Acknowledgements Synthesis of Evidence of Multisectoral Approaches for Improved Nutrition is a product of Banking on Nutrition Partnership, an initiative of the African Development Bank (AfDB), undertaken with the support of Big Win Philanthropy and Aliko Dangote Foundation and with technical assistance provided by Results for Development (USA). This work was overseen by AHHD, with Maïmouna Diop Ly (Chief Health and Social Protection Officer) leading and support from Margaret Wagah (Nutrition Technical Specialist), Ann Defraye (Senior Nutrition Officer), and Carol Obure (Principal Health Economist). Nalini Tarakeshwar (Big Win Philanthropy), Tokunbo Oshin (Big Win Philanthropy), Francis Aminu (Aliko Dangote Foundation) and Wale Falade (Aliko Dangote Foundation) provided leadership on behalf of the other members of the Banking on Nutrition Partnership. The work was supported by the Nutrition team at Results for Development (R4D): Yashodhara Rana (Senior Program Officer) and Carol Levin (Consultant; University of Washington) led the development of the synthesis with support from Daniel Arias (Senior Program Associate), Erin Swearing (Senior Program Associate) and Emily Thacher (Program Associate), with guidance from Augustin Flory (Managing Director), Jack Clift (Program Director), and Julian Schweitzer (Senior Fellow). The team extends a special thanks to the following experts who reviewed findings pertaining to different sections of this report: Harold Alderman (IFPRI), Anna Herforth (Columbia University), Sue Horton (University of Waterloo), Mduduzi Mbuya (Cornell University) and Caroline Wilkinson (UNHCR). 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Foreword The determinants of nutritional status are multifaceted and include individual health status and access to health care; access to safe, nutritious, and diverse foods; access to safe water and proper sanitation facilities; conduction of optimal feeding, caregiving, and hygiene practices; and adequately spaced birth intervals. A 2013 Lancet series on maternal and child nutrition underscored that both nutrition-specific and nutrition-sensitive interventions are necessary to eliminate maternal and child malnutrition. Nutrition-specific interventions help to ensure adequate food and nutrient intake and proper feeding, caregiving, and parenting practices. Nutrition-sensitive interventions address food security; availability of adequate caregiving resources at the maternal, household, and community levels; and access to health services and a safe and hygienic environment. Multi-sectoral nutrition programming enables donors, countries, and implementers to address the multifactorial causes of national nutrition challenges by linking and integrating program design, delivery, and evaluation across disciplines and sectors. Nutrition offers an opportunity for the AfDB to act on, and invest in one of the most important paths to sustainable development outcomes. Investments in nutrition—particularly in support of grey matter infrastructure - are at the heart of the AfDB’s equitable growth agenda, including the Bank’s Ten-Year Strategy (2013-2022) and Poverty Reduction Strategy (2014-2018). To accelerate progress on green and inclusive growth, the Bank has developed the “High-5s” priorities (Light Up and Power Africa, Feed Africa, Industrialize Africa, Integrate Africa, and Improve the Quality of Life for Africans). Nutrition is an integral part of the Feed Africa strategy, and is strongly embedded and contributes to the High Five “Improve the Quality of Life for Africans”. The Banking on Nutrition Partnership November 2017 Table of Contents Rationale Chapter 1 : Investing in nutrition ................................................................................................. 2 The value of investing in nutrition in Africa .............................................................................. 2 Chapter 2 : Determinants of nutrition .......................................................................................... 6 Chapter 3 : Purpose and methods of the review ......................................................................... 7 Scope of report ....................................................................................................................... 9 Synthesis of evidence for impact on undernutrition Chapter 4 : Health interventions ................................................................................................10 Health interventions included in the review ............................................................................10 Evidence for nutrition-specific health interventions ................................................................11 The role of the private sector .................................................................................................17 Value for money of health interventions .................................................................................19 Conclusion ............................................................................................................................21 Chapter 5 : Agriculture interventions .........................................................................................22 Agriculture interventions included in the review .....................................................................22 Evidence for nutrition-sensitive agriculture interventions .......................................................23 General guidance ..................................................................................................................28 The role of the private sector .................................................................................................31 Conclusion ............................................................................................................................35 Chapter 6 : Water, sanitation and hygiene interventions ...........................................................36 WASH interventions included in the review ...........................................................................36 Evidence for nutrition-sensitive WASH interventions .............................................................37 General guidance ..................................................................................................................41 The role of the private sector .................................................................................................42 Conclusion ............................................................................................................................44 Chapter 7 : Social protection interventions ................................................................................45 Social protection interventions included in the review ............................................................45 Evidence for nutrition-sensitive social protection interventions ..............................................45 General guidance ..................................................................................................................51 The role of the private sector .................................................................................................52 Conclusion ............................................................................................................................53 Chapter 8 : Early childhood development and education interventions ......................................54 ECD and education interventions included in the review .......................................................54 Evidence for nutrition-sensitive ECD and school-based interventions ....................................54 Conclusion ............................................................................................................................56