Building upon the firm leadership of the current Government of Guatemala, this commitment will bring together government ministries, international organizations and donors, and private sector actors in order to significantly reduce chronic child malnutrition in Guatemala. This will be accomplished through ensuring that the 13 critical Scaling Up Nutrition interventions are pursued at a national level within the recommended target populations. This includes:
1. Behavior change interventions, including: breastfeeding promotion and support, complementary feeding promotion, and hand washing with soap/promotion of hygiene behaviors.
2. Micronutrient supplementation and deworming interventions, including: vitamin A supplementations, therapeutic zinc supplements, multiple micronutrient powders, deworming, iron supplements for pregnant women, iron fortification of staple foods, salt iodization, and iodine supplements.
3. Complementary and therapeutic feeding interventions, including: prevention or treatment of moderate malnutrition in children 6 - 23 months of age, and treatment of severe acute malnutrition.
The Guatemalan President plans to sign an Executive Order requiring all relevant ministries to develop plans and assign budget resources to this project, as well as identifying gaps in current technical capacity and funding. Guatemala already has solid institutional structures in place including a food security law and corresponding policies, a national Food Security Council chaired by the Vice President (CONANSAN), and a Presidential Secretariat of Food Security and Nutrition (SESAN). The Guatemalan government is in a strong position to strengthen the capacity of the CONASAN and SESAN to provide national leadership and to ensure coordination of and investment in the programming carried out by all the participating Guatemalan Ministries to reduce chronic child malnutrition. WFP in Guatemala has strong capacity to provide technical assistance to the Government in implementing their plans, including strong expertise in the area of complementary feeding.
Once Government plans have been developed and the gap analysis is complete, WFP USA will engage private sector actors in the US and Guatemala and international donors to ensure sufficient support for the full scale up. In addition, WFP USA will ensure effective monitoring, evaluation and reporting on impacts of the program.
The scaling up of critical nutrition interventions will take place over the next few years in three stages to allow for government capacity to increase along with coverage, and to facilitate best practices are captured to ensure steady improvements in service delivery and government capacity over the course of the commitment. The three stages represent steps in scaling up the comprehensive package of interventions. Because infrastructure and capacity will be developed over the duration of the commitment, the interventions will first be implemented in the highest needs municipalities. Subsequently, they will be extended to other municipalities in order to achieve national coverage by the end of 2015. The interventions will be implemented simultaneously, as this comprehensive approach will produce the greatest impact on reducing chronic child malnourishment and stunting.
The Government of Guatemala will take leadership in the implementation of this program, with active support from international organizations, private sector actors and civil society groups with expertise in different areas. The participating government ministries will develop detailed plans, budgets, and gap analysis. This will allow for implementation challenges to be identified and addressed, including gaps in existing infrastructure in the municipalities. Resources to address these challenges will be mobilized on an ongoing basis. This process of gap analysis and mobilizing technical and financial resources to build government capacity is also essential to the sustainability of the commitment.
The government, together with private sector actors, will continuously mobilize citizens and civil society groups to participate in moving the plan forward. For some of the direct interventions - such as supplementary and therapeutic feeding - WFP will take the lead and gradually hand off these activities to the relevant government agencies. The Ministry of Health is the lead on many of the activities and is currently developing detailed plans and budgets. They are currently working on finalizing an indicators framework for use across all relevant agencies.
In addition, private sector and civil society actors will be involved as promoters, financers, implementers and supporters of the interventions, working very closely with the government. There are four bodies that make up the National System of Food and Nutrition Security (SINASAN), through which multi-sector engagement and action will occur:
- The National Council on Food Security and Nutrition (CONASAN) will review plans and progress at the highest level. CONASAN is composed of representatives from the government, the private sector, and civil society organizations.
- The Presidential Secretariat of Food Security and Nutrition (SESAN) will be the interagency coordinating body for program implementation in charge of coordination, budgeting, monitoring and evaluation.
- The third body, called INCOPAS, will be responsible for consultations and social participation in the plans, and as such will be involved in active outreach with the Guatemalan public.
- The Group of Supporting Institutions (GIA) will bring together international donors and other supporters to ensure that their contributions are aligned with the needs of the Guatemalan Government and that gaps in capacity are filled.
By the close of 2012, the program will be expanded to cover 83 municipalities in total. During 2013 this will expand to cover 166 municipalities. By the end of 2014, full national coverage of 334 municipalities will be achieved. This will allow for the final year of the commitment to focus on maintaining national coverage and documenting impacts. The cost per year of this program remains constant for each year, despite the fact that more people will be reached in the final years. This is constructed to allow for additional infrastructure investments at the outset.
The cornerstone of this commitment is the political will of the Guatemalan government and the active support of local private sector actors. Because the vast majority of the financing for this commitment will come directly from Guatemala, it will likely be sustained beyond the three-year duration of the commitment. Furthermore, the ongoing capacity building and gap analysis will ensure that the various government ministries involved in the implementation process will be able to act independently by the end of the commitment. WFP USA will remain involved and will assist in bringing the right supporters and leaders to the table to ensure successful implementation of the 13 nutrition interventions. WFP USA will continue to monitor and evaluate progress, will convene meetings of key players to keep focus on the goals, and will report back regularly to CGI on the progress being made.
Scientific evidence shows that proper nutrition during the first 1,000 days from gestation to two years of age is essential for proper physical and mental development of children. Evidence also shows that physical and mental damage during this critical period is irreversible, with lifelong and generational impacts.
Despite its status as a middle income country, Guatemala suffers from the highest rate of child malnutrition in Latin America, with an estimated 49.8% of children under five chronically malnourished. In addition, Guatemala ranks third in the world in prevalence of stunting, with only Afghanistan and Yemen having a larger percentage of stunted children under 5. (http://www.unicef.org/nutrition/files/Tracking_Progress_on_Child_and_Mat...)
This problem is costly for Guatemala not only in human terms, but also in economic terms. A study by the UN World Food Programme and the Economic Commission on Latin America found that in 2004 child malnutrition cost Guatemala over $3.1 billion, or 11.4% of Gross Domestic Product (GDP). (http://documents.wfp.org/stellent/groups/public/documents/liaison_office...) Yet we know that investments in nutrition are among the most cost-effective development interventions, with the Copenhagen Consensus project estimating returns on nutrition investments as high as 138 to 1.
To address this critical human development challenge, WFP USA is spearheading a commitment in partnership with the Guatemalan Government, private sector and international donors. Through this commitment, Guatemala will achieve national coverage of the 13 critical interventions identified in the internationally recognized Scaling Up Nutrition framework, including behavior change, micronutrient supplementation and deworming, and complementary and therapeutic feeding programs. (http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resource...) This will not only significantly reduce the rates of chronic child malnutrition in Guatemala, but will also make Guatemala a world leader in the Scaling Up Nutrition movement and provide a powerful model for other countries to emulate.