Why governance matters in nutrition
What is good governance? For, it has struck me in recent weeks, that maybe it isn’t at all what I had thought it was, as I have delved into peer-reviewed papers, reports and debates to get the world’s insights on what matters most in delivering great government policies and outcomes.
As it happens, our international bodies have developed governance frameworks to this end, the World Bank, the UNDP. These models are full of accountability and selection procedures for post holders, and the like: all solid stuff. But my focus has been on what makes the biggest difference in the governance we get, and it wasn’t those things, in fact.
In this, one of the most interesting studies was done in Nepal, where researchers interviewed over 500 rural officials on nutrition governance, as they interacted with five government ministries and implemented a national plan of nutrition interventions.
A complicated study, but the findings weren’t complicated at all: the strongest drivers of results were simply knowledge, communication, and collaboration. Yet, still, a piece of slightly floating theory: what does this really mean in creating outstanding governance, even in that one area of nutrition?
So, imagine this: the facts are that child malnutrition is the most damaging issue we have in our future. I may have touched on this before.
But early-childhood iron deficiency, alone, delivers an average 12-point reduction in IQ (a measure of intelligence), a seven times lower chance of completing high school, the same chance of having children, but far lower chances of bringing them up with a partner, low concentration, reduced attention, far lower social abilities and markedly impaired abilities in negotiation, compromise and resolution of issues.
So that causes a lot more unresolved conflict, be it on a football team board or in finding a net-win solution for expanding pastoralist cattle herds. A fair legacy, there, for a bit of missed iron consumption under five.
So, imagine a Kenya where the agricultural extension workers don’t know that. Imagine a Kenya where the MPs, ministers, policymakers, county governments, committees, seed makers, mothers, consumers and even journalists don’t know that. Imagine they don’t know, either, that Vitamin A deficiencies simply remove the immune function, making tiny infections deadly.
And then, imagine, just one health official tries to get Vitamin A supplements out to millions of children. There’s not too much discussion down the implementation command line on how to achieve it, not too much attention to the challenges and how to solve them, it’s just a job, no one is really looking at the children that get missed (not realising that everyone is a permanent casualty), or taking ownership or setting performance targets.
In fact, imagine if most people working on implementing that policy never know what difference it made.
Conversely, imagine if every link in the agricultural policy chain knew a Vitamin A shortage was deadly, as well as that it’s in abundance in orange-fleshed sweet potatoes, but nowhere in maize. Multiply that knowledge by policies, management decisions, and every final interface with a farmer – would we get more children being better fed?
In fact, even knowledge at the top makes a huge difference. I was genuinely thrilled last week to get a call from Agnes Kalibata, the head of the United Nations Food Systems Summit, who was also, previously, the Minister of Agriculture in Rwanda.
She told me how they developed a bean with extra iron in it, and she had packets of the seeds delivered to every Rwandan family. There are many competing beans in Rwanda, but now, about 25 percent of families are eating those iron-rich beans. Imagine, if every politician changed the entire future for a quarter of all our children, and we see why Agnes is now an international leader.
But imagine, too, if our government took a step back on every single policy and delivery for Kenyans and reviewed the information going out with it on its potential impact and why it matters.