Regional Ministerial Consultation on Maternal and Child Nutrition in Asian Countries
Speech by
Geert van der Linden
Vice-President (Knowledge Management and Sustainable Development)
17 September 2004
New Delhi, India
Your Excellencies, distinguished guests, ladies and gentleman.
Let me start by thanking the World Food Programme and Government of India for inviting the Asian Development Bank to participate in this consultation.
I am especially pleased to be chairing and speaking at this important session. Regional cooperation and improved nutrition play a significant part in easing the burden of poverty in the Asia and Pacific region.
1. Brief overview of ADB
This is of special relevance to us at the ADB, a multilateral development finance institution headquartered in Manila and dedicated to fighting poverty in the region.
Established in 1966, ADB is now owned by 63 member countries, mostly from a region that extends from Afghanistan and Central Asia to the furthest reaches of the Pacific.
ADB is committed to assisting its developing member countries reach their Millennium Development Goals. And, we recognize the crucial role nutrition plays in achieving most of the eight goals.
2. Policy context - nutrition, MDGs, and regional cooperation
As leaders in our respective countries and institutions, I am sure that you are only all too aware that the MDGs have a special significance as a measure of success in reducing poverty.
Policies, programs, and projects must all contribute to achieving the MDGs, as this will ensure that national governments and the donor community are all more focused and more accountable.
From what we have heard so far, it is clear that nutrition is an essential building block in achieving at least six of the MDGs.
For Goal 1, there are indicators such dietary intake and proportions of underweight children. Good nutrition reduces poverty by improving productivity for all ages.
Regarding Goals 2 and 3, good nutrition improves educational outcomes and empowers women.
Malnutrition is associated with more than half of all child deaths, so addressing the issue will be essential for achieving Goal 4.
Similarly with Goal 5, we know that malnutrition of women is a contributing risk factor for maternal death.
Last, in relation to Goal 6, there is increasing evidence that good nutrition status slows the onset of AIDS in HIV-positive individuals and increases malaria survival rates.
Unfortunately, progress in achieving the MDGs in the Asia-Pacific Region has been uneven, specifically the nutrition related targets and indicators.
The recently released 5th Report on the World Nutrition Situation highlights some of the critical nutrition issues we face.
For example, in South Asia, 30% of all babies born at full term are underweight compared to only 14% in sub-Saharan Africa and 8% in East Asia and the Pacific.
Low birthweight babies are a reflection of problems with maternal nutritional status both before and during pregnancy. They lead potentially to an ever-repeating intergenerational cycle of poor nutrition and health if the situation is not addressed.
Although Asia is still home to the largest numbers of malnourished children, the figures are improving - slowly.
For example, good progress has been made on the MDG target of halving the number of underweight children under the age of 5 by 2015.
However, the report notes that on a regional level, much of this progress has been driven by improvements in the People's Republic of China. Thus, many countries still have a long way to go.
The important questions for us in this session are:
What role can regional cooperation play in addressing these challenges?
Can better regional cooperation assist you and your colleagues in your national efforts?
Can more support for those structures already in place enhance efficiency and effectiveness?
And what are the potential strengths of regional cooperation and what are the pitfalls?
At a time when our resources - both human and financial - are limited we should consider these questions carefully before launching into major initiatives that may not have a specific focus or potentially valuable outcome.
Now I won't try to provide definitive answers to these in my remarks. Indeed, I wouldn't presume to, given the expertise and experience in this room.
But I will make a few observations based on our own analysis of regional cooperation efforts - both specific to nutrition and more general.
Hopefully, this can provide a few pointers towards the areas in which enhanced regional cooperation might help in the region's fight against malnutrition.
3. Regional cooperation - already achieved in many areas in Asia
Over the years, Asia and the Pacific has already reached impressive heights in regional cooperation.
We can easily call to mind institutions like ASEAN, APEC, South Pacific Regional Trade and Economic Cooperation, and SAARC, as well as the growing body of cooperative agreements, institutions, and projects.
Such regional cooperation has enhanced relationships and improved the general stability, growth and well-being of the people of Asia and the Pacific.
Regional cooperation is good for development as resources are used more efficiently and trade, especially within the region, is encouraged.
It will come as no surprise then that the promotion of regional and subregion cooperation is one of ADB's top priorities.
As an example, for more than a decade, ADB has worked to support cooperation in the Greater Mekong subregion.
This has led to agreements involving road and air travel, river navigation and border development and to projects tackling energy, transport and telecommunications.
After a period of focusing on the "hardware" that promotes regional cooperation, the focus has in recent years shifted to areas such as communicable diseases, education, promoting environmental protection, and the sustainable use of shared natural resources.
Meanwhile, in Central Asia, a Regional Economic Cooperation program was initiated in 1997 to nurture economic growth and raise living standards. The program has focused on encouraging market integration within and outside the region - an effort that I believe can potentially have an important impact on nutrition.
ADB's support for regional cooperation in the South Asia subregion under the South Asia Subregional Economic Cooperation program, initiated in 2000 has focused on complementarities among countries, including the shared natural resources, with projects programmed in the transport sector including roads and inland waterways, energy, industry & finance and social infrastructure.
Such experience has taught us lessons that may be of value in addressing nutrition through regional cooperation.
4. Some working principles for effective regional cooperation
Clearly, there is no blueprint for a successful regional cooperation program.
The size of the region and of the participating countries, the underlying rationale for cooperation and the degree of public or private sector involvement will always vary.
Nevertheless, certain preconditions have to be met if regional cooperation is to be successful. Most of these I believe have relevance to considering regional nutrition cooperation:
There should be a clear vision of the shared social gains and strong public policy support;
There must be political commitment to the success of the initiative and willingness to compromise on measures that improve the possibility of creating regional public goods;
Countries must have ownership as well as capacity to lead, manage, and monitor the initiative;
There needs to be a readiness to invest, to accommodate policy changes and to share costs; and last
Success requires sustained diplomacy and a long-term commitment from the parties concerned.
5. Can regional cooperation make a more specific contribution to addressing MDG challenges?
I would like to suggest that there are four key areas in which enhanced cooperation would offer benefits: knowledge sharing, achieving economies of scale, capacity building, and harmonization of approaches and standards.
First, let me consider knowledge sharing.
The complexity of nutrition demands a constant stream of new knowledge and reviewed information.
We are far from knowing all the answers and yet, we must work with the knowledge we have.
There are a few areas in which our knowledge has been advancing rapidly in recent years. Examples include the role of zinc in children's nutritional status, the role of vitamin A in maternal health, and the role of nutrition in fetal development and the future health of children.
No country or institution or even region can acquire this sort of knowledge on its own. Thus, there is the ever present need for rapid and effective dissemination to those on the frontlines of practice.
If dissemination is not be slowed or halted at national borders, more effective regional mechanisms must be developed.
In addition to the scientific knowledge, there is also an ever-present need for knowledge on how policies and programs work best in practice.
Every nutrition practitioner will tell you that nutrition-in-practice is hard because of the specific contextual circumstances that impact so significantly on effective programs.
Culture, religion, environment and geography are all relevant and can, in some instances, be quite similar from one side of a national border to the other.
This is where the knowledge shared between countries with similar social, economic and cultural situations may greatly enhance the efficiency of improving policies and programs.
In recent years, ADB has worked with five countries - the PRC, Indonesia, Pakistan, Thailand and Viet Nam - as they have developed national country investment plans for food fortification to tackle the critical and persistent problem of micronutrient malnutrition.
The project included four regional forums and workshops with sessions devoted to issues surrounding wheat flour and oil fortification, improving the micronutrient content of complementary foods for young children, and regulation, quality assurance, surveillance, and trade in fortified processed foods.
The process of knowledge sharing through these regional forums has greatly assisted countries in their individual efforts to develop and prepare country investment plans.
Many of these plans are now coming to fruition and show significant potential for improving the nutritional status of vulnerable groups, particularly women and children.
I hope you can find time to look at copies of the report from this project that are available on ADB's website or that we can send to you on request.
The second area where regional cooperation offers benefits is in exploiting the economies of scale that exist when countries combine their efforts.
For some of the important interventions, smaller countries might never have sufficient capacity to independently develop their own systems or approaches.
For example, in Central Asia, ADB has been working with six countries on a project to reduce iodine deficiency disorders and iron deficiency anemia in poor mothers and children.
From a base in the Kazakh Academy of Nutrition in Almaty, Kazakhstan, training and technical workshops, equipment and support for the development of communication materials have been organized.
When the project started, only the Kyrgyz Republic and Azerbaijan had a Universal Salt Iodization Law.
During the past three years Kazakhstan, Mongolia, and Tajikistan have also adopted similar legislation and there have been substantial increases in the production and availability of iodized salt in all countries involved in the project.
This concerted effort and cooperation is now translating into real improvements in health.
It is an outcome we are proud of and congratulate our partners for their efforts. The first phase of this project is concluding this year and ADB plans to support a second phase starting in 2005.
A third area of great potential is capacity building on a regional basis to improve the effectiveness of nutrition assistance.
In this regard, I'm pleased to learn there is already a significant regional initiative underway.
The Task Force for Capacity Strengthening in Nutrition in Asia (CASNA) is run by the UN's Standing Committee on Nutrition and has been in existence for several years.
Led by an expert team based at Mahidol University in Thailand, the group aims to help develop human resources capable of addressing priority research and programs in food and nutrition in Asia.
The group also aims to build a network of institutions that can contribute to capacity building and has recently completed an institution survey to identify expertise and gaps.
The survey has resulted in a database that includes more than 50 institutions.
I understand the Task Force is planning to hold a workshop on advanced nutrition leadership with an emphasis on policy advocacy in nutrition in the first quarter of 2005.
This sounds to me to be an excellent start for regional cooperation on capacity building and, importantly, one that has originated and rests with institutions based in this region.
I hope you will all look to supporting this and building on its momentum.
Last, I believe there is great potential for enhanced regional cooperation on harmonizing approaches and setting standards to ensure optimal opportunities for enhanced nutrition.
An example might be where certain food commodities are traded between nations.
Regional standards and approaches to salt fortification and wheat fortification can ensure that commodities that move between countries meet certain nutritional standards and goals.
They can also ensure that companies producing or trading goods that meet these standards are not disadvantaged as they trade between countries with differing standards, given the costs involved.
ADB's experiences with food fortification in Central Asia and South and Southeast Asia have highlighted this as an area where more work is needed.
6. A vision for nutrition and regional cooperation
Ladies and Gentlemen, can we envision a region, say in 10 years, where the birth of an underweight baby or the death of a mother in childbirth is a rare event?
Where most infants are healthy and grow every day with a smile on their face as they actively engage in the unfolding world around them?
And, where children go to school and are not constrained by the invisible plight of hunger and iron deficiency in their capacity to learn and achieve their full potential?
In a region with remarkable economic growth, even more remarkable potential and vast human and natural resources, this is achievable.
Knowledge sharing, building economies of scale, capacity building, and coordinated standards hold the potential to enhance and catalyze the work many of you are already pursuing at a national and subnational level.
But enhancing this effort through regional cooperation will take initiative, leadership, commitment and resources, and the combined effort of all. Experiences of cooperation in other fields in the region show that it can be achieved.
As the famous expression goes, "the strength of the whole is greater than that of its individual parts."
Working together nations and people and institutions can achieve more for the well being of all, but particularly for those most vulnerable.
Regional cooperation can indeed be an effective tool for enhancing our efforts to reduce poverty, achieve the MDGs and, in general, improve the well being of women and children.
I hope some of the points I have raised and can now form the basis for fruitful discussion of future directions. I now open the floor to your response and comments.
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