The World Bank has been a leader in nutrition policy analysis, and many of the nutrition projects it has supported have been innovative and successful. But though the Bank has developed the economic justification for large-scale investment in nutrition, and has the experience needed to scale up, it has failed to do so. Nutrition lending is an insignificant proportion of the Bank's business, no more than 2.5 per cent of its lending for human development. This level of effort is inconsistent with what the Bank's analytical work has found--that nutrition lending is one of the best economic investments, and critical to progress toward the Millennium Development Goals (MDG). There are significant institutional constraints to scaling up in nutrition. The paper therefore recommends that, if nutrition is to be put higher on the Bank's agenda, its top management will need to be involved in changing the institutional signals, through: (1) emphasizing that, as a precondition of faster progress toward the MDGs, improving nutrition is a Bank-wide responsibility, not just the business of health staff
(2) making 'improvement in nutritional status' a key development outcome and measure of poverty reduction
(3) creating institutional incentives for staff to focus on nutrition
(4) increasing the Bank's staff capacity in nutrition
and (5) raising a grant fund to help countries and Bank country departments scale up.