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. In 2018, UNICEF made significant progress towards achieving results in to improve maternal and child nutrition. In the area of prevention of stunting and other forms of malnutrition, UNICEF worked with national governments to scale up nutrition programmes to improve breastfeeding and the quality of young children’s diets. Globally, UNICEF supported counselling on infant and young child feeding for 23 million caregivers in 2018, including in 38 countries facing humanitarian crisis. Beginning in 2018, UNICEF launched programmes in 42 countries across all seven regions to improve dietary diversity. With UNICEF’s support, 32 countries established comprehensive programmes to improve the diversity of young children’s diets – including measures to increase access to local nutritious foods and fortified complementary foods, leverage social protection services to improve food affordability and promote responsive feeding and stimulation. In settings where nutritious foods are out of reach, UNICEF continued to support countries in scaling up micronutrient supplementation programmes for women and young children. The number of children benefiting from home fortification with micronutrient powders tripled between 2014 and 2017 (the latest figure), increasing from 4 million to 15.6 million children. Fifty-seven countries integrated nutrition counselling within pregnancy care programmes. Vitamin A supplementation, a vital intervention for child survival and development, was provided to more than 255.7 million children in 2017. With UNICEF’s support, many countries adopted and strengthened national legislation to prevent all forms of malnutrition in 2018. Globally, 49 countries had a national stunting prevention strategy, with implementation of comprehensive package of nutrition-specific and nutrition-sensitive services. Moreover, 17 countries had programmes or policies for the prevention of childhood overweight (such as food standards in school settings and measures to regulate the marketing of food and beverages for children). In area of improvement of adolescent nutrition, UNICEF worked to lay the groundwork for the design and scale up of gender-responsive programmes to improve the quality of diets and the nutritional status of school-aged children and adolescents. This included collaborating with national governments in 30 countries and seven regions to roll out comprehensive programmes promoting improved access to nutrition and health information, education, counselling, services and commodities. In 2018, some 58 million adolescent girls and boys were provided with services to prevent anaemia and other forms of malnutrition through UNICEF-supported programmes. In countries facing a double or triple burden of malnutrition, UNICEF worked with governments to develop a package of interventions to prevent nutrient deficiencies and address the rise of overweight, often leveraging the school system as a delivery platform. In area of treatment and care for children with severe wasting and other forms of severe acute malnutrition, UNICEF continued to prioritize the early detection and treatment of children with severe acute malnutrition (SAM) as a life-saving intervention. In 2018, UNICEF supported the scale-up of services to treat and care for children with SAM in both development and emergency contexts in 73 countries, compared with 67 in 2017. More than 4.1 million children were reached with treatment in 2018 with UNICEF support; and 82 per cent of these children fully recovered, exceeding the quality targets set in the Strategic Plan. UNICEF is tracking the number of countries that provide care for children with SAM as part of an essential package of regular health and nutrition services for children. Twenty-four countries provided these integrated services in 2018.
2. UNICEF continues to promote multisectoral nutrition programming, including synergies with health, WASH, ECD, social protection, while promoting linkages with agriculture especially around complementary feeding. For example, in Kenya, UNICEF harnessed stakeholder and government support to establish the 2018–2022 Kenya Nutrition Action plan, which includes nutrition-specific and nutrition-sensitive interventions and strategies for reducing the triple burden of malnutrition (i.e., the coexistence of stunting and wasting, vitamin and nutrient deficiencies, and overweight and obesity). In 2018, UNICEF continued its advocacy and technical assistance with the government with the goal of establishing a high-level multisectoral platform for nutrition as defined in the National Food and Nutrition Security Policy implementation framework. In Nepal, nutrition-sensitive services were provided combined with nutrition programmes by local governments, such as treatment of infections, the promotion of good hygiene and sanitation, early stimulation, prevention of child marriage, improved school health and nutrition, and improving nutritious diets through agriculture and livestock. This was complemented with advocacy, awareness raising and capacity-building on programme planning, prioritization and implementation of nutrition programmes.
3. UNICEF continues to advocate for nutrition in global discussions to promote equity, and commitments to prevent maternal, new-born and child deaths through movements such as Every Woman Every Child. UNICEF continues to call on national policymakers to incorporate nutrition-sensitive focus within their strategies, and monitoring of nutrition outcomes through country scorecards. Specifically, the Global Breastfeeding Collective released an updated breastfeeding scorecard in 2018 enabling countries to track their progress against seven policy actions needed to support breastfeeding, such as funding, maternity protection, access to skilled counselling, and monitoring systems. The scorecard results on monitoring, for example, showed that 40 per cent of countries had collected data on breastfeeding in the past five years. UNICEF supports countries in developing strong national strategies and action plans for the prevention of stunting and other forms of malnutrition. The adoption of a national strategy signals government commitment and is tracked as an indicator in UNICEF’s Strategic Plan. Its effectiveness is measured by having key elements in place, such as government budget allocation and evidence-based nutrition-specific and nutrition-sensitive services provided at scale. Globally, 49 countries had a national stunting prevention strategy with the above criteria in 2018, surpassing the target of 28 countries.
4. UNICEF continues to work with countries to ensure that Child Health and Nutrition Days, and other platforms, are optimized to deliver essential nutrition services, including vitamin A supplementation, deworming, behaviour change communication, screening for severe acute malnutrition, growth monitoring and promotion, as appropriate for the country context. In 2018, UNICEF supplied 517.7 million vitamin A capsules to 58 countries (a 7 per cent increase from 2017), including 461.6 million capsules as in-kind contributions. Globally, two high doses of vitamin A were provided to more than 255.7 million children in 2017, exceeding the target of 250 million (SP1.16). Many countries deliver VAS successfully through campaign events or as part of national immunization days (NIDs) or polio campaigns, with UNICEF support. In Pakistan, UNICEF procured supplies and ensured the delivery of VAS through NIDs, reaching more than 32 million children aged 6–59 months twice a year, a coverage of more than 91 per cent of children in need. Through integration with NIDs in South Sudan and cooperation agreements with civil society organisations, UNICEF helped increase the proportion of counties conducting VAS and deworming from 61 per cent in 2017 to 76 per cent in 2018. More than 2.3 million children benefitted from VAS in 2018, compared with 1.5 million the previous year.
5. Joint Nutrition-WASH programming were implemented in 62 countries, including joint planning and implementation, joint monitoring and data analysis, and joint advocacy and fundraising. UNICEF is increasingly expanding training on child feeding to community workers from other sectors, including water and sanitation: 40 per cent of countries strengthened their community outreach in this way in 2018 (34 countries, compared with 26 in 2017). In Tanzania, to maximize the impact of counselling on stunting reduction, UNICEF worked to integrate components of water, sanitation and hygiene, health, care for child development and growth monitoring, into a holistic package, which was used to train health workers to provide intensive counselling within health-care facilities and the community.
6. In 2018, UNICEF supported the scale-up of services to treat and care for children with SAM in both development and emergency contexts in 73 countries, compared with 67 in 2017. More than 4.1 million children were reached with treatment in 2018 with UNICEF support; and 82 per cent of these children fully recovered, exceeding the quality targets set in the Strategic Plan and globally. UNICEF aims to increase the number of children with SAM receiving therapeutic treatment and care to 6 million annually by 2021. The global response to acute malnutrition has been inadequate for too long, but with renewed global commitment spurred by the No Wasted Lives Coalition this is changing. UNICEF and global partners formed the Coalition in 2016 in response to unacceptably slow progress in ending acute malnutrition. Its goals are to make acute malnutrition a political and public health priority; to discover and disseminate better ways to detect, prevent and treat acute malnutrition; and to mobilize funds and maximize the effectiveness of current spending. No Wasted Lives partners have committed to doubling the number of children with SAM receiving treatment every year. Alongside increased financial and technical support to regional and country offices in 2018, No Wasted Lives continued to develop into a credible, recognized platform for galvanizing data, advocacy, research and operations to improve early detection and treatment of wasting globally. This included establishing three regional posts, in Eastern and Southern Africa, South Asia and West and Central Africa, with the support of the Children’s Investment Fund Foundation, to guide regional scale-up. In 2018, the Coalition convened a consultation on the emerging evidence on wasting in South Asia, which helped mobilize the commitment of global experts to strengthen the evidence base for policy and programme response to wasting in the region.
7. UNICEF and its partners continued to make advancements in improving breastfeeding over the past year as a result of strategic advocacy through the Global Breastfeeding Collective. The Collective is a partnership of more than 20 members led by UNICEF and WHO with the goal of increasing political commitment to and financial investments in breastfeeding. The UNICEF–WHO Baby-friendly Hospital Initiative (BFHI) aims to protect, promote and support breastfeeding in maternity facilities, including by improving the provision of timely and skilled breastfeeding support as a vital component of quality maternity care. In 2018, UNICEF and the World Health Organization (WHO) published updated implementation guidance on the BFHI, including strategies for achieving universal coverage of breastfeeding support in maternity facilities and sustainable improvements in the quality of care. UNICEF supports training programmes to build the capacities of health-care providers on maternal and child nutrition, making them better equipped to support children and their families. In line with the updated BFHI guidance, countries such as Jordan, Mongolia and Suriname are scaling up training for health workers to improve breastfeeding support. UNICEF worked with the Jordan Ministry of Health to develop a standardized national service package to support breastfeeding and piloted training for health workers in five hospitals based on the new guidance. Some countries made important strides in raising their rates of exclusive breastfeeding in 2018: in Burkina Faso rates increased from 47.8 per cent in 2017 to 55.8 per cent in 2018, and in South Sudan the increase was from 45 to 74 per cent between 2010 and 2018.11 The scale-up of breastfeeding counselling, which expanded to reach 950,300 caregivers in 2018 compared with about 539,500 in 2015, contributed to this progress.
8. Real-time information and monitoring remains a key focus area for UNICEF Innovation, and enabled by Rapid Pro, an open source software platform, that UNICEF launched in 2014. At least 16 countries are using real-time technology to support nutrition programming, with support to tasks ranging from supply chain strengthening to screening for severe acute malnutrition.
9. A key global partnership is the Scaling Up Nutrition (SUN) movement, which continued to unite global nutrition partners in 2018 with its support for nationally driven efforts to end malnutrition. UNICEF continued to chair the SUN Lead Group, where the UNICEF Executive Director’s leadership set a renewed sense of direction, purpose and urgency for the movement. Under UNICEF’s leadership, the SUN movement ended 2018 with a commitment to driving change towards the SDGs by ensuring that: (1) change is led by national governments with new political will and investments; (2) focus remains on the prevention of malnutrition in the first 1,000 days of life; (3) governments work to improve women’s nutrition across the life cycle, from birth through the second decade; (4) countries develop a systems approach to nutrition, bringing together food, health and social protection systems to achieve greater results for children; and (5) governments design policies, programmes and incentives to encourage private sector investments in healthy food for children and families. The SUN movement provides opportunities for countries to strengthen governance structures for nutrition, such as in the Sudan, where the country established a multisectoral coordination structure for nutrition in collaboration with the SUN secretariat. As chair of the UN Network for SUN until mid-2018, UNICEF supported the Government of the Sudan in establishing an inter-ministerial committee at undersecretary level across all key line ministries and recruiting a national SUN facilitator. UNICEF also provided technical support to establish other networks under the SUN movement, including business, civil society and donor networks. By partnering with FAO and WFP in Red Sea state and with Concern in West Kordofan in 2018, UNICEF developed joint projects to address both the immediate and more interim determinants of malnutrition, bridging the humanitarian–development–peace nexus.
Additional comment: detailed nutrition results are available in UNICEF’s website: https://www.unicef.org/sites/default/files/2019-06/Global_Annual_Results_Report_2018_Goal_Area_1.pdf
Although original commitment language is vague, substantial work has been undertaken towards all commitments.