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 Senegal, government commitment to nutrition has increased progressively in recent decades. Thecreation in 2001 of the Cellule de Lutte Contre la Malnutrition (the Nutrition Coordination Unit) (CLM) and its Bureau Exécutif National (the National Executive Bureau) (BEN) marked a major turning point, as did an increase in annual budget allocations to nutrition (from US$0.3 million in 2002 to US$5.7 million in 2015) and concomitant intensification of community-based nutrition interventions. This commitment is reflected in the improvement of nutrition indicators. With a 46 percent reduction in under-five stunting, from 34.4 percent in 1992 to 19.4 percent in 2014, Senegal has witnessed one of the biggest rates of improvement in the fight against undernutrition in the world and currently has one of the lowest rates of stunting in Sub-Saharan Africa (Spray 2018). However, these developments have not led to greater visibility of pronutrition interventions in relevant sectors such as agriculture, livestock, health, education, social protection, and hydraulics. Moreover, some nutrition-specific problems with major consequences—low birthweight, iron-deficiency anemia, adolescent nutrition, and maternal undernutrition—still receive little attention. These shortcomings threaten the gains achieved in recent decades. Recognizing the challenge, the government of Senegal joined the SUN Movement in 2011 and adopted the United Nations REACH approach in 2014. Both initiatives aim to strengthen institutional capacity and facilitate a multisectoral process to help governmentsplan, prioritize and more efficiently manage nutrition actions involving multiple stakeholders. With respect to national policy, the Document de Politique National de Développement de la Nutrition (National Policy for the Development of Nutrition) (PNDN) has been adopted for the period 2015 to 2025. The PNDN will be operationalized through a multisectoral nutrition strategy, the Plan Stratégique Multisectoriel de la Nutrition (Multisectoral Nutrition Strategic Plan) (PSMN). The PSMN is designed as a sectoral reform program to broaden coverage and improve the quality of nutrition services.Against this background, this institutional and organizational capacity assessment (IOCA) analyzes the performance of Senegal’s nutrition sector and makes 8 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal recommendations for strengthening implementation of the PNDN and forthcoming PSMN. (Senegal)
Senegal has a reputation for having one of the most effective and far-reaching nutritionservice delivery systems in Africa. Chronic malnutrition has dropped to less than 20 percent, oneof the lowest in Sub-Saharan Africa. The reduction in stunting in particular has been deemed a success in Senegal with the prevalence of child stunting one of the lowest in Sub-Saharan Africa in absolute terms (Nene 2017). This success has at least in part been attributed to broad-based government commitment to nutrition, which has grown from US$0.3 million per year in 2002 to US$5.7 million per year in 2015, increasing from approximately 0.02 percent to 0.12 percent of the national budget. Yet concerns remain regarding whether the level of government support for nutrition is sufficient and the degree to which nutrition has been as effectively “mainstreamed” across major line ministries, such as agriculture, education, water and sanitation, socialprotection and health, to support both nutrition-specific and nutrition-sensitive interventions. Moreover, the nutrition field as a whole is characterized by a myriad of actors (international donors, NGOs, and technical support agencies) whose interventions are not well coordinated, leading to duplications of effort and inefficiencies in the provision of services. A series ofexternal shocks, including food shortages stemming from drought, the global financial crisis, and the instability of prices for local foodstuffs since 2007, has revealed the continued need for additional investment in nutrition and better intersectoral coordination of activities to counter cyclical attention to nutrition and a predominant focus on food insufficiency rather than abroader focus on nutrition. To this end, the government of Senegal, through the CLM, is in the process of drafting the new PSMN to develop a reform agenda for the sector. The PSMN will lay out a framework and timeline for the development of a nutrition financing strategy that will requirespecific analysis of the sector spending and financial basis, linking it to the coverage and quality of nutrition services and assessing the contribution of different sectors and actors to the budget. As part of the Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal series, the World Bank commissioned this report to elaborate the specific political challenges to and opportunities for further raising the profile ofnutrition on the government’s agenda and secure a sustainable effort to reduce maternal and child malnutrition. The nutrition agenda is often prone to political economy challenges when it competes for government support, as the impact of nutritional intervention is neither immediate nor tangible. Though the benefits of proper nutrition are life-long and are foundational to proper growth and development, nutrition can fall by the wayside in policymakers’ inevitably shorter-termoutlook. With this in mind, the objective of this report was to identify the policy and political levers that can be used to foster government leadership and galvanize intersectoral coordination that mainstreams nutrition into government policies and programs and effectively, efficiently, and sustainably delivers nutrition interventions in Senegal. (Senegal)
Nigeria has the highest population of unimmunized children in the world and is one of few countries with less than half the population covered with essential health services. Low coverage of services poses a threat to the health and well-being of Nigerian children, but this threat becomes even more pronounced against a backdrop of the ‘health financing transition’, including the transition from support from the Gavi Alliance, the main source of financing for the country’s immunization program. The Nigeria Immunization Financing Assessment shows how the factors at multiple levels of government and the health system interact to affect four dimensions of health and immunization financing: adequacy; sustainability; efficiency; and predictability. The findings informed the design of the Nigeria Strategy for Immunization and PHC System Strengthening (NSIPSS), which will be used to guide the country as it transitions from Gavi support. This paper emphasizes the need to implement the NSIPSS in close coordination with the current reforms underway in the health sector. Currently, the government of Nigeria is piloting reforms at federal, state, and local levels to fast track implementation of the National Health Act, which aims to bring additional and ‘smarter’ domestic resources for health to the facility level. Also needed are systematic linking of health plans to budgets, more efficient allocation of resources, coordinated advocacy, exploration of demand-side barriers to service delivery, capacity building, and strengthened accountability mechanisms that ensure investments in health lead to improved health outcomes. A transition planning process that is grounded, backed by evidence, monitored and adapted regularly, and backed by the highest level of the government of Nigeria will be critical for changing the trajectory for the children of Nigeria. (Nigeria)
The development objective of the Health Services Reinforcement Project for Burkina Faso is to increase the quality and utilization of health services with a particular focus on maternal, child and adolescent health, nutrition and disease surveillance.It has three components. First component, strengthening health system capacity aims to support the strengthening and integration of several pre-existing and planned health financing policies, namely the launch of the national health insurance scheme and optimization of strategic purchasing mechanisms already in place, such as free care for women and children and performance-based financing (PBF). It has three sub-component. (i) establishment of the national health insurance fund subcomponent aims at strengthening the pooling function of the health financing system, hence bringing more equity in access through increased financial risk protection, especially of the poor. (ii) scale-up and strengthening of purchasing mechanisms will support the strengthening and scaling-up of purchasing mechanisms already in place such as PBF and free health care, based on experience gathered at national level and international best practice; (iii) verification and cross-cutting interventions in health financing will also finance technical assistance to improve the efficiency and effectiveness of the free healthcare scheme; Second component, strengthening delivery of reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH+N) aims to promote UHC and enable the acceleration of the demographic transition to maximize human capital and economic growth through a comprehensive approach to Reproductive, Maternal, Newborn, Child and Adolescent Health and nutrition.It has four sub-components. (i) strengthening maternal, newborn, child and adolescent health service delivery; (ii) investing in the early years and nutrition; (iii) supporting civil registration and vital statistics; and (iv) supporting multisectoral coordination for RMNCAH+N; Third component, reinforcing health security and supporting institutional strengthening will support institutional capacity needed at national, regional, and district levels to prevent, detect, be prepared, and respond to health security risks, hazards and emergencies, as well as overall project implementation and coordination support. It addresses the key weaknesses revealed by a recent Joint External Evaluation (JEE) of Burkina Faso. It has three sub-components. (i) strengthening of National Public Health Surveillance and information systems; (ii) strengthening health system preparedness and emergency response capacity; and (iii) institutional capacity building, project management, coordination and communication. (Burkina Faso)
Despite positive economic growth trends in the past years, Mali is supposed to spend more efforts to achieve the expected level of performance. In summary, conflict and political instability, coupled with Mali’s regular vulnerability to shocks (including both international prices and climate changes), have aggravated the already poor living conditions of a large majority of the country’s population. If this situation continues, the Malian population will experience a significant deterioration in well-being, including increased levels and prevalence of chronic malnutrition, which will have a negative impact on human capital and productivity in the long term. The 2016 Social Protection Policy expands its targets to all, moving away from a simple contributory scheme for public servants and military to protect all children; the unemployed; the workers (active or retired); the public servants (civilian and military, active, or retired); The workers from informal and agricultural sectors including the independents. Moreover, the policy gives special attention to certain categories of people in difficult circumstances, including seniors, persons with disabilities, children and women, pupils in Mali, the unemployed, and those who are human immunodeficiency virus (HIV) positive. Finally, the National Social Protection Policy also aims to adaptively help management of government responses to calamities, disasters, and other humanitarian crises. Nevertheless, the difficult economic situation of the country will have a negative impact on the implementation of this policy. Increase in spending on security, high vulnerability to world market, and limited economic growth are constraints to have adequate budget for social protection programs. The estimated cost for the operationalization of the action plan (2016–2018) is estimated at CFAF 794 billion over three years but the government contribution represents 11.3 percent while 82.4 percent is from the cost recovery of the social security system through institutions of social security and about 6 percent from international development partners. However, except for the World Bank support, most of the current international development partners’ financial support is for temporary or emergency schemes. Therefore, a deeper review of financial health of social protection is needed to help the government to achieve its objectives. To achieve the goal of having an articulated set of programs under a social protection system to reduce poverty, hunger, and food insecurity; promote resilience against shocks; and promote equity requires large investment or a budget reallocation from ineffective to effective policies. The review of the current government expenditures on social protection, including the emergency programs supported by international development partners, will help assess the financing structure of social protection programs in Mali and then provide recommendations on improving the efficiency of spending and fiscal sustainability of the Social Protection and Labor system (SPL system). (Mali)
The development objective of Enhancing Natural Forest and Agroforest Landscapes Project is to improve forest and tree management practices by cocoa farmers, CREMA communities and forest reserve managers to reduce forest loss and degradation in selected landscapes in Ghana. Some of the negative impacts include: (i) lack of access to protective clothing and spray equipment in repair; (ii) no proper labeling of pesticide products;; (iii) reuse of pesticide containers; (iv) pre-harvest interval violations; (v) unsafe storage, transport and handling; (vi) application by women and children; (vii) potential for using pesticides more than necessary; (viii) use of higher-toxicity products; (ix) pesticide spraying near homes; (x) potential for pesticide poisoning; and (xi) poor disposal of used pesticide containers. Some of the mitigation measures include: (i) avoid crops (varieties) that create reliance on pesticides; (ii) spray equipment must be regularly checked and serviced by qualified spray equipment mechanic who should undertake routine equipment maintenance on a clearly defined work program; (iii) continue to engage farmers and train them on the safe storage and use of the chemicals; (iv) prevent reuse of pesticide containers; (v) all spray operators should also be trained in the proper handling of pesticides; (vi) the EPA should be involved in the training of women in the application of pesticides to avoid the incidence; (vii) chemical pesticides must only be as a last resort, in the case of unexpected pest invasion by migratory pests such as armyworms and grasshoppers or grain eating birds; (viii) the surroundings of homes should always be avoided when spraying pesticides, except in vector control programs when it is necessary to undertake indoor spraying with pesticides on walls of homes, and under very strict supervision and monitoring by officials from the ministry of health; and (ix) every precaution must be taken to minimize spraying near standing water bodies or streams or pouring pesticides on the ground around homes, near wells and playing grounds. (Ghana)
Liberia is a low-income country with a GNI per capita (Atlas method) of 380 US dollars in 2017. After a period of conflict and instability, Liberia’s Gross Domestic Product (GDP) grew at an average annual rate of 6.2 percent during 2003-2013. The ebola virus disease (EVD) crisis of 2014-2016 and a drop in global commodity prices resulted in slower average annual GDP growth of 2.1 percent with per capita annual GDP growth at -0.4 percent during 2013-2017. As a post conflict country aiming to achieve sustained broad-based growth, Liberia faces several development challenges: large infrastructure gaps, poor education and health indicators, a large youth cohort, lack of economic diversification, and weak public institutions. The World Bank Group’s country partnership strategy had three pillars: (i) economic transformation; (ii) human development; and (iii) governance and public sector institutions. In addition, the CPS had two cross-cutting themes of capacity development and gender equality. The CPS focus areas and objectives were well aligned with the government’s agenda for transformation with a strong focus on infrastructure. The CLR provided a succinct assessment of the achievement of program objectives. It identified the increases in IDA lending attributable to the EVD outbreak. The CLR review agrees with the CLR lessons: (i) ensure government’s strong commitment to the CPF program through close alignment with the country’s development plans; (ii) adapt and apply a sound post-conflict and fragile country lens in the design of CPF programs for post conflict countries; (iii) keep an eye on medium-term goals even in the face of a crisis such as EVD; (iv) being selective about cross-cutting themes and including outcomes associated with these themes helps maintain the Government’s and Country Team’s focus on them throughout implementation. IEG provides the following additional lessons: (i) flexibility of the CPS program enabled the WBG to respond to the EVD crisis in a timely manner; and (ii) trust fund activities need to have a well-articulated strategic focus and explicit selectivity filters to ensure that they contribute to the achievement of CPS objectives; (Liberia)
The Sahel Women’s Empowerment and Demographics Project of Benin has the objective to increase women and adolescent girls’ empowerment and their access to quality reproductive, child and maternal health services in selected areas of the participating countries, including theRecipients' territory, and to improve regional knowledge generation and sharing as well as regional capacity and coordination. This project is comprised of three components. (1) Improve Regional Demand for Reproductive Maternal Neonatal Child and Adolescent Health and Nutrition (RMNCAHN) Services and Increase Empowerment for Women and Adolescents. (2) Ensuring availability and sustainability of family planning services, including supply chain of modern contraceptives will be a key factor in accelerating the demographic transition in Benin. (3) National capacity in Benin will be built to collect, analyze, translate and use data that can inform population policy, investments in human capital and gender interventions. (Western Africa)
This study investigates the effects of fertility rate, infant mortality rate, population growth rate, and net migration on life expectancy in Nigeria over the period 1991-2025. The study was motivated by limited empirical evidence on the combined influence of key demographic variables on longevity despite their importance for health and development policy. Annual time-series data were analysed using the Autoregressive Distributed Lag (ARDL) approach following Phillips Perron unit root tests and ARDL bounds cointegration analysis. The results confirmed the existence of a stable long-run relationship among the variables. Fertility rate exerted a positive and statistically significant effect on life expectancy, whereas infant mortality rate and population growth rate exhibited significant negative effects. Net migration showed a negative but statistically insignificant relationship with life expectancy. Diagnostic tests revealed no evidence of serial correlation or heteroskedasticity, while normality, specification, and stability tests confirmed the robustness and reliability of the estimated model. The findings suggest that demographic characteristics remain important determinants of life expectancy in Nigeria. The unexpected positive fertility coefficient is interpreted cautiously because it may reflect improvements in maternal and child healthcare, broader socioeconomic progress, and unobserved structural factors rather than a direct beneficial effect of higher fertility. The study concludes that sustained reductions in infant mortality and effective population management are essential for improving longevity. It recommends strengthening maternal and child healthcare services, expanding primary healthcare coverage, promoting voluntary family planning and reproductive health education, and improving demographic data systems. Future research should employ panel datasets to address endogeneity in Nigeria.
