Our goal is to highlight true “exemplars”—that is, not just countries where stunting has declined significantly, but countries where it has declined more than expected based on economic growth. Specifically, to generate a list of candidates, we plot the average annual rate of change in absolute stunting prevalence as a function of the average annual rate of change in GDP per capita.
We select exemplars from among the candidates in consultation with our Technical Advisory Group, made up of stunting experts from around the world. In order to make sure our narratives are useful for a broad range of readers, we optimize for diversity, especially by geography, income level, and population.
Senegal was identified as an exemplar candidate by our quantitative methodology. We selected it because as a medium-sized, low-income country in Francophone West Africa, its story is relevant to many comparable countries struggling to manage their own stunting crises.
Change in stunting rate versus change in GDP per capita
Note: Ethiopia was selected among East African low-income countries
Closest data point to 2000 available for both stunting and GDP per capita, ranging from 1998-2002, and the closest dat point to 2015 available for both stunting and GDP per capita, ranging from 2011-2015; 41 total countries represented
Data Source: Joint Malnutrition Estimates (UNICEF/WHO/World Bank) 2018
Executive Summary
From 1992 to 2017, Senegal reduced its stunting rate from 34 percent to 17 percent.
With help from donors, the country implemented programs that quadrupled coverage of prenatal care, increased primary school enrollment by more than half, and improved access to quality water and sanitation services. Over the same period, the extreme poverty rate dropped from 68 percent (in 1991) to 38 percent, largely as a result of macroeconomic reform and a sharp increase in remittances from Senegalese working abroad. In short, millions of Senegalese escaped poverty and gained access to health, education, and safe water and sanitation, greatly reducing their (and their children’s) risk of malnutrition.
Prevalence of stunting Senegal
Maternal and newborn health care
Maternal and newborn health improved significantly over the course of the 1990s and 2000s, with the progress reflected in two key indicators. From 1993 to 2017, the proportion of women who completed four or more prenatal visits rose from 14 to 57 percent, while the percentage of births assisted by a skilled health provider increased from 47 to 68 percent.
These huge strides were made possible by the expansion of Senegal’s community health system. Supported by USAID, the system is comprised of more than 2,300 health huts and 16,000 community health workers. These health workers provide a wide range of preventative and curative services to women and children in vulnerable communities and refer complicated cases to more advanced government facilities. However, there remains a shortage of skilled health workers (i.e., physicians, nurses, and midwives) in Senegal relative to World Health Organization (WHO) guidelines.
Nutrition commitment
Political commitment to nutrition since the mid-1990s has enabled stunting reduction in Senegal. After mixed results from early coordination and programmatic efforts, in 2001 Senegal introduced the Lettre de Politique de Développement de la Nutrition (Nutrition Development Policy Letter; LPDN), which aligned Senegal’s national strategy with its commitments at the global level and highlighted the multifactorial nature of malnutrition.
To coordinate this new strategy, Senegal developed the Cellule de Lutte Contre la Malnutrition (Coordination Unit for the Fight Against Malnutrition; CLM), based out of the Prime Minister’s Office. The CLM went on to implement key programs with the World Bank’s support, such as the Programme de Renforcement de Nutrition (Nutrition Enhancement Program; PRN).
Education
Senegal adopted a new set of education policies and programs in 2000 after hosting the second World Conference on Education for All in Dakar. The Programme Décennal d'Education et de Formation (Ten-Year Education and Training Program; PDEF) was introduced first, supplemented by the Plan National d’Actions de l’ Éducation Pour Tous (National Action Plan for Education for All; PNA EPT). The initiatives shared the same overarching goal: to improve access to universal quality education and training. While Senegal did not meet the target of 100 percent primary school enrollment rate by 2010, significant progress was still made. Both primary school enrollment rates (44 to 72 percent from 1992 to 2016) and adult literacy rates (38 to 56 percent from 1998 to 2013) rose during this time period, with more progress still to come.
Water and sanitation
Starting in the mid-1990s, Senegal partnered with the World Bank to spearhead a major reform of its water and sanitation sectors, the first of which was named the Water Sector Project. The underlying principle of these reforms, which are ongoing, is privatization. The government contracted with private companies to provide water and sanitation services to the Senegalese population. Funded partially through user fees, these private companies were able to vastly improve the quality of services while promoting equity by subsidizing water and sewer connections for those who could not afford to pay.
In addition to infrastructural improvements, coverage of more basic interventions also increased. Households using piped water increased from 47 to 74 percent (1993-2017).
Poverty Reduction
Between 1991 and 2005, Senegal’s extreme poverty rate dropped from 68 percent to 38 percent.
One of the big drivers of this drop was macroeconomic reform. In 1994, the West African CFA franc was devalued from 50 to 100 African francs for each French franc. In the very short term, this led to inflation and an increase in prices of basic goods, including food. In the medium term, however, it boosted public and private investment in the economy, thereby stimulating economic growth. While inequality within Senegal did not decline drastically, growing incomes brought broad benefits and lifted millions out of extreme poverty.
Since the mid-2000s, remittances, now representing about 11 percent of GDP, have become an increasingly important safety net for Senegalese families wrestling with poverty.
Implementation
Senegal’s stable democracy has helped to make it a strong partner for bilateral and international aid organizations, especially the United States Agency for International Development (USAID), the Agence Francaise de Developpement) French Development Agency; AFD), and the World Bank, the top three donors by a significant margin. Senegal’s partnership with the World Bank drove rapid improvement in water and sanitation, while USAID’s support was instrumental in the scale-up and success of their community health program. USAID’s support of the community health system is also indicative of another important implementation theme in Senegal: decentralization. Communities across Senegal manage their own health huts and health workers, bringing citizens closer to the key services they depend on.
Challenges
Despite its success in reducing stunting, Senegal suffers a severe shortage of skilled health workers, especially in rural areas. The community health system helps fill the gap, but it also faces obstacles. Due to a lack of clarity about roles and responsibilities between the government and the community, these systems are not always managed efficiently. Moreover, most are not funded adequately. To make up for this missing funding, Senegalese must pay fees to use the health system, which can prevent the very poorest from getting all the care they need.
Although Senegal’s progress on stunting has been impressive, progress has not been uniform. In certain areas of the country, especially in the Sahel region, stunting prevalence remains higher than everywhere else. Similarly, the stunting rate among the poorest 20 percent of people nationally has not improved as quickly as it has among the other 80 percent. In the future, these inequalities could be exacerbated unless the government responds with new policies and programs: Senegal faces a growing food insecurity problem due to the frequency and severity of climate shocks.