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)
This paper undertakes two calculations, one for all developing countries, the other for 34 developing countries that together account for 90 percent of the world's stunted children. The first calculation asks how much lower a country's per capita income is today as a result of some of its workers having been stunted in childhood. The analysis uses a development accounting framework, relying on micro-econometric estimates of the effects of childhood stunting on adult wages, through the effects on years of schooling, cognitive skills, and height, parsing out the relative contribution of each set of returns to avoid double counting. The estimates show that, on average, the per capita income penalty from stunting is around 7 percent. The second calculation estimates the economic value and the costs associated with scaling up a package of nutrition interventions using the same methodology and set of assumptions used in the first calculation. The analysis considers a package of 10 nutrition interventions for which data are available on the effects and costs. The estimated rate-of-return from gradually introducing this program over a period of 10 years in the 34 countries is17 percent, and the corresponding benefit-cost ratio is 15:1. (World)
Social Accountability has received much attention as a potentially promising method to engage community members in monitoring the delivery of public services. Recent efforts in Uganda and Nepal found that community monitoring mechanisms led to large improvements in child health outcomes. The government of Uttar Pradesh (UP), as part of the World Bank supported Uttar Pradesh Health Systems Strengthening Project (UPHSSP), implemented Social Accountability (SA) interventions on a large scale. In contrast to previous impact evaluation efforts led by researchers on a smaller scale, this novel effort represents the first large-scale impact evaluation of SA and community-based monitoring that is designed and implemented by the government. This evaluation’s findings strongly suggest that information and facilitation jointly have larger effects than provision if information alone, leading the IE team to strongly recommend that UPHSSP and SIRD continue its policy of investing in community facilitation mechanisms as part of larger SA efforts. The government-run program currently being implemented in the other 10 districts in UPHSSP could be improved by incorporating design features from this 2-district evaluation, especially in terms of information delivery and facilitation of VHSNC meetings. A key feature of the evaluated intervention was its government-led design and implementation, enabling replication at scale by government. Hence, the evaluation’s findings are also relevant for scale up across India, and other countries with a similar context within the South Asia Region, and beyond. The ongoing implementation of SA interventions by UPHSSP in 10 districts, which also follows a block-wise randomized design, is an incredible opportunity to study and document the impacts of SA, when implemented at large-scale. The IE team strongly recommends that the state government continue to improve and implement the SA interventions robustly and invest in efforts to monitor and evaluate the impacts of this large-scale implementation of SA. (India)
India is home to approximately 164 million children 0-6 years of age, constituting about 20 percent of the world’s child population in this age group. Their optimal development is critical to human capital development in the world. Yet, with 38.4 percent children under 5 years of age in India stunted, 21 percent wasted and only 9.6 percent children aged 6-23 months receiving an adequate diet, optimal child development in India is still a goal for the future. Indicators on cognitive development, while currently not available at the national level, are also likely to exhibit a similar status, as conditions for adequate cognitive development of the child are similar to those required for adequate health and nutrition. Investments in early childhood development (ECD) are thus critical. They are known to positively impact school attendance, retention, learning and lifetime earnings. Recognizing the relevance of strengthening their investments in ECD, India in 2012 restructured their Integrated Child Development Services (ICDS) program framework to focus more on children under 3 years of age. One element of this strengthening was a proposal to introduce on an experimental basis, the provision of day care crèches for care and development of children 6-72 months of age whose mothers go to work, in 5 percent of existing Anganwadi Centers (AWCs). The model involved expanding the scope of the existing services provided at the AWC under the ICDS scheme to include crèche services for children under 3 years of age. The primary objective of adding creche services to the existing nutrition and pre-school education services provided at the AWC was to strengthen the focus on early childhood care and stimulation among children under 3 years of age. In other words, the model sought to enhance child care by including child stimulation along with a package of child feeding and health care being delivered through the Government’s ICDS program. The pilot or the AWC-cum-creche model was implemented entirely by and through Government systems, with some technical assistance from IFPRI and the World Bank in the form of capacity building of the newly recruited creche workers. Being completely government managed and owned makes the model not only potentially scalable but also provides a clear understanding of the barriers, limitations and opportunities if it is adopted and scaled up. (India)
The fact that tens of millions of people are at risk of starving to death is a tragedy. And in the 21st century, the fact that we haven’t ended famine is a collective failure of shameful proportions. It’s also a critical economic issue. From a human capital standpoint, famines raise child mortality, increase stunting, and impair cognitive development for children in utero at the time of the famine and of the children who survive. Child mortality increases by roughly 60 percent; the average height for children under five falls by two centimeters; and time in school drops by roughly half a year. Investing in more proactive responses to avert humanitarian crises could save millions of lives, and it can also reduce the costs to the international community by as much as 30 percent. Second, we need sustained collective action, before, during, and after crises. Humanitarian actors play a vital role in responding when famines strike, but they cannot do it alone. The development community must complement the talent, financing, and dedication of humanitarian workers, and indeed help safeguard all of the advances that have been made so that they can continue to push the frontiers of their efforts. Finally, the FAM will work with key partners and build on the ongoing efforts taking place at the country and global levels to help ensure that resources are channeled to the most effective and well-coordinated interventions. Instead of creating parallel structures, we will work with existing systems as much as possible to make the best use of our limited resources, such as building social safety nets. (United States)
This paper describes the methodology for a new World Bank Human Capital Index (HCI). The HCI combines indicators of health and education into a measure of the human capital that a child born today can expect to obtain by her 18th birthday, given the risks of poor education and health that prevail in the country where she lives. The HCI is measured in units of productivity relative to a benchmark of complete education and full health, and ranges from 0 to 1. A value of x on the HCI indicates that a child born today can expect to be only x x100 percent as productive as a future worker as she would be if she enjoyed complete education and full health. The methodology of the HCI is anchored in the extensive literature on development accounting. (World)
