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Thirdly, what are the appropriate roles and expected contributions of United Nations agencies, funds and programmes, and allied international organizations, in a world of many more and diverse development partners whose collective resources dwarf those that can be mobilized by the UN system alone? Should the UN agencies be counted as simply one among many partners for countries, or should there be a differentiation of roles based on the unique responsibilities and accountability of UN agencies in relation to member-states? One important potential role of the UN agencies, which follows from their unique standing in the multilateral system, is to serve as facilitator and coordinator of international support. But is it realistic for agencies that also seek donor funds to serve as neutral and 94 Ending Malnutrition trusted facilitators of actions? Do the agencies themselves want to play this role, especially if playing it would restrict their own fund-raising activities?
Since they cannot establish a credible field presence without strong donor support, it would be self-defeating for UN entities to focus exclusively on normative and policy guidance, and eschew any responsibility for delivery or implementation.
Overcoming inertia: The vital contribution of Sustainable Development Goals In developing answers to these questions, we focus particularly on the role of global governance – the multilateral, especially UN-centred, processes and institutions that help to set norms, standards, and expectations, provide appropriate (non-prescriptive, norm-based) policy guidance, enable measurement and monitoring of standardized results, mobilize resources and facilitate coordinated action by many actors across sectors and disciplines.
Ultimately, most effective actions to improve nutrition outcomes take place at the country level rather than at the regional or global level. But it is a fallacy to assert that global and regional advocacy and coordination efforts are therefore necessarily redundant, inefficient or ineffective, and therefore a dispensable means of sustaining effective country-level action. To overcome the forces of inertia and fragmentation, it is vital to recognize that important action needs to be taken at all levels, including the international and regional levels, to sustain high-level national political attention to nutrition.
Attending only to the national level may weaken nutrition champions and leave them without important sources of information, guidance, and moral and financial support when they confront strong national inertia, political competition and complexity, and powerful institutional rivalries.
The potential for effective national action, as the experience of the UN Millennium Development Goals (MDGs) shows, can be greatly strengthened and sustained by an international milieu that provides strong norms;
simplified, consistent, flexible, and adaptable policy guidance; facilities for knowledge and experience-sharing among political leaders; resources for building technical and institutional capacity; and comparable data for measuring and monitoring progress.
One of the most important vehicles for building a global milieu for sustained nutrition action, therefore, is the post-2015 development agenda, at whose core are the 17 Sustainable Development Goals (SDGs) and their 169 Targets. Nutrition looms large in the new framework. As noted earlier, the SDGs, which will formally be adopted by the UN memberstates in September 2015, contain at least six goals and eighteen targets that are materially related to nutrition outcomes. Together, they work at all levels of the political economy of nutrition outlined in Figure 6.1, Governance 95 addressing ‘basic’ issues of social and economic marginalization such as women’s empowerment and access to resources; “underlying” causes, such as weak systems for food and water access, health, and sanitation; and immediate causes, such as inadequate uptake and absorption of nutrients, and diseases that are both the cause and consequence of malnutrition. The question, of course, is how can action on all these fronts be best organized and sustained?
For many observers, the sheer number of goals and targets in the new SDGs has itself become a major cause of bewilderment and criticism. In a published comment in The Lancet, the editor Richard Horton gave pointed expression to these concerns: “The SDGs are fairy tales”, he wrote, “dressed in the bureaucratese of intergovernmental narcissism, adorned with the robes of multilateral paralysis, and poisoned by the acid of nation-state failure. Yet this is served up as our future” (Horton, 2014). Given the stakes, one can easily understand the frustration, and perhaps even the bitterness, behind such remarks. But these are fundamentally misplaced, reflecting a deep misunderstanding of both the logic and intention behind the successor generation of global development goals.
The new SDGs depart from the previous generation’s development agenda in three essential respects. First, they are the product of an intergovernmental process based on the multilateral principle; in other words, they have been written, and owned, by the UN member-states.
Secondly, they are intended to be universally relevant and are defined to constitute a global social, economic, and environmental compact that aims to induce ambitious and transformative action, albeit without being prescriptive. They are a vision that reflects language agreed on by consensus of 193 nations, with balances of interests and compromises that reflect contemporary political reality in all its unavoidable complexity. Thirdly, they deliberately eschew the specificity that characterized the previous developmental goals, precisely because it was widely recognized that the segregated, siloed or vertical approaches of the MDGs missed out on key developmental linkages necessary for accelerated impact and long-term sustainability.
The last point bears particular emphasis. There are no true standalone goals in the new SDGs, despite the habit of many commentators of describing the headline goals in these terms. On close inspection, each
goal is itself an amalgam of several desiderata. SDG 2, for example, reads:
“End hunger, achieve food security and improved nutrition, and promote sustainable agriculture.” The targets carry the same integrative agenda to another level. Target 2.2 of SDG 2 states: “by 2030 end all forms of malnutrition, including achieving by 2025 the internationally agreed targets on stunting and wasting in children under 5 years of age, and address the nutritional needs of adolescent girls, pregnant and lactating women, and older persons.” The goals and targets do in fact set up an extraordinarily 96 Ending Malnutrition ambitious agenda, but provide only limited substantive guidance on how it is to be implemented. For that, a supplement is needed – a trigger to unlock the potential of the new framework, backed by a system that can provide the impetus to action, legitimated norms, time-bound frameworks, appropriate technical and policy guidance, robust monitoring, and mechanisms for systemic learning and adaptation.
Needed: A trigger for unified global support The key to overcome political fragmentation and inertia, and to sustain action at the national level, paradoxically, lies at the global level. The new SDGs, properly understood, provide a comprehensive and potentially powerful global set of intergovernmentally agreed goals and targets for sustained action over a period of fifteen years – an agenda that comprehensively addresses all the causes of malnutrition. If we look beyond the segregated silos that defined the MDGs, understand that the SDGs are designed to enable the development of broad laterally integrative strategies, and accept that there are therefore no true “stand-alone” goals in the new framework for any sector or “vertical”, we could begin to recognize their true value in creating the possibility for sustained action on nutrition.
But to make all these elements cohere, it is essential to consolidate the broad array of political commitments that have been made into a unified framework for action and then back it with an effective set of mechanisms for animating the global commitment to nutrition in all its dimensions. The first task was accomplished with the twin outcomes of ICN2: the Rome Declaration on Nutrition and the Framework for Action. What remains is to provide the trigger, adjust the international architecture for nutrition and energize it.
The natural trigger for following up ICN2 would be the one recommended to the United Nations General Assembly in the Rome Declaration:
a ten-year programme of action, which could be branded as a comprehensive UN Decade of Action on Nutrition, supported by all UN institutions, member-states, and allied organizations. A more modest alternative would be to fashion a schedule of UN system reporting under the standard rubric of “follow-up to a major UN conference”, that could be designed to tie together the disparate indicators and monitoring of actions and institutional developments for nutrition in the SDGs. The costs of both options would be modest, with most expenses being borne by the respective UN entities out of their own resources in fulfilment of their mandates. The chief difference is at the level of UN system coordination, which depends principally on agencies, funds, and programmes’ willingness to work together in support of a global agenda, and also at the level of publicity that can be generated by the UN’s Governance 97 Department of Public Information, which has the capacity to significantly increase the visibility of UN messages at the global scale.
The proposed UN decade met with resistance from countries concerned about making action-commitments on specific topics while the new SDGs were still being negotiated. The second idea would be a fall-back and would likely not receive the high-level publicity that a UN decade typically generates, but could still provide powerful incentives to coordinated action in a UN system called upon to demonstrate that it is “fit for purpose” in supporting the new SDGs. The UN General Assembly adopted a resolution welcoming the ICN2 outcomes on 6 July 2015, but decided at the same time to postpone consideration of follow-up actions, including the question of the decade, until after the conclusion of the SDG Summit in September 2015.
By then, it should be clear that supporting the SDGs necessarily implies supporting a broad and ambitious global agenda on all forms of malnutrition – undernourishment, undernutrition, especially micronutrient deficiencies and overweight/obesity.
Whichever course is chosen, the key question will remain: is the UN system¹⁰ really capable of delivering on the promise of the SDGs? Certainly the UN agencies, funds, and programmes cannot undertake to provide all the services needed. Then what is to be their role in enabling and facilitating action by the various other actors comprising “the international nutrition system” today? Why would others accept that role? And how will the UN system organize itself to play this role? There are serious doubts about the UN’s approach, as we have noted, and a history of inter-agency rivalry and competition that is still to be overcome. How, then, will the rules of the game be defined and adjusted? How will all nutrition action be monitored so that progress is measured, lessons learned, and success emulated? And how will all parties – including UN system agencies – be recognized for their contributions or their failures?
What is to be done? By whom? And how?
The key requirements for effective action on nutrition are widely recognized.
They include sustained political commitment and mobilization of effective nutrition action across sectors; provision of authoritative, evidence-based norms and standards; clear, simple guidance on policy and regulation;
¹⁰ The term “United Nations” is inherently ambiguous, as it can refer to either the UN member-states who collectively comprise the United Nations, or to the Secretariat, or both.
Thus it is conventional among specialists and diplomats to refer to the “UN system” when referring to the UN specialized agencies, funds, and programmes. This practice is followed herein. The terms “UN system” and “UN agencies” always refer to the specialized agencies of the United Nations including the World Bank and the International Monetary Fund, UN funds, and UN programmes, each of which has its own respective mandates and governing bodies, as well as the United Nations Secretariat, led by the Secretary-General.
98 Ending Malnutrition selection and monitoring of appropriate indicators of progress toward desired nutrition outcomes; progressive development of institutional as well as individual capacities, including for strategic leadership and innovation;
and, of course, sustained mobilization of resources to support large-scale change.
Of these, there are a number of tasks that can be performed most efficiently or most effectively at the global or supra-national levels: agreement on appropriate shared norms, goals, and targets; formulating clear, implementable policy and guidance; setting nutrition, food, and safety standards; systematic learning from diverse experiences; selection of indicators and design of instruments for tracking progress against key targets; and monitoring and reporting on national, regional, and global performance.
This is the stuff of global governance. Each of these services has a public goods aspect in that it is unlikely to be supplied privately, and needs an internationally legitimated process or institution to support it. But this is not the same as providing all these goods by public institutions alone.
A vital development in contemporary international governance has been the increasingly widespread practice of linking intergovernmental institutions and processes to multistakeholder platforms that make the process of developing and providing these services more open and inclusive, a shared responsibility of diverse social actors. The same development also makes international rule-making more complex and demanding. And all this in an era when funding for such public purposes has long been scarce. Thus, the question of what needs to be done quickly gives way to the questions, who is going to do all this and how? Specifically, which international institutions are going to be responsible for which activities?