Introduction to Fill the Nutrient Gap (FNG)
The effects of malnutrition are globally recognized as being devastating and far-reaching. Malnutrition in Zambia takes many forms and is widespread. Despite concerted efforts it remains a major public health concern. Micronutrient deficiencies are common among children and pregnant and breastfeeding women. Anaemia has remained high at 41 percent of pregnant women, 28 percent of breastfeeding women and 58 percent of children under five. Overweight and obesity rose from 13 percent in 2002 to 23 percent in 2014, suggesting that the triple burden of malnutrition – the co-existence of chronic malnutrition, micronutrient deficiencies and overnutrition – is becoming an increasing concern. There are glimmers of hope: between 1992 and 2018 the national prevalence of stunting fell to 35 percent, though with significant disparities between provinces, ranging from 46 percent in Northern Province to 29 percent in Western Province.
In the past decade the government of Zambia has made progress in integrating nutrition objectives into multisectoral policy and different government ministries have begun including nutrition as an objective in their respective policies. It is imperative that national stakeholders and champions now have access to evidence, data, and advocacy tools for the further advancement and integration of nutrition so that past gains are not lost and nutrition remains a national priority.
FNG in Zambia: Purpose
The overarching objective of the Fill the Nutrient Gap (FNG) analysis was to bring stakeholders together to identify and prioritize context-specific policies and programmes across different sectors aimed at improving nutrition among target groups across the lifecycle. The FNG process was initiated to support the objectives set forth by the First 1,000 Most Critical Days Programme (MCDP II), a multisectoral initiative coordinated by the National Food and Nutrition Commission (NFNC). The aim of the analysis was to identify and analyse entry points for interventions within the scope of ongoing MCDP II programmes and Zambian government policy, and to support expansion or implementation of those programmes with evidence-based advocacy messages.
Building consensus for improved nutrition
Nutrition is a crucial pillar in the development of a healthy, productive nation. Good nutrition enhances physical and cognitive development, prevents disease, and increases the potential of the workforce and society. Improving diets, especially of children and women, brings immediate and long-term health, education and economic benefits. The 2013 Lancet series on maternal and child undernutrition identified a variety of nutrition interventions that have proven effective. Successfully improving nutrition outcomes depends on interventions being tailored to the local context.
FNG is an analytical process comprised of a secondary literature review in combination with Cost of the Diet (CotD) linear optimization to understand the availability, cost and affordability of a nutritious diet. This process – applying the CotD findings to contextual analysis and intervention modelling – is dedicated to identifying and prioritizing the scaling up of proven interventions that are most likely to be effective in a given setting.
This report presents findings from the analysis and a discussion of its process, methodology and limitations. It highlights the recommendations and priorities for advocacy messages identified by stakeholders. By identifying and contextualizing new findings, the FNG analysis contributes towards building consensus around a vision and a path forward for sustainable improved nutrition in Zambia.
FNG Zambia: Process and Scope of the Analysis
The FNG process in Zambia was led by the NFNC with WFP providing technical assistance. FNG analysis was informed by guidance and input from secondary data sources, CotD modelling, and the development of recommendations by several stakeholders (see full report for list).
The process started in October 2020 with meetings between WFP and the NFNC, government, NGOs, UN agencies and other development partners. To define the focus, stakeholders established consensus on the analysis and identified ongoing and potential interventions for modelling during the inception workshop in November 2020. The FNG team then conducted preliminary analysis and validated findings with stakeholders in the first half of March 2021. Revisions to the analysis with intervention modelling were completed and final results presented at a dissemination workshop at the end of March 2021. During this workshop, stakeholders developed recommendations based on FNG main findings (Figure 1).