80% of the world's undernourished children live in just 20 countries. Intensified
nutrition action in these countries can lead to achievement of the first Millennium
Development Goal (MDG) and greatly increase the chances of achieving goals for child
and maternal mortality (MDGs 4 and 5). Despite isolated successes in specific countries
or for interventions--eg, iodised salt and vitamin A supplementation--most countries
with high rates of undernutrition are failing to reach undernourished mothers and
children with effective interventions supported by appropriate policies. This paper
reports on an assessment of actions addressing undernutrition in the countries with
the highest burden of undernutrition, drawing on systematic reviews and best-practice
reports. Seven key challenges for addressing undernutrition at national level are
defined and reported on: getting nutrition on the list of priorities, and keeping
it there; doing the right things; not doing the wrong things; acting at scale; reaching
those in need; data-based decisionmaking; and building strategic and operational capacity.
Interventions with proven effectiveness that are selected by countries should be rapidly
implemented at scale. The period from pregnancy to 24 months of age is a crucial window
of opportunity for reducing undernutrition and its adverse effects. Programme efforts,
as well as monitoring and assessment, should focus on this segment of the continuum
of care. Nutrition resources should not be used to support actions unlikely to be
effective in the context of country or local realities. Nutrition resources should
not be used to support actions that have not been proven to have a direct effect on
undernutrition, such as stand-alone growth monitoring or school feeding programmes.
In addition to health and nutrition interventions, economic and social policies addressing
poverty, trade, and agriculture that have been associated with rapid improvements
in nutritional status should be implemented. There is a reservoir of important experience
and expertise in individual countries about how to build commitment, develop and monitor
nutrition programmes, move toward acting at scale, reform or phase-out ineffective
programmes, and other challenges. This resource needs to be formalised, shared, and
used as the basis for setting priorities in problem-solving research for nutrition.