Just as every country we studied took a unique path to reducing its stunting burden, every country faced a unique set of challenges. However, by comparing and contrasting countries’ experiences, we can draw some general conclusions about the kinds of barriers that have tended to get in the way of progress.
Globally, challenges persist even as some countries make progress. The need to sustain leadership for a long-term agenda, ensure financing is available (both domestic and donor funding) and is deployed at the right time against the right investments, build equitable and high-quality systems to enable progress, and secure community-level buy-in to encourage legitimate change all remain difficult to execute against consistently and in parallel.
In many countries that have made notable progress on stunting but still have further to go (for example, Ethiopia and Nepal), it is not clear that the same strategies that have been effective so far will continue to be so when prevalence is lower. Sustained progress may depend on continual monitoring and evaluation to adjust the prioritization and deployment of interventions as the burden shifts and changes, and in many cases this will require further investments in data systems.
Moreover, in most countries that have been successful, the pattern has been for wealthier and more urban populations to make progress faster than less wealthy and more rural populations, so countries need to continue to fine-tune approaches to addressing the drivers of stunting in an equitable way. One notable challenge in this area for many countries is high rates of out-of-pocket spending on health, which means that adequate health care is still, to a certain extent, a luxury for those who can afford it.
One step countries can take to address some of these issues is improving coordination between the public and private sectors. In some cases, especially Senegal’s water sector, innovative public-private partnerships can provide high-quality services at affordable prices. In other cases, the public sector can do more to align with the private sector, for example by ensuring that food producers abide by fortification regulations or that private healthcare providers meet quality standards.
Many countries that have been successful in addressing stunting still struggle with a range of persistent nutritional challenges, including high rates of anemia for children and mothers, an emerging “double burden” of both over- and under-nutrition, and stubborn pockets where wasting (and of wasting and stunting together) remain common.