‘Reset’ wasting prevention and treatment to catalyse action and accountability

Wasting refers to rapid weight loss due to inadequate dietary intake and/or infection. It is associated with a significantly elevated risk of mortality yet is one of the most ignored nutrition problems globally. With 45.4 million children under five years of age currently suffering from wasting (WBG 2021), and with most countries off track to meet SDG nutrition targets (GNR, 2020), the time has come for a ‘reset’. Further challenges lie ahead, including anticipated increases in wasting and other forms of undernutrition due to the effects of climate change (WFP, 2018) and the COVID-19 pandemic (Roberton et al, 2020). The need for radically improved prevention, early detection, and treatment efforts at scale is therefore critical. Despite the considerable international interest and investment in reducing wasting as well as strong support from national governments, the speed of progress is not currently fast enough to ensure global targets are met. The bedrock for effective nutrition programming is a conducive financial and policy environment, driven by strong political will and established within food, health, and social protection systems that operate to prevent undernutrition. This Solution will provide further impetus to generate the high-level political support needed to ensure global wasting targets are met.

Cost-benefit analyses looking at the critical impact of improved management of wasting have highlighted the vital importance of focusing on this solution, such as the Lancet Maternal and Child Nutrition Series (2013, 2021) and the World Bank estimates on ‘Scaling Up Nutrition: What Will it Cost?’ (Horton et al. 2010). Wasting and stunting co-exist and are causally related (Wells et al. 2019), hence strategies to reduce child wasting will also improve stunting. There is a wealth of literature on the grave economic costs associated with childhood stunting and the resulting rationale for investing in improved nutrition (e.g., McGovern et al. 2017). An integral part of this reset will be building on the UN-joint Global Action Plan (GAP) on Child Wasting (FAO, UNHCR, UNICEF, WFP, WHO, 2020). The GAP uses a multi-systemic conceptual framework describing the range of potential evidence-based actions that governments and their partners can explore to improve the prevention, early detection, and treatment of child wasting. It puts prevention at the core of the approach and highlights the importance of coordinated action across food, health, social protection, and water, hygiene and sanitation systems. National governments and their partners develop operational roadmaps to prioritise and adequately resource the services and actions necessary to address context-specific needs and opportunities.

A maximum of 30 people, comprised of high-level representatives from government, UN, academia, civil society, donors, and the private sector (e.g., food producers), will form a roundtable group. They will be provided with information from six working groups (WGs), each focussing on a specific domain critical for the scale up of wasting prevention, early detection and treatment: 1) prevention, 2) financing, 3) advocacy, 4) treatment scale-up, 5) policies & guidelines, and 6) nutritional products. The WGs will establish consensus-driven solutions: realistic actions that national governments and other stakeholders can and must take in order to significantly reduce wasting by 2030. Each WG will prepare a brief, which will inform the identification of the critical components of the ‘reset’ — e.g., what can be built on, what needs to change, how to galvanise political support, and what the critical next steps are to announce the manifesto at the UN FSS and launch at N4G. The solution involves a reset of thinking, funding, and practice to reach SDG 2 (Zero Hunger) by 2030. Continuing the existing approach is not going to be enough; course corrections need to be identified through re-examination of what has been successful (identifying exemplars) and what obstacles remain.

Many organisations, groups, alliances, and initiatives have been working to increase attention and action for the scale up of wasting prevention and treatment. Current support is exemplified by GAP frontrunner countries committing to implement detailed action plans, known as ‘GAP Operational Roadmaps.’ This Solution incorporates the GAP framework whilst also broadening the range of stakeholders involved in the wasting reset to further increase the current momentum and uptake of actionable solutions. The inspiration for this Solution evolved from discussion between key government representatives, UN agencies, coalitions, global and national civil society members, the Global Nutrition Cluster Technical Alliance, global and regional wasting advocacy groups, and the AT1 Leadership Team.