UNICEF (United Nations Children’s Fund)

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. In 2021, UNICEF supported countries to recover from pandemic-related service disruptions, helping them regain – and at times accelerate – progress towards targets. Despite the setbacks of the last two years, UNICEF achieved or exceeded nearly all nutrition output targets in the Strategic Plan 2018–2021, with progress rates of more than 90 per cent

With the support of global thematic partners, UNICEF achieved the following headline results in 2021:

• 335.9 million children were reached with services to prevent stunting and other forms of malnutrition (a 38 per cent increase from 2020)

• 67.4 million adolescents benefited from services and support to prevent anaemia and other forms of malnutrition (a 90 per cent increase from 2020).

• 150 million children were screened for wasting (a 9 per cent increase from 2020) and 5.4 million children received treatment for life-threatening wasting (a 10 per cent increase from 2020).

The ability of UNICEF programmes to withstand and bounce back from the shocks and constraints of the COVID-19 pandemic reflects years of investments in systems-strengthening together with national governments. It also highlights how UNICEF support in identifying strategies and innovations to safely deliver nutrition services allowed countries to maintain and recapture programme coverage in the face of significant pandemic-related service disruptions.

To protect and promote diets, services and practices that support optimal nutrition in middle childhood and adolescence, UNICEF uses a coordinated approach, underpinned by responsive actions across the education, food, health, water and sanitation, and child protection systems. These actions aim to improve availability and access to nutritious, safe, affordable and sustainable diets, including fortified foods; improve children’s food environments in and around schools; promote the use of micronutrient supplementation and deworming prophylaxis where nutrient-poor diets are common; enhance knowledge and skills about good nutrition and physical activity; and promote good diets and active lifestyles through large-scale communication programmes. In addition, UNICEF leverages programmes and policies across sectors to overcome gender barriers and reinforce adolescent girls’ access to resources, decision-making and agency.

2. In line with the UNICEF Nutrition Strategy 2020–2030, UNICEF aims to strengthen the capacities and accountabilities of five key systems – food, health, water and sanitation, education, and social protection systems – to make good nutrition a reality for children, adolescents and women.

As part of its systems approach to nutrition, UNICEF is working with governments to integrate nutrition objectives within the policies of key related sectors. For example, 46 countries have social protection policies with nutrition components, 57 countries have education policies with nutrition components included, and 37 countries have a national water and sanitation policy with nutrition components.

UNICEF led efforts to strengthen regional nutrition policies and approaches in 2021. In the Pacific Islands, UNICEF supported the development and implementation of the ‘High-Impact Nutrition Interventions’ (HINI) framework in five high-burden countries. UNICEF carried out high-level advocacy events at regional and country level and provided technical guidance to strengthen nutrition policies and frameworks. In addition, multisector nutrition coordination structures were established in three out of five countries and key preventive interventions – such as point-of-use fortification, VAS, deworming and screening for malnutrition – were introduced or revitalized in three countries.

Social and behaviour change communication (SBCC) strategies were particularly significant in 2020 and 2021, as UNICEF used large-scale communication campaigns to encourage recommended IYCF practices during the COVID-19 pandemic and dispel myths and misinformation. UNICEF also seized opportunities to leverage water, sanitation and hygiene (WASH), social protection and early childhood development (ECD) platforms to reach communities and families with messages on early childhood nutrition to shift behaviours and practices.

3. UNICEF supports governments in adopting new laws and improving existing legislation to prevent all forms of malnutrition. This includes legislation to restrict the marketing of breastmilk substitutes, enforce maternity leave and other family-friendly policies, mandate food fortification, and establish taxes on sugar-sweetened beverages and other unhealthy foods, as well as front-of-package food labelling measures and comprehensive restrictions on the marketing of unhealthy foods to children).

The International Code of Marketing of Breast-milk Substitutes and subsequent World Health Assembly resolutions (known together as ‘the Code’) aim to protect and promote breastfeeding by prohibiting the promotion of breastmilk substitutes. To mark the fortieth anniversary of the Code, UNICEF, WHO and the Global Breastfeeding Collective hosted an event to build national capacities in country-level Code implementation, including tools and strategies for strengthening this important global policy framework for protecting breastfeeding.

Throughout the Strategic Plan period, UNICEF provided technical support to governments to implement the Code through the adoption, monitoring and enforcement of national legislation. In Lao People’s Democratic Republic, for example, UNICEF technical and financial support between 2019 and 2021 culminated in stronger legislation to protect families from the inappropriate marketing of breastmilk substitutes and a new monitoring tool to track violations. To strengthen Code monitoring in Indonesia, UNICEF introduced a WhatsApp chatbot system to report Code violations, which was implemented nationwide.

Despite high levels of stunting in the Philippines, the country had limited investment in nutrition interventions at the start of the 2018–2021 Strategic Plan period and no specific legal framework to address stunting reduction. UNICEF developed a business case highlighting the costs of inaction and leveraged it to successfully advocate for a strengthened national legislation with Senate and Congress. In 2019, UNICEF provided support for a nationwide multisectoral consultation to develop implementing rules and regulations for a first 1,000 Days Law – which provides a legal and policy framework for the scale-up of integrated nutrition interventions nationwide – and provided subsequent support to draft and finalize it. Interventions were rolled out between 2019 and 2021, with an emphasis on capacity-building, systems-strengthening, local leadership and governance. UNICEF provided technical assistance to chief executives and legislators to establish local ordinances, policies and action plans, with increased investments for nutrition in the first 1,000 days. As a result, nutrition-specific spending in the health sector increased from US$1 million in 2018 to $3 million in 2020 and nutrition investments in three UNICEF-supported provinces rose from US$609,400 in 2019 to more than $1 million in 2021.

4. UNICEF has supported governments to implement vitamin A supplementation (VAS) programmes for more than two decades and is the main provider of VAS globally. Vitamin A capsules are provided every year to select countries as an in-kind donation from the Government of Canada, implemented by Nutrition International and UNICEF. In 2021, UNICEF delivered 401.7 million vitamin A capsules to 49 countries.

After declines in the coverage of VAS in 2020 due to COVID-19-related disruptions, UNICEF worked with governments to resume VAS campaigns, strengthen routine delivery and close gaps to reach more children in 2021. With this support, VAS programmes recovered to reach an estimated 251 million children under age 5 with two doses of VAS in 2021, compared with 141.3 million in 2020 and 245.4 million in 2019.

In Nigeria, very few children received both doses of VAS in 2020 when distribution campaigns were suspended as a pandemic containment measure. In 2021, UNICEF and the Government prioritized VAS as a core indicator in the annual management plan and worked to regain coverage by convening key stakeholders, providing training and improving micro-planning. VAS was delivered to children via Maternal, Newborn and Child Health Weeks in 2021, reaching 26.6 million children with two doses (80 per cent coverage) compared with no children reached with two doses in 2020. To boost coverage, UNICEF also identified opportunities to deliver VAS via other platforms; for example, Oyo State integrated VAS into the first polio outbreak response, reaching more than 1 million children (double the planned number). The success of this approach demonstrated how leveraging a range of delivery platforms and delivering integrated interventions can boost programme coverage.

To strengthen the reach and coverage of VAS in Pakistan, UNICEF and Nutrition International convened vitamin A task force meetings with key stakeholders to improve programme performance and coordination. As part of these efforts, UNICEF supported the Government to integrate vitamin A indicators into lot quality assurance sampling – a survey tool for monitoring the performance and impact of nutrition services – which will be used to improve programme quality. Through these efforts, 31.8 million children in Pakistan were fully protected with VAS in 2021 (88 per cent of eligible children). In Chad, VAS delivery was integrated within measles vaccination campaigns targeting all 23 provinces, reaching 3.4 million children with VAS and deworming, exceeding the target.

UNICEF made significant contributions to expanding the evidence base for VAS in 2021 through peer-reviewed papers published on prioritizing the youngest children; measuring VAS coverage; COVID-19-related disruptions in VAS coverage; consumption of vitamin A-rich foods and tackling service delivery bottlenecks. In addition, UNICEF carried out a scoping exercise to identify innovations for redesigning the vitamin A capsule to improve delivery in the field, enabling integration into PHC, during routine health visits and possibly in the home. These specifications will be included in a 2022 tender for manufacturers of vitamin A capsules.

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 2021, Social and behaviour change communication (SBCC) strategies were particularly significant, UNICEF seized opportunities to leverage water, sanitation and hygiene (WASH), social protection and early childhood development (ECD) platforms to reach communities and families with messages on early childhood nutrition to shift behaviours and practices. To improve the quality of health care, UNICEF also supported water, sanitation and hygiene (WASH) interventions in 3,618 health-care facilities.

6. Prevention is paramount to reducing the number of children suffering from wasting. But when efforts to prevent malnutrition fall short, early detection, feeding, treatment and care can save lives and put children back on the path to healthy development.

An estimated 45.4 million children under 5 globally (6.7 per cent) suffer from wasting – the most visible and life-threatening form of hunger and malnutrition. More than half of children with wasting are younger than 2 years of age. Even before the COVID-19 pandemic, there was little progress towards the SDG target of reducing the prevalence of child wasting to <3 per cent by 2030. Now, as a result of the pandemic’s socioeconomic impacts, the number of children with wasting could increase by 20 per cent by the end of 2022, with grave consequences for children’s growth, development and survival.

While the number of children accessing effective treatment has continued to rise in recent years, fewer than one in three children with wasting is being reached with treatment globally. In 2021, UNICEF launched No Time to Waste – an institutional action plan for tackling this persistent global crisis. Aligned with the Global Action Plan on Child Wasting, No Time to Waste outlines concrete actions for protecting the most vulnerable children – the youngest, the poorest and those left behind by humanitarian crises. It is a consolidation of years of partnership-building with national governments, civil society, partners, donors and the private sector around a common goal: that no child dies of wasting.

While the COVID-19 pandemic exposed the weaknesses of current approaches to child wasting, it was also a pivotal opportunity to shift course. In 2020 and 2021, UNICEF supported countries to transition rapidly to a number of simplified approaches to early detection and treatment delivered at community level – specifically, empowering caregivers to detect child wasting at home, engaging community health workers to provide treatment, and simplifying elements of the standard treatment protocol to expedite and ensure care. As a result, UNICEF and its partners treated nearly 5 million children with wasting in 2020 (the same number as in 2019) and expanded services to reach 5.4 million children in 2021.

7. UNICEF supports counselling for mothers and caregivers to equip them with the knowledge and skills to improve infant and young child feeding (IYCF) practices. Counselling can be provided within health-care facilities or through community platforms; delivered by skilled health workers alone or with the support of experienced mothers; provided in individual or group settings; and delivered in-person or using virtual modes. In 2021, UNICEF supported IYCF counselling for more than 57 million caregivers, a 24 per cent increase from the 46.1 million reached in 2020.

In 2021, UNICEF strengthened its technical support and guidance to countries through the release of Implementation Guidance on Counselling Women to Improve Breastfeeding Practices, together with WHO. Together with the Global Breastfeeding Collective, UNICEF also published a compendium of case studies on skilled breastfeeding counselling to share lessons from countries that have successfully implemented the recommended breastfeeding policy actions. UNICEF also revised its integrated training course on IYCF counselling with WHO, which, together with the abovementioned guidance documents, were downloaded more than 700 times in 2021.

Many countries combine IYCF counselling with large-scale communication campaigns to raise awareness about optimal child feeding practices while providing direct support to caregivers. This approach was particularly important in the context of COVID-19 to prevent declines in recommended feeding practices.

8. UNICEF works closely with governments and partners to strengthen national capacities to collect and use data, monitor and evaluate nutrition programmes, and track the nutrition status of women and children. This has been particularly critical during the COVID-19 response, to monitor how service disruptions were impacting the coverage of nutrition programmes, and to employ innovative monitoring strategies to collect information on how populations were impacted.

The UNICEF–WHO/World Bank Joint Malnutrition Estimates (JME) are the leading nutrition data collaboration to track the status of child malnutrition globally. To produce the 2021 Edition, the JME group developed the first-ever country-level model to generate country, regional and global estimates for stunting and overweight. The 2021 Edition includes country data, individual countries’ share of the global burden of child malnutrition and, for the first time, an assessment of progress towards the 2030 nutrition targets.

UNICEF developed the first global Guidance on National Nutrition Information Systems (NNIS) in 2021, with the WHO–UNICEF Technical Expert Advisory Group on Nutrition Monitoring (TEAM). The guidance is accompanied by an online e-course that teaches country-level stakeholders how to bu ild an NNIS and use it to support nutrition programmes. Recommendations for the first ever District Health Information Software 2 (DHIS2) Nutrition Module were finalized with partners, which will enable the timely collection of standard administrative data on nutrition to be easily visualized to improve programmes. UNICEF and WHO also released updated guidance on standard indicators and tools for collecting, analysing and reporting on IYCF practices, including the first global standard indicators for measuring unhealthy eating practices among infants and young children (i.e., consumption of sweet beverages; unhealthy foods; and zero vegetables or fruit). This is a critical step towards better tracking the nutritional impact of poor feeding practices.

In 2021, UNICEF carried out an in-depth review of NutriDash (the organization’s global nutrition monitoring platform). The findings will be published and used to make the platform more accessible and fit for purpose. With UNICEF support throughout the current Strategic Plan period, the number of countries reporting to NutriDash rose to 127 in 2021, and the quality of data collected has improved each year. NutriDash data are being used at all levels to monitor progress towards targets and inform decision-making; improve accountability; report key trends; strengthen nutrition information systems; inform supply forecasting; and build political will and catalyse investments.

9. Throughout the Strategic Plan period, UNICEF continued to provide leadership and technical support to the Scaling Up Nutrition (SUN) Movement, including strategic support to the Executive Director in her role as Chair of the SUN Lead Group. In 2021, the SUN Movement launched its 2021–2025 Strategy to guide the Movement during its third phase and endorsed a mutual accountability framework and indicators of success, addressing key issues related to country delivery, knowledge management, financing, governance and accountability.

In Cambodia, UNICEF advocated for the Government and United Nations partners to develop a GAP road map in 2021. Through UNICEF’s strategic leadership and coordination with partners, including United Nations agencies, Scaling Up Nutrition networks, civil society and academia, the Government finalized a US$25 million GAP national road map for the prevention and treatment of wasting through integrated health, food, social protection and WASH priority actions. Oversight of the operational road map occurs at a high level – under the Technical Working Group for Food Security and Nutrition, which is chaired by the Deputy Prime Minister and Chair of the Council of Agriculture and Rural Development.

Additional comment: detailed nutrition results are available on UNICEF's website: https://www.unicef.org/reports/global-annual-results-2021-goal-area-1