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UN Global Action Plan (GAP) Framework for Child Wasting and the Asia and Pacific Region

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By Harriet Torlesse, Roland Kupka, Warren T K Lee, Britta Schumacher and Angela de Silva

Harriet Torlesse is the Regional Advisor Nutrition at the United Nations Children’s Fund (UNICEF) Regional Office for South Asia.

Roland Kupka is the Regional Advisor Nutrition at the UNICEF East Asia and Pacific Regional Office.

Warren T K Lee is the Senior Nutrition and Food Systems Officer at the Food and Agriculture Organization (FAO) of the United Nations, Regional Office for Asia and the Pacific.

Britta Schumacher is the Senior Regional Nutrition Advisor at the World Food Programme (WFP), Regional Bureau for Asia and the Pacific.

Dr Angela de Silva is the Regional Advisor, Nutrition and Health for Development at the World Health Organization (WHO) Regional Office for South-East Asia

The global and regional context for wasting

Child wasting in early life adversely affects growth and development and increases the risk of mortality if left untreated.1 For this reason, the Sustainable Development Goals (SDG) incorporated the World Health Assembly target to reduce the wasting prevalence to <5% by 2025 which was later extended to <3% by 2030.2 However, progress has been slow globally and there has only been a modest reduction in the wasting prevalence between 2015 (7.4%)3 and 2019 (6.9%)4.

Two thirds (66%) of the world’s wasted children – some 30.8 million – live in the Asia and Pacific region.5 Most of these children are concentrated in the eight countries of South Asia (25.1 million), however the burden in East Asia and the Pacific is also substantial (5.7 million). In fact, the prevalence of wasting exceeds the threshold for a public health concern (>5%) in 70% of countries in Asia and the Pacific.6

The global nutrition community recognises that the response to wasting has been inadequate. In Asia and the Pacific, there has been insufficient attention to addressing the drivers and determinants of wasting in a comprehensive and coordinated manner to prevent children from becoming wasted. In some countries, efforts to address wasting have primarily focused on treatment, often in the context of humanitarian crises, yet the coverage of treatment also remains unacceptably low across all countries where wasting is a public health concern.

To accelerate progress towards the SDG targets on wasting, there is a need to develop and scale up radically improved solutions to address the underlying drivers and determinants of wasting while ensuring that treatment is available to all children who need it. A long-term impact on these drivers can only be achieved through a combination of sustainable and resilient food systems to ensure access to healthy diets, health services that provide quality universal health coverage with essential nutrition and health actions for children and women and social protection mechanisms to protect those who are most vulnerable. However, to date, the response by all stakeholders – including the UN system – has been too siloed and fragmented.

It is now more important than ever, in the context of the COVID-19 pandemic, to resolve the bottlenecks and barriers that are holding back progress. Unless effective action is taken, the number of wasted children in the region is likely to increase due to the secondary impacts of the pandemic on the access to nutritious foods and on the delivery, access and utilisation of health and nutrition services to prevent and treat wasting.  

The United Nations Global Action Plan on Wasting

In March 2020, five UN agencies (FAO, UNHCR, UNICEF, WFP and WHO) released the Framework for Action for the UN Global Action Plan on Child Wasting (hereafter ‘GAP Framework’) to accelerate progress in preventing and managing child wasting.7

The GAP Framework identifies four outcomes to achieve the SDG targets on child wasting and to improve the early detection and treatment for those who need it: (1) reduced incidence of low birth weight, (2) improved child health, (3) improved infant and young child feeding and (4) improved treatment of children with wasting. For each of these outcomes, the GAP Framework defines proven pathways to accelerate the delivery of essential actions and to create a more enabling environment for their success.

The GAP Framework aims to support countries in prioritising and coordinating the delivery of preventive and treatment actions across four key systems: food, health, social protection and water, sanitation and hygiene. It is designed to be relevant for all populations affected by wasting, including development and humanitarian contexts as well as marginalised groups, and recognises the need to engage and empower communities. It will be accompanied by a global Roadmap for Action to form the complete UN Global Action Plan on Child Wasting.

The Asia and Pacific Regional Action Plan

During the development of the GAP Framework, the regional offices of four UN agencies (FAO, WFP, WHO and UNICEF) considered how the UN can collectively support regional and country efforts to prevent and treat wasting in the Asia and Pacific region. These regional-level consultations took place within the Asia United Nations Network on Nutrition for the Scaling Up Nutrition Movement (AUNNS) and contributed to the design of the GAP Framework in order that it reflected policy and programming priorities in the region.

On the basis of these consultations, the AUNNS developed a preliminary Asia Regional Action Plan in November 2019. The GAP Framework was released in March 2020, just weeks into the COVID-19 pandemic. In September 2020, the AUNNS reconvened to review and update the preliminary regional plan to:  

  1. ensure alignment between the GAP Framework and the regional plan;
  2. take into consideration the impact of the COVID-19 pandemic on wasting and on services to prevent and treat wasting;
  3. identify regional level actions on regional advocacy and platforms, technical support, evidence generation and knowledge sharing, resource mobilization, and support for the operationalization of the GAP Framework at country level and on tracking progress; and
  4. include intermediary milestones under each focus area, with agency leads.

With regional UN coordination mechanisms already in place in Asia and the Pacific, this regional plan, once finalised, will help to ensure that the AUNNS focuses its efforts on a core set of catalytic actions, with clear agency accountabilities, to support priority countries in accelerating national efforts to prevent and treat wasting.

Operationalising the GAP Framework at country level

In the coming months, UN agencies at both regional and country level will support countries with high wasting burdens to develop Country Roadmaps for Action under the leadership of national governments. These roadmaps will identify a set of priority actions needed to accelerate progress on the prevention and treatment of wasting which can then be integrated into broader national policies, strategies and plans. Countries will be encouraged to follow a comprehensive approach to develop these roadmaps that engages actors across multiple systems (health, food, social protection and water, sanitation and hygiene) and multiple stakeholders (development and humanitarian partners, bilateral and multilateral organisations, civil society and the private sector).

Child wasting is part of a wider nutrition crisis in Asia and the Pacific that includes stunting, overweight and micronutrient deficiencies. These forms of malnutrition affect the same countries, communities and often the same child. They also share common risk factors including poor maternal nutrition, poor feeding practices and diets and socio-economic deprivation. We therefore recognise that it is crucial to integrate actions to prevent and treat wasting into existing or forthcoming national multi-sector nutrition strategies and plans and we reconfirm our commitment to support governments in addressing maternal and child malnutrition in all its forms.

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Endnotes

1 WHO, UNICEF & WFP (2014). Global Nutrition Targets 2025: Wasting policy brief. https://www.who.int/nutrition/publications/globaltargets2025_policybrief_wasting/en/ .

2 WHO and UNICEF (2018). The extension of the 2025 Maternal, Infant and Young Child nutrition targets to 2030. Discussion paper. 

3 UNICEF, WHO and the World Bank Group (2016). Levels and trends in child malnutrition. Joint Child Malnutrition Estimates. Key findings of the 2016 edition.

4 UNICEF, WHO and the World Bank Group (2020). Levels and trends in child malnutrition. Joint Child Malnutrition Estimates. Key findings of the 2020 edition.

5 UNICEF, WHO and the World Bank Group (2020). Levels and trends in child malnutrition. Joint Child Malnutrition Estimates. Key findings of the 2020 edition.

6 FAO, WFP, WHO and UNICEF (2019). Asia and the Pacific, Regional Overview of the State of Food Security and Nutrition.

7 Global Action Plan on Child Wasting: a framework for action to accelerate progress in preventing and managing child wasting and the achievement of the Sustainable Development Goals. https://www.who.int/publications/m/item/global-action-plan-on-child-wasting-a-framework-for-action

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Harriet Torlesse, Roland Kupka, Warren T K Lee, Britta Schumacher and Angela de Silva (2020). UN Global Action Plan (GAP) Framework for Child Wasting and the Asia and Pacific Region. Field Exchange 63, October 2020. p96. www.ennonline.net/fex/63/ungapasiapacificregion

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