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How can we end childhood stunting in Rwanda?

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Ramping up access to government social protection for mothers and children is key to unlocking the economy.

Rwanda aims to become a middle-income country by 2035, thereby alleviating poverty for millions. Building up the nation’s economy is a priority for the government and its development partners, who recognise that a solid human capital and a highly skilled workforce are crucial to sustainably drive the required economic growth.

Stunting affects 33% of children under the age of five in Rwanda, limiting their physical and cognitive development. Local economic growth suffers as a result, which is why the Government of Rwanda introduced the Stunting Reduction Programme (SRP) in 2018 as part of a wider development mission.

Co-financed through a partnership between the Government of Rwanda, World Bank, Global Financing Facility and The Power of Nutrition, the programme focuses on supporting the government’s commitment to eliminate stunting in the country by strengthening national delivery systems for priority social services.

The SRP sits across sectors covering health, nutrition, and social protection, making it a fully integrated programme. High-level coordination between government agencies was needed to integrate interventions across multiple sectors and improve planning, implementation, and monitoring of a complex programme. These approaches have allowed the government to achieve economies of scale and synergies that come from cross-sector interventions.

Evidence shows that access to health and social protection services, such as antenatal care or cash transfers for pregnant and lactating women, are some of the most effective interventions to prevent childhood stunting in Rwanda. Improving access and demand for these critical services are the foundation of the SRP.

Applying a digital approach to analogue problems

Access to government services in low-income countries is often dogged by inadequate infrastructure. Monitoring how individuals access different social services, such as health, education, and social protection, is difficult and fragmented. Improving access and the delivery of public services needed unique approaches.

The first was adopting digital technology for the civil registration of all births and issuing birth certificates at the community level. The SRP piloted digital registration of children at birth in 55 health facilities across the country, allowing the authorities to track how pregnant and lactating women, as well as their children, were accessing cash transfers and associated health and nutrition services.

Most Rwandans still use cash for transactions, slowing down the delivery of social protection services. To ensure services are available on time, the second approach was to digitize payments through technologies such as mobile money. Families and community groups now have immediate access to social protection payments, supporting family’s access to foods and health services and freeing up their time and money for other needs.

Aside from digital innovations, the programme also integrated rigorous quantitative and operational research to monitor outcomes, performance and effectiveness of the different interventions. The findings are used to develop and revise delivery approaches to reach more women and children.

Improving is just as important as providing better access to services

Making services available at health facilities or at community level does not automatically translate into the uptake of the services. Evidence from the programme showed demand was still low, despite improved access.

Including a social behaviour change campaign helped create demand for the services, improving the overall effectiveness and impact of the interventions by creating stronger messaging that fits the evolving cultural context in Rwanda. This was critical for Rwanda but is also true of other countries where uptake of services can be a challenge. Context specific demand creation should be part of any plan to implement cross-sector programmes at scale.

Programme is seeing results, but there is more work to be done

Recent results from the Demographic and Health Survey (DHS) shows stunting in Rwanda has declined from 38% in 2015 to 33% in 2019. The number of women who have had four or more antenatal care visits has risen from 43% to 47%. These visits provide a great opportunity to reinforce key messages on health and nutrition. In total the programme has reached 857,372 women and 694,745 children with nutrition interventions.

Conditional cash transfers have been accessed by 16,078 pregnant women and 68,521 children, incentivising them to take up health and nutrition services. Early childhood development centres are also being used to support care givers and community health workers to stimulate children at an early stage and promote optimal nutritional and health practices.

Doubling down on effective approaches

Recent progress has been encouraging. To accelerate the reduction in stunting, the government and development partners should continuously review and analyse emerging approaches. Only by being bold, innovative and holding development programmes to the highest standards will Rwanda be able to build on its recent economic success.

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