Foreword to Country Case Studies1

¹This foreword, written in 1993, introduced each of the country case-studies, and is included here to give context.

Viewing improved nutrition as an outcome of development processes expands the area of concern for policy-makers and practitioners who seek to combat malnutrition. These processes operate at different levels in society, from (he individual through to the whole arena of governmental policy and indeed international relationships. The SCN, in deciding on initiating a series of country-wide reviews of nutrition-relevant actions in 1990, aimed to provide a rich base of documented experience of why and how such actions were undertaken and what was their effect on nutrition.

This country-wide approach built on the progress made at the 1989 workshop on "Managing Successful Nutrition Programmes" held at the 14th IUNS Congress in Seoul. The focus here had been on nutrition programmes, and the essential factors determining their success, and the synthesis of findings and individual case studies were later published as ACC/SCN Nutrition Policy Discussion Paper No. 8.

Two other influential documents were the SCN's "Nutrition-Relevant Actions" that emerged from the 1990 workshop on nutrition policy held in London, and UNICEF's 1991 Nutrition Strategy document. Together these provided both a common analytical framework for organizing the reviews and a common language for discussing the various actions that impinge on nutrition. The value of such a framework has been demonstrated by the ease with which it lends itself to analyses of both the nutrition problem and its potential solutions. The food - health - care triad of underlying causes of malnutrition, in particular, proved to be a very useful framework for orienting the inputs and subsequent discussions at the 1992 International Conference on Nutrition, co-sponsored by FAO and WHO. Communication and thus advocacy are facilitated when people share such a conceptual understanding.

UNICEF had originally proposed that a series of country-wide reviews be undertaken and the results presented at the 15th IUNS Congress in September 1993. At the time of writing, preparations for this workshop are well underway - in fact, the richness of documented material has necessitated the organization of an additional two-day satellite meeting in Adelaide. We are extremely grateful to UNICEF for their financial support throughout this exercise. The series editor for these country reviews was Stuart Gillespie, and the SCN Advisory Group on Nutrition (AGN) also technically examined the drafts as these emerged. In addition, I would like to express gratitude to the external technical reviewers, selected for their in-depth knowledge of particular countries, who provided the authors with comments and suggestions on initial drafts.

The essential value of these country case studies lies in their ability to describe the dynamics involved when a national government attempts to combat malnutrition. Questions such as the role of the political economy in determining policy options, obstacles met in implementation, how programmes are modified or expanded, and how they are targeted, are all addressed. The need for actions to be sustainable to achieve results over the long-term, and the importance of both measurable objectives and a system of surveillance to monitor progress, are examples of important conclusions. These reviews thus provide valuable insights into the questions of "how" as well as "what", in terms of nutrition policy.

The country reviews are intended for a wide audience including those directly concerned with nutrition in developing countries, development economists, and planners and policy makers. Along with the output of the Adelaide meeting, they will be valuable for advocacy in underscoring that effective actions will improve nutrition. It is hoped that these reviews and the proceedings of Adelaide will provide guidance for a strengthening and expansion of future actions for reducing nutritional deprivation.

Dr A. Horwitz
Chairman, ACC/SCN
April 1993