Undernutrition is a silent crisis impacting millions of children and women globally. Despite progress, alarming statistics from 36 GFF partner countries in 2022 reveal that 76.5 million children were stunted, 17.8 million were wasted, and 9.8 million were overweight. Women of reproductive age face high rates of anemia, and many newborns suffer from low birth weight. Addressing double burden of nutrition of malnutrition is essential to achieving global nutrition targets by 2030.

Systemic challenges exacerbate these issues, including weak nutrition governance, poor integration of nutrition interventions within health systems, heavy reliance on donor funding, low domestic resource mobilization, a shortage of trained nutrition officers, and supply chain issues hinder progress.

Data and monitoring gaps also present significant challenges. Nutrition monitoring primarily depends on DHS and MICS surveys conducted every five years, resulting in infrequent updates. There is also a low level of integration of nutrition-related indicators within national health information systems.

In the section below, you can explore the progress with global nutrition targets across GFF partner countries from 2012 to 2022.

Many GFF partner countries continue to face many governance challenges including insufficient multi-sectoral coordination and critical gaps in resource mobilization strategy and budget tracking.

Multisectoral Nutrition Plans

The analysis of multisectoral action plans across various countries reveals multiple opportunities for improvement to ensure effective nutrition governance and implementation. Majority of countries (28 out of 36) have developed multisectoral nutrition plans, but only 23 countries have fully costed national nutrition plans, and just 21 have integrated monitoring and evaluation frameworks while only 25 countries had nutrition advocacy and communication plans.

Multistakeholder Nutrition Platforms

While 34 out of 36 countries have established a National Multi-Stakeholder Platform (MSP), only 20 have comprehensive annual action plans for their MSPs. Additionally, subnational nutrition coordination mechanisms are present in 31 countries, but many still lack fully implemented mechanisms, particularly at the subnational level where only 22 countries have annual action plans for their subnational MSPs. Although 34 countries have established a SUN Civil Society Network, fewer have engaged business (26), academia (23), and donor (26) networks adequately. Additionally, only 10 countries have established broader stakeholder networks involving youth, parliamentarians, and media.

Nutrition Financing

The analysis of nutrition financing reveals critical gaps in mobilization strategies, budget tracking exercises, the identification of funding gaps, and domestic expenditure nutrition tracking are often incomplete or absent in many countries. Specifically, only 8 countries have a resource mobilization strategy and less than 15 countries have conducted budget tracking exercises. The identification of funding gaps is relatively better, with 18 countries reporting this practice, yet it still leaves room for improvement. Lastly, only 13 countries are tracking domestic expenditures on nutrition, underscoring the need for better financial monitoring and accountability.

In the section below, you can explore each of the individual elements of nutrition key governance indicators.

The Global Financing Facility (GFF) employs a comprehensive strategy to tackle nutritional challenges, encapsulated in a robust Theory of Change. The strategic directions from 2021 to 2025 focus on five key areas: enhancing country leadership and partner alignment, advancing equity and gender equality, safeguarding high-quality essential health systems, building strong health financing systems, and maintaining an unwavering focus on results.

The GFF Nutrition Action Areas for 2024-2030 includes catalyzing more and better financing for nutrition by aligning efforts with RMNCAH-N platforms and prioritizing investments to reach the most vulnerable populations. This strategy involves integrating high-quality nutrition interventions within health systems to address the triple burden of malnutrition among women, children, and adolescents. Additionally, the GFF seeks to implement financing reforms to increase domestic resources for nutrition and improve spending efficiency, thereby strengthening country data systems for better decision-making. Execution approaches include mobilizing financing, generating knowledge and learning, collaborating with international partners, and scaling up high-impact interventions.

Based on the contextual analysis, specific focus countries could include Nigeria, Pakistan, DRC, Indonesia, Ethiopia, Bangladesh, Tanzania, Niger, Afghanistan, Mozambique, Uganda, Madagascar, and Vietnam, where targeted efforts aim to maximize impact.

GFF Nutrition Theory of Change

With a focus on linking reforms to outcomes, the GFF engagement in Indonesia has focused support upon Indonesia’s multi-sectoral program or Convergence Approach in which multisectoral interventions are coordinated to jointly target priority geographic areas and most at-risk populations.

Engagement and Support

GFF supports management capacity and accountability system across sectors and levels of government and works with government to use existing resources more effectively. Specific examples include:

• Coordination platforms: to improve management capacity and align incentives horizontally (across sectors) and vertically (between levels) across government.
• Public financial reform: to address PFM issues to improve the efficiency in the allocation and use of existing resources. 
• Data systems and utilization for decision-making: to establish and utilize data to course correct program implementation towards results. 
• Delivery of critical gaps in the package of services: the focus is on  ECD for children 0-3 yeas-old, nutrition-sensitive food assistance, locally-adapted interpersonal behavioral change communication) critical to stunting reduction.
• Citizen engagement and accountability: to generate demand and improve accountability for nutrition interventions at the community level.

Implementation Progress

• Increased public spending from USD 1.9 billion in 2018 to USD 2.7 billion in 2021 informed by budget tagging and evaluation results.
• Established an integrated monitoring dashboard at national level managed by Vice President Office.
• Established a publicly accessible dashboard to monitor convergence actions implementation at the district level.
• Utilization of monitoring dashboard data to inform coordination platforms and regional planning and budgeting.
• Publication of District Performance Assessment results to inform the fiscal transfers allocation.
• Nutrition budget note presented to parliament in 2020 and 2021.
• Established Indonesia’s first annual anthropometric surveys to regularly measure stunting outcomes up to district level.

The GFF works with Exemplars in Global Health (EGH) to support both global and country uptake and use of evidence generated through the EGH program.

Exemplars in Global Health brings together experts, funders, and partners around the world with the mission of identifying positive global health outliers, analyzing what makes countries successful, and disseminating core lessons so they can be adapted in comparable settings. The program aims to help country-level decision makers, global partners, and funders make strategic decisions, allocate resources, and craft evidence-based policies. Become a member of the EGH community and sign up for the EGH monthly newsletter to learn more.

To learn more about stunting in children under 5 years, visit the Exemplars in Global Health webpage: Stunting Overview.

Several GFF countries have made great strides in reducing childhood stunting using a multisectoral approach.

Ethiopia
Exemplars in Global Health, in collaboration with The Hospital for Sick Children (SickKids) and Addis Ababa University, developed a case study to understand the drivers of stunting reduction in Ethiopia. From 1992 to 2016, Ethiopia cut its stunting rate from 67% to 38%. To achieve this, Ethiopia made significant investments in agriculture, education, vocational training, health systems and WASH conditions through impressive community-based programming, to deliver services at a large scale. This successful implementation was driven by a unified plan with decentralized execution, pro-poor policies targeting the most vulnerable communities, training for community health workers, effective donor coordination, strong data collection and evidence-based program design. Study details and additional key learnings can be found on the Exemplars in Global Health webpage: Ethiopia Overview.

Senegal
Exemplars in Global Health, in collaboration with The Hospital for Sick Children (SickKids) and Institute for Training and Research in Population, Development and Reproductive Health (IPDSR), developed a case study to understand the drivers of stunting reduction in Senegal. From 1992 to 2017, Senegal cut its stunting rate in half, from 34% to 17%. To achieve this, Senegal established the Cellule de Lutte contre la Malnutrition (CLM), a dedicated nutrition body within the office of the Prime Minister, that provides oversight and implements nutrition programming. Additionally, Senegal expanded its community health system and saw the number of women who completed four or more antenatal care visits increase from 14% to 57%. Study details and additional key learnings can be found on the Exemplars in Global Health webpage: Senegal Overview.

Uganda
Exemplars in Global Health, in collaboration with The Hospital for Sick Children (SickKids) and Makerere University School of Public Health, developed a case study to understand the drivers of stunting reduction in Uganda. From 1988 to 2016, Uganda reduced stunting rates from 48% to 29%, through implementation of direct and indirect nutrition actions, often using community-based delivery platforms. Much of the change in under-five stunting can be attributed to the scale-up of malaria control, specifically insecticide-treated nets (ITNs), to prevent malaria in pregnancy and during childhood, along with broader improvements to the health system. Investments in expanded access to primary and secondary education, especially for girls, improved school attendance over the last several decades. This had downstream, positive effects on women’s empowerment, employment opportunities and adolescent births and reduced the intergenerational transfer of malnutrition. Study details and additional key learnings can be found on the Exemplars in Global Health webpage: Uganda Overview.