Recommendations

When drawing lessons from other countries’ experience with fighting stunting, it is important to distinguish between what we can learn from each Exemplar country’s unique path and what we can learn from commonalities among those paths.

One way of analyzing these commonalities is to break down stunting interventions into categories, including those within the health sector that have a direct effect on child nutrition, those within the health sector that have an indirect effect on child nutrition, and those in other sectors (which can also have a direct and indirect effect on nutrition). Within these categories are sub-categories as listed below. The average split among these three categories is just under one-third health/direct, just over one-tenth health/indirect, and approximately one-half other sectors, although each country’s split is different.

This categorization underscores that no single intervention can solve stunting on its own; indeed, one half of the impact, on average, comes from investments outside the health sector. Effective impact on population-level stunting requires an integrated set of investments that are strategically planned and adequately resourced.

Based on the insights gleaned from our research, we present the following roadmap for countries seeking to reduce stunting at scale. It does not prescribe specific investments, but it provides a two-phase framework for thinking about how to invest to maximize the chances of success.

Phase I

• Conduct a robust situational assessment to diagnose gaps in key drivers of stunting reduction. The results of this analysis should point to gaps / thematic challenges where investments may be most needed.
• Leverage existing data and tools (e.g., Optima Nutrition)  to identify high-return investments that target gaps identified. This should inform the development of a fiscally responsible plan to scale up.
• Engage stakeholders early and often. Refine and present findings to stakeholders across government, civil society, and donor organizations can spur a collaborative decision-making process that leads to consensus about priorities, roles, and responsibilities.

Phase II

• Based on diagnostic, investment value, and stakeholder engagement, design programs that deliver impact at scale: With investments divided among each category (direct, health; indirect, health; indirect, other sectors) and sub-category (e.g., maternal and newborn health, health facility infrastructure, education).
• Strengthen deployment systems to ensure programs are delivered in a efficient and targeted manner for sustainable progress.
• Establish specific objectives and indicators in each category and subcategory: Tracking progress in this way allows for joint accountability, evidence-based adjustments to policies and programs— and ultimately to the most impact with limited investment.