How Can We Reach World Health Assembly 2025 Nutrition Targets? Using the Lives Saved Tool to Support Strategic Planning by the Nutrition Sector in Low-and Middle-Income Countries
Heidkamp, R.A., A. Clermont, and N. Walker, How Can We Reach World Health Assembly 2025 Nutrition Targets? Using the Lives Saved Tool to Support Strategic Planning by the Nutrition Sector in Low-and Middle-Income Countries. The FASEB Journal, 2017. 31(1 Supplement): p. 312.4-312.4.
In 2012, World Health Assembly (WHA) Member States committed to ambitious global targets for improved nutrition outcomes among women and children by the year 2025. Many countries lack systematic approaches to selecting interventions and setting feasible coverage targets in order to move toward these goals. The Lives Saved Tool (LiST) is a software tool used by governments and partners in more than 90 low- and middle-income countries to model how changes in coverage of maternal, newborn, and child health and nutrition interventions impact mortality and nutrition outcomes including stunting and wasting. In 2015–2016 we carried out a comprehensive review and update of the nutrition-related pathways in LiST to include new interventions (e.g., early initiation of breastfeeding), linkages (e.g., impact of malaria prevention on anemia) and outcomes (e.g., anemia in women of childbearing age, low birth weight) consistent with WHA targets. We used the updated tool with government partners in Malawi and Tanzania to refine national and subnational 5-year strategic plans. In each country, we examined historical trends in nutrition outcomes and intervention coverage over the last 10–15 years (based on data from nationally representative household surveys such as Demographic and Health Surveys and Multiple Indicator Cluster Surveys) and then used LiST to prospectively model multiple 5–10 year intervention scale-up scenarios. For example, in Malawi, we found that if the country were to reach its current National Nutrition Monitoring and Evaluation Framework targets, stunting among children would only decrease from 45.8% in 2014 to 43.7% in 2020, far short of the 38% target. If Malawi were to add three additional effective interventions to its current plan – including providing macronutrient supplements for food insecure children 6–23 months and pregnant women with low body-mass-index – stunting would be further reduced to 41.2% in 2020. In both Tanzania and Malawi, our findings suggest that intervention mix and coverage targets should vary at sub-national level. LiST is a useful tool for target setting in the nutrition sector but limitations related to the availability of coverage data and the lack of ability to model nutrition-sensitive interventions need to be addressed for it to fully support nutrition planning processes.