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Food and nutrition bulletin
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Food and Nutrition Bulletin
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The Food and Nutrition Bulletin incorporates and continues the PAG Bulletin of the former Protein-Calorie Advisory Group of the United Nations system and is published quarterly by the United Nations University Press in collaboration with the United Nations ACC Sub-committee on Nutrition. The views expressed are those of the authors and not necessarily those of the United Nations University or the ACC Sub-committee on Nutrition.
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Food and Nutrition Bulletin
Editor: Dr. Nevin S. Scrimshaw
Assistant Editor: Ms. Edwina B. Murray
Editorial Consultant: Ms. Sarah Jeffries
Associate Editors:
Dr. Hernán Delgado, Director, Institute of Nutrition of Central
America and Panama (INCAP), Guatemala City, Guatemala Dr. Peter
Pellet, Professor, Department of Food Science and Nutrition,
University of Massachusetts, Amherst, Mass., USA Dr. Aree
Valyasevi, Professor and Institute Consultant, Mahidol
University, Bangkok, Thailand
Food and Nutrition Bulletin, vol. 12, no. 2
(c)The United Nations University, 1990
United Nations University Press
The United Nations University, Toho Seimei Building
15-1 Shibuya 2-chome, Shibuya-ku, Tokyo 150, Japan
Tel.: (03) 499-2811 Fax: (03) 499-2828
Telex: J25442 Cable: UNATUNIV TOKYO
WHFNB 46/UNUP-755
ISBN 92-808-0792-7
ISSN 0379-5721
Typeset by Asco Trade Typesetting Limited, Hong
Kong
Printed by Permanent Typesetting and Printing Co. Ltd., Hong Kong
John B. Mason
Development depends on people. Sustained development depends on people being productive and effective in the long run. People need skills, motivation, resources, and much else besides, including a satisfactory institutional setup to work in.
Such overall concepts relating to development in general apply with equal force to nutrition, and are now being elaborated in this context. The two papers that follow-by Dr. Scrimshaw and Dr. Gillespie- concern institutions for nutrition, looking at two different aspects: one a historical view of largely successful institution building, the other an analysis of how to enhance the future benefits of external assistance for institutions.
For nutrition, the long-run objective is to reduce and finally eliminate malnutrition in children, mothers, and everyone else. This has been articulated by WHO and UNICEF as specific goals for the 1990s [1]. A necessary interim objective, because it is people in developing countries who must ultimately achieve this, is to build the capacity for reaching this goal. Sustainability in this context means keeping effective programmes going, with flexibility in response to changing conditions, and starting and maintaining necessary programmes where nutrition is deteriorating or not improving as fast as it should.
Where is capacity needed? What are the "institutions" concerned? Four aspects of institutions are put forward in this context by Soekirman [2]: human resources, technology, information, and organization. He recognizes, both with reference to Indonesia and in general, that "human resources are the key element in institution building." Since this essentially means people with the necessary skills, training is involved, but the issue goes much further. Motivation comes not only from dedication to a worthwhile cause, but from satisfactory rewards, prospects, contacts, and recognition. People also means the staff who must maintain programmes in the field day in and day out, who are often the missing link between successful pilot programmes and the long haul of "going to scale," managing routine service-delivery programmes, as well as planning and monitoring them.
In his paper, Dr. Scrimshaw describes the development of a number of largely successful nutrition institutions in developing countries. Both a reason for their success and a mark of it is that they continue to command financial support, internal and external. An important insight given by Greiner [3] in a recent review of external support to institutions in Africa, is that the first-reaction logic of external funding should be reversed: When institutions are not functioning well is precisely not the time to pull out; but, when they are up and running, the donor should, with due care, withdraw in order to foster self-reliance. The donor can be a midwife to the institution, but it does not own the baby. Nor should it give it up because of a difficult gestation. Certain of Dr. Scrimshaw's examples well illustrate these principles.
While such principles are becoming better understood, it remains to incorporate them usefully in most external assistance projects. The issue is complicated by the concern that many activities, unrelated in intention to institution building, may in practice inhibit the development of self-reliant and effective institutions. One way to begin is to find out what is actually happening.
The procedure put forward in Dr. Gillespie's paper is a step toward this. Prospectively, the way would be to set institutionally related objectives for projects, to extend the process of defining problems and hence programme needs, and to include the institutional requirements for running the programmes. To provide guidance, knowledge is needed, first, on how the capacity of institutions relates in practice to programme responsibilities and, second, on how externally assisted projects (with or without specific institution-building objectives) have in fact affected the capacity of local institutions. The framework outlined in Dr. Gillespie's paper proposes a way of getting some urgently needed information.
What is an institution in this context? The idea goes beyond those that are clearly identifiable by having buildings, equipment, and budget-line staff. Research institutions, universities, and government departments are all clearly defined as institutions. Effective programme-management units have many of the same needs as more "bricks-and-mortar" institutions; these should be included. The aims of "institutional capacity" in reality include the ability of all those working in the area of nutrition in a country or region to be productive. This relates to many of precisely the same factors as those that allow institutions to flourish: adequate skills, motivation, and some assurance of continuity. SO, in assessing institution building, the interests of the network of field workers, in communities as well as headquarters and in clinics as well as ministries, should be included. Projects that enhance these people's sustained ability to function well should be judged worthwhile institutionally.
The information that Dr. Gillespie proposes gathering would be enlightening. One can guess at some results, and foresee the types of policy changes that donors might want to consider. Increased sensitivity to the effects of programmes on local institutions is one possible outcome. A longer time-horizon in donor project planning could be another. Because of real political and bureaucratic considerations, donor planning has sometimes sought instant gratification- short-term, definable, "concrete" impact-despite the complexity of the problems and the desirability of fostering self-reliance. Is it dreaming to imagine tenor twenty-year time spans for projects? (The Chinese, for example, routinely think in such terms.) Could one imagine a financial commitment, say for a million dollars, deliberately spread out as $$50,000 for twenty years, rather than $50O,000 for two-accepting the long delay of impact? Some financial investment projects are planned in this way. Maybe recognizing that people are central, and that their institutions need development too, would lead in this direction.
References