Nutrition for Growth (N4G) commitment
1. Expand support to countries that are formulating national policies, building capacity, and implementing and monitoring programs with the goal of reducing stunting and other forms of undernutrition.
2. Promote synergies between nutrition-specific and nutrition-sensitive programming.
3. Through A Promise Renewed (APR), a global effort to reduce child deaths, UNICEF will call on national policymakers to incorporate a nutrition-sensitive focus within their strategies, and nutrition outcomes will be monitored through country scorecards.
4. Over the next five years, UNICEF will work with government partners to include essential nutrition services in all health intervention packages delivered through Child Health Day (CHD) events.
5. Over the next five years, UNICEF will integrate an explicit nutrition focus within the community-based water, sanitation, and hygiene (WASH) programs, using stunting as an indicator of major programs’ effectiveness and advocating for others to do the same.
6. UNICEF will scale up support to children with severe acute malnutrition (SAM).
7. UNICEF will demonstrate leadership in areas such as breastfeeding promotion and infant and young child feeding.
8. UNICEF will employ innovative methodologies to strengthen real-time monitoring in more than 20 countries. Experience in Rwanda, Uganda, Malawi, and Nigeria using SMS technology to improve program management will be expanded. Over the next 3 years, UNICEF will support the implementation of Multiple Indicator Cluster Survey (MICS) in about 50 countries.
9. Analysis of the work of the four main UN agencies active in nutrition has allowed strengthened coordination in Scaling Up Nutrition (SUN) countries. The United Nations’ Renewed Efforts Against Child Hunger and undernutrition (REACH), which is operational in 13 SUN countries, plans to expand to 2 additional countries. Further expansion will be explored.
1. UNICEF implemented nutrition programmes in 133 countries in 2020, with the support of 691 nutrition staff members. UNICEF country-driven programmes improve maternal and child nutrition at key moments throughout the life course, from early childhood, to middle childhood and adolescence, and during pregnancy and breastfeeding. Knowledge generation is at the heart of this work, with evidence guiding advocacy, policies and programmes.
In 2020, UNICEF launched its new Nutrition Strategy 2020-2030, which sets out the organization's priorities for maternal and child nutrition over the next decade. The Strategy re-commits to rights-based and context specific nutrition programming and calls for a systems approach to nutrition that strengthens the capacities and accountabilities of national systems to deliver good nutrition for all children, adolescents and women - now and on the path to 2030.
With the support of partners, UNICEF achieved the following 2020 headline results:
- 244 million children under 5 years of age were reached with services to prevent stunting and other forms of malnutrition in early childhood.
- 35 million adolescents were reached with services to prevent anaemia and other forms of malnutrition.
- About 5 million children were reached with services for the early detection and treatment of severe wasting, in both humanitarian and development contexts.
Despite the setbacks of 2020, UNICEF is on track to achieve most of UNICEF's Strategic Plan nutrition targets. Where results have fallen short, there is still time to accelerate progress - and, in some cases, exceed 2021 targets. Building on the lessons learned during this unparalleled year, UNICEF is leveraging new strategies and innovations, along with the acceleration strategies identified during the 2019 midterm review, to close gaps and drive faster progress towards a world without malnutrition by 2030.
The UNICEF response to Covid-19 has focused on maintaining the continuity of services through programming adaptations and by leveraging innovations to respond to delivery challenges across all regions. Many essential services to prevent malnutrition - such as vitamin A supplementation, deworming, counselling for caregivers, the provision of micronutrients and interventions to prevent overweight - were disrupted or constrained due to the pandemic. Despite these disruptions, in 2020 UNICEF reached 244 million children with services for the prevention of stunting and other forms of malnutrition, compared with 317 million children in 2019.
2. The UNICEF Nutrition Strategy 2020-2030 sets out the organization's strategic intent to leverage a systems approach to nutrition that aims to strengthen the capacity and accountability of five systems - food, health, water and sanitation, education, and social protection - to deliver diets, services and practices that support adequate maternal and child nutrition. For example, improving the quality of children's diets requires a food system that produces a range of nutritious foods that are available and affordable to families; a health system with well-trained staff to counsel caregivers on the benefits of a nutritious diet for children; a water and sanitation system that provides free, safe and palatable drinking water for a healthy diet and the safe preparation of foods; and a social protection system that reduces inequalities by ensuring that nutritious foods are affordable to vulnerable children and families.
Nutrition-responsive social protection programmes can mitigate the effects of poverty on the nutrition of vulnerable children and families. There are 50 countries implementing social protection programmes specifically aiming to improve nutrition; the most common of these are cash transfers and school feeding programmes. In 2020, UNICEF published a meta-analysis of the effect of cash transfers on child nutrition outcomes. This research provides evidence that cash transfer programmes targeted to households with young children improved linear growth and contributed to reduced stunting. UNICEF will use this evidence to improve the design and implementation of nutrition-responsive social protection programmes.
In Rwanda, the integrated social protection and nutrition programme, developed in partnership with the Ministry of Local Government, the National Early Childhood Development Programme and World Relief, has shown promising results in improving nutrition-sensitive interventions, strengthening decentralized coordination mechanisms and developing a system of community case management and referral through involving public service providers and users.
In several countries, including Belarus, the Central African Republic, Lesotho, Malawi, Namibia, South Africa, Uganda, the United Republic of Tanzania and Zambia, UNICEF-supported peer-led programmes mobilized young people and mothers in the community to provide social protection packs containing food and cash support, Covid-19 prevention information, HIV prevention counselling and HIV care services to hundreds of pregnant and breastfeeding adolescents.
The pandemic accelerated the implementation of the systems approach to nutrition. UNICEF leveraged water and sanitation (WASH), social protection or early childhood development (ECD) platforms to reach communities and families with adapted information and messages on early childhood nutrition in the context of Covid-19; 102 countries (out of 143) reported better integration of WASH in services delivered to children during the pandemic. In the first three months of 2020, 10 countries (out of 24) reported implementing or scaling up social protection actions to mitigate the impact of Covid-19 on the nutritional status of children. The systems approach is also increasingly being mainstreamed in all UNICEF guidance documents, including those on improving children's diets, preventing overweight, and the forthcoming guidance on maternal nutrition and the nutrition of school-age children and adolescents.
3. UNICEF continues to advocate with national policymakers to incorporate a nutrition-sensitive focus within their strategies, as part of a systems approach to nutrition. For example, 46 countries have social protection policies with nutrition components and 57 countries have education policies with nutrition components included. In 80 countries, the government implemented measures to advance integrated multisectoral coordination of agriculture and other sectors to improve children's nutrition; 62 of these were supported by UNICEF. UNICEF supports governments in fostering an enabling environment for adolescent nutrition through the adoption of national strategies, policies and plans that uphold the right to nutrition. More countries are adopting these frameworks to protect the nutrition of school-age children and adolescents: 93 countries had a policy, strategy or plan of action in place for this age group in 2019 (the latest estimate), compared with 87 in 2018. The Global Breastfeeding Collective, led by UNICEF and WHO, continues to promote, protect and support breastfeeding through the Global Breastfeeding Scorecard, first introduced in 2017, which monitors indicators at the national and global levels. The Collective has identified seven policy action priorities, each with an indicator and a set target to be achieved by 2030. The Collective responded to the increased need for evidence-based guidance during the pandemic with a series of guidance documents and strategies.
4. In 2020, the large campaign-based events typically used to deliver Vitamin A supplementation (VAS) and deworming in many priority countries were suspended as a measure to reduce transmission of Covid-19. UNICEF supported governments to adapt delivery platforms, including delivering VAS via routine health system contacts and child health days, to minimize the potential for virus transmission. UNICEF also leveraged existing opportunities - such as the response to a vaccine-preventable disease outbreak or bed net distribution - to distribute VAS during the pandemic, and supported plans to re-establish population-based VAS events once conditions warranted.
Most countries adapted their programmes in the context of Covid-19 and were still able to implement two rounds of supplementation in 2020, despite significant challenges. In West and Central Africa, for example, most countries delivered both VAS rounds in 2020. In Burkina Faso, UNICEF partnered with Helen Keller International to support two rounds of VAS, deworming and screening for acute malnutrition, which benefited more than 3.45 million children (full coverage). Similarly, in Togo, UNICEF supported VAS through Child Health Days, reaching 1.39 million children (92 per cent) during the first round and 1.45 million (96 per cent) during the second round, as well as providing deworming, with similarly high coverage. UNICEF is the main supplier of VAS globally. Some 441 million vitamin A capsules were provided to 56 countries in 2020 through a contribution in-kind financed by the Government of Canada and implemented through Nutrition International. In addition, 53.6 million capsules were procured by 160 countries in 2020.
Working with partners in the Global Alliance for Vitamin A (GAVA), UNICEF developed recommendations and operational guidance for the safe delivery of VAS programmes in response to the Covid-19 pandemic. VAS delivery systems were also strengthened through the development of methodology for coverage estimation and country guidance for validation of administrative data. In parallel, systems for delivering and recording VAS were strengthened through technical assistance, implementation research, documentation, sharing of experiences and effective forecasting of country needs. Subsequently, the reach of VAS in 2020 exceeded expectations, despite the challenges faced: an estimated 141.3 million children under 5 years of age received two doses, compared with 245.4 million in 2019. Deworming prophylaxis was provided to 97 million children. The GAVA recommendations allowed a number of countries to adapt their VAS campaigns in response to Covid-19. Nepal achieved 85 per cent coverage of VAS among children aged 6-59 months (out of a total of 2.7 million children) living in 753 rural/urban municipalities during its biannual distribution rounds in 2020. Nepal also achieved 83 per cent deworming coverage among children aged 12-59 months (out of 2.4 million children). This was made possible because of technical assistance from UNICEF to develop an interim guideline on vitamin A, MNP and deworming tablet distribution to preschool children in the context of Covid 19, which was adapted from the GAVA guidance. In Bangladesh, the first VAS campaign of 2020 was postponed; however, with careful planning and additional safety measures put in place - including the use of personal protective equipment (PPE), physical distancing, the installation of additional hand-washing facilities and holding the campaign over a longer period of time to avoid large crowds gathering - 20.8 million children (97 per cent of the target) were reached by the VAS campaign in October 2020. UNICEF is working with countries to transition to delivering VAS through routine health systems contacts to promote sustainability of this critical nutrition service. To shift from campaign-style distribution to routine distribution, UNICEF and Helen Keller International provided technical assistance to the Government of Cameroon to develop a transitional plan, taking advantage of existing health and nutrition service platforms. Similarly, in South Sudan UNICEF supported the Ministry of Health to develop guidelines, training materials and reporting tools as part of national efforts to integrate VAS and deworming services into routine health services for children.
5. The water and sanitation system comprises the policies, programmes, services and actors needed to ensure a population's access to safe drinking water and safe sanitation and hygiene services. In 2020, 102 countries (out of 143) reported better integration of WASH in services delivered to children during the pandemic. There are 37 countries implementing joint programming to promote improved access and safe use of complementary foods, water and clean household environments for children. In Cameroon, for example, UNICEF supported the implementation of a WASH and Nutrition Strategy, which helped reach 20,000 families affected by acute malnutrition to improve hygiene and sanitation practices. Similarly, in Mauritania, UNICEF improved WASH access in 60 health centres providing care for children with acute malnutrition, thereby improving their quality of care. Many countries are moving towards greater convergence of WASH and nutrition programming. In Ethiopia, UNICEF continued to support the "Baby WASH" program, focusing on baby and infant hygiene and the safe disposal of children's faeces. The approach was adopted by the Ministry of Health as part of its approach to stunting reduction and national training was integrated into the Health Extension Workers' programme and cascaded to all regions. In three provinces of the Philippines, UNICEF supported 19 municipalities/cities to develop costed Local Nutrition Action Plans and 15 municipalities to develop or review costed WASH plans to be included in their annual investment plans. This included capacity-building of Governors and Mayors to deepen their understanding of nutrition and WASH, advocating for budget allocation and facilitating multisectoral programming at the local level. Resolutions were passed to facilitate investment and implementation of nutrition and WASH activities benefiting women and children in the three provinces.
6. UNICEF prioritizes the early detection and treatment of child wasting as an essential intervention to help severely undernourished children survive and thrive, in both development and humanitarian contexts. In 2020, UNICEF supported the scale-up of services to treat children with wasting in 74 countries across seven regions, compared with 69 countries in 2019. Globally, 4.96 million children accessed treatment for wasting in 2020 - an increase of 300,000 children from 2019. The indicators of programme performance and quality in the detection and treatment of children with wasting (at the aggregate global level) have improved steadily in recent years. In 2020, UNICEF programmes maintained high-quality care, with 88 per cent of children recovering - the same proportion as in 2019.
In 2020, the Covid-19 pandemic put an additional 6.7 million children at risk of developing wasting and other forms of acute malnutrition. Existing services to detect and treat these children were also severely affected, reducing the number of children accessing treatment at different points in the year. UNICEF responded by launching a coordinated effort to adapt services using programmatic innovations to maintain service continuity. This included guidance and tools for adaptations to service delivery modalities, such as reducing the regularity of follow-up visits, supporting screening for wasting by caregivers and increasing stocks at district/facility levels. More than 70 countries around the world adopted these programmatic solutions. Despite the disruptions due to Covid-19, an estimated 137 million children were screened for early detection of wasting in 2020 - about 87 per cent of the total number of children screened in the previous year. Where possible, UNICEF leveraged existing platforms to deliver services, such as in Burkina Faso, where screening was integrated within three rounds of the seasonal malaria chemoprophylaxis campaign. An average of 3,684,050 children between 6 and 59 months old were screened for wasting at each round (112 per cent coverage) and referred for treatment as needed. Similarly, in Venezuela, 148,390 children (including 114 children of African descent, 10,780 indigenous children and 589 children with disabilities) were screened for wasting; of these, 5,656 children were diagnosed with wasting and received treatment.
Covid-19 has deepened existing humanitarian crises in many parts of the world and triggered a second crisis of hunger and malnutrition. In the face of multiple pandemic-related constraints, UNICEF and its implementing partners ensured the delivery of nutrition services to detect and treat children with wasting during complex, protracted humanitarian crises in 2020. In these humanitarian contexts, 4.03 million children with wasting were treated in 2020, compared with 4.05 million in 2019, achieving the milestone of 3.5 million. Of these children, 93 per cent fully recovered. The Covid-19 pandemic has further strained Yemen's fragile health system, reversing progress made in previous years and leaving 325,000 children suffering from severe wasting in 2020. UNICEF continued to focus on community prevention and scaling up the integrated community management of acute malnutrition programmes through the Ministry of Public Health and Population and nine partnerships with local and international NGOs. UNICEF and Nutrition Cluster partners supported treatment for more than 265,000 children with wasting, representing 81 per cent of children in need and 90 per cent of the UNICEF target for 2020. Of these children, 86 per cent recovered, representing improvements in programme quality in recent years; however, 68 districts had lower coverage due to pandemic constraints, including the suspension of some mobile teams.
7. Counselling to caregivers to improve infant and young child feeding (IYCF) practices is the cornerstone of actions to prevent malnutrition in early childhood. IYCF counselling services may be provided within health-care facilities or through community platforms; delivered by skilled health workers alone or with the support of experienced mothers; and provided in individual and group settings. In the context of Covid-19, UNICEF programming priorities were to strengthen the capacities of health workers to provide skilled IYCF counselling and support, either safely face-to-face, by telephone or by using virtual modes. UNICEF is expanding its support for improved IYCF to more countries, and more mothers than ever before are being reached with counselling. Through UNICEF support, 46.1 million caregivers of children under 2 received counselling through health-care facilities, community platforms or remote platforms to protect breastfeeding and complementary feeding in 2020. As in previous years, many of those counselled lived in countries facing humanitarian crisis. In partnership with the United States Agency for International Development (USAID) and the Infant Feeding in Emergencies Core Group, UNICEF developed a counselling package of IYCF recommendations when Covid-19 is suspected or confirmed, which includes a set of 10 counselling cards and a recommended practices booklet. This counselling package was translated into more than 10 languages and adapted for training and counselling in over 20 countries across regions. To support counselling on complementary feeding practices, UNICEF collaborated with Global Health Media to produce a series of 17 videos for caregivers and front-line workers on complementary feeding. The videos were made available in 26 languages and can be downloaded through a digital platform and used via a phone application.
Recommendations for breastfeeding in the context of Covid-19 were released early in the pandemic by the World Health Organization (WHO) and supported by UNICEF; however, the extent to which they were adapted at country level was not well understood. To respond to this gap and inform programmatic response, UNICEF conducted an online survey in seven regions. The survey results were used to support governments in aligning their approaches to breastfeeding counselling with evidence-based global standards. Further, very early in the pandemic, UNICEF regional offices in Eastern and Southern Africa and West and Central Africa led the development of a joint United Nations statement on IYCF in the context of Covid-19 - the first guidance released on this topic. With technical and advocacy support from UNICEF, 88 countries across seven regions adopted breastfeeding recommendations in the context of Covid-19. Throughout 2020, UNICEF supported countries to adapt IYCF counselling in line with global recommendations. Many countries responded to service disruptions by leveraging alternative delivery platforms to reach caregivers with counselling. In Pakistan, social protection service delivery platforms were leveraged to reach 1.3 million people - mostly vulnerable mothers, who were less likely to have access to electronic media - on safe IYCF practices during the pandemic. Continued efforts to build national IYCF counselling capacity in the context of Covid-19 led to 20,531 (224 per cent of target) health workers being trained on the promotion of breastfeeding and complementary feeding in all provinces in 2020. UNICEF also supported provincial governments in creating more than 11,100 mother support groups and more than 7,200 father support groups, reaching more than 1.4 million caregivers in their communities with IYCF messages. In response to pandemic containment measures, many countries shifted to virtual modalities for counselling delivery, such in the Islamic Republic of Iran, where UNICEF supported the Ministry of Health and Medical Education in establishing a breastfeeding tele-counselling centre. In Indonesia, an online counselling service using a chatbot was established to improve access to counselling services for caregivers during the pandemic. In response to lockdowns and physical distancing measures in India, UNICEF supported front-line community workers across 12 states in delivering IYCF counselling to caregivers through WhatsApp groups via videos, recorded audio messages and text messages, and responding to queries from caregivers. Building on these efforts, the Government of Maharashtra created an authorized channel: 'Waves of well-nourished Maharashtra', a stronger digital platform to deliver essential nutrition messages and updates to service providers and caregivers. By December 2020, more than 1 million families were reached through broadcast calls, 190,000 users accessed messages through a WhatsApp chatbot and more than 271,000 users accessed a dedicated helpline for essential nutrition information. Despite the challenges of 2020, many countries were able to maintain - and in some cases expand - counselling services with UNICEF support. In the United Republic of Tanzania, more than 522,000 (85 per cent) of caregivers of children under 2 years of age in 5 UNICEF focus regions were reached with regular nutrition counselling services, a 20 per cent increase from 2019. UNICEF, through the Development Partners' Group for Nutrition and the National Infant and Young Child Nutrition Working Group, advocated for and influenced the scale-up of community-based nutrition counselling services, which contributed to an increase in the nationwide coverage of mothers receiving community-based IYCF counselling services from 54 per cent (2.1 million) in 2018/2019 to 65 per cent (2.5 million) in 2019/2020. In Uganda, more than 2.1 million caregivers benefited from IYCF counselling services in 20 priority districts with UNICEF support in 2020, reaching 96 per cent of those targeted. In Burkina Faso, UNICEF supported IYCF counselling services for more than 552,300 pregnant and breastfeeding women with children under the age of 2 years (76 per cent of those targeted). With UNICEF funding and technical support, implementing partners trained more than 8,870 community-based health workers in 3,224 villages (80 per cent of annual target) on social and behaviour change communication related to optimal IYCF practices, hygiene and early stimulation. More than 26,230 mother-to-mother support groups were established, reaching nearly 385,800 pregnant women and caregivers. An independent evaluation supported by UNICEF showed that these women had gained a better knowledge of key IYCF and family practices; for example, 40 per cent of breastfeeding mothers knew at least four IYCF practices, compared with 11.9 per cent of other women of childbearing age.
8. UNICEF provides technical support and guidance to strengthen data, monitoring and evaluation systems for nutrition and to build the capacities of governments and partners. Strengthening data and knowledge management was particularly critical in the response to Covid-19. UNICEF was able to build on, and leverage, existing data systems to respond to urgent needs for data on the impact of Covid-19 on diets, services and practices by developing a nutrition dashboard to better communicate the impacts of the pandemic on nutrition to support advocacy, programming and policies. Fifty-six countries reported having functional routine information systems (e.g. District Health Information Systems) reporting national nutrition information data, even before Covid-19; 29 countries had a reduced nutrition impact systems (NIS) function due to Covid-19; and 10 countries had planned or completed data collection through NIS on programmatic adaptations to respond to the pandemic.
UNICEF also developed guidance on nutrition information management, surveillance and monitoring in the context of Covid-19. To provide timely data for key interventions delivered in 2020, despite pandemic-related disruptions, UNICEF launched another round of data collection through NutriDash (the organization's global nutrition monitoring platform). UNICEF also collected data through surveys on disruptions in the provision of essential nutrition services, which were conducted across regions at various time points from the start of the pandemic. These data were used to launch a Call to Action with other United Nations agencies on child malnutrition and Covid-19. UNICEF is also testing some digital innovations for data collection during the pandemic, such as text-based service delivery reporting, Facebook surveys and U-Reports (where adolescents receive text-based survey questions related to food consumption). Globally, in 2020 UNICEF continued to serve as the custodian of nutrition data and information systems to track progress towards the Sustainable Development Goals (SDGs) and other global targets. The UNICEF NutriDash platform supports this work, capturing, storing, analysing and visualizing information on essential nutrition interventions at country, regional and global levels. With UNICEF support, the number of countries reporting to NutriDash has risen steadily in recent years, and the quality of data collected has improved. Between 2016 and 2020, UNICEF supported the implementation of Multiple Indicator Cluster Surveys (MICS) in 51 countries.
9. In keeping with the United Nations Reform agenda, UNICEF supported efforts to harmonize the collective work of United Nations agencies working on nutrition. In 2020, the United Nations Secretary-General announced the establishment of UN-Nutrition, following an extensive consultation and evaluation process led by the Food and Agriculture Organization of the United Nations (FAO), International Fund for Agricultural Development (IFAD), UNICEF, WFP and WHO. This new entity was born out of the merger of the United Nations Standing Committee on Nutrition and the United Nations Network for Scaling Up Nutrition. In 2020, UNICEF provided leadership and technical support to the Scaling Up Nutrition (SUN) Movement to develop and finalize the SUN Strategy 2021-2025. This was a critical achievement, which will guide the SUN Movement in its third phase. As part of these efforts, UNICEF provided strategic and technical support to the Executive Director in her role as Chair of the SUN Lead Group. Advancements to strengthen national SUN structures were also made in 2020, such as in the Central African Republic, where the SUN Civil Society Network was established with the support of UNICEF and Action Against Hunger.
Additional comment: detailed nutrition results are available on UNICEF's website: https://www.unicef.org/media/102426/file/Global-annual-results-report-2020-goal-area-1.pdf
At least half of the individual commitment components are assessed to be on course