USAID nutritionist leaves legacy of saving lives

(September 1, 2012) Frances Davidson recently retired from the United States Agency for International Development (USAID) after dedicating 24 years to efforts for improving the nutritional well-being of people in developing nations. She served as acting Director of USAID Office of Nutrition and Director of nutrition programming at USAID during that time. Hunger Notes took the occasion of her retirement for an interview, to gain a perspective on USAID’s important work on nutrition during those years.

Frances Davidson
After completing a doctorate at the London School of Hygiene and Tropical Medicine Davidson came to Washington, DC, with her husband, who took a post at the British Embassy. She was hired in 1987 to work in the US Agency for International Development’s Office of Nutrition and soon afterwards rose to directing the office. She oversaw the merger of the Office of Nutrition into the larger Office of Health and Nutrition (later the Office of Health Infectious Disease and Nutrition-HIDN) within USAID where she continued to focus on issues of malnutrition in low income countries.

During her tenure at USAID, she grew the Agency’s nutrition program by establishing relationships with related sectors such as reproductive health, education, infectious diseases, agriculture, and gender.

As an anthropologist/nutritionist, she recognized the need to consider socioeconomic and cultural factors related to the prevention of malnutrition in differing contexts. Her view is that child malnutrition is a symbol of a systems failure within a country and only by focusing on all parts of the system, e.g., food production, distribution, health care and the policy framework could long term prevention and control of malnutrition in all its forms be prevented.

Given the modest resources of the nutrition program, she worked with colleagues to catalog the reasons for malnutrition in a particular country and then identified the aspects that were appropriate for USAID investments. To this end, she built upon previous work and continued the funding of research and analysis, both scientific and programmatic in developing countries through agreements with universities, governments, non-governmental organizations, foundations and private enterprise organizations.

One of her major accomplishments was to continue supporting vitamin A research and propelling forward vitamin A policies and intervention campaigns to address this debilitating deficiency. Part of that initiative was to support Dr. Alfred Sommers’ groundbreaking research on vitamin A’s relation to young childhood morbidity and mortality. (Sommers’ research on vitamin A in the 1970s and 1980s discovered that dosing severely vitamin A deficient children with an inexpensive, large dose vitamin A capsule twice a year reduces child mortality by as much as one-third. The World Bank and the Copenhagen Consensus record vitamin A supplementation as one of the most cost-effective health interventions in the world).

The USAID Office of Nutrition drove the vitamin A research through grants to non-governmental agencies such as Helen Keller International (HKI) to conduct some of the piloting field work. Monies and mentoring opportunities were made available to young researchers, especially women, in developing countries through NGOs such as International Center on Research for Women (ICRW). Davidson recognized that Vitamin A deficiency and programs to overcome it were more easily understood than the complex of malnutrition factors. By helping countries accomplish vitamin A deficiency prevention programs, USAID gained the confidence of colleagues and could expand programs to include other nutritional deficiencies.

Congressional support for efforts to increase child survival and prevent childhood malnutrition allowed Davidson’s office to expand the original idea of blindness prevention through vitamin A distribution to one that included treatment, rehabilitation and skill development to enable individuals with varying types of sight impairment to lead productive and meaningful lives. USAID worked closely with the Perkins Institute on blindness prevention as well as the SEVA Foundation HKI, the International Eye Foundation(IEF) and others to achieve this. In order to maximize impact, USAID sought out innovative ideas to reach those in need and beyond the range of most programs. In order to help accomplish this, the Office of Nutrition worked on developing private and public partnerships, such as with Hoffman La Roche/Sight and Life Foundation and BASF Global (Badische Anilin und Soda Fabrik) to supply vitamin A capsules and conduct research. For instance, Hoffman La Roche supported “Sight and Life” to promote young investigators’ work.

In recognizing the need to document the impact of USAID programs and track program progress in collaboration with host country colleagues, nutritional surveillance efforts were supported. She considers it an accomplishment that USAID supported countries incorporated indicators of nutritional status into their ongoing health indicators reports. Along with USAID Mission colleagues, she worked to get nutrition mainstreamed with other important health interventions such as tuberculosis and HIV/AIDs, food fortification with key micronutrients (vitamin A, iron, iodine)—vital nutrients often missing in people’s diets in developing nations. A focus on diet quality and micronutrient nutrition became a strong component in USAID mission policies and programs especially where there was high young child mortality (under five- year-olds) signaling micronutrient deficiencies – the silent cause of death of young children.

Additionally, she and her office developed and fostered private sector partnerships to promote food fortification with micronutrients and other important nutrients in a number of countries. The Division of Nutrition joined with the Gates Foundation and others to help start GAIN, the Global Alliance for Improved Nutrition, with the focus on expanding the application of food technologies to improve nutritional quality of foods in as many low income countries as possible.

Translation of science and technology into programs that were appropriate to low income countries and that improved lives was central to her work.

Political will is a universal aspect of successful programs. She noted the critical importance of having devoted congressional support for USAID’s efforts. Political leaders such as George McGovern, Tony Hall and Mickey Leland, and key staffers such as Tim Rieser were essential, as was the Select Committee on Hunger which raised the visibility of the problem and encouraged cooperative and innovative solutions. The existence of an office or committee on Capitol Hill with a mission to improve food security and nutrition to push forward the knowledge base and programs to combat malnutrition was important to the success of USAID supported programs.

Recognizing the fact that if a population was deficient in one critical nutrient, such as vitamin A, there was a good chance they were deficient in others, Davidson expanded the program and policy portfolio to include a range of vital nutrients, in particular iron deficiency anemia which has compromised the well being of countless women and children. In order to help countries document the extent of the deficiency, USAID supported the development of the hemocue, a simplified field tool that could be used by minimally trained field workers to assess iron deficiency. DHS began using it in select country assessments.

In addition to documenting the extent of anemia in populations, Davidson and her office worked hard to get important nutrition indicators such as dietary diversity to better understand nutritional deficiencies and their health outcomes included in Demographic and Health Surveys (DHS), health surveys conducted in many different developing countries over a many years which have been crucial in demonstrating progress, or the lack of it, in key measures of health. There were many obstacles and challenges to having these questions integrated into the DHS; however, it was important information to enable ministries and governments to weigh and consider the ramifications of nutritional deficiencies and what they meant in terms of development for their country’s populations. Likewise, it was important for those funding nutrition programs to gain an understanding of the impact of nutritional on national security, political stability and overall development issues. One core factor in USAID’s nutrition work has always been the close collaboration with other agencies, and host country colleagues in order to ensure suitability of programs. Policy impact and sustainable improvements in the health and well being of the most disadvantaged.

The efforts of Davidson and her colleagues at USAID have advanced overall knowledge of micronutrient deficiencies, their role in health and wellbeing and policies and programmatic practices to treat nutritional problems in order to promote the development of individuals and their communities.

Thank you, Dr. Frances Davidson!

Ferris-Morris is a nutrition consultant and a board member of the World Hunger Education Service, the publisher of Hunger Notes. This article is based on a July 2012 interview with Dr. Davidson.