67

Lh
WPA, 19
Lh
-24
Lh
of May 2014, Ceneva
ACl lnLernaLlonal


!""#$%&'# &)%#*+,%&-) -" ).%+&%&-) &)%- %/# /#,0%/ 1#$%-+
What ro|e for the Wor|d neath Assemb|y?

!" $%&'( )*+, -.' /0110)" 23014,+" 5),14504+ 40+4 6+7),+ 83+0, 70783 60,8349:. ;)<8 )7 83+<+ 23014,+" 10*+4 0"
4+*+1)=0"> 2)?"8,0+< 9"4 40+4 )7 9 40<+9<+ ), 2)/60"980)" )7 40<+9<+< 8398 2)?14 6+ +9<01: =,+*+"8+4 ),
8,+98+4. @"4+,"?8,080)" 2)"8,06?8+< 21)<+ 8) )"+ 0" 85) ?"4+, A 23014 4+983<
0
. B3+,+ 0< 504+<=,+94 2)"<+"<?<
)" 83+ ,)1+ 83+ 3+9183 <+28), =19:< 7), "?8,080)" 9"4 9>,++/+"8 )" 83+ 7928 8398 /9C0/0D0"> 83+ +77+280*+"+<<
/+9"< 0"8+>,980"> "?8,080)"E,+198+4 9280)"< 0"8) 83+ 3+9183 <:<8+/<( 3+9183 <8,98+>: 9"4 3+9183 6?4>+8 )7
+*+,: 2)?"8,:. F)5+*+,( 0/=1+/+"8980)" ,+/90"< 9 23911+">+ 7), /9": 2)?"8,0+< 9"4 7?,83+, 9280)"< 9,+
,+G?0,+4 8) 04+"807: )=80/91 4+10*+,: /)4+1< 7), /91"?8,080)" =,+*+"80)"( 04+"80702980)" 9"4 8,+98/+"8
<+,*02+<( 949=8+4 8) <=+20702 2)"8+C8<. B3+ 29=9208: )7 3+9183 <:<8+/< <3)?14 6+ 98 83+ 2),+ )7 83+ 4+698+ 7),
83+ <?<890"960108: 9"4 1)">E8+,/ <?22+<< )7 83+ ?"4+,"?8,080)" ,+<=)"<+.

1owards better |ntegrat|on
Slnce Lhe publlcaLlon of Lhe 2008 LanceL serles on MaLernal and
Chlld undernuLrlLlon, Lhe evldence base for effecLlve nuLrlLlon
lnLervenLlons and dellvery sLraLegles has grown. Accordlng Lo Lhe
2013 LanceL serles, lf Lhe coverage of Lhe Len proven nuLrlLlon-
speclflc lnLervenLlons - mosL of whlch depend on Lhe healLh secLor
for lmplemenLaLlon - were scaled-up Lo 90, chlld under 3
morLallLy would be reduced by 13 years
ll
, Lhe prevalence of
sLunLlng by 20 and LhaL of severe wasLlng by 60. Cn Lop of
exlsLlng Lrends, as hlghllghLed by Lhe LanceL auLhors, Lhls
lmprovemenL would comforLably reach Lhe WPA LargeLs for
2023". (.) CenLral Lo Lhls scaled-up supporL ls Lhe creaLlon of an
enabllng envlronmenL Lo bulld commlLmenL and ensure LhaL lL ls
LranslaLed lnLo ouLcomes"
lll
.
AlLhough many counLrles have adopLed lnLegraLed sLraLegles for
maLernal, newborn and chlld healLh LhaL lncorporaLe nuLrlLlon
lnLervenLlons, Lhe acLual dellvery of nuLrlLlon lnLervenLlons ln
healLh servlces remalns llmlLed and ofLen lnadequaLe. lndeed, Lhe
lnLegraLlon of nuLrlLlon acLlons wlLhln Lhe dlfferenL healLh sysLem
bulldlng blocks ofLen ralses many challenges.
1he 2013 LanceL serles on nuLrlLlon reporLs Lhe governance and
leadershlp bulldlng block as Lhe mosL challenglng
lv
. 1he nuLrlLlon
dlvlslons (or unlLs) of MlnlsLrles of PealLh are ofLen undersLaffed
and sLruggle Lo coordlnaLe wlLh oLher essenLlal healLh dlvlslons (or
deparLmenLs) such as maLernal and chlld healLh.
1he lack of lnsLlLuLlonal prlorlLlzaLlon of nuLrlLlon wlLhln MlnlsLrles
of PealLh ls a key facLor for Lhe poor malnsLreamlng of nuLrlLlon ln
Lhe healLh secLor globally.
AnoLher ma[or consLralnL ls Lhe lnsufflclenL long Lerm and predlcLable fundlng, sLlll Loo ofLen donor drlven.
LasLly, Lhe assessmenL of Lhe ouLcomes of lnLervenLlons ls hlndered by Lhe poor quallLy of monlLorlng and
evaluaLlon daLa. ln addlLlon, Lhere are mlssed opporLunlLles ln lncreaslng Lhe reach of nuLrlLlon servlces lnLo
Lhe communlLy. 1he lack of effecLlve lnLegraLlon of prevenLlve and curaLlve nuLrlLlon servlces, such as
communlLy case managemenL, undermlnes Lhe lmpacL of malarla, dlarrhoea and pneumonla LreaLmenL.

233+#11&)* ).%+&%&-) &1 $+&%&$,0 %-
".0"&0 %/# +&*/% %- /#,0%/4
Chiluien whose health status is
unueimineu by unueinutiition aie
immuno-compiomiseu anu
susceptible to acquiiing common
chiluhoou infections. Theii nutiitional
status is fuithei impoveiisheu uuiing
episoues of uisease thiough loss of
appetite, incieaseu neeu foi nutiients
as well as impaiieu absoiption of
nutiients. This weakens the immune
system anu fuithei woisens the
seveiity of the uisease, piolongs
iecoveiy fiom infections finally
leauing to a vicious cycle between
unueinutiition anu infection, that will
leau to ueath if not bioken. It is
estimateu that a malnouiisheu chilu,
uue to his impoveiisheu nutiitional
status, is 6 times moie likely to uie
fiom uiaiihoea oi measles, 9 times
fiom pneumonia, anu 2 times fiom
malaiia. 0veiall, seveiely
malnouiisheu chiluien uie 9 times
moie likely than the healthy ones
1
. Yet
unueinutiition is still a neglecteu
conuition in public health stiategies.

67
Lh
WPA, 19
Lh
-24
Lh
of May 2014, Ceneva
ACl lnLernaLlonal


Leverag|ng nutr|t|on sca|e up |n a nea|th Systems strengthen|ng perspect|ve
ueLecLlon, prevenLlon and LreaLmenL programmes wlll be as effecLlve as Lhe sysLem Lhrough whlch Lhey are
belng dellvered. Weak healLh sysLems ln hlgh-burden counLrles are currenLly a ma[or consLralnL Lo expandlng
baslc healLh care, nuLrlLlon lnLervenLlons lncluded.
WlLh Lhe global flnanclal pressures ln Lhe 1970s and 80s, and Lhe sLrucLural ad[usLmenL of pollcles, whlch led Lo
Lhe collapse of Lhe healLh sysLems ln some counLrles, flnanclal resources were lncreaslngly pulled lnLo verLlcal,
dlsease-speclflc, programmes. 1oday, a growlng focus on Lhe overall healLh sysLem ls noLlceable. WPC has
esLabllshed a lramework for AcLlon LhaL ouLllnes lLs fundamenLal prlnclples
v
and lncreased funds are
channelled ln supporL of healLh sysLem sLrengLhenlng acLlvlLles. ln Lhls conLexL, a|| efforts shou|d be made to
ensure that essent|a| nutr|t|on |ntervent|ons are |ntegrated at a|| |eve|s of serv|ce de||very, whlle
parLlclpaLlng ln sLrengLhenlng Lhe healLh sysLem as a whole.
1hls approach has been adopLed wlLhln Lhe Comprehenslve
lmplemenLaLlon lan on MaLernal, lnfanL and ?oung Chlld nuLrlLlon'
(Cl) adopLed by Lhe 63
Lh
World PealLh Assembly ln 2012
vl
, whlch
sLaLes LhaL sLrengLhenlng healLh sysLems forms a cenLral elemenL of
a successful nuLrlLlon sLraLegy"
vll
and addresses speclflc
recommendaLlons for lnLegraLlng nuLrlLlon lnLo Lhe healLh sysLems
bulldlng blocks Lo Member SLaLes, WPC SecreLarlaL and
lnLernaLlonal arLners.
1he Cl recommends Member SLaLes lnclude nuLrlLlon ln all relevanL
sLraLegles, Lo achleve Lhe lnLegraLlon of Lhe proven nuLrlLlon
lnLervenLlons ln maLernal, chlld and adolescenL healLh servlces and
ln exlsLlng communlLy programmes, ensurlng unlversal access. 1he
Cl also hlghllghLs Lhe need Lo ldenLlfy and map capaclLy needs, and
Lo lmplemenL a comprehenslve approach Lo capaclLy bulldlng.
8egardlng flnanclng, lL encourages Lhe Member SLaLes Lo cosL Lhe
human resources expanslon plan, lncludlng Lhe one for capaclLy
developmenL and sLrengLhenlng of servlce dellvery, wlLh Lhe supporL
of lnLernaLlonal arLners. 1he Cl lasLly recommends LhaL Lhe
Member SLaLes, wlLh Lhe supporL of Lhe WPC, develop or sLrengLhen
survelllance sysLems and lmplemenL Lhe WPC chlld growLh
sLandards Lo monlLor lndlvldual growLh paLLerns and populaLlon
levels of sLunLlng, wasLlng and overwelghL.
5&6&%#3 &)%#*+,%&-)7 %/# $,1# -" 829
Bespite the enoimous piogiess in the past 2S yeais on seveie acute malnutiition (SAN) management, 0NICEF
estimates that only 7 to 1S% of chiluien affecteu by SAN in 2u12 have hau access to tieatment. Although the
WB0 lists SAN as a uisease, its management is ineffectively integiateu in the minimum package of health
seivices.
The tieatment shoulu be available anu accessible ovei the long teim in ioutine seivices. When a chilu attenus
a hospital, a health centie oi is assesseu by a community health woikei, its nutiitional status shoulu always be
pait of the basic consultation piocess anu appiopiiate tieatment options available foi a moie holistic anu
impactful appioach to chilu suivival anu health.
2$.%# 9,0).%+&%&-) &) %/# :-1% ;<=>
?#'#0-@6#)% A+,6#B-+C
The CIP piogiess iepoit shows
stagnation on piogiess on wasting
since 199u. 0igent action is neeueu to
ensuie Nembei States aie collectively
on tiack to ieach the WBA 2u2S global
taiget. Bowevei, no call foi Nembei
States is incluueu. At a time when the
Post 2u1S Bevelopment Agenua is
being uiscusseu, it is paiamount to
ensuie that acute malnutiition is
auequately incluueu in that
fiamewoik as pait of enuing
unueinutiition in all its foims. As
taigets in the Post 2u1S goals aie
laigely being set to 2uSu, a new taiget
on wasting shoulu be agieeu, builuing
on anu going beyonu the global WBA
taiget of ieuucing wasting below S%
by 2u2S. This woulu mean setting an
agieement to ieuuce wasting at least
below 4%, howevei with auuitional
commitments anu political will
Nembei States coulu agiee anu
achieve an even gieatei ieuuction.
67
Lh
WPA, 19
Lh
-24
Lh
of May 2014, Ceneva
ACl lnLernaLlonal

ICIN US aL Lhe S|de Lvent organlsed by ACl lnLernaLlonal, 1he lnLernaLlonal edlaLrlc AssoclaLlon
and Clobal PealLh AdvocaLe: B3+ ,)1+ )7 83+ 3+9183 <+28), 0" <2910"> ?= 40,+28 0"8+,*+"80)"< 0"
"?8,080)"( 9"4 3)5 8) /)*+ 7),59,4 7,)/ HFI 8) !JK$( )" H+4"+<49: $&
<8
;9: $%&L( &MN%%
O9190< 4+< K980)"<.

i
0NS Aiue-mmoiie N178 ; Septembie 2u1S
ii
The maximum effect on lives saveu is noteu with management of acute malnutiition.
iii
The Lancet seiies on Nateinal anu Chilu Nutiition 4 - The politics of ieuucing malnutiition: builuing commitment anu acceleiating
piogiess.
iv
0p Cit. The Lancet seiies on Nateinal anu Chilu Nutiition 4 - Panel S: Nain points fiom an online electionic consultation among
stakeholueis fiom six Scaling 0p Nutiition (S0N) countiies.
v
See WHO (2007). Strengthening Health Systems to Improve Health Outcomes - WHOs Framework for Action.
vi
See 8esoluLlon WPA63.8
vii
Bocuments A6S11 - 26 Apiil 2u12 anu A6S11 Coii.1 - 11 Nay 2u12, paia. S6.
D/,% 1/-.03 %/# EF
%/
DG2 3-H
1wo years afLer Lhe adopLlon of Lhe 'Comprehenslve lmplemenLaLlon lan on MaLernal nuLrlLlon, lnfanL and
young chlld nuLrlLlon', Lhe 67
Lh
World PealLh Assembly wlll dlscuss Lhe flrsL reporL of progress (olnL 13.2 of
Lhe agenda and assoclaLed documenL A67/13).
uesplLe Lhe deploymenL of many global lnlLlaLlves slnce 2012, Lhe WPC SecreLarlaL reporL underllnes Lhe slow
progress on Lhe ground of Lhe excluslve breasLfeedlng LargeL and Lhe sLagnaLlon of wasLlng. 1he reporL
provldes only occaslonal examples of lnlLlaLlves regardlng healLh sysLems sLrengLhenlng lnlLlaLlves and Lhe
lnLegraLlon of nuLrlLlon lnLervenLlons ln prlmary healLh care or unlversal access Lo servlces. Whlle Lhe
SecreLarlaL's reporL underllnes Lhls lack of progress, lL does noL call on Lhe Member SLaLes, Lhe SecreLarlaL, or
lnLernaLlonal arLners Lo do more or beLLer ln Lhese areas. 1he reporL also falls Lo make a sLrong llnk wlLh
oLher elemenLs LhaL are on Lhe agenda of Lhe Assembly, such as Lhe Lvery newborn AcLlon lan (lLem 14.2),
Lhe follow-up of Lhe '8eclfe ollLlcal ueclaraLlon on Puman 8esources for PealLh' (lLem 13.8) and Lhe on-golng
negoLlaLlons on 'PealLh ln Lhe posL- 2013 agenda' (lLem 14.1). 1hese elemenLs provlde clear lndlcaLlon of Lhe
lack of allgnmenL and lnLegraLlon of nuLrlLlon lssues wlLhln Lhe global healLh agenda, healLh sysLems and oLher
healLh programmes.
kecommendat|ons to Member States on po|nt 13.2 of the 67
th
WnA agenda
1. 8ecognlzlng LhaL scallng up nuLrlLlon lnLervenLlons wlll noL be feaslble wlLhouL effecLlve lnLegraLlon of dlrecL
nuLrlLlon lnLervenLlons aL all levels of Lhe healLh servlce, and LhaL embeddlng and scallng up nuLrlLlon
lnLervenLlons wlLhln weak healLh sysLems wlll furLher undermlne boLh healLh servlce dellvery and efforLs Lo
address common dlseases, we urge Lhe Assembly Lo requesL Member SLaLes, Lhe WPC SecreLarlaL and
lnLernaLlonal arLners Lo:
Increase the|r support to ach|eve an accurate d|agnos|s of hea|th systems, to def|ne pr|or|ty areas of
strengthen|ng |n order to ensure effect|ve |ntegrat|on of nutr|t|on |ntervent|ons throughout a|| |eve|s of
hea|th serv|ce de||very,
Cpt|m|ze the ||nks and coord|nat|on between frameworks, d|agnos|s too|s, techn|ca| expert|se and
fund|ng ded|cated to hea|th system strengthen|ng and to nutr|t|on at a|| |eve|s,
Inc|ude a "tracer |nd|cator" w|th|n the future G|oba| Mon|tor|ng Iramework, spec|f|ca||y dea||ng w|th
the effect|ve |ntegrat|on of nutr|t|on |ntervent|ons |nto hea|th systems and ask the Secretar|at to
spec|f|ca||y report on th|s |ssue,
Lnsure cons|stency between the s|x g|oba| targets of the CI, on-go|ng hea|th system reforms
d|scuss|on and the future g|oba| ost 201S Deve|opment Agenda framework,
Agree to Adopt dur|ng the 68
th
WnA a new reso|ut|on h|gh||ght|ng the need for an appropr|ate and
systemat|c |ntegrat|on of nutr|t|on |ntervent|ons |nto a|| bu||d|ng b|ocks of the hea|th systems to
ensure the effect|ve and susta|nab|e de||very of |ntervent|ons for the management of ma|nutr|t|on and
other ch||dhood |||nesses.