Policy Initiatives making a Difference in the Fight Against Stunting: Stories from developing world
Some countries enjoy tremendous success in fighting stunting. While others, even after continued efforts, struggle to reduce stunting prevalence significantly. What are the factors that influence this? Is there a single approach that doesn’t suit all, or do different success stories adopt different approaches? Let’s dig into four impact stories identified in a brief by Ashi Kohli Kathuria, Aneesa Arur and Edith Kariko from the World Bank to understand what works and why.
Peruvian story of making invisible stunting visible: reducing stunting by nearly half in less than a decade
From 2022 to 2013, Peru doubled its per capita income, tripled its GDP, and invested significantly in food through food aid. Yet, stunting prevailed, recorded to be the highest in Latin America and the Caribbean. Something remained amiss and had to be identified and sorted immediately. Peruvian administration in 2007 took the policy reform road and developed a strategic roadmap to fight stunting. The first step was identifying stunting as a human development issue that put it at the centre of political priority. Political will played a critical role as successive governments did not drop the agenda and continued to set ambitious targets to address stunting.
Various initiatives such as CRECER, Results Based Budgeting, and Conditional Cash Transfer (CCT) program allowed bringing global evidence to the context of the poorest communities, doubling resources, ensuring fair and judicious expenditure of allocated money, incentivizing regional government and mothers to promote quality health and nutrition services and availing.
Control of Growth & Development for Infants and Children (CRED) in Peru supported the parents in tracking a child’s growth, health and nutrition while providing counselling for behaviour changes. It helped make the invisible problem of stunting visible to the parents, while the nudging techniques motivated parents, local governments, and providers to seek better nutrition and health services. All these developments led to the establishment of the Ministry of Development and Social Inclusion, and collectively, chronic malnutrition became everyone’s issue in the community, from national governments to parents.
Ultimately, Peru reduced stunting prevalence by half, from 28% in 2008 to 13% in 2016.
Integrated community-based action backed with resources & political support: How Thailand reduced stunting by 50%
In the 1980s, Thailand recognised malnutrition as a development issue and a symptom of poverty. Such recognition led to integrating malnutrition reduction into the poverty alleviation program. Nutrition interventions were also integrated into existing primary health care activities besides community development initiatives. It made nutrition an integral part of national socio-economic and health plans. Stunting eradication found strength in the mobilization of the community down to the individual level. Some of the key features were:
Mobilizers were the village health volunteers, comprising 80% women. They provided regular counselling and support to caregivers to improve feeding, care and hygiene practices and prevent and treat disease.
Teaming service providers with community leaders and volunteers played a strategic part in the program. It led to the involvement of women in decision-making and the inclusion of community-based organizations and community leaders. These measures parallely complemented the implementation of poverty alleviation programs.
The Basic Minimum Needs approach with elements of process and outcome indicators was adopted. It provided a common tool for government officials and community members to identify priority areas for development, devise a set of actions to address them, monitor progress and evaluate accomplishments. For example, the progress indicators could be immunization and antenatal service, while outcomes indicators could be the rate of child malnutrition, low birth weight and more.
Community-level data was fed into district, province, and ministry monitoring datasets. Facilitators supported the mobilizers, providing them with on-the-spot training, problem-solving skills and technical support.
Nutrition Champions convinced high-level policymakers in finance and planning ministries to invest in nutrition. Commitments secured at the central level were taken down at the provincial level. It helped generate engagement and buy-ins from the regional policymakers.
Such mass mobilization and integration of community members strengthened the fight against malnutrition.
Battling stunting by targeting the underlying socio-economic determinants: Brazil’s prioritization of equity
To fight stunting, Brazil built resilience on four pillars: maternal education, empowering families through cash transfers, improving sanitation, and expanding health care quality. Investments in health and food programs besides supporting potable water, sewerage and immunization coverage were undertaken. The Bolsa Familia Program (BFP) helped break the inter-generational cycle of poverty by providing cash transfers to families with health and education conditionalities.
Both political will and civil society pressure stimulated the launch of policies such as Food and Nutrition Security that covered the strategies for improving family-owned agriculture, local food banks, community kitchens, school meals and healthy food habits. A multisectoral approach was integrated into the policy undertakings via the Fome Zero (Zero Hunger) framework. Under this, the economic and social policies fought hunger and poverty promoted income redistribution, and universal access to education, health, nutrition, and sanitation.
The policy framework was also supported by several initiatives supported with monitoring and evaluation, strengthening the incentivization, correcting policy actions, and scaling up programs. Brazilian programs ensured universal access to primary and secondary schools to improve women’s education. They also targeted the poorest rural municipalities and peri-urban slums, providing access to family healthcare teams of doctors, nurses, and community healthcare workers.
Consequently, over three decades, Brazil reduced child stunting in under-fives prevalence by 80%, particularly among the poor.
Reduced stunting prevalence with rapid economic growth: Vietnam’s key policy instruments
In 1984, Vietnam was one of the five poorest countries in the world. But that changed by 1999 when Vietnam was one of the fastest-growing economies in the world. How did that happen? In 1986, the government introduced a series of economic reforms emphasising increased nutrition investment to overcome the economic stress.
As part of the country’s socio-economic development plan, almost one-fourth of the health budget was allocated to nutrition. The nation’s first nutrition strategy actively involved the women, youth, and farmers in targeting mothers and children and the authorities at various levels. In 2006, special focus was given to the nutrition status of mothers, while a Child Malnutrition Control Program helped educate the women and newly married about various aspects of nutrition, pregnancy, child care, and diet diversity.
Targeted maternal and child health programs addressed immunization, diarrheal diseases, and respiratory infections. The National Institute of Nutrition monitored the performance of nutrition targets. The mobilisation of local budgets and government, assigning responsibility to different sectors to move towards intersectoral collaboration and coordination, helped make strides to reduce stunting prevalence.
Lessons to learn
To effectively tackle stunting, it’s important to understand that there is no one-size-fits-all approach to policies and programs. They must be tailored to the specific population context to be effective.
Sustained political will is crucial to eradicating stunting, and it’s important to improve programs based on feedback from monitoring and evaluation consistently. By doing so, we can ensure that the programs meet the population’s needs and make a real impact.
Adopting a multisectoral approach that addresses the socio-developmental aspects of human development, such as education, nutrition, and sanitation is crucial. This approach will require collaboration across various sectors, including health, education, agriculture, and water and sanitation. Equitable access to basic amenities, such as clean water and sanitation facilities, is crucial to addressing stunting.