) providing the right nutrition support at the right life stages; 3) reducing missed opportunities in existing programs; 4) aligning many partner organizations; and 5) choosing a starting point such as strengthening existing field programs. The ENA framework defines specific nutrition actions and could help integrate nutrition into various sector programs to maximize coverage of proven interventions through the SUN Movement.

1. Essential Nutrition Actions Framework
Potential for the SUN Movement
Victoria Quinn, PhD
Helen Keller International
Core Group Spring meeting
5 May 2014

2. Essential Nutrition Actions
Relevance to global nutrition
movements
“new opportunities for ENA”

3. Scaling Up Nutrition –SUN Movement
SUN is a unique
Movement
founded on the principle
that all people have a
right to food &
good nutrition.

4. 4
Lancet Nutrition
Series
February 2008
These data had an
immense impact on
subsequent nutrition
strategies and global
development events
Funded by BMGF

5. 5
Increased focus on
the ‘Global Nutrition
Architecture’
Lancet 2008 Nutrition Series
“The international nutrition
system—made up of international
and donor organisations, academia,
civil society, and the private
sector— is fragmented and
dysfunctional…”
Morris et.al, 2008 Lancet Nutrition Series
Paper 5

6. 6
Sparked series of
consultations in nutrition
community to rally around
the new 2008 Lancet
nutrition findings which
provided evidence on ‘what
worked’.

7. Publication of
‘Scaling Up
Nutrition:
Framework for
Action’ (Feb. 2010)
released by coalition
of nutrition partners
representing many
different
constituencies

8. Endorsed by nearly a hundred partners – from civil society, governments, academia,
UN agencies, World Bank, Foundations & private sector groups
National Nutrition Institute,
MOH Egypt
Cornell University Division
of Nutritional Sciences
Cornell University, USA
THE WORLD BANK
Public-Private Partnerships
The International Life Science
Institute Focal Point in China
,

9. Exceptionally unique point in time for nutrition!
SUN is a unique
Movement
founded on the principle
that all people have a
right to food &
good nutrition.

10. Over 165 million children under 5
are stunted as a result of malnutrition.
• 52 million children are too thin and require special
treatment.
• At the same time, 43 million children are overweight -
some as a result of poverty, when families are unable to
afford a balanced, nutritious diet.
• 2 billion people are deficient in key vitamins & minerals
A reminder - why nutrition? The facts

11. ROOTED IN
Poverty Disempowerment
of women
Political & Cultural
Environment
Insufficient access to
affordable, nutritious
FOOD
throughout the year
Lack of good
CARE
for mothers & children
& support for parents on
appropriate child feeding
practices
Inadequate access to
HEALTH
sanitation & clean
water services
SUN recognizes the causes of malnutrition
are interconnected
Environmental
Degradation

12. Feeding Practices & Behaviors:
Encouraging exclusive breastfeeding
up to 6 months of age and continued
breastfeeding together with
appropriate and nutritious food up to
2 years of age and beyond
Fortification of foods: Enabling access
to nutrients through incorporating
them into foods
Micronutrient supplementation:
Direct provision of extra nutrients
Treatment of acute malnutrition:
Enabling persons with moderate and
severe malnutrition to access effective
treatment
Agriculture: Making nutritious food more
accessible to everyone, and supporting
small farms as a source of income for
women and families
Clean Water & Sanitation: Improving
access to reduce infection and disease
Education & Employment: Making sure
children have the nutrition needed to
learn and earn a decent income as adults
Health Care: Access to services that
enable women & children to be healthy
Support for Resilience: Establishing a
stronger, healthier population and
sustained prosperity to better endure
emergencies and conflicts
Nutrition-Sensitive StrategiesSpecific Actions for Nutrition
Nutrition strategies increase the impact of specific
actions for nutrition

13. Feeding Practices & Behaviors:
Encouraging exclusive breastfeeding
up to 6 months of age and continued
breastfeeding together with
appropriate and nutritious food up to
2 years of age and beyond
Fortification of foods: Enabling access
to nutrients through incorporating
them into foods
Micronutrient supplementation:
Direct provision of extra nutrients
Treatment of acute malnutrition:
Enabling persons with moderate and
severe malnutrition to access effective
treatment
Agriculture: Making nutritious food more
accessible to everyone, and supporting
small farms as a source of income for
women and families
Clean Water & Sanitation: Improving
access to reduce infection and disease
Education & Employment: Making sure
children have the nutrition needed to
learn and earn a decent income as adults
Health Care: Access to services that
enable women & children to be healthy
Support for Resilience: Establishing a
stronger, healthier population and
sustained prosperity to better endure
emergencies and conflicts
Nutrition-Sensitive StrategiesSpecific Actions for Nutrition
Nutrition strategies increase the impact of specific
actions for nutrition

14. Countries around the
world have committed
to making
nutrition a priority
& global partners
are working together
to support the
efforts of SUN countries.
Countries are at the center of scaling up nutrition

15. The SUN approach – starting in 2010
• The Scaling up Nutrition Movement relies on national leaders
taking ownership and responsibility for delivering
sustainable solutions to improve nutrition in their countries.
• Through country-led efforts that focus on equity and realization of rights,
SUN countries are enabling women, families & communities
to create stronger foundations for their people & transforming the
future of our world.
• SUN enables countries to take a collaborative approach
bringing together the people & resources needed to rapidly
scale up nutrition-specific interventions as well as implement
cross-sector strategies that are nutrition-sensitive.

16. The SUN approach –Country level
Country
governments
lead national
efforts to scale
up nutrition.
Within each
country a
SUN Focal Point
is identified

17. The SUN approach – Country level
The Focal Point brings people together in a
multi-stakeholder platform
Technical
Community
United
Nations
Government
Partners
Civil Society
Donors
Business

18. The SUN approach – Country level
The multi-stakeholder
platform
Works to align and
coordinate action
across sectors.
Women’s
Empowerment
Health
Development
& Poverty
Reduction
Agriculture
Education
Social
Protection

19. The SUN approach – Global level
Using a unique approach that
works for each country.
These efforts are underway
in all SUN countries
Multi-sector, multi-
stakeholder platform
Together the combined efforts of all
countries make up the core of the
Movement - The SUN Country Network

20. With overall support and
coordination provided by the
SUN Secretariat
and
SUN Lead Group
Country
Network
Donor
Network
Civil Society Network
Business
Network
United Nations
Network
Global Networks
of stakeholders shift
resources &
align actions to support
country efforts.
The SUN approachn – Global level

21. Making progress – Country level
Creating Political and
Operational Platforms,
with strong in-country leadership
& shared multi-stakeholder spaces
where people come together to
align their activities & take joint
responsibility for scaling up
nutrition.
Incorporating Best Practices
into National Policies
for scaling up proven
interventions; including the
adoption of effective laws
& policies
Align Actions Across Sectors
around high quality and well-
costed country plans, with an
agreed results framework and
mutual accountability.
Increasing Resources and
Monitoring Implementation
for coherent, aligned, effective
action and maximum impact.
1 2
3 4
Within each country, SUN Movement stakeholders are brought together around
4 key processes: progress is reviewed every six weeks

22. Tracking and reporting impact
Establishing targets to measure impact: Countries
are encouraged to establish their own ‘costed
plans’ with targets for nutrition goals in the
following areas:
Annual SUN Movement Progress Report:
Released in September each year by the SUN
Movement Secretariat, the report provides
updates on progress in achieving the Movement’s
goals and strategic objectives.

23. Supporting global impact
Together, countries and supporting stakeholders are
collectively working to reach the global targets by 2025 set out by the
World Health Assembly 2012 Resolution:
Reducing and maintaining childhood
wasting to less than 5%
Target 1:
Target 2:
Target 3:
Target 4:
Target 5:
Target 6:
40% reduction of the global number of
children under 5 who are stunted
50% reduction of anemia in women of
reproductive age
30% reduction of low birth weight
No increase in childhood overweight
Increase exclusive breastfeeding rates in
the first 6 months up to at least 50%

24. Today the SUN Movement
is growing in numbers & strength
100+ global stakeholders
are providing support to
46 countries
with the opportunity to reach
82 million stunted
children

25. How does the ENA framework fit in?
Creating Political and
Operational Platforms,
with strong in-country leadership
& shared multi-stakeholder spaces
where people come together to
align their activities & take joint
responsibility for scaling up
nutrition.
Incorporating Best Practices
into National Policies
for scaling up proven
interventions; including the
adoption of effective laws
& policies
Align Actions Across Sectors
around high quality and well-
costed country plans, with an
agreed results framework and
mutual accountability.
Increasing Resources and
Monitoring Implementation
for coherent, aligned, effective
action and maximum impact.
1 2
3 4
Within each country, SUN Movement stakeholders are brought together around
4 key processes: progress is reviewed every six weeks

26. Creating Political and
Operational Platforms,
with strong in-country leadership
& shared multi-stakeholder spaces
where people come together to
align their activities & take joint
responsibility for scaling up
nutrition.
Incorporating Best Practices
into National Policies
for scaling up proven
interventions; including the
adoption of effective laws
& policies
Align Actions Across Sectors
around high quality and well-
costed country plans, with an
agreed results framework and
mutual accountability.
Increasing Resources and
Monitoring Implementation
for coherent, aligned, effective
action and maximum impact.
1 2
3 4
Within each country, SUN Movement stakeholders are brought together around
4 key processes: progress is reviewed every six weeks
Country Level - how does the ENA framework fit in?

27. Nutrition specific actions

28. Feeding Practices & Behaviors:
Encouraging exclusive breastfeeding
up to 6 months of age and continued
breastfeeding together with
appropriate and nutritious food up to
2 years of age and beyond
Fortification of foods: Enabling access
to nutrients through incorporating
them into foods
Micronutrient supplementation:
Direct provision of extra nutrients
Treatment of acute malnutrition:
Enabling persons with moderate and
severe malnutrition to access effective
treatment
Specific Actions for Nutrition
Nutrition specific actions

29. Feeding Practices & Behaviors:
Encouraging exclusive breastfeeding
up to 6 months of age and continued
breastfeeding together with
appropriate and nutritious food up to
2 years of age and beyond
Fortification of foods: Enabling access
to nutrients through incorporating
them into foods
Micronutrient supplementation:
Direct provision of extra nutrients
Treatment of acute malnutrition:
Enabling persons with moderate and
severe malnutrition to access effective
treatment
Specific Actions for Nutrition
Nutrition specific actions

30. Feeding Practices & Behaviors:
Encouraging exclusive breastfeeding
up to 6 months of age and continued
breastfeeding together with
appropriate and nutritious food up to
2 years of age and beyond
Fortification of foods: Enabling access
to nutrients through incorporating
them into foods
Micronutrient supplementation:
Direct provision of extra nutrients
Treatment of acute malnutrition:
Enabling persons with moderate and
severe malnutrition to access effective
treatment
Specific Actions for Nutrition
Nutrition specific actions
Essential
Nutrition
Actions

31. The ‘what’ of ENA…

32. Creating Political and
Operational Platforms,
with strong in-country leadership
& shared multi-stakeholder spaces
where people come together to
align their activities & take joint
responsibility for scaling up
nutrition.
Incorporating Best Practices
into National Policies
for scaling up proven
interventions; including the
adoption of effective laws
& policies
Align Actions Across Sectors
around high quality and well-
costed country plans, with an
agreed results framework and
mutual accountability.
Increasing Resources and
Monitoring Implementation
for coherent, aligned, effective
action and maximum impact.
1 2
3 4
Within each country, SUN Movement stakeholders are brought together around
4 key processes: progress is reviewed every six weeks
How does the ENA framework fit in?

33. So… “how” do we do it?

34. The ENA Framework
may provide a nice fit for
what is needed to scale
up proven nutrition
actions under the SUN
movement

35. 35
1st task…
Reach women and children at
broad scale with the
Essential Nutrition Actions
to make a public health impact

36. 36
2nd task….
Provide the right nutrition
support at the right time to the
right person
(e.g. children, women and …
adolescent girls)?

37. Critical Life-Cycle Contact Points for the
Nutrition of Women, Infants and Young
Children?
pre-pregancy and adolescence
during pregnancy & lactation
at birth
during post-natal period
from 0-6 months
from 6-24 months

38. Source: adapted from Lancet Nutrition Series 2013
Providing the right support at the right time:

39. 3rd task…
Reduce the many ‘missed
opportunities’ in existing
health programs to provide
nutrition support

40. 40
•Nutrition Programs
•Child survival programs
•Neonatal
•Reproductive health
•Infectious diseases
•Agriculture
•Education
•Micro-credit
•Emergency
•Social
Protection
•WatSAN
Outside
the health
sector
Within the
health
sector
Potential to integrate ENA into health
sector and non-health sector programs

41. 41
•Nutrition Programs
•Child survival programs
•Neonatal
•Reproductive health
•Infectious diseases
•Agriculture
•Education
•Micro-credit
•Emergency
•Social
Protection
•WatSAN
Outside
the health
sector
Within the
health
sector
Potential to integrate ENA into health
sector and non-health sector programs

42. 42
•Nutrition Programs
•Child survival
programs
•Neonatal
•Reproductive health
•Infectious diseases
•Agriculture
•Education
•Micro-credit
•Emergency
•Social
Protection
•WatSAN
Outside
the health
sector
Within the
health
sector
Potential to integrate ENA into health
sector and non-health sector programs

43. 43
•Nutrition Programs
•Child survival
programs
•Neonatal
•Reproductive health
•Infectious diseases
•Agriculture
•Education
•Micro-credit
•Emergency
•Social
Protection
•WatSAN
Outside
the health
sector
Within the
health
sector
Potential to integrate ENA into health
sector and non-health sector programs

44. 44
4th task…
Lots of partners!
Need to align ourselves in each
country

45. 45
National Nutrition Institute,
MOH Egypt
Cornell University Division
of Nutritional Sciences
Cornell University, USA
THE WORLD BANK
Public-Private Partnerships
The International Life Science
Institute Focal Point in China

46. 46
All these groups are aware,
committed and mobilized!!

47. 47
Under USAID funded LINKAGES Project (1996-2006)
• Ethiopia: >60 ENA partner groups
• Ghana: ~ 15 nutrition partners groups (regional &
district networks)
• Madagascar: >50 ENA partners groups (national &
regional networks)
Create broad partner networks to
increase coverage, allow fast-tracking and
and leverage of resources

48. 48
5th task…
Choosing a starting point.

49. 49
Where to start - harmonize and
strengthen existing field programs
Fine-tune existing programs to make them
better
Focus on capacity development of government
& NGO staff, key community members, etc…
especially in behavior change and counseling
Strive for same nutrition messages, BCC
strategy, IEC materials, training materials...

50. 50
Where to start - harmonize and
strengthen existing field programs
Fine-tune existing programs to make them
better
Focus on capacity development of government
& NGO staff, key community members, etc…
especially in behavior change and counseling
Strive for same nutrition messages, BCC
strategy, IEC materials, training materials...

51. Different customized training
targeted to:
Health workers (government
and CSO staff, etc..)
Community members &
volunteers
• Short-term, skills-based ENA training
• Heavy on interpersonal communication skills (e.g.
counseling/negotiation)
• Lots of practice with real mothers
Capacity building in ENA for health
workers and community members

52. The Core Group
http://www.coregroup.org/resources/core-tools
New Generic ENA Behavior Change Training for Health
Workers and Community Level: English & French

53. The ENA Framework
may provide a nice fit for
what is needed to scale
up proven nutrition
actions under the SUN
movement

54. • SUN Secretariat Powerpoint (December 2013) downloaded from SUN Website (adapted for this
presentation)
• Why Nutrition The Facts: UNICEF-WHO-The World Bank: Joint child malnutrition estimates -
Levels and trends. Global Database on Child Growth and Malnutrition
• A Smart Investment: Lawrence Haddad. Child Growth=Sustainable Economic Growth: Why we
should invest in Nutrition. May 2013
• Experts Agree: Copenhagen Consensus: Solving the world’s challenges. May 2012
• SUN Countries’ success in reducing stunting: The number of countries with AARRs greater than
2% is calculated based on historical data from 2000 to mid-2013. This figure is currently under
review, and the new number will be reported once the reanalysis of latest available data is
finished.
The SUN Movement Secretariat is supported by Canada, France, Germany, Ireland, the Netherlands,
the United Kingdom and the European Union, together with the Micronutrient Initiative.
How has stunting been reduced?References and Technical NotesReferences & technical notes from SUN website

55. 55