Review of USAID"s micronutrient portfolio : a summary

The overriding conclusion is that USAID has played an indispensable leadership role in creating awareness of the negative, even fatal, consequences of micronutrient malnutrition in poor populations. What understanding of, and commitment to, micronutrients exist in the world is due in large measure to the Agency"s pioneering efforts. Evidence of this impact extends from USAID"s early support for groundbreaking vitamin A research in Indonesia, to its sponsoring of countless expert meetings and support of the leading technical associations, to its involvement in bringing micronutrient interventions to scale in countries such as Nepal, the Philippines, and Indonesia. The activities listed above have proven categorically the importance of vitamin A supplementation to early child health, and developed models to make possible national capsule coverage. Dietary diversification through the social marketing of vitamin A-rich foods has become a possibility worthy of further testing and evaluation. The financial and technical viability of vitamin A, iron, and iodine fortification of food commodities has been proven, and important national fortification efforts have been launched in Asia and Latin America. Efforts to make fortification an element of national policy have been especially successful when the private sector has been involved as an expert partner, and when emphasis has been placed on creating demand for fortified products; a special focus on private/public partnerships is urged. As far back as the 1970s, the research component of USAID"s micronutrient portfolio has been especially vibrant, effectively laying the technical and strategic groundwork for field implementation programs to follow. While the primary focus has been on applied research into vitamin A deficiency, important investments have also been made in research into iron deficiency anemia (IDA) and iodine deficiency disorders, and a start made at analyzing the importance of zinc to maternal and child health. This research has been central to health policymaking and resource allocation decisions in many countries. Current USAID-funded applied research on the impact of vitamin A, iron, and zinc supplementation of pregnant women on maternal and infant outcomes, and of vitamin A on mother-to-child transmission of HIV attest to the broad significance of micronutrient research to the field of international health. USAID should continue its leadership role in IDA research, strengthen its involvement in IDA and zinc research, and heighten its attention to applying research results to field programs with no unnecessary delay. Several problems warrant attention: (1) OMNI, USAID"s principal vehicle for micronutrient field work, should focus in a more intensive, integrated way on a manageable number of countries. Its communications capability also needs to be made more effective. (2) The continued low level of enthusiasm within USAID Missions, especially in Africa, for incorporating the micronutrient agenda into their Strategic Objectives is problematic. Efforts likely to persuade Missions include use of lessons learned from successful interventions, an awareness of local political and cultural realities, and a willingness to integrate micronutrients with other national and Mission priorities. (3) Management weaknesses are perhaps the most acute area of concern, especially in the case of OMNI, starting with the selection of prime contractors and subcontractors and their surprising miscalculations on their roles in implementing such a complex project. These problems have led to bad feelings and poor communication (a situation now improving thanks to current OMNI senior management), and ultimately a high level of distrust about OMNI within USAID and in the wider micronutrient community -- much of it undeserved. To give OMNI every chance to accomplish its objectives, the Office of Health and Nutrition of the Global Bureau for Programs, Field Support, and Research should allow flexibility and innovation; this would require regular, scheduled discussion among key players. A complete review of the process by which Micronutrient Reserve funds are allocated within the portfolio is also urged. More generally, consistent attention to continuity of effort and collaboration among all stakeholders is advised. Future directions for USAID"s micronutrient portfolio in both the short term (1997-98) and the long term (1999-2005) are included.