© UNICEF / Tremeau © UNICEF

Scaling up nutrition in West and Central

INTRODUCTION

West and Central Africa is the largest SUN region and comprises 21 countries1 at different stages of their scaling up nutrition efforts. The region includes some of the earliest members to join the Movement (with 8 joining SUN in 2011), and 2 of its most recent members, and (both of whom joined the Movement in late 2016 and early 2017). 15 countries are francophone, while 5 countries are anglophone. - is the only lusophone .2 Most countries in the region have made strides towards creating an enabling environment for country partners to work hand-in-hand for nutrition results. 18 out of 21 countries have created,

1 West African SUN countries include: , , Côte d’Ivoire, , , Guinea, Guinea-Bissau, , , , , , , and Togo. Central African SUN countries include: , Central African Republic, , Congo, Democratic and Gabon. 2 Unless cited otherwise, data presented in this section are from the SUN Monitoring, Evaluation, Accountability and Learning (MEAL) database. These data have been compiled from various sources, as listed in the SUN MEAL Framework 36 Baseline Document, which is available at: https://scalingupnutrition.org/progress-impact/monitoring-evaluation- accountability-and-learning-meal/. 2018 SUN Movement Annual Progress Report 37

Chapter 3: Scaling up nutrition 1.0 4 6.0 4 7.3 4 3.0 3 .4 7.7 4 .8 1 4 .1 .1 Republic 8 .4 0 Republic 7 Democratic of the Congo 2.6 .5 Central African 4 0.7 2 4 Chad 3.0 1 9.9 report for more information. more for report 3 1.4 4 joint child malnutrition estimates, joint child malnutrition estimates, *UNICEF-WHO- Bank Group Group Bank *UNICEF-WHO-World 8.0 9.8 2 4 2018 edition, and the Joint-Assessment edition, and the Joint-Assessment 2018 .7 6 3.3 2 See the Country Profiles at the back of this at Profiles See the Country .2 results completed in 2018 by SUN Countries. by in 2018 completed results 5 .5 Cameroon 1 1.7 Nigeria 1.9 3 0.8 5 1 2.9 3.6 3 4 9.5 4 .9 5 3.3 8.9 2 Congo 4 .2 6.9 8 .0 4 3 5.4 9.1 6 5 1.2 Niger 1.6 2 4 0.3 .1 .5 1 1 5 9.6 .9 1 Togo 4 2.2 .7 .7 4 Benin 5 7 0.1 .0 5 5 Gabon .4 3.8 3 2 .2 1 2.2 3 7.5 .6 1 7 2.9 so Burkina Fa 5 7.3 2 3.5 1.3 51 - 75% progress weighted 51 - 75% progress weighted 2 5 6.4 4 .5 1 7.3 2.1 3 5 .0 .9 6 1 .6 2 Côte d’Ivoire Mali Under five (%) overweight Under five (%) overweight 1.6 Ghana 3.5 2 .7 1 4 4.7 0.6 3 5 0.4 3 8.8 1 5.2 4.6 Anaemia in women (%) years 15-49 Anaemia in women (%) years 15-49 3 5 .2 .0 3 4 Liberia Guinea 26 - 50% progress weighted weighting 26 - 50% not available progress weighted weighting not available .1 .6 8 5 7.2 3 8.0 2.1 4 2.4 fragile governance and effects of conflict and climate-related stressors threaten threaten stressors and climate-related of conflict and effects governance fragile 3 Under five (%) wasting Under five (%) wasting 3 3 1.4 1.4 4 3 .3 1 .9 9.9 8 4 4.8 .4 Mauritania 1 6.4 9 3.8 3 Sierra Leone 4 In March 2018, 14 countries in the region were listed as “least developed countries”, with several countries being being countries with several countries”, developed as “least listed were in the region 14 countries 2018, In March 7.9 7.5 .9 landlocked. 3 or are in the process of creating, multi-stakeholder platforms (MSPs), and the 2018 Joint- and the 2018 (MSPs), platforms multi-stakeholder of creating, in the process or are a median from an increase 1 – show except all countries by – undertaken scores Assessment development economic However, 2017-2018. in per cent 61 to in 2014-2016 per cent of 52 challenges, progress seen in many countries over the past years. years. the past over countries seen in many progress and ensuring of malnutrition fight these underlying drivers to efforts ahead, concerted Looking men and all women, good nutrition for ensure to of actions will be essential the sustainability Africa. and Central in West children 2 7.9 5 0 2.5 3 5 6.8 Senegal .2 4 .3 7 2 0-5 months old exclusive (%) breastfeeding 0-5 months old exclusive (%) breastfeeding 0 - 25% progress weighted 0 - 25% progress weighted Under five (%) stunting Under five (%) stunting 76 - 100% 76 progress weighted 76 - 100% 76 progress weighted .2 3 7.0 .0 1 6 Nutrition situation Nutrition situation 1.1 Progress towards the SUN Movement strategic objectives objectives strategic the SUN Movement towards Progress in 2018)* as reported weighted, (total Nutrition situation SCALING UP NUTRITION SCALING UP NUTRITION AND CENTRAL AFRICA IN WEST Guinea-Bissau 1 7.6 The Gambia 2 5.0 2 A SNAPSHOT OF NUTRITION AND DIETS ACROSS THE LIFECYCLE

Nutrition situation Although trends vary greatly from country to country in this region, certain parallels can be drawn vis-à-vis malnutrition and security trends.

The stunting picture – in terms of Under five NutritionUnderlevels and changessituation five – is very diverse. GHANAUnder IS 1 OF ONLY five 6 Ghana and Mauritania show the SUN COUNTRIES ON TRACK stunting (%) wastinglargest percentage (%) of stunting overweight (%) reductions over time.4 Stunting TO MEET GLOBAL STUNTING affects a median of 30 per cent of AND WASTING TARGETS girlsUnder and boys fiveunder five in the 21 Under five Under five countries (with a range of 17 to 44 per cent), while the median rate of wasting isstunting at 8 per cent (with (%) a range of 3 to 15 per cent).wasting In both West and (%) Central overweight (%) 0-5 months old exclusiveAfrica, the poorest children haveAnaemia significantly higher in rates women of wasting (around 1.5 times higher) than the richest children.5 But, several countries are making breastfeeding (%) encouraging progress. Côte d’Ivoire,15-49 Ghana yearsand Liberia are(%) on track to meet the World Health Assembly stunting target, with Benin and Ghana on track to Nutrition situation meet the wasting target. 0-5 months old exclusive Anaemia in women

Westbreastfeeding and Central Africa has the (%) lowest levels of child overweight (with a 15-49 years (%) Under five Under five medianUnder of 2.5 per five cent and a range between 0.9 to 8.9 per cent). Almost half 0 - 25% of the 23 SUN26 countries - 50% that are on course to halt the rising rate of overweight51 - 75% stunting (%) wasting (%) childrenoverweight under five can be (%) found in West and Central Africa. Burkina Faso, weighted progress Cameroon, Chad,weighted Côte d’Ivoire, Democratic progress Republic of the Congo, Ghana,weighted progress Guinea-Bissau, Nigeria, Senegal and Sierra Leone are on track to meet the NutritionWHA0 - overweight 25% situation target. 26 - 50% 51 - 75% 0-5 months old exclusive76 - 100% Anaemiaweighted in womenweighting progress weighted progress weighted progress breastfeeding (%) weighted progress15-49 years (%)not available Under five Under five Under five 76 - 100% weighting

stunting (%) wasting (%) / Diarassouba © UNICEF overweight (%) weighted progress not available 0 - 25% 26 - 50% 51 - 75% The breastfeeding picture is quite varied. Less than half (or 44 per cent) of weighted progress weighted progressinfants0-5 are months breastfed within weighted oldan hour exclusiveafter birth. About progress one third of infants are Anaemia in women exclusively breastfed (with a median of 33 per cent). Togo is the “leader of thebreastfeeding pack” with an exclusive breastfeeding (%) rate of 65.4 per cent, followed by 15-49 years (%) Guinea-Bissau (52.5 per cent) and Ghana (at 52.1 per cent). Chad has a very low exclusive breastfeeding rate of 0.1 per cent.6 However, Benin, Burkina 76 - 100% weighting Faso, Cameroon, Congo, Côte d’Ivoire, Democratic Republic of the Congo, The Gambia, Guinea-Bissau, Mali, Mauritania, and Sierra Leone are on track weighted progress not available to meet the WHA breastfeeding target. 18 out of 21 countries are performing extremely well in ensuring continued breastfeeding of girls and boys at 1 year old0 – -with 25% 11 countries having rates above 90 per cent.7 26 - 50% 51 - 75% weighted progress weighted progress weighted progress 4 FAO, (2017). Regional Overview of Food Security and Nutrition in Africa 2017. The food security and nutrition–conflict nexus: building resilience for food security, nutrition and . Available at: http://www.fao.org/3/a-i8053e.pdf [accessed October 2018]. 5 UNICEF/WHO/ Group Joint Child Malnutrition Estimates, (2018). Levels and trends in child malnutrition: Key findings of the 762018 edition. - 100% Available at: http://www.who.int/nutgrowthdb/2018-jme-brochure.pdf?ua=1weighting [accessed October 2018]. 6 WHO, (2018). Enabling women to breastfeed through better policies and programmes: Global breastfeeding scorecard 2018. Available at:weighted http://www.who.int/nutrition/publications/infantfeeding/global-bf-scorecard-2018/en/ progress not [accessedavailable October 2018]. 7 Ibid. As per this data the following countries have rates above 90 per cent: Benin, Burkina Faso, Democratic Republic of 38 the Congo, The Gambia, Ghana, Guinea, Guinea-Bissau, Mali, Niger, Senegal and Togo. Rates from Central African Republic, Chad, Côte d’Ivoire, Liberia, Mauritania, Nigeria, and Sierra Leone fall right below 90 per cent, meaning they are on par.

Chapter 3: Scaling up nutrition 2018 SUN Movement Annual Progress Report 39 © UNICEF / Le Du Le / UNICEF © Today, however, trends trends however, Today, 8 51 - 75% progress weighted

11 13 Of the 20 countries most dependent on food food on dependent most countries 20 the Of 12 suffer from vitamin A deficiency. from suffer 9 Under five Under (%) overweight Of the 2 sub-regions, Central Africa’s prevalence rate of rate prevalence Africa’s Central Of the 2 sub-regions, 10 Anaemia in women Anaemia (%) years 15-49 undernourished people in 2017 was significantly higher (at 26 per cent) than 26 per cent) (at higher significantly was people in 2017 undernourished 15 per cent). (at Africa of West that The region saw a fall in the prevalence and number of undernourished in the prevalence a fall saw region The (2014- but, in subsequent years and 2009-2011, 1999-2001 people between Leone Liberia and Sierra Guinea-Bissau, hitting has been a rise, there 2016), the hardest. Infant and young child feeding practices across the region are quite poor. poor. quite are the region across practices child feeding and young Infant a minimum 6-23 months of age receive of children (median) Only 7 per cent – with only 13 per 3 and 17 per cent) between (with a range diet acceptable (with a range minimum diet diversity the median) receiving (if looking at cent (with a under five half of all girls and boys Over 5 and 34 per cent). between per cent) median of 52 Anaemia in girls and women is a key malnutrition concern in West and Central and Central West in concern malnutrition a key is and women in girls Anaemia of non-pregnant per cent and 47.7 women of pregnant per cent 57.2 Africa. target the towards progress has been little anaemia. There from suffer women Liberia but also globally. Africa, Central and in West anaemia, not only for seen have countries 12 however, progress, most the made have Ghana and half of adolescent Anaemia also affects rates. in their anaemia an increase 40 and 64 between (with ranges the ages of 15 and 19 years girls between per 70 available. with data – based on the 14 countries in the region per cent) between (with a range anaemic are this region in five under children of cent with data). on the 17 countries based 58 and 86 per cent, 10 in the top been ranked and Mali have Republic African Chad, Central highly has been ranked Leone while Sierra dietary patterns, healthy globally for items. unhealthy of fewer consumption 8) for (place Countries in West and Central Africa are amongst some of the most food food some of the most amongst are Africa and Central in West Countries face their families men and of women, one third Almost globally. insecure 50 per almost is at while this figure Africa, insecurity in West food severe Africa. Central in cent imports globally, 9 are in the region. In 2017, 13 countries were dependent on were 13 countries In 2017, region. in the 9 are imports globally, of their 20 per cent least at having with 5 countries assistance, food external of crisis. in a situation population show increased consumption of unhealthy and nutrients in the region. in the region. and nutrients foods unhealthy of consumption increased show of the prevalence in increase has been a steady there 2000 and 2016 Between median prevalence and adults. The among adolescents and obesity overweight (6 per cent 14 per cent at stands girls adolescent obesity for and of overweight and 22 per adult women for per cent 37 is at this whereas boys), adolescent for among men.cent

Supra note 4. note Supra Supra note 4. note Supra Food Security Information Network, (2018). Global Report on Food Crises 2018. Available at: https://docs.wfp.org/api/ at: Available Crises 2018. on Food Global Report (2018). Network, Security Information Food FAO, IFAD, UNICEF, WFP and WHO, (2018). The State of Food Security and Nutrition in the World 2018. Building climate Building climate 2018. Security and Nutrition in the World of Food State The (2018). WFP and WHO, UNICEF, IFAD, FAO, Development Initiatives, (2017). Global Nutrition Report 2017: Nourishing the SDGs. Bristol, UK: Development Initiatives. Initiatives. UK: Development Nourishing the SDGs. Bristol, 2017: Global Nutrition Report (2017). Initiatives, Development The Lancet, (2015). Global Health, Volume 3, ISSUE 3, Pe132-e142, March 01, 2015. Dietary quality among men and 2015. 01, March 3, Pe132-e142, 3, ISSUE Global Health, Volume (2015). Lancet, The weighting not available 26 - 50% progress weighted women in 187 countries in 1990 and 2010: a systematic assessment. Available at: https://www.thelancet.com/journals/ at: Available assessment. a systematic 1990 and 2010: in countries in 187 women 2018]. October [accessed langlo/article/PIIS2214-109X(14)70381-X/fulltext [accessed [accessed documents/WFP-0000069227/download/?_ga=2.30744312.697980888.1540906685-920717876.1527583340 2018]. October [accessed October October [accessed http://www.fao.org/3/I9553EN/i9553en.pdf at: security and nutrition. Available food for resilience 2018]. 10 11 12 13 8 9 [accessed November 2018]. November [accessed http://165.227.233.32/wp-content/uploads/2017/11/Report_2017-2.pdf at: Available

wasting (%) wasting Under five Under 0-5 months old exclusive 0-5 months (%) breastfeeding 0 - 25% progress weighted Under five Under (%) stunting 76 - 100% 76 progress weighted Nutrition situation Nutrition PROGRESS TOWARDS THE SDGS: MAKERS AND MARKERS OF GOOD NUTRITON

West and Central Africa is greatly affected by natural disasters, conflict and humanitarian crises. 10 countries have high humanitarian risk contexts, while 5 countries are at very high risk. This heightens the probability of infectious disease, food insecurity and inadequate access to essential nutrition and health services. Across SUN regions, West and Central Africa has the highest (median) annual Humanitarian Risk Level GDP growth per capita. However, 40 per cent of women, men and their Medium families (median of 44 per cent) live High below the international poverty line Very High – although poverty levels range from 6 per cent (in Mauritania, data from 2014) to 77 per cent (in Guinea-Bissau, data from 2010). The existence and coverage of social protection programmes in this region is very low. However, Niger is at 20 per cent coverage, Côte d’Ivoire is at 27 per cent, Sierra Leone at 30 per cent and Mauritania is at 45 per cent.14 Creating safety nets for the most vulnerable is essential for lasting BENIN HAS COMMITTED success. TO ENSURING UNIVERSAL In terms of access to basic sanitation services, the ACCESS TO SAFE region scores the lowest – a median of 22 per cent DRINKING WATER BY 2021 have this access – which is key for nutrition results. AND HAS INTEGRATED The perpetuation of malnutrition is closely linked to WATER RESOURCE the status of women and girls, and unless action is MANAGEMENT IN ITS 2016- taken, malnutrition is likely to be a burden passed on from one generation to the next. In certain areas, 2021 DEVELOPMENT PLAN countries have made substantial progress over the past decades. In Côte d’Ivoire the rate of girls completing primary school increased from 33 per cent in 2000 to 56 per cent in 2015,15 while Burkina Faso, The Gambia, Ghana, Guinea-Bissau, Mauritania, Senegal and Sierra Leone have closed the gender gap in primary school enrolment.16 Across the board, girls in the region still have lower levels of educational attainment than boys. In Chad, girls’ enrolment is less than half that of boys. West and Central Africa has the highest proportion of girls married by the age of 18 (with a regional median of 36 per cent versus 24 per cent in other SUN countries) and the highest adolescent fertility rate (median 120 births per 1,000 women 15-19 years, versus 71 for other SUN countries). The World Economic Forum Gender Gap Index shows that Cameroon (ranked 87), Senegal (ranked 91), Liberia (ranked 107), Guinea (ranked 113) and Benin (ranked 116) have seen progress in closing their gender gap in 2017-2018.17 Benin and Guinea have closed more than 80 per cent of their gap in economic participation and opportunity.18

14 Please note there is no data from 7 countries in this region. 15 Global Partnership for Education, (2018). Factsheet: Breaking down barriers to gender equality and girls’ education. Available at: https://www.globalpartnership.org/content/factsheet-breaking-down-barriers-gender-equality-and-girls- education [accessed October 2018]. 16 OECD, (2018). Gender equality in ? The key role of social norms. Available at: https://oecd-development- matters.org/2018/03/08/gender-equality-in-west-africa-the-key-role-of-social-norms/ [accessed October 2018]. 17 World Economic Forum, (2017). The 2017: Sub-Saharan Africa. Available at: http://reports. weforum.org/global-gender-gap-report-2017/sub-saharan-africa/ [accessed November 2018]. 40 18 World Economic Forum, (2017). The Global Gender Gap Report 2017. Available at: https://www.weforum.org/reports/ the-global-gender-gap-report-2017 [accessed November 2018]. Chapter 3: Scaling up nutrition 2018 SUN Movement Annual Progress Report 41 MSPs exist at at MSPs exist 20 CÔTE D’IVOIRE HOSTED D’IVOIRE CÔTE 1,000 THAN MORE MEMBERS OF THE SUN THE 2017 MOVEMENT AT GATHERING, GLOBAL FOR WHICH PLACE TOOK THE FIRST TIME IN A SUN COUNTRY The 2017 SUN Movement Global Gathering, held in SUN Movement 2017 The of high-level a range together brought in November, the SUN received d’Ivoire Côte nutrition. for advocates SUN Global Gathering, the 2017 at Award Team Country nutrition. Mr. and championship for their dedication for Office the of Director Deputy Ahoutou, Koffi Emmanuel Point, Focal SUN Government and Prime Minister of the Ngoran- and Dr Patricia of Coordinator Theckly, undertook their Joint-Assessment by bringing together their together bringing by Joint-Assessment their undertook 19 EXPAND AND SUSTAIN AN ENABLING POLITICAL AN ENABLING POLITICAL AND SUSTAIN EXPAND ENVIRONMENT the decentralised level in 13 countries – with the Democratic Republic of the Congo and of the Congo Republic – with the Democratic in 13 countries level the decentralised in MSPs exist instance, In Benin, for theirs. of decentralising Mauritania being in the process 40 out of 77 municipalities today. different at placed are points in the region Focal In 9 SUN of ministries. within a range levels, point is positioned within the the focal countries, Vice (Benin and Congo), of the President offices Gambia,Ghana, The d’Ivoire, (Côte President Minister Prime or Leone) Sierra and Liberia and Guinea). of the Congo Republic (Democratic the convene their ability to strengthens This In 9 countries, country. in the nutrition community within the Ministry point is placed the SUN focal of Health. possible the best for groups stakeholder across more MSPs work national-level In 2017-2018, a 11 have with businesses, 12 work with civil society, working report impact. 18 countries in all SUN exist for UN Networks a donor convener. have and 13 countries UN convener in 16 exist Civil Society Alliances today. well function deemed to with 7 Networks countries, Mali, Nigeria, Ghana, Guinea-Bissau, d’Ivoire, Côte in Burkina Faso, with Alliances countries, Network A SUN Business of functionality. in terms Senegal being highly ranked Leone, Sierra in development of in early stages Networks Business in Nigeria, with well and works exists Mali. and d’Ivoire Côte nutrition, which for advocates of high-level is the mobilisation 2017-2018 from result A key mobilised the media, have countries 8 priority. top a remains nutrition that ensure to key is important An 2016. in countries 3 only to compared 2018, in champions and parliamentarians nutrition – to for of parliamentary networks is the development trend regional emerging with also collaborating are countries More powers. and budgetary their legislative harness their role. harnessing academia with 13 out of 20 countries and SUN Government Programme Nutrition the National the award. accepted Point, Focal Technical a Lifetime given Bendech, of Mali, was Dr Mohamed Ag nutrition in his improve to his dedication for Award as a whole. but also on the Continent, country, Most countries in the region are progressing in ensuring an enabling environment for for an enabling environment in ensuring progressing are in the region countries Most with in place, (MSP) platform multi-stakeholder functioning a have countries 16 nutrition. their MSPs. of setting up Gabon being in the process and Liberia Congo, Central African Republic and Togo have not set up multi-stakeholder platforms. not set up multi-stakeholder have and Togo Republic African Central Guinea-Bissau is the only country in the region who did not undertake the SUN Joint-Assessment in 2018. the SUN Joint-Assessment who did not undertake in the region is the only country Guinea-Bissau nutrition communities. These assessments show encouraging progress – with an increase in the – with an increase progress encouraging show assessments These nutrition communities. in 2017-2018. per cent 61 to in 2014-2016 per cent 52 from score median total 20 19 In 2018, 20 out of 21 countries 20 In 2018, SUN MOVEMENT THE REACHING OBJECTIVES STRATEGIC PRIORITISING AND INSTITUTIONALISING EFFECTIVE ACTIONS THAT CONTRIBUTE TO GOOD NUTRITION

As is the case for other SUN regions, West and Central Africa varies greatly in their ability to ensure a coherent legal and policy framework for nutrition.

Democratic Republic of the Congo and Niger are the only 2 countries that explicitly guarantee the right to adequate food in their Constitutions. The right to food is implicitly protected as part of broader rights in the Constitutions of Central African Republic, Côte d’Ivoire, Guinea, Mali, Senegal and Togo. Given the ongoing conflicts and climate-related stressors in many of the region’s countries, the ability to realise the right Nutritionto food varies situation greatly, as is the case for countries with a weak level of constitutional protection.

AcrossUnder regions, fiveWest and Central Africa has the Underbest median scorefive with Under five regards to the integration of malnutrition in National Development Plans. 11stunting of the 15 top-ranked (%) countries in Africa for the extentwasting to which nutrition (%) overweight (%) features in their national development plans are from this region.21

4 out of the 5 SUN countries who have ratified the ILO Maternity Protection Convention 2000, (No. 183) can be found in West Africa (Benin, Burkina Faso,0-5 Mali monthsand Senegal). 15 old countries exclusive have maternity protection laws or Anaemia in women regulations in place. Gabon, Cameroon, Chad, Côte d’Ivoire and Togo allow forbreastfeeding fathers to take up to 10 days’ (%) paid leave upon the birth of their child, 15-49 years (%) covered under family allowance leave. Having said that, more can be done to ensure gender equality and promote and protect breastfeeding in the region. While 13 countries have some legal measures in place to prevent aggressive marketing of breast-milk substitutes, 8 have none. Benin, Gabon, The Gambia, Ghana have full provisions in law. Ghana is the region’s highest performer when it comes to baby-friendly health facilities, with 35 per0 cent- 25% of facilities designated as baby-friendly, but the median26 is only - 450% 51 - 75% perweighted cent among the 9 progresscountries with data for this indicator. weighted progress weighted progress

About half of the countries have Nutrition situation mandatory food fortification CENTRAL AFRICAN legislation76 - 100%in place for at least one REPUBLIC AND MALIweighting ARE 2 staple food (e.g. wheat or ) OF ONLY 6 SUN COUNTRIES asweighted well as and oil.progress 86 per not available cent (or 18 out of 21) of countries WHO HAVE PUT IN PLACE Under five Under five haveUnder mandatory five iodised salt HEALTHY DIET POLICIES legislation in place and over stunting (%) wasting (%) three-quartersoverweight of households (%) (median 77 per cent) have access to iodised salt. Central African Republic and Mali (or 2 out of 6 SUN countries across the Movement) have put in place healthy diet policies to restrict the marketing of foods and beverages to children, reduce the salt/sodium consumption and limit saturated fats, trans-fatty acids, free sugars or salt. 0-5 months old exclusive Anaemia in women breastfeeding (%) 15-49 years (%)

0 - 25% 26 - 50% 51 - 75% weighted progress weighted42 21 IDS, progress (2017). Hunger and Nutrition Commitment Indexweighted Africa. Available at: http://africa.hancindex.org/progress [accessed November 2018].

76 - 100% weighting weighted progress not available Chapter 3: Scaling up nutrition 2018 SUN Movement Annual Progress Report 43 A RECORD-BREAKING WEST CENTRAL AND 11 AFRICAN COUNTRIES UNDERTAKENHAVE BUDGET THE 2018 EXERCISEANALYSIS

EFFECTIVELY USING AND SIGNIFICANTLY INCREASING INCREASING USING AND SIGNIFICANTLY EFFECTIVELY NUTRITION FINANCIAL RESOURCES FOR IMPLEMENTING EFFECTIVE ACTIONS ALIGNED WITH ALIGNED ACTIONS EFFECTIVE IMPLEMENTING RESULTS COMMON © UNICEF / Le Du Le / UNICEF © 16 of the 21 countries have, over the past years, years, the past over have, 16 of the 21 countries of spending analysis budget national a conducted record- a is that 2018 from result A key nutrition. for regions, across number the highest 11 countries, breaking – with exercise tracking the SUN financial undertook Leone Gabon, Sierra Mali and Republic, African Central countries that shows This time. the first doing this for advocate to using financial information increasingly are bridge gaps. 10 CRFs to investments and better more for and Ghana in of the Congo Republic Democratic Congo, with Benin, Cameroon, costed, are theirs. of costing the process SUN regions, across is the lowest nutrition-specific interventions of spending for level The have countries Only a few under five. per each girl or boy a median of USD 0.1 at estimated In track. difficult to has proven spending when it exists, a nutrition-specific budget line and and short- emergency funding is going to most that report countries fragile addition, many under-funded. largely remain nutrition interventions while preventive interventions, term nutrition seen donor spending for have Africa and Central in West half of countries Over donors by spending total the However, five. under boy or girl stunted per 10 USD than more in 13 under five than USD 1 per child is less on high-impact nutrition-specific interventions ranges spending donor nutrition-sensitive to nutrition-specific of ratio The countries. 21 of in 12 out of 21 countries. 50 per cent exceeding 96 per cent), to 19 per cent widely (from donors. financial alignment with report of countries than 50 per cent less Overall, of the list been added to and Mali have d’Ivoire Côte Republic, African Central Burkina Faso, such as the Global Financing funding sources, innovative benefit from could that countries enable to is essential mobilisation resource prompt cases to Using investment (GFF). Facility budgets. nutrition is prioritised in national that and ensure More and more, West and Central African SUN countries are aligning actions around aligning actions around are SUN countries African and Central West and more, More 15 SUN countries coherence. more ensure capacities to and strengthening results common 13 out action plans. which have 14 of (CRFs), frameworks results common in place put have and nutrition- nutrition-sensitive through sectors various together bring CRFs of these of 15 plans. and evaluation monitoring have 6 CRFs specific actions. Only in nutrition policies, their national and approved developed have Guinea and Togo In 2018, theirs. National developing are Faso MSPs, while Benin and Burkina with their collaboration frequency the greater by undernutrition, as reflected on addressing plans primarily focus anaemia. While and wasting, stunting, for include WHA targets with plans that of countries it will be the region, types of malnutrition in common the more given this is understandable, and obesity of overweight and control the prevention consider to countries important for the lifecycle. throughout

© UNICEF / Sokhin © UNICEF

THE WAY FORWARD: ACCELERATING PROGRESS

Although progress, especially vis-à-vis the SUN Movement strategic objectives, is palpable across the West and Central African region, sustaining and scaling up effective actions are needed for lasting human impact. Priority actions should be to increase the promotion and protection of breastfeeding – especially in the first 6 months, and ensuring more infants and older children receive enough nutritious food. Building social protection floors – or safety nets – will be key, especially with regards to mitigating fragility. Making sure that individuals at the highest levels of the executive power have nutrition at the top of their political agenda will also go a long way – to nutrition as a lasting priority also following elections. This could also make a big difference in ensuring enough resources go towards nutrition-sensitive and nutrition-specific actions. Working towards gender equality and the empowerment of women and adolescent girls will be essential. © UNICEF / Tremeau © UNICEF

44 Chapter 3: Scaling up nutrition 2018 SUN Movement Annual Progress Report 45 has had a domino

22 © UNICEF / Asselin / UNICEF © The Governor of Couffo, Mr. Christophe Megbedji was nominated to be a SUN Nutrition Champion in 2016. to nominated Megbedji was Christophe Mr. of Couffo, Governor The 22 BENIN CAN! SCALING UP NUTRITION AT THE DECENTRALISED LEVEL THE DECENTRALISED UP NUTRITION AT BENIN CAN! SCALING the (PSDAN), and Nutrition Food Plan for Development Strategic of the In Benin, the preamble participatory a new represents PSDAN “The states: efforts, document guiding nutrition reference managers being the municipalities themselves, (…) with project approach and accountability financial support”. provide in to step to with donors being invited their nutrition into integrate to been encouraged municipalities in Benin have 2011, Since In 2018, efforts. boost point to and a focal budget line plans – with a dedicated development and set up a Cadre their nutrition efforts decentralised of 77) have 40 municipalities (out officials and alongside locally elected mayor, the by chaired (CCC) de Concertation Communal also ‘CCCs’ These services. and social protection health, education, decentralised basis to and meet on a quarterly groups women’s and with civil society organisations work and fundraise. progress, activities, review monitor interventions, coordinate of Benin all 12 governors targeting advocacy these efforts, accompany To SCALING UP NUTRITION IN WEST AND CENTRAL AND NUTRITION IN WEST SCALING UP CHANGE OF AFRICA: STORIES effect: many governors have then requested mayors to consider nutrition when drafting their nutrition when drafting consider to mayors then requested have governors many effect: of Benin Municipalities Association National a budget. The for plans and voting development (MSP), CAN. platform multi-stakeholder these municipalities in the national (ANCB) represents nutrition municipality-led best for the prize awarded municipality was – Ouèrè the Adja In 2014, efforts. © UNICEF / Phelps © UNICEF

THE UN NETWORK IN SIERRA LEONE SPEARHEADS AND PARTNERS UP FOR POLITICAL NUTRITION DIALOGUE The UN Network for SUN took great advocacy strides in Sierra Leone, leading up to the Country’s presidential and parliamentary elections, held in March 2018. Seizing windows of opportunity such as the elections and national planning processes, parliamentarians and running candidates were strategically targeted to ensure that nutrition would be placed high on the political agenda of the new Government. A Multi-Sectoral Nutrition Overview (MNO), which provides a visual narration of the nutrition situation in the country, show that while moderate stunting and wasting has decreased, severe forms have increased. The MNO analyses trends across multiple sectors, including indictors ranging from breastfeeding rates to food insecurity, adolescent pregnancy and women’s empowerment. It also highlights which geographical areas are most in need of action. A comprehensive mapping was also used, looking at nutrition-specific and sensitive programming supported by all relevant stakeholders – from Government to the UN, civil society and donors. This mapping generated valuable coverage data critical to identifying gaps, overlaps and potential areas where efficiencies can be enhanced, to maximise impact. These findings were complemented by a Policy and Plan Overview (led by the Renewed Efforts Against Child Hunger, REACH, Facilitator), which assessed nutrition-specific and sensitive policy commitments, in light of the current needs (MNO) and existing programmes. The discrepancy, once identified, was taken a step further through advocacy. A critical ingredient of success was the coming together of multiple stakeholders, ranging from donors (especially Irish ), civil society, the private sector and UNN – complemented by the hands-on support of the REACH Facilitator, to lobby as ‘One’ for concrete political nutrition commitments. A breakfast meeting was held with members of , to discuss the country’s nutrition needs – culminating in a declaration by parliamentarians during a televised dialogue. This domino effect prompted the enactment of a Food and Feed Safety Bill later that day. Just two weeks after, 14 registered political parties included food and nutrition security, as 46 well as teenage pregnancy and WASH in their respective manifestos. These measures have kept nutrition on the political agenda irrespective of the election outcomes.

Chapter 3: Scaling up nutrition 2018 SUN Movement Annual Progress Report 47 © UNICEF / Sokhin / UNICEF © REINVIGORATING DONOR COLLABORATION WITH THE GOVERNMENT IN MALI IN MALI WITH THE GOVERNMENT DONOR COLLABORATION REINVIGORATING IMPACT – FOR HUMAN strengthening by of the SUN Movement objectives the strategic to contribute to aims to contribute to measures effective and institutionalising environment an enabling policy across of the Movement supporter in Mali. A longstanding in all its forms malnutrition eradicate and human of accountability issues as key Canada sees nutrition and gender equality the world, showing Verret, Louis Mr. Mali, His Excellency to Ambassador Canada’s has led to This dignity. the SUN for the donor convenor and has become alongside his team, his personal commitment, in the country. Donor Network this revitalise to initiative the took Djibril Bagayoko, in Mali, Mr. Point Focal SUN Government The Civil Society and the national UN agencies, USAID, also brings together that important group, are donors, and the right donors more that ensure is to in this Network role Canada’s Alliance. is harmonised and aligned assistance and technical their financial and that together, brought political priority. a key nutrition remains ensuring that plans and policies – always with national to efforts held – showing meetings are and monthly 2018, for has been developed A roadmap of this Network the success and ensure commitment sustain a high-level Ambassador, the Canadian and of the Government guidance under the In July, on bringing who collaborate ministries 19 Malian together It brought convened. meeting was and bilateral multilateral alongside life, Nutrition to Plan for Action National the Multi-Sectoral cementing towards an important step wasas event This actors. cooperation development to scale up nutrition and key to partners’ work cooperation and development governmental of actions. duplication and avoid align financial resources