National nutrition financing program (Programa Articulado Nutricional - PAN)

PAN was a results-based financing program created by the Ministry of Economics and Finance in 2008. It allocates funding toward interventions specifically designed to reduce stunting prevalence (prioritized introduction and scale up of PCV, rotavirus vaccine, and CRED visits involving education on exclusive breastfeeding, complementary feeding, and handwashing), and does so in the states of Peru with the highest rates of chronic malnutrition. Beyond the top-priority interventions, PAN also funds iron supplementation for children and pregnant women, development of local and regional government operational capacity, improvement in drinking water and sanitation, and provision of micronutrients.

Literature Review

Case studies have noted that PAN was important for solidifying government accountability for childhood stunting reduction. It is cited as a program that aided Peru’s reduction in stunting beyond what would have been achievable through economic growth alone.^{1 2}

Quantitative Analysis

In the linear mixed effects regression, PAN significantly influenced stunting prevalence in the expected direction for 2000-2016 period. For the 2000-2016 period, effect size was the largest of any single factor (on par with SIS and Juntos at 1.64 Cohen’s F2). This relationship was significant at the 5 percent level.

However, PAN was not found to be significant in the decomposition analysis. This may be due to the fact the program was not initiated until 2008, and not scaled up until afterwards. As such, the lack of an association was likely due to the late scale up of PAN; a few more years of data will be required to improve our understanding of impact.

Qualitative Analysis

PAN was universally identified by interviewees as one of the most important drivers of accelerated stunting reduction after 2008. Three facilitating factors for implementation were noted specifically:

Conclusion

Crude and adjusted multivariable models provided statistical evidence of the positive impact of PAN on the stunting decline in the 2000 to 2016 analysis. In fact, when the effect size of individual programs was estimated during the 2000-2016 period, PAN, together with Juntos and SIS, had the largest effects on stunting reduction over the study period. This is in line with the qualitative messages from experts, which described PAN as having the most prominent role in stunting reduction for the post-2008 period. However, given the relative recent scale up of the program, additional follow up will be required for further quantitative assessment of program impact.

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