UN

UNICEF (United Nations Children’s Fund)

Nutrition for Growth (N4G) commitment

Reported progress

Assessment

Commitments
London 2013

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.

Reported progress

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. In 2019, UNICEF made significant progress towards achieving results to improve maternal and child nutrition. Nutrition programmes continued to expand in 2019, with more children and caregivers reached with interventions to prevent malnutrition in all its forms and treat severe acute malnutrition in early childhood, often through the strategic integration of actions across the food, health, education and social protection systems. UNICEF achieved the following 2019 headline results: 307 million children under 5 were reached with services to prevent stunting and other forms of malnutrition in early childhood; 60 million 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. Additionally, with UNICEF support the number of caregivers receiving counselling on infant and young child feeding through facility- and community-based platforms rose to 24 million in 2019; and 17.7 million children benefitted from home fortification programmes to improve the nutrient quality of complementary foods. The number of countries with programmes to improve the diversity of childrens diets reached 114; the number of countries implementing mandatory iodised salt, vitamin A-fortified oil, and/or wheat or maize flour fortified with essential micronutrients reached 147; and 250 million children benefitted from UNICEF-supported vitamin A supplementation (VAS) programmes. Access to maternal nutrition services improved, with the number of countries integrating nutrition counselling with antenatal care programmes reaching 68 in 2019. Twenty-three countries reported implementing policy actions or programmes for the prevention of overweight and obesity in children and/or adolescents (compared to 17 in 2018). UNICEF supported the scale-up of services to treat children with severe wasting in 69 countries across seven regions, reaching about 5 million children, with 88% of them recovering. UNICEF supports countries in developing strong national strategies and action plans for the prevention of malnutrition. The adoption of a national strategy signals government commitment and is tracked as an indicator in the UNICEF Strategic Plan, 2018-2021. Its effectiveness is measured by having key elements in place, such as government budgets allocated to maternal and child nutrition, a focus on evidence-based nutrition interventions, and an emphasis on coverage and service delivery provided at scale. Globally, 54 countries had a comprehensive nutrition policy for the prevention of stunting and other forms of malnutrition, compared with 49 countries in 2018. Countries rated as having a comprehensive policy or strategy have six or seven of the following interventions included: protection, promotion and support of breastfeeding (children aged 0-2 years); promotion and support of appropriate complementary feeding (children aged 6-23 months); promotion of adequate dietary diversity (children aged 6-23 months); home fortification with micronutrient powders (children aged 6-59 months); VAS; deworming of preschool-aged children; prevention of overweight for preschool children.

2. Promote synergies between nutrition-specific and nutrition-sensitive programming. With the release in 2019 of the State of the Worlds Children: Children, food and nutrition, UNICEF drew global attention to the triple burden of malnutrition and issued a call to action to put childrens right to food and nutrition at the centre of food systems. UNICEF then began developing a 2020-2030 nutrition strategy to guide programming over the next decade towards the global goal of ending malnutrition in all its forms by 2030. UNICEF addresses the drivers of malnutrition through a systems approach that aims to make five key systems food, health, water and sanitation, education, and social protection better equipped and more accountable for preventing malnutrition in all its forms. Adopting a systems approach to improve diet quality, for example, involves influencing: the food system, to produce diverse and nutritious foods that are available and affordable to families; the health system, to provide well-trained staff to counsel caregivers on the benefits of nutritious diets; the water and sanitation system, to provide free, safe and palatable drinking water as part of a healthy diet and for the safe preparation of foods; the education system, to deliver nutrition services and improve knowledge and skills on good nutrition and active living; and the social protection system, to provide safety nets that make nutritious foods accessible to the most vulnerable families. Caregivers abilities to provide a diverse diet for young children depend on the availability and affordability of nutritious foods. Nutrition-responsive social protection programmes, such as food, voucher or cash transfers, can mitigate the effects of poverty on the nutrition of vulnerable children and families. In 2019, 75 countries conducted school feeding programmes and 56 countries provided nutrition-responsive cash transfers. UNICEF supports countries in developing integrated nutrition policies and strategies that leverage multiple systems to deliver results for children. For example, 84 countries had nutrition-responsive education policies (76 the previous year); 28 had nutrition-responsive gender policies (25 the previous year); and 61 had nutrition-responsive social protection policies (the same number as the previous year). Many countries made progress in strengthening the enabling environment for nutrition in schools in the first two years of the UNICEF Strategic Plan. According to the latest 2018 estimates, 70 countries integrated physical education within the school curriculum, compared with 35 the previous year; 58 countries had a school feeding programme, compared with 33 the previous year; 50 countries had integrated nutrition education within the school curriculum, compared with 24 the previous year; and 48 had safe drinking water provided free of charge in schools, compared with 23 the previous year.

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. UNICEF continues to advocate for nutrition in global discussions to promote equity, and commitments to prevent maternal, newborn and child deaths through movements such as Every Woman Every Child. UNICEF continues to call on national policymakers to incorporate a nutrition-sensitive focus within their strategies and monitoring of nutrition outcomes through country scorecards. For example, in South Sudan a country scorecard was used to assess the performance of non-governmental partners and prioritise those requiring support in severe acute malnutrition (SAM) programmes. The expansion in SAM treatment sites corresponded with a significant increase in the coverage from 77% in 2018 to 91% in 2019, reaching 237,120 children in 2019 compared with 206,670 in 2018. The quality of SAM treatment also improved, with 91% of children successfully recovering, compared with 88% the previous year. Quarterly assessments and star ratings of nutrition facilities were a significant innovation in 2019 that motivated nutrition facilities to continuously improve quality. Nutrition facilities were provided with tools, equipment, trained personnel and other aspects of programme quality for better and consistent nutrition service delivery. 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. Over the next five years,

4. UNICEF will work with government partners to include essential nutrition services in all health intervention packages delivered through Child Health Day (CHD) events. CHD campaigns and polio national immunisation days have historically been effective platforms for reaching children with essential nutrition services. However, following progress in polio eradication and resource constraints in many countries, these campaigns are being phased out or moving from national to subnational implementation. UNICEF helps governments strengthen health systems capacities to deliver preventive nutrition interventions sustainably. Routine health system contacts, such as immunisation and growth monitoring, are providing important alternative opportunities to deliver VAS and other key preventive nutrition interventions. An increasing number and proportion of VAS doses are now delivered through routine systems. In 2018 (the latest estimates), about 83 million doses were delivered to children aged 6-59 months through routine systems. This represents 17% of all doses distributed through all platforms and a 3% increase from the previous year. To support health systems strengthening for VAS, in 2019 UNICEF facilitated a sharing of experiences among countries on fostering a smooth transition to routine health systems without declines in coverage. Some countries, such as Malawi, are scaling up the integration of VAS in routine immunisation, whereas others are integrating VAS within existing community-based platforms and workforces. For example, Guinea introduced VAS within a package of services delivered in 40 communes in 2019, with a plan to expand gradually towards national coverage. The country also began integrating the financing of vitamin A capsules into the health system, using government funds for procurement to ensure programme sustainability. Since 2017, Burkina Faso has been using community platforms to reduce operational costs for VAS delivery. Some countries are testing innovations to better track VAS delivery. Benin, for example, is piloting the integration of VAS into health and community-focused information systems. This involves the use of community registers to track individual children and monitor VAS and vaccination status to ensure that all children who receive a first dose of the measles vaccine also receive vitamin A through routine services.

5. Over the next five years, UNICEF will integrate an explicit nutrition focus within community-based water, sanitation and hygiene (WASH) programmes, using stunting as an indicator of major programmes effectiveness and advocating for others to do the same. UNICEF is strengthening synergies in joint nutrition and WASH policies and programming, with specific focus on four countries (Burkina Faso, Niger, Nigeria and the United Republic of Tanzania). Seventy-two countries have joint nutrition and WASH programming with support from UNICEF. In Chad, UNICEF supported the Ministry of Public Health to integrate a WASH component into the Integrated Nutrition and Food Action Plan and revise the national WASH in Nutrition strategy. In Mali, WASH and nutrition integration has been strengthened through a dedicated sub-cluster working group and the validation of the WASH and Nutrition National Strategy in 2019. An integrated UNICEF humanitarian WASH and Nutrition programme in three regions reached 61 health centres (2019 annual target: 25), with the support of the Central Emergency Response Fund and partners. In Kenya, UNICEF supported the integration of nutrition counselling into community-led total sanitation in two arid and semi-arid lands counties in 2019. In Cameroon, UNICEF supported the implementation of the Wash-in-Nut strategy which helped to reach 15,000 families with children affected by SAM with appropriate information on hygiene, sanitation practices and WASH kits.

6. UNICEF will scale up support to children with SAM. UNICEF prioritises the early detection and treatment of children with SAM as an essential intervention to help severely undernourished children survive and thrive, in both development and humanitarian contexts. In 2019, UNICEF supported the scale-up of services to treat and care for children with SAM in 69 countries across all seven regions. With UNICEF support, almost 5 million children were reached with therapeutic feeding and care, compared with 4.1 million in 2018. UNICEF aims to increase this number to 6 million able to access treatment annually by 2021. The indicators of programme performance and quality in the detection and treatment of children with SAM (at the aggregate global level) have improved steadily in recent years. Of the children admitted for treatment of SAM, 88% fully recovered in 2019 compared with 82% in 2018. UNICEF is the leading global procurer of ready-to-use therapeutic foods (RUTF) to treat children with SAM, procuring an estimated 75-80% of RUTF globally. Most RUTF is sourced from programme countries, in line with the UNICEF supply objective to use local products and improve access to supplies at country level.

7. UNICEF will demonstrate leadership in areas such as breastfeeding promotion and infant and young child feeding. UNICEF supports counselling for caregivers to equip them with the knowledge and skills to improve breastfeeding and complementary feeding practices. Counselling 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 both individual and group settings. Globally, the number of caregivers receiving such counselling through health-care facilities and community platforms rose from 23 million in 2018 to 24 million in 2019. The UNICEF-WHO Baby-friendly Hospital Initiative (BFHI) aims to protect, promote and support breastfeeding in maternity facilities, including through the provision of timely and skilled breastfeeding support as a vital component of quality maternity care. In 2019, UNICEF and WHO rolled out the revised BFHI implementation guidance developed in 2018. The number of countries implementing the Ten Steps to Successful Breastfeeding in maternity facilities increased from 64 in 2017 to 92 in 2018 (the latest estimates). UNICEF advocates for governments and businesses to better support breastfeeding mothers through key workplace provisions, such as paid leave, nursing breaks and dedicated nursing spaces. The Global Breastfeeding Collective developed advocacy tools and engaged with key stakeholders to advocate for family-friendly policies and support for working mothers to breastfeed. In Mexico, UNICEF coordinated with the ministries of labour and health and the private sector to develop a guideline on the protection and promotion of breastfeeding in the workplace and distributed it among private sector companies. The Bangladesh [email protected] programme, which supports businesses in the ready-made garment sector to create enabling environments for maternity rights and breastfeeding, expanded to 92 factories, reaching about 160,000 working mothers and more than 2,860 young children in 2019. To scale up the programme, a standardised toolkit was developed to guide implementation in factories; a partnership with the Ministry of Labour and Employment was established to systemise roll-out; and a partnership with the Garment and Knitting Association was launched aiming to reach 2 million female workers in Bangladesh by 2030.

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 programme management will be expanded. Over the next three years, UNICEF will support the implementation of the Multiple Indicator Cluster Survey (MICS) in about 50 countries. Real-time information and monitoring remains a key focus area for UNICEF Innovation, enabled by RapidPro, an open source software platform that UNICEF launched in 2014. UNICEF is testing mobile innovations to improve nutrition service delivery in communities. In Mozambique, a mobile health app called Upscale is being used by community health workers in three provinces to upload real-time VAS data and improve follow-up of children who miss their visits for VAS at the community level. In Bangladesh, the ability to track maternal nutrition programmes is the result of UNICEF support to the Government to strengthen its health information system in 2019. Maternal nutrition indicators were integrated within the District Health Information System (DHIS2) platform and UNICEF supported the Directorate General of Health Services to develop an e-tracker to support real-time monitoring. The pregnancy registration system was also improved to identify at-risk pregnant women as early as possible. In Malawi, to strengthen the implementation, effectiveness and focus of nutrition programmes in the response to Cyclone Idai, UNICEF used real-time data collection, geo-information and satellite imagery to inform programme design. The RapidPro-based nutrition commodities tracking system was scaled up nationally and allowed a continuous supply of RUTF for children with SAM. UNICEF continued to support the implementation of MICS surveys, with six surveys finalised in 2019.

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 two additional countries. Further expansion will be explored. In keeping with the UN Reform agenda, UNICEF supported efforts to harmonise the collective work of United Nations agencies on nutrition. In 2019, after extensive consultations with the Food and Agricultural Organization of the United Nations (FAO), World Food Programme (WFP) and WHO, the UN Standing Committee on Nutrition and the UN Network for Scaling Up Nutrition were merged into a single entity, UN Nutrition, to be established in 2020. The SUN Movement continued to galvanise global commitment to ending malnutrition in 2019, with UNICEF maintaining its leadership as chair of the SUN Lead Group. In 2019, SUN membership increased to 61 countries and four Indian states, from 60 countries and three Indian states in 2018. In Sudan, UNICEF helped strengthen the national SUN coordination body in 2019, contributing to the development of an operational manual for SUN, which outlines key coordination structures with specific terms of reference at both federal and state levels, to be operationalised in 2020. Additional comment: detailed nutrition results are available on UNICEFs website: https://www.unicef.org/reports/global-annual-results-2019

Assessment
On course
Basis of assessment

At least half of the individual commitment components are assessed to be on course