Overview

Stunting reduction in Ethiopia

From 1992 to 2016, Ethiopia cut its stunting rate from 67 to 38 percent.

Starting in 1992, when it one of the poorest countries in the world, Ethiopia cut its stunting rate from 67 to 38 percent. See how it achieved broad-based progress to fight stunting and become one of the fastest-growing economies in the world.
Authors
Nadia Akseer Seifu Gebreyesus Kaitlin Conway Hana Tasic Emily Keats Bilal Shikur Afrah Mohammedsanni Muhammad Islam Anushka Ataullahjan Argie Gingoyon Zahra Hussain Rachel Jardine Erica Confreda Kimberly Charbonneau Zulfiqar A Bhutta

Contents

A health extension worker measures a young mother's blood pressure during a house call in Ethiopia.
Health extension worker is measuring the mother's blood pressure on a house call.
©GATES ARCHIVE

Key insights

Progress in four key sectors played a pivotal role in reducing stunting. Since the early 1990s, agricultural productivity has more than doubled, enrollment in primary school has quadrupled, immunization rates have more than doubled, and open defecation has declined by almost three quarters. In each sector, massive community-based systems created by Ethiopia’s government to deliver services at scale were instrumental in this success.

Improved feeding practices and household food security

Improving agricultural production

In a country that was almost 90 percent rural (and is still approximately 80 percent rural), investments in agricultural productivity were essential for food security and poverty reduction.

The government has consistently surpassed the African target for agricultural spending, training 70,000 agricultural extension workers who bring farmers fertilizer, improved seeds, and up-to-date knowledge. As a result, adoption rates of these inputs are much higher in Ethiopia than in most neighboring countries.

Since the early 1990s, agricultural productivity has skyrocketed. Cereal output increased from 974 kg per hectare in 1993 to 2,538 kg per hectare in 2017. Between 1993 and 2016, the crop production index more than tripled.

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DataBank World Development Indicators. Washington, DC: The World Bank. 2017.
Increased income and resources

Investing in education

Education was the new government’s top priority as early as 1992, with one quarter of the national budget routinely going to expand access.

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DataBank World Development Indicators. Washington, DC: The World Bank. 2017.

Ethiopia’s sizable investments have gone primarily to building schools and hiring teachers to staff them. Since the early 1990s, the number of schools has tripled, enrollment in primary school has quadrupled, and literacy has more than doubled. Girls, who used to be underrepresented at all school levels, have achieved parity in primary school enrollment.

Like many other sectors, the education sector is turning its attention to the issue of quality. Specifically, its priorities are ensuring that students learn what they are supposed to learn in each grade and that they continue on from primary to secondary school.

Improved care and health services

Health

Maternal and newborn health care improved significantly over the course of the 2000s and 2010s due to the massive expansion of the community health system and significant investment in health facilities and medical education.

In 1992, given the severe shortage of medically trained personnel and the sheer size of the country, health care was effectively unavailable to most Ethiopians. Taking a cue from the agriculture sector, the Ministry of Health in the early 2000s trained 40,000 community members to serve as health extension workers and provide preventive care—and eventually basic curative care—in every village in the country. At the same time, the government continued expand the network of clinics and hospitals and to train more midwives, nurses, and doctors to staff them.

Ethiopia achieved most of the health-related Millennium Development Goals, including a 67 percent reduction in mortality among children under age five, a 71 percent reduction in maternal mortality, a 90 percent reduction in new HIV infections, a 73 percent reduction in malaria deaths, and a more than 50 percent reduction in tuberculosis deaths.

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SickKids Analysis, Analysis based on Ethiopian MoH data
Healthy household environment

Water, sanitation, and hygiene

Ethiopia’s community health workers prioritized raising awareness about the dangers of open defecation, leading to the largest decline in the practice in the world.

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DataBank World Development Indicators. Washington, DC: The World Bank. 2017.

One of the jobs assigned to health extension workers was persuading people to stop practicing open defecation. Between 2000 and 2017, the percentage of people defecating in the open dropped from 79 to 22 percent, the largest decline in the world. At the same time, the number of people with access to “improved” water sources doubled.

However, these improved water sources and the low-quality toilets constructed in many communities do not guarantee that fecal contamination is reduced to zero. The next priority is to meet the more stringent global standard of “safely managed” sanitation.



Oaxaca Blinder Decomposition, HAZ score increase in Ethiopia, children under five, 2000 2016

Demographic and Health Survey (DHS), SickKids Analysis