The proposition is formulated in a way that attempts to balance the interests and strengths of multiple constituencies in a constructive manner, without assigning proprietary rights to any one group or the other. This is with a view to building synergies and contributing to collective action in pursuit of what I consider to be a public good. A meeting of agency representatives and other stakeholders in Rome (May 31st and June 1st) will explore the extent to which all of us collectively can match the aspirations of a movement to the institutional capacities, flexibilities and strengths we all bring to the table. We will need to consider how these capacities can be strengthened over time as the movement progresses. Background documents:

• David Nabarro introduces SUN
• Scaling Up Nutrition: A framework for action

The Context Many different groups are moving forward on an effort to scale up nutrition (SUN). We are witnessing the emergence of a movement: there is powerful leadership from within countries of all levels of economic development. The movement engages civil society, private sector, research groups governments, regional bodies and international organizations. It provides an opportunity for all to work together while maintaining their own mandate and identity. There is growing political support and an increasingly precise focus for the work. The movement will lead to changes in existing programmes so that they are more sensitive, and responsive, to the challenges posed by under- nutrition. Elements of the proposition Early Growth and Nutrition is Critical: The numbers of children under-nourished in the first two years of life exceeds 130 million: they are at risk of long-term adverse consequences. To prevent these, they need access to adequate micronutrients, protein and energy - ideally through locally grown nutritious food. If they can access and use adequate nutrients they are able to realize the long term benefits associated with good nutritional status. (a) Nutrition-Sensitive Development: Development programmes have paid insufficient attention to under-nutrition in recent decades. i) Actions undertaken in many different programmes can have a major impact on Nutrition: These include those which are designed to secure health, agriculture, social protection and education outcomes. There is scope for adapting these programmes in ways that are sensitive to the determinants of under-nutrition so that they contribute to nutritional outcomes as well. ii) Much depends on Women’s capacity to Nurture their Children: To be in a position to invest in their children’s early well-being, women need control over their time and to be able to access cash, nutrient-dense foods and effective health care. This calls for programming that empowers women to be able to promote better child nutrition. (b) Nutrition-Specific Interventions: A series of highly-effective and low-cost nutrition-specific interventions has been identified. These were described in peer-reviewed articles in the Lancet two years ago. If implemented within the context of nutrition-sensitive development programmes they will have a major impact on nutritional status. (c) Focus on Results Information Systems are needed to steer and monitor this effort, and to ensure accountability. These would be based on reliable indicators for (a) and (b) above. There is an emerging scientific consensus that monitoring children’s linear growth in the first 1000 days following conception provides a reliable indication of their nutritional status. Next Steps Although they will agree with its general thrust, not all of the stakeholders in the movement will be ready to agree on all the elements of this proposition. They are, though, helping it to evolve, and want to help advance the agenda over the next few months – ie up to, and through, the September 2010 summit on the Millennium Development Goals in New York. I propose that we work together on May 31st and June 1st to address a set of questions.

• How can we nurture the movement, and help it grow, in ways that are both empowering and effective?
• How can we ensure that the specific perspectives of individual stakeholders can be reflected in this effort?
• How can we avoid the development of entrenched positions that undermine our synergy?

This discussion will help us establish how we can each (in our different ways) contribute to the movement. David Nabarro 28th May 2010