There is a wide body of research which has identified that the 1,000 days from conception to the age of two is the critical period for influencing the health of a child. The nutritional quality available to the mother and the child over this period has a lifetime impact on the height of an individual and, more importantly, their cognitive capacities. The fact that 45% of the children under five in Zambia suffer from stunting caused by poor nutrition was the stimulus for my latest Commission trip. I spent a fascinating week travelling to different parts of the country meeting mothers and children and looking at programmes designed to tackle this issue.
This month, which marked the third anniversary of my retirement, also ended up being a bit of a walk down memory lane vis-a-vis Accenture: In Paris, London and Frankfurt I enjoyed breakfast or dinner meetings with Bruno Berthon, Mark Spelman, Frank Riemensperger and Karl-Heinz Floether. This was a chance to hear more about the strategic direction for the old place as well as catch up on a former colleague’s own post-Accenture experiences and varied portfolio career. My most surprising and rewarding interaction with the firm though was a day spent in Frankfurt, at the invitation of Walter Hagemeier to speak to the Resources Community meeting in the wonderful surroundings of the Kronberg Accenture office. I took as my main theme “Whatever Happened to the Multi Polar World” and enjoyed weaving threads around the current state of the world, the evolution of emerging markets to a new plateau of maturity and my own experiences in the very developing world of the Commission. It really felt like old times and I was impressed by the energy of the team and the clear momentum in the country practice and its position at the heart of the industrial and digital revolution.
This has been a big month for Board meetings – I made another trip to New York to join my Board colleagues in welcoming Tracy Wolstencroft, from Goldman Sachs, as the new CEO to Heidrick and Struggles. This appointment has come as the culmination of a thorough search process (as one would expect given the executive search focus of the company) and it was great to see the organisation move to plan for the future with a fresh sense of purpose and direction under new leadership. We were also able to mark the outstanding contribution of Jory Morino the Interim CEO who has stewarded the company over the past six months. There was also a Fidessa Board and a meeting of the RSC Board. The big success story of the current season has been the dramatisation of the Wolf Hall and Bring Up the Bodies historic novels of Hilary Mantel. The adaption for the theatre of these Booker prize-winning books concerning the history of Henry VIII seen through the eyes of Thomas Cromwell has been a huge critical success. Sandy and I invited our friends Margaret and Mike to a back-to-back presentation of the plays on one very enjoyable day at Stratford on Avon.
It has been exciting to be part of discussions in the Commercial Board of the RSC about the transfer to London of this outstanding production as well as planning for the opening of Matilda the Musical in Australia in 2015. A rather different cultural experience was a night watching the Australian Pink Floyd as they thrilled me and other sad prog rock dinosaurs as their tour came to Guildford.
The Zambian trip came straight on the back of the review in the Philippines which I described in last month’s blog. I landed at Lusaka via Nairobi after a spectacular flight over Mount Kilimanjaro. The week-long visit began and ended in the capital wrapped around field visits to Mumbwa District several hours north of the city and the Monze District to the south. This set of trips was part of a thematic study the Commission is conducting into Nutrition programming. Over the past few years this area of development has come more and more to the fore, as the theories about the importance of nutrition quality to stunting, health and cognitive ability have been refined. The Lancet magazine has issued a series of papers which describe interventions ranging from breast feeding practices, through supplementing food, vitamin A, iron, zinc and micronutrients, to hygiene and de-worming interventions, and the fortification of staple foods as well as dietary diversification.
Zambia has put itself forward as one of the “early riser” countries for the internationally-sponsored SUN (Scale Up Nutrition) initiative. The sheer prevalence of stunting in the country is a big driver and the Vice President Guy Scott has been a major champion of the importance of the area. There are particular challenges resulting from the way that Zambia suffers from a very distinct wet season and dry season over the year. The crops do not last between the fertile periods and there has been a tendency to rely upon the staple food of maize, made into a porridge called “nshima” with little additional nutrients.
The National Food and Nutrition Commission is working hard to join all the dots across a initiative which involves multiple ministries, including importantly the Ministry of Agriculture. From the international community the NGO CARE has taken a leadership role in the coordination of the 1,000 MCD programme and we met with their team who are trying to bring order to the multiple central and district level ministries and administer the funds of the programme effectively. The challenges of creating and maintaining momentum across such a breadth of players was clear and we were encouraged to meet the CSO Alliance which has been funded by DFID to bring together local NGOs, media companies and other stakeholders to advocate with MPs and other key influencers on the topic.
Much of our trip was focused on seeing examples of the interventions which should play a part in the District nutrition plans. We met with some women villagers who have been mentored in ways to grow diverse crops by one of their fellow female small-holders. They were enthusiastic about the new crops that they had learnt about and the quality seeds they had been given. It was clear that the mentor was doing a great job in setting a personal example as she showed us around her splendid garden with some 15 plus different crops – as well as showing off the livestock who were being stored in cages off the ground to avoid disease.
She has been piloting a new seed-drying box which is designed to retain more of the goodness of the vegetables as they are dried for the less fertile seasons. This same lady then played a leading role in a drama that she and her friends put on to increase awareness about the positive health impacts of diverse diets. She was quite an actress and was not put off by the pouring rain which interrupted the show! Nor was another lady who proudly took us through her “diverse food cookery course” showing us a range of different sauces, porridges and additives which could be used to increase dietary mix. I must admit that, for all the amazing enthusiasm of the display I was quite pleased that I was not expected to taste any of it!
My expertise in latrines (which has been developing since my trip to the Congo a year or so back!) was increased by investigating several very robust new structures which had been built as part of a UNICEF managed programme in this region. There is also emerging research which has made a strong link between sanitation and hygiene and reduced stunting. The hypothesis is that if children are exposed to fecal matter on the ground and around their food there is damage done to the inside of the stomach which undermines the ability to absorb nutrients. This so-called “tropical entropathy” is why the progress of rolling out “Open Defecation Free” villages is such a big part of the work in this space.
The link to health care is clear and we joined a community health worker (Ben) as he first showed us around his clinic, including watching an ante-natal class in progress, and then made a routine visit to a farmer and his family. Ben had been freshly trained and it is hoped that he can also deliver nutrition advice and interventions alongside his other activities. There is much more to do to strengthen this area, and in the end it was clear that poverty and the seasonal limitations made life for the family very hard, whatever the support to hand from this enthusiastic young man.
One of the biggest challenges in the stunting area is that of measurement. There is a difference between measuring wasting and malnutrition (seen through weight to age ratios and height to weight ratios) and stunting which is seen more through height to age ratios. Several times the difficulties of measuring the length of wriggling babies was pointed out as a big issue in this space too! The reason why health workers are seen as important is the fact that many of the Zambians live in dispersed rural locations which are very hard to access. We experienced this first hand as we bounced our way over dirt tracks past sporadic communities and homesteads and when we were stuck for the best part of an hour in a muddy track – which nearly defeated even the 4X4 capabilities of our Discovery.
One of the highest impact parts of the trip was a session with the students and staff at the University of Lusaka who are on the new BSc course in Nutrition which has been funded by DFID. These young students, many of whom had been drawn from the various ministries, have been learning to become nutritionists and dieticians and they are creating a new cadre of experts which will have a major influence on the progress of this agenda in the country.
This world could not be further from the luxury and choice of foodstuffs which Sandy and I were enjoying just a few days later in South Africa. This has become a regular winter break for us and this year we spent time on the rugged Garden Route coast near Hermanus and in our favourite wine tasting centre of Franschhoek. The weather was glorious and I even had my second golf lesson of the year – with limited obvious signs of improvement!
Sadly Sandy’s damaged achilles tendon limited our hiking plans substantially, but did not stop us from exploring vineyards, shops and restaurants with our usual enthusiasm. We returned to the UK to find that the worst of the storms and floods that have beset the country for the past couple of months seem to be behind us. Bring on March and the start of Spring!
postmarkfromfoster 