Malnutrition is responsible for nearly half (45 percent) of all deaths in children under five. Children who are undernourished between conception and age two are at high risk for impaired cognitive development, which adversely affects the countrys productivity and growth.
... See More + The World Bank is supporting nutrition-related interventions through multiple projects. For example, the PNPM Generasi Sehat dan Cerdas (National Program for Community Empowerment, Healthy and Bright Generation) has set nutrition-sensitive targets including improving the use of maternal and child health services and consumption of Vitamin A for children under five. In 2014, PNPM Generasi is expected to extend to three more provinces, and to include a new focus on stunting reduction by providing IYCF (Infant and Young Child Feeding) training to service providers and community volunteers to improve their counseling skills. In the PKH/Program Keluarga Harapan, a conditional cash transfer is being piloted to focus on improving the health and education services utilization including prenatal and postnatal check-ups, professionally attended birth, growth promotion and monitoring, Vitamin A supplementation, etc. At the policy level, the World Bank is supporting the Review of Double Burden of Malnutrition (DBM) in Indonesia to discuss the magnitude and causes of this emerging problem, and to improve the capacity and governance to address the DBM in the country.
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The Senegal Nutrition Enhancement Project II received a satisfactory outcome rating with moderate risk to development outcome. Both the Bank and the Borrower received satisfactory performance ratings.
... See More + The project was restructured four times. The first time was in 2008 to reallocate project funds within the project. About 15 percent of the International Development Association (IDA) credit planned for purchase of pharmaceutical products and unallocated funds were reallocated to strengthen the community-based nutrition scale up (Component 1). The second restructuring, again for a reallocation of project funds, was conducted in 2011. The third restructuring was conducted in 2012 when an additional financing from IDA resources became available in March 2012. An extension of the project closing date by 13 months was approved. This additional financing and project extension made it possible to add a fifth PDO and adjust targets upwards that had already been achieved before time. New indicators to strengthen the response mechanisms for the protection of nutrition among vulnerable groups were also added and they reflected a stronger focus on: (i) anemia prevention; and (ii) multi-sectoral approaches at community level to reduce vulnerability to external shocks. The following lessons were gained from this project: (1) A shift in the nutrition discourse to move beyond emergency aid and therapeutic care of malnutrition into the objectives of poverty reduction and development is significant in establishing and sustaining partnerships with Local Governments and sectors infrequently engaging with health and nutrition. (2) The onset of different crises with serious economic consequences demonstrates the need to enhance household and community resilience. (3) Ten years of collaboration between the Government of Senegal and the Bank can improve sustainability of nutrition policy development. (4) Strong national leadership is fundamental to break the invisibility of nutrition and the fragmentation in the discourse surrounding it. (5) Fostering formal partnerships between Local Government, civil society, private sector and sector ministries at the operational level can contribute to the reduction of malnutrition. (6) CEAs characteristic of being flexible in producing innovative and inclusive forms of community mobilization is essential in gradually turning over the leadership to the local governments. (7) The subsidiarity principle has contributed to: (i) a lean management structure (and low overhead expenditures); and (ii) the development of local capacity among mothers, village leaders and Local Government. (8) Scaling-up nutrition interventions to reach 70 percent of the target population is possible through a community-based approach. (9) The package of direct nutrition interventions have been effective in reducing chronic malnutrition (linear growth retardation), but has done little in making a difference in the rate of acute malnutrition. (10) Effective communication for behavioral change and counseling requires specific messages on the promoted behaviors that build on positive examples.
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Implementation Completion and Results Report ICR2449 DEC 29, 2014
This review examines the implementation of the FY2009-12 country partnership strategy (CPS) of FY2009 and the CPS progress report (CPSPR) of FY2011, and assesses the CPS completion report (CPSCR).
... See More + The CPS was implemented by International Bank for Reconstruction and Development (IBRD) and International Development Association (IDA) and this review covers their program. The Banks CPS consisted of three pillars. Pillar one, promoting good governance and public sector capacity, through reduced and better-managed liabilities, strengthened management of public resources at central and local levels, and strengthened public administration regulatory and oversight role. Pillar two, improving competitiveness and the investment climate for private sector-led growth, through improved business climate and improved access to and quality of key economic infrastructure services. Pillar three strengthening human capital and social inclusion through better positioning of the education and technical and vocational education and training (TVET) sectors to meet the needs of the labor market and improved targeting of public expenditures and specific programs. The CPSCR draws a number of lessons to be heeded in the next CPS. These lessons include: (a) the results matrix needs to be aligned only with outcomes of projects in the portfolio, and not with outcomes dependent on external factors; (b) the Bank can assist Cape Verde in facilitating South-South exchanges on sector reforms and on the provision of guidance to low-income countries; and (c) stronger institutional capacity building will be necessary to strengthen the sector ministries, particularly in the collection, evaluation, and dissemination of the data needed to monitor projects and programs. Independent evaluation group (IEG) finds that the value of a candid assessment of risk to development outcomes during the implementation status report and CPSPR processes can enable mid-course correction and provide more solid ground to assess the likelihood and sustainability of achievements.
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Widespread lack of improved sanitation in rural areas of Vietnam leads to stunting, i.e. children being too short for their age. It is not the water that makes children sick and malnourished, it is the feces: sanitation is the primary barrier to stop the ingestion of human feces.
... See More + Stunted children are not only short for their age, but also more likely to have poorer cognitive and educational outcomes in later childhood and adolescence. They are more likely to become less productive adults, and be less able to contribute to their nations growth. In addition to the mothers and childs dietary diversity, health care and hand washing and hygiene practices, improved sanitation determines a childs health. Improved sanitation serves as a primary barrier to stop a child from digesting feces that causes disease and reduces the uptake of vital nutrients. Thus, the elimination of open defecation and unimproved sanitation should be a priority issue for policy makers who are concerned with maximizing the current and future human capital of their country. In simple terms: investing in sanitation means investing in a future generation of smart and productive adults.
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A long literature in demography debates the importance of place for health. This paper assesses whether the importance of dense settlement for child mortality and child height is moderated by exposure to local sanitation behavior.
... See More + Is open defecation, without a toilet or latrine, worse for infant mortality and child height where population density is greater? Is poor sanitation an important mechanism by which population density in?uences health outcomes? The paper uses newly assembled data sets to present two complementary analyses, which represent di?erent points in a trade-o? between external and internal validity. The first analysis concentrates on external validity by studying infant mortality and child height in a large, international child-level data set of 172 Demographic and Health Surveys, matched to census population density data for 1,800 subnational regions. The second analysis concentrates on internal validity by studying child height in Bangladeshi districts, with a new data set constructed with Geographic Information System techniques, and controls for ?xed e?ects at a high level of geographic resolution. The paper ?nds a statistically robust and quantitatively comparable interaction between sanitation and population density with both approaches: open defecation externalities are more important for child health outcomes where people live more closely together.
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Policy Research Working Paper WPS7124 NOV 01, 2014
Hathi, Payal; Haque, Sabrina; Pant, Lovey; Coffey, Diane; Spears, Dean
Investing in young children is one of the best investments that countries can make. A childs earliest years present a unique window of opportunity to address inequality, break the cycle of poverty, and improve a wide range of outcomes later in life.
... See More + A growing body of literature demonstrates that the returns on investments in young children are substantial, particularly when compared to investments made at later stages in life. Yet while there is an emerging consensus that investments in early childhood development (ECD) should be a priority and can have high returns, countries continue to fall short in their investments in ECD. This is due in part to budget constraints, but also to the fact that ECD is complex and multi-sectoral. There is still lack of awareness of how countries can design successful policies and scalable programs in this area. This note, which is based on Denboba et al. (2014), provides an accessible introduction to key interventions and broader principles that can help policy makers and practitioners think about how to effectively invest in ECD.
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The royal Cambodian government (RCG) has achieved remarkable progress in recent years in reducing the poverty rate by more than half. However, the majority of those escaping from poverty only did so marginally and remain largely near-poor and still highly vulnerable to the slightest of shocks.
... See More + One of the most critical factors in enabling the poor to escape from poverty, and not only remain non-poor but go on to prosper, lies in ensuring higher levels of health welfare in these households. This is especially important in rural areas, where most of Cambodias poor reside and where health indicators show a stark divergence with those for urban areas. If poverty is to continue to decline apace, and the gap between rich and poor is to continue to narrow, then the RCG will need to ensure that poor and near-poor peoples health care is greatly improved such that they can make the most of the new opportunities in education and employment that are now becoming available. With significant improvements in some health indicators over the past decade, the major challenges in health care going forward are now becoming clearer. These include: making a breakthrough in tackling high levels of child mortality and child malnutrition; addressing equity more effectively in health service provision and health spending, through pro-poor targeted programs and improvements in the coverage and rates of use of health equity funds (HEF); and the improved monitoring of unregulated private providers of medication used by the majority of the poor. In addition, another crucial step forward will be providing adequate financing and ensuring the implementation of Cambodias first national social protection strategy (NSPS).
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To address the issues of food and nutrition insecurity in Nepal, the World Bank has provided support to the Sunaula Hazar Din- Community Action for Nutrition Project (SHD) Project with funding from the South Asia Food and Nutrition Security Initiative (SAFANSI).
... See More + Sunaula Hazar Din (SHD) translates into English as the "first 1000 days" and refers to the period between conception and 24 months of age, when children are most vulnerable to malnutrition. The overall objective of the SHD program is to enable Nepal to develop better knowledge, attitudes and practices (KAP) in order to improve nutritional outcomes for children during these first 1000 days. The project began in 2013 with two objectives: (1) to introduce a results-based community mobilization approach to improve nutrition in selected pilot areas of the SHD Project; and (2) to improve nutrition outcomes at the ward level by sensitizing communities to the importance of nutrition in the first 1000 days to build their capacity to manage their own nutrition outcomes and to demand appropriate services from government. The Rapid Results Institute, an international organization that has developed the Rapid Results Initiative (RRI), was contracted to support this pilot in four different Wards.
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Although the importance of diet quality for improving child health is widely recognized, the roles of environmental factors and the absorption of nutrients for children's physical growth and morbidity have not been adequately integrated into a policy framework.
... See More + Moreover, nutrient intakes gradually affect child health, so it is helpful to use alternative tools to evaluate short-term interventions versus long-term food policies. This article emphasizes the role of diet quality reflected in the intake of nutrients such as protein, calcium, and iron for children's physical growth. Vitamins A and C are important for reducing morbidity. Children's growth and morbidity affect their cognitive development, which is critical for the future supply of skilled labor and economic growth. Evidence on these issues from countries such as Bangladesh, India, Kenya, the Philippines, and Tanzania is summarized. The supply of nutritious foods is appraised from the viewpoint of improving diet quality. Finally, the roles of educational campaigns and indirect taxes on unhealthy processed foods consumed by the affluent in developing countries are discussed.
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Policy Research Working Paper WPS7072 OCT 01, 2014
Investing in young children is one of the best investments that countries can make. A childs earliest years present a unique window of opportunity to address inequality, break the cycle of poverty, and improve a wide range of outcomes later in life.
... See More + Recent brain research suggests the need for holistic approaches to learning, growth, and development, recognizing that young childrens physical and intellectual well-being, as well as their socio-emotional and cognitive development, are interrelated. To fully benefit from future opportunities in life and become productive members of society, by the end of early childhood, young children must be: healthy and well-nourished; securely attached to caregivers; able to interact positively with families, teachers, and peers; able to communicate in their native language; and ready to learn throughout primary school. This document draws on these existing frameworks and broad evidence on the impacts of ECD interventions. It summarizes some of the existing literature on this topic with the aim to identify key interventions needed for children. The document is intended to provide an easily accessible introduction to interventions and integrated services that could help policymakers and practitioners think about how to effectively invest in ECD. In addition to identifying key interventions, the document outlines four principles that can help countries design and implement strong ECD policies and programs. Countries should: (i) prepare an ECD diagnostic and strategy; (ii) implement widely through coordination; (iii) create synergies and cost savings through integrated interventions; and (iv) monitor, evaluate, and scale up successful interventions. In terms of interventions, within the ECD period, 25 key interventions are identified as essential for a childs growth and development. For each intervention, illustrative costs and impacts are provided. These are based on existing evidence and are only intended to be indicative. The document suggests that these interventions can be delivered through five integrated packages at different stages in a childs life. The five packages of interventions include: (a) the family support package, which should be provided throughout the ECD period, (b) the pregnancy package, (c) the birth package (from birth to six months), (d) the child health and development package, and (e) the preschool package.
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Investing in young children is one of the best investments that countries can make. A childs earliest years present a unique window of opportunity to address inequality, break the cycle of poverty, and improve a wide range of outcomes later in life.
... See More + Recent brain research suggests the need for holistic approaches to learning, growth, and development, recognizing that young childrens physical and intellectual well-being, as well as their socio-emotional and cognitive development, are interrelated. To fully benefit from future opportunities in life and become productive members of society, by the end of early childhood, young children must be: healthy and well-nourished; securely attached to caregivers; able to interact positively with families, teachers, and peers; able to communicate in their native language; and ready to learn throughout primary school. This document draws on these existing frameworks and broad evidence on the impacts of ECD interventions. It summarizes some of the existing literature on this topic with the aim to identify key interventions needed for children. The document is intended to provide an easily accessible introduction to interventions and integrated services that could help policymakers and practitioners think about how to effectively invest in ECD. In addition to identifying key interventions, the document outlines four principles that can help countries design and implement strong ECD policies and programs. Countries should: (i) prepare an ECD diagnostic and strategy; (ii) implement widely through coordination; (iii) create synergies and cost savings through integrated interventions; and (iv) monitor, evaluate, and scale up successful interventions. In terms of interventions, within the ECD period, 25 key interventions are identified as essential for a childs growth and development. For each intervention, illustrative costs and impacts are provided. These are based on existing evidence and are only intended to be indicative. The document suggests that these interventions can be delivered through five integrated packages at different stages in a childs life. The five packages of interventions include: (a) the family support package, which should be provided throughout the ECD period, (b) the pregnancy package, (c) the birth package (from birth to six months), (d) the child health and development package, and (e) the preschool package.
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Over the past two decades, Nepal has achieved economic growth and improvements in social and health indicators. However, the poor nutritional status of first, women, manifested in a low body mass index, and second, children, seen in low birth weights, underweight, stunting, and wasting, has not shown much improvement over this period.
... See More + The Nepal's scaling-up nutrition initiative technical assistance (SUNITA) fund started at the suggestion of Government of Australia's department of foreign affairs and trade (DFAT) to provide technical support in the form of analytical work, evaluations of interventions, and technical assistance to target actions that effectively address gaps in nutrition interventions. SUNITA complements the South Asia food and security initiative (SAFANSI) trust fund, which was established in 2010 to address the South Asian enigma - how chronic malnutrition remains intractable despite high economic growth. The ultimate objective of SAFANSI is to increase the commitment of governments and development partners in pursuing more effective and integrated food and nutrition-related policies and investments. SUNITA will increase the commitment of governments and development partners to more effectively integrate food and nutrition-related policies and investments.
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