Looking forward Peru’s commitment to reducing child undernutrition has been successfully translated into action. Thanks to interventions supported by CRECER, stunting has fallen substantially over a short period of time. Yet more needs to be done. More than half a million children under the age of 5 are too short for their age.96 Inequalities have narrowed nationally, but they persist: Over the past five years, stunting rates among the poorest children have remained 10 times higher than among the richest.97
Key strategy: Transitioning a national emergency plan into a community-centred approach In April 2009, building on the previous communitybased nutrition programmes and energized by the personal interest of the nation’s President, Rwanda initiated a National Emergency Plan to Eliminate Malnutrition (EPEM). This move created new momentum and led to opportunities to strengthen collaboration between sectors and support innovative programming.
Peru must now turn to maintaining its commitment to scaling up nutrition and ensure the sustainability of recent successes, despite political and economic challenges. The country has underscored its commitment by joining the SUN movement and renewing its pledge to reduce the prevalence of chronic malnutrition. The newly created Ministry of Inclusion and Social Development, which leads the intersectoral coordination of nutrition, is working to further reduce inequities.
The EPEM addressed both acute and chronic undernutrition, focusing first on the most vulnerable. Village-level identification and treatment of severe acute malnutrition in facilities was scaled up beginning in 2009. Around 30,000 community health workers received refresher training on how to screen, identify and refer cases for treatment.
Interventions to assure sustainable household food security included expanding kitchen gardens and increasing the availability of livestock. Behaviour change interventions helped promote optimal maternal and child care and feeding practices, and growth monitoring was combined with nutrition programming in 15,000 villages. Monthly data collection and analysis at district and national levels helped to monitor progress and improve planning. It should be noted that in 2010, 85 per cent of infants aged 0–5 months were exclusively breastfed in Rwanda, and almost 80 per cent of infants 6-8 months received timely introduction to solid, semi-solid or soft foods.
Rwanda: Reducing stunting through consolidated nationwide action
In 2005, more than half of Rwanda’s children under 5 (nearly 800,000) were stunted. Just five years later, stunting prevalence had decreased from an estimated 52 per cent to 44 per cent.98 This success was achieved through multi-sectoral approaches, led by the government, and the scaling up of communitybased nutrition programming to all of the country’s 30 districts. Rwanda had been working to improve social services for some time. These efforts included a nearly universal community-based health insurance scheme and health financing and delivery of communitybased nutrition programmes in districts since the 1990s. A boost for nutrition came when advocacy led to consolidated nationwide action. Strong evidence on the effectiveness of nutrition interventions and programme successes in parts of the country persuaded the government of the importance of investing in nutrition and demonstrated the possibility of eliminating undernutrition.
At the same time, additional preventive measures were initiated in communities to improve household food security and care practices nationwide.
Lessons learned from the EPEM were incorporated into the subsequent National Multisectoral Strategy to Eliminate Malnutrition (NmSEM) in 2010. This strategy is being implemented primarily in communities, guided by district-level multi-sectoral plans to strengthen and scale up nutrition interventions. The emphasis is on behaviour change communication to promote optimal nutrition practices during pregnancy and the first two years of the child’s life.
It Can Be Done: Success Stories in Scaling Up Nutrition
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