Projects that

work for improved

Nutrition

Case studies from EU-funded projects

International
Partnerships
 1 P ROJEC T S T H AT WO R K FO R IM P ROV ED N U T RI T ION

Acronyms
2FAS Food Fortification Advisory Service
AGPII Second Agricultural Growth programme (Ethiopia)
BReST Building Resilience through Social Transfers for Nutrition Security in The Gambia
CARI Consolidated Approach for Reporting Indicators of Food Security
COVID-19 Coronavirus Disease 2019
CSA Climate Smart Agriculture
DAC Development Assistance Committee
DeL EUROSAN Local Development (Honduras)
DFID UK Department for International Development
(Now the Foreign, Commonwealth & Development Office - FCDO)
DINU Development Initiative for Northern Uganda
EU European Union
EU-TF EU Reslience Trust Fund in the Northern Areas of Burkina Faso
FNS Food and Nutrition Security
GAIN Global Alliance for Improved Nutrition
IFAD International Fund for Agricultural Development
IFPRI International Food Policy Research Institute
INCOPAS Consultation and Social Participation Instance (Guatemala)
INSIDER Integrated Strategies for Micronutrient Deficiency Reduction
IPC Integrated Food Security Phase Classification (Honduras)
MAGA Ministry of Agriculture, Livestock and Food (Guatemala)
MDGc1 Millennium Development Goal c1
N4G Nutrition for Growth
NCD Non-Communicable Disease
NDICI Neighbourhood, Development and International Cooperation Instrument
NGO Non-Governmental Organisation
NNP II Second National Nutrition Programme (Ethiopia)
NSSS National Social Security Strategy (Bangladesh)
PAPS II Sectoral Health Budget Support Programme in Burkina Faso
PFOA Food Fortification Project for Vulnerable Populations in Madagascar
SDGs Sustainable Development Goals
SETSAN Secretariat for Food and Nutrition Security (Mozambique)
SESAN Food and Nutrition Security Secretariat (Guatemala)
SUN Scaling Up Nutrition
TWG Technical Working Group
UN United Nations
UNICEF United Nations Children’s Fund
UNOPS United Nations Office for Project Services
WASH Water, Sanitation and Hygiene
WHA World Health Assembly
WHO World Health Organization
 2 P ROJEC T S T H AT WO R K FO R IM P ROV ED N U T RI T ION

Table of Contents
Introduction_________________________________________________________________________________3

Map of the projects__________________________________________________________________________4

Sectoral health budget support programme in Burkina Faso (PAPS II)_______________________________6

Suchana: 2016-2022 - Ending the cycle of undernutrition in Bangladesh____________________________7

AGPII: Harnessing agricultural investments

to improve the diets of women and children in Ethiopia___________________________________________9

Development Initiative for Northern Uganda (DINU)_____________________________________________11

The MDG1c programme:

building resilience for better diets in Mozambique__________________________________________________ 12

EU support to National Social Security Strategy (NSSS)

reforms in Bangladesh 2019-2024____________________________________________________________14

EU Resilience Trust Fund in the northern areas of Burkina Faso (2017-2020)________________________15

Building Resilience through Social Transfers for Nutrition Security in The Gambia (BReST)____________17

Support to the Lao PDR National Nutrition Strategy and Plan of Action_____________________________19

Food and Nutrition Security (FNS) Sector Reform Contract –

EUROSAN Local Development (DeL) in Honduras 2020-2024______________________________________20
 3 P ROJEC T S T H AT WO R K FO R IM P ROV ED N U T RI T ION

Introduction
The Tokyo Nutrition for Growth (N4G) Summit December 7-8, 2021 comes at a critical time: mid-way through the
United Nations (UN) Decade of Action on Nutrition, we have nine years to reach the Sustainable Development Goal
(SDG) 2 − ending hunger and malnutrition in all its forms by 2030 − and four years to achieve the World Health
Assembly (WHA) targets on maternal, infant and young child nutrition.

Important progress has been achieved in the ongoing decline in child stunting. However, even before the COVID-19
pandemic, the world was not on track to achieve targets for any nutrition indicators by 2030. More than ever, our
shared efforts to learn and apply important lessons from the experience of what has worked and not in recent years
are going to make the difference between our collective success and failure.

Focusing on the critical roles of food, health and social protection systems in delivering good nutrition for all, the
Summit provides a historic chance to transform our way of tackling the global challenge of malnutrition, and to
deliver renewed action on policy and financing commitments to SDG 2, which again is an underlying driver for
12 of the 17 SDGs.

The European Union's approach for improved nutrition is a sustained, multi-sectoral, gender-transformative and
rights-based approach. Therefore the EU has invested in both support for inclusive, sustainable food systems −
encompassing economic, social and environmental dimensions of sustainability – and in the public provision of
universal health, education and social protection services. The transformation of entrenched inequalities, such as
those related to wealth and gender, remains a fundamental cross-cutting priority.

Spanning the world from Burkina Faso, Ethiopia, Gambia, Mozambique and Uganda in Africa, to Bangladesh and Lao
PDR in Asia and Honduras in Latin America, the case studies highlighted in this booklet represent a range of different
country contexts. The studies show how the European Union is supporting partner countries and how resources are
being transformed into results. They demonstrate measurable improvements in the lives of women and children,
whether in terms of breastfeeding, dietary quality, household resilience, food security or stunting reduction.

A happy girl in Fada,

in the East of Burkina Faso.
© UNICEF/UN0487716/Dejongh
4 P ROJEC T S T H AT WO R K FO R IM P ROV ED N U T RI T ION

Map of the projects

THE GAMBIA
Building Resilience through Social Transfers for
Nutrition Security in The Gambia (BReST): 2016-2020
In alignment with the National Development Plan, BReST
strengthened the resilience and improved nutrition security
by establishing a nutrition-sensitive social protection
approach. The prevalence of acute malnutrition in children
under 2 years decreased from 5.6% to 2.2%, and rates
improved for exclusive breastfeeding, dietary diversity in
infants 6-24 months, infant and young child feeding and
hygiene practices, and household economic resilience.

HONDURAS
Food and Nutrition Security (FNS)
Sector Reform Contract - EUROSAN
Local Development (DeL)
in Honduras: 2020-2024
Budget support and complementary
technical assistance for local
development initiatives to improve
access to nutrition services for over
160 000 pregnant women and children
under five in 39 municipalities.

BURKINA FASO
EU Resilience Trust Fund in the northern areas of Burkina Faso
(EU-TF Resilience-BF): 2017-2020
Adopting a holistic approach to strengthening resilience through
improved local governance, access to services, social protection and
livelihood support, EUTF-Resilience made it possible to reduce
severe food insecurity by 20% in two years and to significantly
prevent stunted growth in children under 5, by 10% for moderate
forms and by 33% for severe forms.

Sectoral health budget support programme in Burkina Faso

(PAPS II): 2016-2020
PAPS II supported national efforts to strengthenthe public health
system with a focus on prevention and treatment of acute
malnutrition. From 2017 to 2020, more than 90% of the children
treated were cured and the number of children supported by the
Government’s Therapeutic Foods budget line increased from none in
2016 to 100 000 in 2019.
5 P ROJEC T S T H AT WO R K FO R IM P ROV ED N U T RI T ION

BANGLADESH
Suchana: 2016-2022
The project takes a multi-sectoral approach that involves working
UGANDA closely with seven ministries to diversify livelihoods and income,
empower women, and improve access to key services. Among the
Development Initiative for project results, women’s and children’s (6-23 months) diets have
Northern Uganda (DINU): improved, women’s dietary diversity has almost doubled, and the
2017-2023 number of children getting a minimal acceptable diet has more than
tripled, while severe household food insecurity has more than halved.
In 38 districts community-based
nutrition interventions were scaled
up along with interventions to EU support to National Social Security Strategy (NSSS)
promote the production of reforms in Bangladesh: 2019-2024
diversified healthy foods while at Supporting the introduction and scale up of the flagship national
the same time empowering nutrition sensitive child benefit programme, covering 7.5 million
women across the food system. children in rural and urban areas.

ETHIOPIA
Second Agricultural Growth
Programme (AGPII): 2015-2020
Implemented by the Ethiopian
Government within the framework of LAO PDR
the NNPII, this flagship programme
contributed to sustainable
Support to the Lao PDR National Nutrition
agricultural transformation while
Strategy and Plan of Action: 2019-2022
improving the food and nutrition
security of vulnerable groups. Backing the Government’s commitment to
Children in the regions of intervention deliver quality nutrition services, including via
are now consuming more pulses, agriculture, education and health, as well as the
grains, roots, tubers, fruits, adoption of a decree to protect and promote
vegetables and animal and milk breastfeeding (‘Decree on Food Products and
products than previously. Feeding Equipment for Infants and Toddlers’)

MOZAMBIQUE
Millennium Development Goal c1 (MDGc1): 2013-2019
Adopting a holistic approach, MDGc1 addressed undernutrition in areas
with high agricultural potential but poor nutrition. The share of
food-insecure households was halved, thereby increasing resilience to
shocks; the diversity of children’s diets improved, as did the diets of
women and adolescent girls; and the prevalence of child stunting fell by
5 percentage points at district level, while breastfeeding doubled.
 6 P ROJEC T S T H AT WO R K FO R IM P ROV ED N U T RI T ION

Sectoral health budget support

programme in Burkina Faso (PAPS II)

A baby is being weighted, measured and vaccinated

in Boulpore, the central plateau region of Burkina Faso.
© UNICEF/UN0487638/Dejongh

Programme Sectoral Health Budget Support Programme in Burkina Faso (PAPS II) 2016-2020

Implementation: Government of Burkina Faso. Budget: EUR 84 million (of which

EUR 14 million technical assistance and EUR 70 million budget support).

Objective Building on several years of EU humanitarian assistance – including treatment of severe

acute malnutrition – PAPS II supported national efforts to strengthen public systems for the
achievement of universal health coverage.

Achievements Creation of a national budget line for the purchase of therapeutic food:
The number of children affected by severe stunting and supported by the government’s
Therapeutic Foods budget line increased from none in 2016 to 110 000 in 2019.

Integration of indicators for tracking both the quality of acute malnutrition

management and the number of children in care within the health system:
The increasing integration of severe acute malnutrition care into the health system has
not compromised the quality of care. From 2017 to 2020, more than 90% of the children
treated were cured.

Supporting the operationalisation of the National Health Insurance Fund with the
exemption of children aged 0-5 and pregnant women:
The programme has contributed to building a social contract between families and the
health system, together with the political commitment required to ensure that the most
vulnerable are not left behind.

Ensuring annual nutrition data to reinforce government commitment and accountability

at all levels: Annual nutrition surveys are now routinely financed from the national budget.
 7 P ROJEC T S T H AT WO R K FO R IM P ROV ED N U T RI T ION

Suchana: 2016-2022 - Ending the cycle

of undernutrition in Bangladesh

Women coming back from the field, Dhaka Hills, Sreemongal, Bangladesh. © EU © UNICEF/UN0487638/Dejongh

Malnutrition in Bangladesh
While Bangladesh could potentially still meet the global target for 2025 (25%) and child stunting has fallen by 12
percentage points between 2007 and 2017-18, child stunting remains highly prevalent (31%)1. One in 12 children
under the age of five also suffer from wasting – associated with weakened immunity and increased risk of death.
At the same time, and with 40% of adult women anaemic, overweight and obesity continue to rise at national level.
Undernutrition comes with high social and economic costs, which disproportionately affect the poorest households.
Globally, nutrition-related factors are estimated to contribute to about 45% of deaths in children under-5 years of
age2. Undernutrition has lifelong consequences: by undermining a child’s physical and cognitive development, it can
lead to long-term reduction in productivity and a greater risk of chronic diseases later in life. The economic cost of
undernutrition is estimated to exceed USD 1 billion per year in Bangladesh3.

Suchana (2016-2022)
Suchana is a EUR 53.8 million programme jointly supported by the EU and the UK Foreign, Development and
Commonwealth Office (FCDO). It aims to significantly reduce the incidence of stunting in children under two in two
districts of Sylhet Division (which has the highest stunting and wasting prevalence, as well as the worst levels of
gender inequality in Bangladesh). The programme’s multi-sectoral approach focuses on tackling undernutrition within
the critical 1 000 days from conception until children reach their second birthday. This involves working closely with
key ministries representing multiple sectors to strengthen delivery systems and improve people’s access to key
nutrition-related services as well as directly empowering women and men through support to income-generating
activities, homestead gardening and awareness about health and nutrition. At the same time, Suchana is harnessing
evidence of progress to catalyse support from government and other stakeholders to scale up a multi-sectoral
approach and improve nutrition governance across the country. Core programme targets include:

1 Bangladesh Demographic Health Survey (2018).

2 WHO (2019); https://www.who.int/news-room/fact-sheets/detail/children-reducing-mortality
3 Howlader, S.R. et al. 2012. Investing in Nutrition Now: A Smart Start for Our Children, Our Future.
 8 P ROJEC T S T H AT WO R K FO R IM P ROV ED N U T RI T ION

• livelihood diversification and increased income for 1.3 million people;

• empowering 68 000 adolescent girls from poor households to extend school attendance and prevent child marriage;
• delivering improved nutrition services through the local health system to a quarter of a million poor households.

To ensure that nutritionally vulnerable households and individuals are better able to absorb climatic, health and
economic shocks, a key component of the programme focuses on increasing access to government social protection
schemes, including maternity allowance4. Suchana is implemented by a consortium of national and international
NGOs led by Save the Children.

Tangible results in the lives of women and children

Suchana has been designed to boost knowledge and evidence and so promote commitment and momentum for
change. Following the collection of baseline data in 2016, the results of the impact assessment (2019-2020) confirm
significant improvement, even when compared to the control group. Driven by the boost to household income and
savings, severe household food insecurity has more than halved, while women’s dietary diversity has almost doubled.
The rate of exclusive breastfeeding has increased by more than 20% and the number of children aged 6-23 months
getting a minimally acceptable diet has more than tripled.

Outcomes5 2017 2018 2020

Median income per year (Taka) 80 000 86 000 96 000

Households with any savings 34.5% 34.3% 56%

Severe food insecurity 29% 19% 13%

Women’s diet 27% 34% 53%

Children’s diet 10% 15% 35%

Exclusive breastfeeding 62% 73% 85%

Women’s empowerment 27% 45% 56%

Realising human potential

Access to adequate nutritious food is a fundamental human right and provides the foundation for healthy individuals
and societies. Suchana reinforces Bangladesh’s national plan of action for nutrition by demonstrating that efforts to
improve the nutrition of women and children should be understood as an investment in realising human potential,
rather than a cost. Using a rights-based and gender-transformative strategy, Suchana positions women’s political,
social and economic empowerment centre-stage: for example, by supporting women to establish village savings and
loan groups to strengthen their decision-making in the household, while at the same time ensuring men’s participa-
tion in education and counselling sessions on maternal and child nutrition.

Tackling climate and environmental challenges

Bangladesh is uniquely vulnerable to climate change, with two-thirds of the country less than five metres above
sea level. In 2017, severe flooding was experienced across the intervention area. Suchana has taken concrete
steps to support beneficiaries to adopt climate-resilient livelihoods and disaster preparedness practices to increase
resilience to shocks and stresses. Interventions include production diversification, eco-friendly cropping patterns
and climate-smart cultivation techniques. Early warning systems have been introduced to help beneficiaries to get
information and knowledge on short-term/rapid climatic hazards (such as cyclones, floods and storms), as well as
long-term/slow hazards (such as drought and long-term climate change).

4 The EU also supports the Government of Bangladesh (via budget support) to scale up national coverage of maternity allowance and child benefit. A programme
reorientation is enabling the provision of income support to garment workers who have lost their livelihoods as a result of the COVID-19 outbreak in the country
5 Results from Suchana Impact Assessment undertaken by icddr,b. Baseline data collected in 2016. Endline data in 2019. Internationally recognised indicators used:
for severe food insecurity, household level; for women’s diet, minimum dietary diversity for women; for children’s diet, the minimum acceptable diet; for women’s
empowerment, decision making power of mothers (major household purchases).
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AGPII: Harnessing agricultural

investments to improve the diets
of women and children in Ethiopia

Boys playing in a market, Ethiopia. © EU

Malnutrition in Ethiopia
Ethiopia has set ambitious targets to reduce malnutrition and has made considerable progress on reducing stunting
among children under five. However, stunting is still very common (38%): over 6 million children are affected by
stunting and 1 in 10 suffer from wasting. Only 7% of children aged 6 to 23 months get a minimum acceptable
diet6. One in 4 adult women are anaemic. At the same time the number of overweight and obese children and adults
continues to rise. Malnutrition continues to undermine national development efforts: the cost of undernutrition has
been estimated at 16.5% of annual GDP7.

Second agricultural growth programme (2015-2020)

AGPII is a EUR 418 million flagship programme implemented by the Ethiopian Government within the framework of
its second national nutrition programme (NNPII). AGPII is supported by multiple donors8 including the EU (EUR 45 m)
along with Member States, Spain and the Netherlands. The goal of AGPII is to contribute to sustainable agricultural
transformation while improving the food and nutrition security situation of vulnerable groups. The programme focuses
on areas of considerable agricultural potential in seven regional states9 with high stunting prevalence. More than
20 million smallholder farmers are expected to benefit from the intervention while 1.6 million smallholders (40% of
them women) are direct beneficiaries. The programme components include public support services for agriculture,
agricultural research, small-scale irrigation, agriculture marketing and value chain promotion. EU support includes
a EUR 5 million complementary action designed to accelerate the provision of nutrition training and promotion of
nutrition-sensitive technologies to farmers. This component also develops nutrition-related capacities for the delivery
of public services across agriculture, education and health sectors. Overall, AGPII reinforces the focus of the NNPII on
tackling the underlying causes of malnutrition via a multisectoral approach10.

6 Ethiopia Demographic and Health Survey 2016.

7 The Social and Economic Impact of Child Undernutrition in Ethiopia, UNECA/WFP 2013.
8 The principal donor is the World Bank (USD 350 million), along with the EU, USAID, Canada, Spain and the Netherlands.
9 Amhara, Oromia, SNNPR, Tigray, Benshangul-Gumuz, Gambella and Harar as well as Dire Dawa city administration.
10 This follows a narrower focus during the first phase to address the more immediate causes and treatment of malnutrition.
 10 P ROJEC T S T H AT WO R K FO R IM P ROV ED N U T RI T ION

Tangible results in the lives of women and children

AGPII closely monitors the links between agriculture and nutrition outcomes along the dietary pathways of women
and children. Improving complementary feeding of children aged 6 to 23 months has been identified as a crucial
pathway to prevent stunting in Ethiopia11. While very few Ethiopian children get a minimum acceptable diet and
the diet of most mothers is inadequate, the programme has already led to significant changes between 2017
and 2019. Children in the regions of intervention are now consuming more pulses, grains, roots, tubers, fruits,
vegetables and animal and milk products than previously12. Data from the outset of the programme showed that
in female-headed households surveyed no young children were getting an acceptable diet. As a result of AGPII this
is beginning to change.

Outcomes13 2017 2019

Children's diet in male-headed households 5.4 % 9.3 %

Children's diet in female-headed households 0% 6.7 %

Women's diet 17.9 % 30 %

Household diet 65 % 84 %

Realising human potential

Ethiopia’s NNPII adopts the lifecycle approach with a particular emphasis on the crucial period of pregnancy and the
first 2 years of life (first 1 000 days) during which good nutrition and healthy growth deliver lasting benefits throughout
life. AGPII is playing a fundamental role in raising awareness of the contribution that nutrition-sensitive agriculture
and food systems play in achieving this goal. However, addressing the overlapping inequalities of wealth and gender
remains a challenge. AGPII therefore focuses on rural households with access to limited resources and specifically
ensures the inclusion of women farmers. Support is explicitly provided to build the capacity, representation and
financing of women in agriculture through a transformative approach. Attention is given to ensuring that the workload
of women is not exacerbated through access to relevant information, labour-saving technologies and regular gender
impact evaluations.

Tackling climate and environmental challenges

Ethiopia is especially vulnerable to climate change. AGPII is therefore committed to mainstreaming climate smart
agriculture (CSA) approaches across the entire programme, thereby providing an important contribution to Ethiopia’s
climate resilient green economy strategy. The programme also includes the establishment of a climate advisory
service across the agricultural extension system to promote CSA technologies while supporting improved conservation
and management of the natural resources upon which farmers and pastoralists depend.

11 Baye, Kaleab et al, Irrigation and women’s diet in Ethiopia: A longitudinal study. IFPRI Discussion Paper 1864, 2019.
12 Kuma, T., Changes in household and children’s dietary diversity in AGP intervention areas, Policy Studies Institute, December 2019.
13 The Policy Studies Institute AGPII Impact Evaluation Report, May 2019, has applied internationally recognised indicators: for children’s diet, the Minimum Acceptable
Diet 6-23 months; for women’s diet, the Dietary Diversity Score for pregnant women; for household diet, the Household Dietary Diversity Score.
 11 P ROJEC T S T H AT WO R K FO R IM P ROV ED N U T RI T ION

Development Initiative
for Northern Uganda (DINU)

A member of the Jujumbu farmers group which is made up

of refugees and host community members in Lobule, northern Uganda.
© WFP/Hugh Rutherford

Programme Development Initiative for Northern Uganda (DINU) 2017-2023

Implementation: Office of the Prime Minister, UNICEF and various non-state actors. Budget:
EUR 150.6 million (EU contribution EUR 132.8 million).

Objective The programme operates in areas where there is high prevalence of child stunting and
anaemia in women (covering 38 districts) and aims to scale up interventions that will
increase household incomes and improve food security and nutrition as well as strengthen
markets and promote gender responsive governance.

Achievements Scaling up of community-based nutrition interventions:

These include maternal and young child feeding practices, micronutrient supplementation,
improved hygiene, sanitation and child care practices and family planning.

Interventions to strengthen food supply chains: These include increasing production of

diversified, nutritious foods (plant-based and animal products), while also empowering
women in both agriculture and business sectors as well as improving market accessibility
and transport infrastructure.

Nutrition governance: Aligned with guidance from the Office of the Prime Minister, this
includes investing in gender-sensitive capacity development at district level so as to support
local government efforts to more effectively plan, monitor and coordinate the scale-up of
multi-sectoral interventions prioritised in district nutrition action plans for 2020-2025.

Improved data collection and analysis: Information systems are strengthened at district
and sub-county levels that are critical to understanding and monitoring the situation of food
security and nutrition, including regular assessments.
 12 P ROJEC T S T H AT WO R K FO R IM P ROV ED N U T RI T ION

The MDG1c programme:

building resilience for better diets in Mozambique

Caption: Group photo of youth, Mozambique. From the project Sesame and Honey 2020. © EU. Credit: Ellie Tomassi

Malnutrition in Mozambique
Mozambique’s strong economic performance has not been accompanied by a significant reduction in malnutrition.
At 43%, the national prevalence of child stunting remains very high14. With more than 2 million stunted children,
Mozambique is off-track to meet global nutrition targets on stunting, and children from the poorest households are
disproportionately affected. At the same time anaemia affects almost 7 out of 10 children and more than half of
women, while overweight and obesity is increasing across all groups. The causes of malnutrition are multi-faceted
and include poor diets, inadequate childcare, inability to access a quality education and health services, unsafe water
and sanitation, gender inequalities and persistent multidimensional poverty. Malnutrition – in all its forms – comes
with unacceptably high, yet preventable, human, social and economic costs. Mozambique loses over 10.9% GDP each
year to child stunting alone, equivalent to USD 1.6 billion15.

Accelerate progress towards MDG1c in Mozambique (2013-2019)

This EUR 87 million16 programme was funded under the EU MDG1c initiative to reduce hunger and undernutrition
in areas with high agricultural potential but poor nutrition17. Adopting a holistic approach, the programme’s aims
included improving agricultural and fisheries production to increase access to food and improving the nutrition
status of vulnerable groups and low income households, with a focus on women and young children. Interventions
included strengthening value chains in the agricultural and fisheries sectors, farmer field schools, e-vouchers,
home gardens, food fortification, strengthening market information systems and nutrition education (including
social behaviour change).

14 Mozambique DHS 2011; SETSAN Baseline Study 2013.

15 The Cost of Hunger in Africa (COHA) Mozambique study 2017.
16 EU support EUR 77.3 million including EUR 10 million top-up following El Niño emergency in 2016.
17 The programme’s geographical focus is on the Beira and Nacala corridors (76 districts in 10 provinces).
 13 P ROJEC T S T H AT WO R K FO R IM P ROV ED N U T RI T ION

Covering six ministries, the action was designed to reinforce existing national programmes and implementation
brought together three UN agencies: IFAD, FAO and WFP. Crucially, programme coordination and monitoring were
in the hands of the government’s technical secretariat for food and nutrition security (SETSAN). As identified by a
2015 midterm review, achieving a multi-sectoral approach to address nutrition at scale can be challenging. Key
lessons learned have included the importance of adapting the programme to local contexts, strengthening nutrition
governance and developing nutrition-related capacities of service providers at every level.

Tangible results in the lives of women and children

An evaluation of the MDG1c programme confirmed a measurable improvement in the food security, diet and nutritional
status of children as compared to control groups who did not benefit from the programme18. In particular, the share
of food-insecure households was halved, thereby increasing resilience to shocks; the diversity of children’s diets
improved, as did the diets of women and adolescent girls19, and the prevalence of child stunting fell by 5 percentage
points at district level. A particularly important finding was that the gains in food and nutrition security were much
higher for households reached by the greatest range of interventions.

Outcomes20 2013 2018

Stunting 45 % 40 %

Food insecurity 31 % 16 %

Coping strategy index 45 % 20 %

Exclusive breastfeeding 27 % 54 %

Children's diet 30 % 35 %

Realising human potential

Malnutrition on the scale found in Mozambique has long term negative consequences in terms of poor health, low
levels of child development and reduced productivity leading to lower incomes. Social and economic inequalities
between men and women can exacerbate poor nutrition while good nutrition and gender equality are mutually
reinforcing. The programme set out to address gender inequalities with a number of interventions (such as farmer
field schools for women and men, mothers’ care groups, and women’s savings groups) to ensure positive effects
on women’s empowerment. One women’s savings group in Barue (Beira corridor) saw women start up successful
businesses with the additional income allowing families to improve or build a new house or afford a better education
for their children. As a result, the programme has contributed directly to breaking the cycle of deprivation connected
to maternal disadvantage and malnutrition.

Tackling climate and environmental challenges

Mozambique is one of the countries most vulnerable to natural disasters and climate change and in recent years has
faced repeated emergencies. The severe El Niño drought in 2016, followed by two cyclones in 2019, caused widespread
damage to already vulnerable livelihoods and further deterioration of food insecurity. During the humanitarian
and early recovery response period, e-vouchers developed and institutionalised by the MDG1c programme worked
effectively to distribute assets to affected populations. Communities were able to become more resilient by having
better knowledge on how to prevent disease, improved crop production during the lean season and periods of crisis,
and the building of community assets such as irrigation schemes, water harvesting systems and roads.

18 SETSAN (2018) Endline Study (district level) and Impact Evaluation (community level) of MDG1c programme in Mozambique. Note: limitations of the Endline Study
do not allow to attribute impact only to MDG1c while there is a greater level of confidence with the Impact Evaluation.
19 Evaluation of IFAD/PROMER agricultural marketing interventions showed the Minimum Dietary Diversity for Women indicator improved both for women (from 28%
to 40%) and adolescent girls (from 55% to 68%) between 2017 and 2018.
20 Internationally recognised indicators used: for food insecurity, the Food Consumption Score; for coping strategy index, the Reduced Coping Strategy Index; for
children’s diet, the Minimum Dietary Diversity.
 14 P ROJEC T S T H AT WO R K FO R IM P ROV ED N U T RI T ION

EU support to National Social Security Strategy

(NSSS) reforms in Bangladesh 2019-2024

A woman kisses her daughter

in Shonir Akhra Bazar, Dhaka, Bangladesh.
© UNICEF/UN0336451/Babajanyan/VII Photo

Programme EU support to National Social Security Strategy (NSSS) reforms in Bangladesh 2019-2024

Implementation: Government of Bangladesh. Budget: EUR 150 million (EU contribution

EUR 130 million; German contribution EUR 20 million).

Objective The support strengthens national efforts to break the cycle of poverty by improving the
efficiency and effectiveness of social assistance programmes with a strong focus on
improving the diets of pregnant women and children under the age of five as well as
protecting vulnerable workers.

Achievements Strengthening governance and accountability frameworks for a more demand-

responsive social security system: This is achieved by consolidating inter-ministerial
coordination mechanisms and strengthening public financial management in the sector,
including planning, budgeting and execution.

Developing national capacities to more effectively design, manage and monitor the
social security system: These include evidence-based policy formulation, planning and
implementation through robust systems for information management, monitoring and
evaluation (including monitoring the nutritional status of pregnant women and children).
Three out of four young children in Bangladesh do not receive a minimally acceptable diet.

Support to the introduction and implementation of a comprehensive national child

benefit programme: This support aims to ensure inclusiveness, optimum coverage,
adequacy and predictability of benefits to initially cover 7.5 million children in rural and
urban areas, and then progressively scale up.

Providing a platform for the 2020 Team Europe response to the COVID-19 crisis in
Bangladesh: This platform is enabling the delivery of income support to ready-made
garment and export-oriented industry workers affected by the COVID-19 crisis.
 15 P ROJEC T S T H AT WO R K FO R IM P ROV ED N U T RI T ION

EU Resilience Trust Fund in the northern areas

of Burkina Faso (2017-2020)

A woman sifts flour, which will be used to bake

biscuits to sell in local markets in Garango,
Burkina Faso. ©IFAD/Aubrey Wade

Malnutrition in Burkina Faso

Malnutrition levels in Burkina Faso are declining steadily since two decades. Yet, one child out of four is still stunted21,
totalling nearly one million, and due to the strong population growth, the numbers are falling only marginally. Each
year the country loses nearly 8% of GDP to child stunting alone22. In the most fragile areas of the country, affected
by chronic food insecurity and crumbling social cohesion, the prevalence of malnutrition is even higher: in the Sahel
region for instance stunting prevalence reaches 43%23. The response to this situation requires a holistic approach
supporting the most vulnerable populations in various aspects of their lives, whether social or economic.

EU Resilience Trust Fund in the northern areas of Burkina Faso (2017-2020)

The EUTF Resilience-BF is an EU-funded EUR 31.7 million programme covering 4 regions in northern Burkina Faso,
reaching nearly 950 000 beneficiaries. These rural populations are chronically affected by food and nutrition insecurity,
and social instability and insecurity issues are growing. The goal is to strengthen the populations’ resilience through
sustainable and integrated measures. Adopting a holistic approach, the EUTF Resilience-BF specifically aims to:

1. improve populations’ access to basic social services (health, nutrition, water and sanitation);
2. restore and strengthen vulnerable livelihoods through interventions in small-scale agriculture and livestock,
income generating activities, cash transfers and social cohesion;
3. enhance the cohesion between civil society, vulnerable populations and local authorities for improved governance
in food and nutrition security.

This multisector/actor approach triggers synergies and strengthens the capacities of every stakeholder in responding
to the challenges. Despite the extremely fragile context, all the interventions are carried out in close collaboration
with local communities and decentralised extension services. Building on the interventions, a research protocol has
been put in place to identify good practices in resilience strengthening.

21 Enquête Nutritionnelle Nationale SMART 2020.

22 The Cost of Hunger in Africa (COHA) Burkina Faso study 2015.
23 Enquête Nutritionnelle Nationale SMART 2020.
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Tangible results in the lives of women and children

The EUTF Resilience-BF impact assessment24 confirmed a significant improvement after only two years (between
2018 and 2020) in the food security, livelihoods, and nutritional status of children25. Spectacular gains in food and
nutrition security were reached for those households benefitting from a full intervention package of:

1. monthly cash transfers,

2. productive assets such as vouchers to access sheep and goats and poultries, and/or seeds, support for soil
conservation and fertility,
3. nutrition interventions (generally enriched flour for 6-23 months children and pregnant and breastfeeding
women, nutrition education).

The combined effect of these interventions for the poorest households made it possible to reduce severe food
insecurity by 20% in two years and to significantly prevent stunted growth in children under 5, by 10% for moderate
forms and by 33% for severe forms.

Outcomes (intervention group full package) Initial rate + 1 year + 2 years

Stunting 36.7 % 29.4 % 27.1 %

Severe food insecurity26 30.8 % 24.7 % 17.1 %

However, there were no significant changes in the control groups that received only a partial package (cash transfer
only and cash transfer coupled with animal transfers). This suggests that to significantly improve the nutrition of
children in these highly vulnerable households, it is necessary to implement specific nutrition activities such as
distribution of enriched flour to young children and training of mothers, alongside economic support. Households
benefiting from the full activity package were also able to increase their land by 13%.

Realising human potential

The negative consequences of malnutrition are long term and undermines the fundamental right of every child to
develop in accordance with their full potential. The severe instability and insecurity faced by these Sahel populations
further exacerbate poor nutrition as well as gender, social and economic inequalities. The EUTF Resilience-BF shows
it is possible, even for the most marginalised populations living in fragile contexts, to gradually escape from a logic
of simple survival to one of improving human and economic capital. Furthermore, to contribute to social stability in
these areas undergoing massive social and environmental changes, it is essential to reduce inequalities − economic,
gender, power balance − and extreme poverty. However, this requires tailoring of approaches to the context combining
social cohesion measures, coaching, organisational support, and so on. For instance, by empowering women to set
up village savings and loan groups, EUTF Resilience-BF enabled also the poorest women to add commercial value to
their agricultural products, generating jobs and incomes

Tackling climate and environmental challenges

The Sahel is one of the world’s most vulnerable regions to natural disasters and climate change and has in recent years
faced repeated emergencies. By partnering effectively with decentralised government services and civil society, the
EUTF Resilience-BF set out a good example to improve local governance accountability and civil society participation,
thereby showing the value of territorial approaches in local development. In a context where local authorities are
affected by lack of resources to effectively implement decentralisation, positive experiences were demonstrated in
better and more responsible water management, public works and resource management. Improving the relationship
of trust between local authorities and citizens also made it possible to improve the payment of local taxes − in 7
communes, these increased by 20% − making it possible to initiate other local actions.

24 Research carried out through Innovations for Poverty Action (IPA).

25 A total of 168 villages were randomly assigned to either the comparison group (receiving community-based nutrition awareness/education only), or to the
participation group. Households in the participation villages were then randomly assigned to one of 3 intervention components: 1) cash grant; 2) cash grant + asset
(livestock voucher); 3) cash grant+ asset + nutrition (fortified food).
26 In IPA research, food insecurity is measured through CARI indicators, food security index and dietary diversity.
 17 P ROJEC T S T H AT WO R K FO R IM P ROV ED N U T RI T ION

Building Resilience through Social Transfers for

Nutrition Security in The Gambia (BReST)

A woman watering a tomato garden. © WFP/Mamadou Jallow

Malnutrition in The Gambia

Over the past 10 years, The Gambia has made considerable progress in reducing the prevalence of stunting (13.6%)
and wasting (6%) among children under five, despite poor basic services, inadequate sanitation, fragile food and
nutrition security and the current COVID-19 pandemic. However, there are significant disparities between the west
(capital Banjul) and the east of the country, up-river, where rural households are poorer and gender inequalities
prevail. In recent years, iron deficiency has increased among both children and women, and anaemia affects 57.5% of
women of reproductive age. The Gambia remains one of the poorest countries in sub-Saharan Africa. It ranked 148th
out of 162 countries in the 2019 Gender Inequality Index, with a value of 0.61227. In a context of high population
growth, low agricultural production and diversification, frequent droughts and poverty contribute to people’s food
insecurity and malnutrition, particularly among children.

BReST (2016-2020)
Building Resilience through Social Transfers for Nutrition Security in The Gambia (BReST) was a European Union-
funded (EUR 3 million) programme covering three of the country’s regions: Upper River Region, North Bank Region, and
Central River Region. In line with the National Development Plan (NDP) 2018-2021, BReST’s goal was to strengthen
resilience and improve the nutritional status of breastfeeding women and children under 2. BReST was specifically
mentioned in the NDP as a key social protection initiative to address vulnerabilities. It was implemented by the United
Nations Children’s Fund (UNICEF), in partnership with two main government partners, the National Nutrition Agency
(NaNa) and the Ministry of Women, Children and Social Welfare (MoWCSW). BReST combined cash transfers (GMD
60028/month per mother-child pair) with a strong nutrition education component, through two interrelated pathways:

1. resilience-building through cash transfers,

2. improved nutritional and care practices through nutrition education and hygiene promotion targeting mothers.

27 The European Commission Gambia Nutrition Country Profile 2021 (in press) is the main source, based on data from the UNICEF/WHO/ World Bank Joint Child
Malnutrition Estimates, the Global Nutrition Report, and the UNDP Gender Inequality Index.
28 600 Gambian dalasi equals about 10 euro.
 18 P ROJEC T S T H AT WO R K FO R IM P ROV ED N U T RI T ION

It also sought to improve the implementation of related Government policies through strengthening the social
protection capacities of government partners and civil society organisations. The project targeted regions with the
highest infant malnutrition rates.

Tangible results in the lives of women and children

BReST created a continuum of care for women and children during a key life stage (the first 1 000 days) by supporting
mothers to diversify their diets and access health and nutrition services. The programme registered 6 176 mother
and child pairs, exceeding the original target of 5 850 beneficiaries. On payment days, the women took part in an
hour long health and nutrition education lesson, focusing on different aspects of infant and young child feeding (IYCF)
practices. In parallel the health facility staff monitored the children’s growth and provided Vitamin A supplementation
and deworming tablets where needed. Mothers requiring additional counselling beyond the monthly IYCF sessions
were identified and received follow-up support at the household and community level. The final evaluation of BReST
confirmed that the prevalence of acute malnutrition in children under 2 decreased from 5.6% (2016) to 2.2% (2019).
Higher rates of exclusive breastfeeding improved dietary diversity in infants of 6-24 months and improved IYCF and
hygiene practices; improved household economic resilience was also reported29.

Outcomes 2013 2018

Acute malnutrition (children under 2) 5.6% 2.2%

Individual dietary diversity 34.2% 55%

Minimum meal frequency (infants 6-24 months) No data 63%

Dietary diversity (infants 6-24 months) No data 81.9%

Exclusive breastfeeding 52% 93%

Realising human potential

The BReST programme is anchored in a fundamental rights approach. By focusing on the first 1 000 days, BReST
promotes the realisation of mothers’ and children’s rights and potential. BReST strategically advocated for a social
empowerment mechanism that takes a holistic view of malnutrition. This is an important step towards achieving
progressive coverage of social protection policies in The Gambia. The Government has presented the programme
at several conferences, including the Annual National Social Protection Forum and the 62nd UN Commission on the
Status of Women. In January 2020, the Government established a National Social Protection Secretariat with the
support of the EU and development partners. BReST has been adopted as a social protection flagship programme
within the National Development Plan and provides evidence to support social protection as part of an integrated
health, nutrition improvement and poverty reduction strategy30.

Tackling health, economic, climate and environmental challenges

In the Sahel, droughts are becoming more and more intense and have serious consequences for the population,
who live mainly from agriculture. BReST effectively targeted the most vulnerable regions. It promoted ownership by
government services at all levels, which implemented social transfers and collated evidence on the importance of
such a programme. BReST was able to respond to the COVID-19 pandemic by providing emergency cash transfers
to the registered beneficiaries. This proved to be critical in supporting families to cope with the economic challenges
caused by COVID-19 and to sustain gains made during implementation. During the programme, the majority of
women improved their household productive capacity or savings, which in turn reduced negative coping mechanisms,
such as taking a child out of school to save money for food, to economic or climatic shocks. One of the programme’s
unexpected effects has been the improvement of intrahousehold gender dynamics, with the woman and her spouse
discussing whether to spend or save the cash to benefit the health and wellbeing of the children and family.

29 UNICEF, 2021. Building Resilience through Social Transfers for Nutrition Security in The Gambia (BReST). Final Narrative Report: 1 August 2016-31 August 2020.
The video “Building Resilience through Social Transfers for Nutritional Security (BReST)” - YouTube provides a human interest story from the project.
30 Social Policy Research Institute (SPRI), 2020. BReST Evaluation. Evaluation reports | UNICEF Evaluation in UNICEF
 19 P ROJEC T S T H AT WO R K FO R IM P ROV ED N U T RI T ION

Support to the Lao PDR National Nutrition

Strategy and Plan of Action

A girl smiles while drinking water in Adone, Ta Oi District,

Saravane Province, the Lao People’s Democratic Republic.
© UNICEF/UNI182989/Noorani

Programme Support to the Lao PDR National Nutrition Strategy and Plan of Action 2019-2022

Implementation: Government of Lao PDR. Budget: EUR 50 million (complementary support

EUR 11.85 million).

Objective The support reinforces government commitment to accelerate results from the National
Plan of Action on Nutrition (2016-2020) by strengthening accountability for delivery of
quality, multi-sectoral nutrition-related services.

Achievements Ensuring more effective multi-sectoral nutrition-related service delivery with a focus on
women, children and disadvantaged groups: This includes, to date, the operationalisation
of 10 Provincial Nutrition Committees; the development of 35 nutrition-sensitive agriculture
plans; an increase in the number of health facilities with staff trained to manage acute
malnutrition; and an increase in the number of schools with year-round access to potable
drinking water.

National recognition of the significance of the 1 000-day window for nutrition and child
development: The government strongly recommends that babies be exclusively breastfed
for the first six months, and continued breastfeeding with other safe and nutritious food
until the age of two.

Adoption of the Marketing of Breastmilk Substitutes Decree to protect and promote

breastfeeding in the country: The decree is national legislation in line with the International
Code of Marketing of Breastmilk Substitutes (adopted by the WHA in 1981). The code
protects and promotes breastfeeding by ensuring adequate information on appropriate
infant feeding and regulation on marketing of breastmilk substitutes, bottles and teats.
 20 P ROJEC T S T H AT WO R K FO R IM P ROV ED N U T RI T ION

Food and Nutrition Security (FNS)

Sector Reform Contract – EUROSAN Local
Development (DeL) in Honduras 2020-2024

A woman holds her nephew in a hammock,

Conception de Maria, Honduras. @WFP/Julian Frank

Programme Food and Nutrition Security (FNS) Sector Reform Contract – EUROSAN Local
Development (DeL) in Honduras 2020-2024

Implementation: Government together with Spanish Agency for International Development.

Budget: EUR 38.1 million, of which EUR 28.4 million in budget support, including EUR 3.5
million for COVID-19 response support.

Objective The Contract aims to improve access to nutrition services and strengthen the integrated
territorial approach to local development, for improved nutrition of both mothers and young
children in 39 municipalities.

Achievements Decentralisation for improved nutrition-related service delivery: Effective support is

being given to the decentralisation of maternal and child health and nutrition services in
all targeted municipalities, such that over 81 000 children under five years and 82 000
pregnant women have been reached.

Assistance to the government response to COVID-19 across multiple areas:

This has included the provision of electronic cash transfers and emergency food aid
(Bolsa Solidaria) to vulnerable populations, as well as strengthening the overall response
of the public health system.

Technical support for capacity development and guidance at the level of municipalities:
Technical inputs are provided to the Government’s development and adaptation of the
Methodological Guide for the Territorial Management of the Food and Nutrition Security
Policy (within the framework of Municipal Development Plans) and the Food and Nutrition
Security Investment Manual.
 MN-01-21-150-EN-C
MN-01-21-429-EN-N
© European Union 2021

Published by Directorate-General International Partnerships

Directorate Green Deal, Digital Agenda, October 2021

The contents of this publication do not necessarily represent the official position or
opinion of the European Commission. Neither the European Commission nor any
person acting on behalf of the Commission is responsible for the use which might
be made of information in this publication.

Directorate-General International Partnerships

Rue de la Loi 41 – B-1049 Brussels
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ISBN 978-92-76-43553-2
DOI 10.2841/025646