In January 2022, I embarked on my first trip to Rwanda, East Africa, as the Task Team Leader for the World Bank's Rwanda Stunting Prevention and Reduction Project (SPRP).
Little did I know that this project, which had begun in 2018, would become a significant chapter in my life's mission. During my first visit, along with my colleagues, we drove out of Kigali to visit project sites and meet some of the people impacted by the project.
The problem we are tackling is widespread: stunting affects approximately 148 million children under the age of five globally.
Stunting implies that a child is shorter than expected for their age. Being stunted in early childhood is a marker of sub-optimal growth and development. It can lead to various consequences, including poorer health and poorer performance in school as affected children grow older.
By undermining the human capital stock of the country, stunting also reduces its potential for long-term economic growth. Importantly, stunting, which is the result of chronic undernutrition, can be transmitted through an inter-generational cycle, where undernourished mothers are more likely to have stunted children. In Rwanda, one in every three (33%) children under five years old is stunted, according to the 2020 Demographic and Household Survey (DHS).
Despite Rwanda's impressive progress in sustaining high levels of economic growth in recent decades, and its exceptional response to the COVID-19 pandemic (reflecting a strong commitment to protecting public health), the country is not immune to the challenge of stunting.
The Rwanda Stunting Prevention and Reduction Project (SPRP) operates in 13 districts of Rwanda and initially had a budget of US$55 million when it commenced in 2018. Originally slated to conclude in April 2023, the Rwanda government has since mobilized an additional US$79 million in funding, extending the project until December 2025.
The project seeks to contribute to the reduction of stunting among children under five years old through preventive approaches at the community and household levels.
The project acknowledges that achieving good nutrition entails more than simply providing food to vulnerable households and children. It also encompasses access to quality health and nutrition services, clean water, and adequate sanitation facilities.
Additionally, it emphasizes the importance of health and nutrition-related knowledge, behaviours, and practices, improving access to quality Early Childhood Development (ECD) services, addressing the needs of socio-economically vulnerable populations, empowering communities, and facilitating access to financial and other resources. This necessitates increased investments and coordinated partnerships at both the national and local levels.
The World Bank is collaborating with the Government of Rwanda and other partners to address the issue of stunting. One notable aspect of this project is the strong political commitment from the government.
The Ministry of Finance and Economic Planning, (MINECOFIN) and the recipient ministries (the Ministry of Health, MoH, and the Ministry of Gender and Family Promotion, (MIGEPROF)) are fully dedicated to supporting and ensuring the project's success. The Government is also providing substantial complementary resources and activities to augment the project.
Considerable progress has been made in nutritional outcomes. Stunting levels in the 13 intervention districts decreased from 43.6% in 2015 to 36.6% in 2020. Among children under two years, stunting declined from 37.1% to 28.4%.
The project has supported the establishment of over 13,000 ECD settings, benefiting over 300,000 children across the 13 districts. Additionally, more than 26,000 community health workers have received training on integrating ECD services into their community health service package nationwide.
Furthermore, fortified blended food supplements have been provided to over 120,000 children aged 6 months to 23 months, as well as over 60,000 pregnant and lactating women from the most vulnerable households.
Nevertheless, there are challenges that must be addressed. Community health workers and caregivers, who play vital roles, are volunteers. Finding incentives to sustain their commitment without further burdening the government's fiscal resources is necessary.
Additionally, the involvement of other sectors, such as agriculture, is crucial to ensuring food security and mitigating risks that could hinder the project's objectives. Ensuring the availability of clean water and sanitation products is also of utmost importance.
Despite the challenges, our government counterparts, my colleagues, and I remain optimistic. We are actively collaborating with other sectors to address these risks and support the development of multi-sectoral plans at the district- and sector level to combat malnutrition comprehensively.
The government's unwavering commitment to the project instils hope that stunting can be overcome in Rwanda. The eradication of stunting is vital for the future of well-being of Rwanda's children.
My involvement with the Rwanda Stunting Prevention and Reduction Project has been an inspiring journey. Our team's efforts are making a tangible difference in the lives of children and families in Rwanda.
It serves as a reminder that each of us has a role to play in tackling global issues like stunting. By working together and committing to change, we can create a positive impact in the world.
The author is a Senior Nutrition Specialist at the World Bank