From our research to date on five Exemplar countries (Peru, Nepal, Kyrgyz Republic, Senegal and Ethiopia), we have noted several common cross-cutting strategies that were considered drivers of improvement in stunting reduction. Firstly, investing in data systems is critical. A country will require a functioning and sustainable data system to undertake a baseline assessment and continued monitoring of stunting prevalence, along with data pertaining to determinants of stunting (e.g., improved water and sanitation, health systems indicators such as the number of facilities/workers, coverage of maternal and child health interventions such as antenatal care, skilled birth attendance, vaccinations, and disease incidence data). Data capture over time will allow for assessment of national trends, sub-national change over time, and will provide insight into where a country is excelling or lagging. Additionally, sub-national data can inform targeting and allocation of resources that will help nutritional gains to be equitable.

Peru is a good example of a country that heavily invested in granular data for decision making. The Articulated Nutrition Program (PAN), considered a very important program for driving stunting decline in Peru, was designed around results-based budgeting. This meant that good quality and up-to-date data was required, and that regional budget allocation for a program was dependent on the compliance of that region with coverage and impact targets (i.e., funding was not established by previous benchmarks, but instead was based on a realistic understanding of goals, scale, and local conditions). Having a functional information system for monitoring was critical for PAN’s successful implementation and allowed for much more efficient targeting of resources. For example, three years into PAN, budget was increased and funds were allocated towards the regions of Peru with the highest burden of malnutrition. Having the data to i) target the appropriate regions and ii) understand where more resources should be spent (e.g., for investing in vaccinations, improving community health worker coverage, etc.) allowed Peru to reduce child stunting rates in an equitable manner.

Secondly, Exemplar countries typically exhibited good governance around the topic of nutrition, aligning national-level strategies and policies with local programming and implementation. Obtaining buy-in from government, but also other stakeholders working in the area of nutrition (e.g., bilaterals, multilaterals, donors, NGOs and interest groups), is key for stunting reduction programs to be successful and to ensure that efforts are not duplicated or in conflict with one another. We found that countries did not necessarily require a direct focus on stunting; achievements in stunting reduction were the product of strong nutrition strategies and targets more generally. However, as coverage declines and countries are striving to reach the last mile (i.e., reduce stunting to 0%), a more focused approach on stunting may be needed. Senegal is an example of a country with strong governance around nutrition. In 2001, the Coordination Unit for the Fight Against Malnutrition (CLM) was created to act as the coordinating body for nutrition in Senegal. Housed within the Prime Minister’s office, the CLM provides technical assistance in defining and implementing nutrition policy; examines and approves proposals for collaboration between Ministries; develops synergy between various sectors and stakeholders working in nutrition (e.g., provides a consultative framework for technical Ministries, nutrition policy-makers, NGOs, and other community-based organizations); and supports national capacity for effective implementation of nutrition programs. The CLM was deemed very important to stunting decline in Senegal. Not only did its creation represent the government’s commitment to improving malnutrition, but it allowed for coordination and collaboration between nutrition-specific and sensitive sectors, which ultimately led to improved funding for nutrition and better nutrition outcomes.

In summary, stunting reduction programs will be maximally effective where there is support for their implementation from government and other stakeholders, and sustainable data capture systems that can inform program priorities and monitor targets over time. For more information on strategies common to all Exemplar countries, please read our cross-country synthesis.