The development objective of Accelerating Nutrition Results in Nigeria Project is to increase utilization of quality, cost-effective nutrition services for pregnant and lactating women, adolescent girls and children under five years of age in select areas of the Recipient's territory. This project has two components. 1) The first component, Basic Package of Nutrition Services, aims to scale up a basic package of nutrition-related interventions in twelve states. 2) The second component, Stewardship and Project Management, aims to strengthen key stewardship functions at the federal and state levels for the sustained delivery of nutrition services. (Nigeria)
The objective of the Investing in Nutrition and Early Years Project for Indonesia is to increase simultaneous utilization of nutrition interventions by 1,000‐day households in priority districts. Indonesia is the world’s largest archipelagic state, fourth most populous nation, and tenth‐largest economy in purchasing power parity terms. It is a member of the Association of Southeast Asian Nations group of countries as well as the G‐20. Indonesia has a population of more than 261 million, with 300 distinct ethnic groups and over 700 languages and dialects. With a gross national income per capita of about $3,440 (2015), Indonesia is classified as a lower middle‐income country. Indonesia has made significant gains in economic growth and poverty reduction in the past decade. Relatively strong economic growth (5.5 percent per year since 2000) has been accompanied by a sustained decline in poverty rates: about 31 percent and 6.8 percent of the population lived on $3.1 a day and $1.9 a day, respectively, in 2016, down from 82 percent and 48 percent, respectively, in 1998.1 However, Indonesia’s progress on poverty reduction contrasts sharply with its performance in sharing prosperity. Inequality, as measured by the Gini coefficient, increased from 30 points in 2000 to 41 points by 2014, by far the fastest widening in the East Asia and Pacific Region. The county’s strong growth and sustained investments in human capital, allocating 25 percent of the national budget to health and education, have translated into significant progress in service delivery and human development. In education, gross enrollment has reached 100 percent, 83 percent, and 32 percent in primary, secondary, and tertiary education, respectively; life expectancy at birth has steadily increased to 69 years in 2015, up from 63 years in 1990; and the under‐five mortality rate has declined from 85 per 1,000 live births in 1990 to 26 in 2016. Furthermore, the convergence of priority nutrition‐specific and nutrition‐sensitive interventions on households with pregnant mothers and children under two is low. There is growing global and local evidence that a ‘convergence’ approach, in which multisectoral interventions are coordinated to jointly target priority geographic areas and beneficiaries, is critical to accelerating improvements in health and child development outcomes and can help address stunting. (Indonesia)
Poverty rates in Guatemala are among the highest in Latin America and the Caribbean, and Guatemala is now the second poorest country in the region, with only post-earthquake Haiti being poorer. Guatemala is an extreme outlier in the region in terms of chronic malnutrition, and almost half of all children in the country suffer from stunting. This report is part of a global initiative to improve the evidence base on the linkages between water supply, sanitation, and hygiene (WASH), human development, and poverty and seeks to understand this paradigm through a careful examination of trends in access to water and sanitation and in corresponding linkages to poverty and health. It also reviews the governance structure and expenditure plans underpinning service delivery in WASH sectors in Guatemala. Finally, the report the challenges facing the water and sanitation sector in Guatemala are significant and will require, among other things, stronger political leadership to successfully reform and regulate the sector, greater focus on rural sanitation, and increased spending and budget execution. One of the key elements of this diagnostics is highlight what conditions led to a struggling WASH sector, particularly in rural areas. Despite a steep increase in water and sanitation coverage in the last 15 years, sanitation coverage is falling far behind drinking water coverage, with the lowest levels of coverage in rural areas affecting predominantly indigenous populations. (Guatemala)
Nutrition has been ingrained in key social and economic development policies in Senegal since the birth of the Republic. The evolution of nutrition policy, and its impact on the state of nutrition in Senegal, is the result of a constant interplay between social, environmental, and economic events; politics; the state of nutrition knowledge; and the engagement and influence of external stakeholders. Nutrition policy also encompasses what actually gets implemented; therefore, it is also influenced by available capacity and resources at all levels. With a 46 percent reduction in under-five stunting, from 34.4 percent in 1992 to just over 19.4 percent in 2014, Senegal has witnessed one of the biggest rates of improvement in the world and currently has one of the lowest rates of stunting in West Africa. This success has put Senegal in the spotlight, and other countries, especially those in Francophone Sub-Saharan Africa, look to Senegal as a model for nutrition intervention. Indeed, in the global fight against malnutrition, more often than not Senegal has been ahead of the curve, in a position of informing global advocacy initiatives, not just a beneficiary of the global evidence base. The purpose of this report is to provide an historical overview of nutrition policies in Senegal including analysis of the nutrition policy landscape, the evolution of nutrition policies and institutions, and their implications in terms of programming and prioritization of interventions. In so doing, the report aims to provide context to future nutrition investment and the PSMN currently under development, and to inform the decision-making process at this critical juncture. Here, ‘policy’ refers to all guidance for the management of nutrition, be it effective (everyone does it) or ineffective (it never leaves the paper it is written on), formal (written and adopted) or informal (unwritten institutional behaviors and practices). The timeline of nutrition policies and related initiatives is provided in appendix A. (Senegal)
The objective of the Towards Zero Stunting in Djibouti Project is to reduce stunting among children under five in Djibouti. There are four components to the project, the first component being high-impact health and nutrition services to reduce stunting. This component focuses on the delivery of services and interventions that address stunting at both the facility and community levels. This component includes two subcomponents: strengthening of health and nutrition services at the facility level; prevention and management of stunting and wasting at the community level. The second component is the strengthening multi-sectoral interventions for stunting reduction. This component will focus on creating an enabling environment for strengthening multi-sectoral interventions that are critical for reduction of stunting. This component includes three subcomponents: using multi-sectoral platforms for the prevention and management of stunting; addressing stunting in relevant policies and strategies; and multi-sectoral capacity building. The third component is the strengthening coordination, project management and monitoring and evaluation. This component includes two subcomponents: institutional strengthening for coordination, project management and M&E, and strengthening the use of information systems for enhanced M&E capacity. Finally, the fourth component is the contingent emergency response component. (Djibouti)
Uganda needs to allocate more resources to the social sectors (education, health and social protection) and to productivity-enhancing policies in the agriculture sector. Higher levels of investment in education, social protection, health (complemented by investments to increase access to water and sanitation services), and agriculture, are required for Uganda to attain two of its medium-term policy objectives: reducing poverty and inequality, and promoting economic growth in Uganda. While education has been a major factor in reducing poverty and inequality in the past, current levels of funding are inadequate. Education also helps households to smooth adverse shocks, making them less vulnerable to factors outside the control of households and individuals. Additional investment is needed to address the recent decline in primary enrollment rates and increase the quality of education at this level. Also, improving the availability and affordability of secondary education, especially in rural areas, is essential the raise the stubbornly low secondary enrollment rates. Addressing the high levels of under-five mortality, child stunting and teenage pregnancy requires the GoU to improve the provision of health care services to women and children. This in turn requires devoting more resources to the delivery of these services. Given the multi-faceted nature of these issues, complementary efforts in other sectors are also required, particularly through education programs and investments in sanitation and hygiene facilities. Programs aimed at increasing the agricultural productivity of smallholder farmers should have sufficient funding in the budget. The GoU should promote programs that improve the quality of inputs in local markets through certification programs and should increase the availability of extension services and credit to smallholder farmers. (Uganda)
Senegal is known for having one of the most effective and far-reaching nutrition service delivery systems in Africa. Government commitment to improving the nutritional status of the population has increased over time and has been marked, among other things, by the creation in 2001 of the CLM and its Bureau Exécutif National (National Executive Bureau) (BEN); an increase in annual budget allocations to nutrition (from $0.3 million in 2002 to $5.7 million in 2015); and intensificationof community-based nutrition interventions. These commitments are reflected in the improvementof nutrition indicators, notably a 46 percent reduction in under-five stunting from 1992 to 2014.Unfortunately, these improvements have not led to greater visibility of nutrition sensitive interventions in relevant sectors such as agriculture, livestock, education, social protection and health. This shortfall, combined with a recent series of exogenous shocks, has led to recurrent fragmentation of nutrition approaches, paradigms and interventions, resulting in the absence ofa general framework that provides guidance on both nutrition-specific and nutrition-sensitive investments.Meanwhile, progress in reducing stunting has slowed,and low birthweight, iron-deficiency anemia, adolescent undernutrition, and maternal undernutrition have received little attention. These shortcomings threaten the achievements of recent decades. Recognizing this challenge, the government of Senegal joined the Mouvement pour le Renforcement de la Nutrition (Scaling Up Nutrition) SUN Movement in 2011 and adopted the United Nations Approach to Renewed Efforts Against Child Hunger and Undernutrition (REACH) in 2014. These initiatives aim to strengthen institutional capacity and facilitate a multisectoral process to help governments plan, prioritize and more efficiently manage nutrition actions involving multiple stakeholders. With respect to national policy, the government of Senegal has adopted the Politique Nationale de Développement de la Nutrition (National Policy for the Development of Nutrition)(PNDN)2 covering the period 2015 to 2025, which will be operationalized through a multisectoral nutrition strategy, outlined in the Plan Stratégique Multisectoriel de la Nutrition (Multisectoral Nutrition Strategic Plan) (PSNM). These policies aim to expand coverage and improve the quality of nutrition services in sectors whose functional prerogatives affect the prevention and management of malnutrition. (Senegal)
In the 1980's Indonesia became an example for other countries concerned with reducing high levels of malnutrition. At the time, Indonesia had started nutrition programming and surveillance at the village level using the integrated weighing and child health posts, or Posyandu. In the ensuing decades there have been successes: small scale and bigger scale interventions that reduced malnutrition. At the same time, there have been set-backs, loss of attention, other priorities, decentralization, weak management and poor governance. In August 2017, the Indonesian government unveiled a new strategy to accelerate reductions in rates of stunting. This book looks at what will be required to turn that strategy - the National Strategy to Accelerate Stunting Prevention (StraNas Stunting) 2017-2021 – from vision into reality. It looks at the country's ambitious reforms and goals to reduce stunting. It examines the government's plans to boost awareness about the economic, social and personal cost of stunting, to ensure a truly national "multi-sectoral" effort to tackle the problem at scale in a coordinated and cohesive fashion in communities across Indonesia. It chronicles past successes and setbacks, drawing lessons from them about the future. We think Indonesia is on a path towards new success: this time at scale. It is a story worthtelling. (Indonesia)
Substantial work has demonstrated that early nutrition and home environments, including the degree to which children receive cognitive stimulation and emotional support from parents, play a profound role in influencing early childhood development. Yet, less work has documented the joint influences of parenting and nutrition status on child development among children in the preschool years living in low-income countries. Using panel data on parenting, nutrition status, and early developmental outcomes of about 7,000 Cambodian preschool-age children, this paper demonstrates that inequities in early development associated with family wealth are evident at the start of preschool and increase over time. A significant share of these inequalities can be explained by differences in parental stimulation and early nutrition status. Better educated parents engage in better parental activities that stimulate children's development. However, the positive association between parental activities and child outcomes is particularly strong for non-stunted children, and parental activities can only explain about 8-14 percent of the cognitive gap between the lowest and highest wealth quintiles. The results highlight the need for integrated interventions that address both parenting and early nutrition, also suggesting that parenting interventions for the most disadvantaged families should be carefully designed and evaluated to ensure maximum effectiveness. (Cambodia)
