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Evaluation database

Evaluation report

2017 Rwanda: Reducing Stunting in Children Under Five Years of Age: A Comprehensive Evaluation of UNICEF's Strategies and Programme Performance Rwanda Country Case Study

Executive summary

With the aim to continuously improve transparency and use of evaluation, UNICEF Evaluation Office manages the "Global Evaluation Reports Oversight System (GEROS)". Within this system, an external independent company reviews and rates all evaluation reports. The quality rating scale for evaluation reports is as follows: “Highly Satisfactory”, “Satisfactory”, “Fair” or “Unsatisfactory”. You will find the link to the quality rating below, labelled as ‘Part 2’ of the report, and the executive feedback summary labelled as ‘Part 3’.


Approximately 156 million of the world’s children under the age of 5 are stunted, with an estimated 80% of these children concentrated in only 14 countries. Stunting jeopardises child survival and development by contributing to child mortality, morbidity, and disability, including impaired or nonoptimal physical growth and cognitive development. In recent years, the global nutrition community has increased its focus on stunting. Scientific developments have supported the causal relationship between stunting and short-term childhood development, as well as with long-term intergenerational effects on families. These relationships highlight the critical importance of nutrition during the first 1,000 days between a woman’s pregnancy and her child’s 2nd birthday, a period associated with risks of irreversible effects. In addition, research has provided evidence identifying effective, cost-efficient, and scalable interventions to address stunting. Concurrently, the international community working to reduce stunting has recognized lessons learned and models to support multi-sectoral approaches to improving nutrition.
Country selection took into account the range of country contexts where stunting is widely prevalent, giving attention to development settings and to contexts affected by fragility and humanitarian emergencies. Rwanda was selected as one of the two case study countries for the Eastern and Southern Africa region because it has experienced one of the fastest declines in stunting prevalence in the region, but prevalence of stunting remains high. It also represents an opportunity to explore the effects of strong high-level political commitment and decentralised stunting reduction efforts.


This country report was developed to provide evidence of UNICEF Rwanda’s accountability, effectiveness, and organizational learning and to advance its work to reduce stunting among young children in Rwanda.

  1. Assess the relevance, appropriateness, and coherence of UNICEF’s country strategies and plans to address stunting in young children.
  2. Assess the effectiveness, efficiency, and sustainability of UNICEF’s country programmes in addressing stunting in young children, with particular attention to less-reached, disadvantaged, and vulnerable groups, and draw lessons on equitable progress in reducing stunting in various programme contexts.
  3. Assess UNICEF’s leadership, guidance, and technical support, as well as the adequacy of UNICEF staffing and institutional capacity to respond to the lead role the organization is expected to play at the field level in contributing to the sustainable and equitable reduction of stunting.


The evaluation uses a theory-based approach that examines UNICEF efforts to reduce stunting through nutrition-specific and nutrition-sensitive action (see Evaluation Framework in Exhibit 2). The evaluation explores the relevance, appropriateness, and coherence of UNICEF’s global strategic plans; global and regional support; country programmes and plans; the effectiveness, efficiency, and sustainability of country programmes; and UNICEF’s leadership, guidance, and technical support at all levels. The evaluation also considers the extent to which UNICEF engages across sectors to reduce stunting, both internally and externally.

The Rwanda case study relied on four data sources:

  1. Document review of UNICEF-provided documents
  2. Secondary quantitative data
  3. Key informant interviews (KIIs) with UNICEF Rwanda staff and relevant external stakeholders
  4. CO and external stakeholder survey data

Findings and Conclusions:

  • The theory of change for the first proposal includes nutrition-specific components, such as Infant and Young Child Feeding (IYCF) and food availability, and also nutrition-sensitive components of hygiene and health services. It addresses the immediate causes of stunting as well as underlying causes.
  • As per the evaluation framework, the analysis considers both nutrition-specific and nutrition-sensitive interventions included within the Rwanda programme, and in view of the scope of the evaluation the analysis, focuses on the 2012–2016 country programme
  • UNICEF Rwanda’s successful leveraging of EKN and GON funds has been critical to the efficient implementation of nutrition interventions. Staff and financial resources are adequate given stunting programme goals and intended outcomes
  • UNICEF Rwanda promotes the sustainability of its stunting reduction programming, primarily through building ownership at the district and sector levels (a sector is an administrative subdivision of a district).
  • UNICEF has played an integral role in several national coalitions and alliances, 
  • UNICEF Rwanda’s 2013-2018 country programme states that its interventions focus on equity many times, but the overarching approach to equity is not included. Stakeholders identified a number of population groups who were more vulnerable to stunting
  • UNICEF Rwanda’s nutrition programme takes an equity approach to geographical targeting.
  • UNICEF Rwanda funded the collection of subnational stunting data through the DHS.
  • UNICEF Rwanda has been a major player in developing the RapidSMS tool, which collects information on several indicators, including antenatal care (ANC) visits
  • Data availability and promotion has been a key driver of the effectiveness of the UNICEF Rwanda’s stunting reduction approach. The inclusion of subnational stunting data in the DHS, which UNICEF funded, was an important part of this success, as it allowed the targeting of vulnerable geographic areas.


  1. Continue building on the successes of UNICEF’s stunting reduction approach to further reduce stunting in the country. Maintain focuses on behaviour change communication, increasing access to, availability of, and utilisation of nutritious food, and flexibility in implementation approaches. Work with UN partners to initiate a consultative process to better understand and address (within each agency’s mandate) the issues of population density and growth and their effect on stunting. Continue building capacity at national level around stunting as a multi-sectoral issue, making an economic argument when appropriate without overshadowing the human rights dimensions of nutrition.
  2. Document and disseminate lessons learned and recommendations on successful components of UNICEF Rwanda’s stunting reduction initiatives to other stakeholders. Other UNICEF offices have used Rwanda as an example of substantial progress and would benefit from learning about Rwanda’s experience.
  3. Identify vulnerable populations (e.g., refugees, people living with HIV [PLHIV], boys, historically marginalized populations, and disabled children) and determine whether they have nutrition-related needs outside of the interventions that are being provided on a district level. Build considerations of these needs into UNICEF’s approaches in the districts it directly supports and consider working with partners to ensure that refugee populations receive multi-sectoral programming support for reducing stunting, not just acute malnutrition. 
  4. Strengthen accountability and incentive structures for stunting and other nutrition outcomes to facilitate the contribution of expertise from all relevant sectors within UNICEF. Involve nutrition-sensitive sectors from the beginning in programme design and include them in budget allocation discussions.

Lessons Learned:

  1. Lessons on behavior change communication for stunting reduction learned from the 1,000 Days nutrition campaign
  2. Lessons learned on decentralized multi-sectoral programming and implementation, including increasing access to, availability of, and utilization of nutritious food (linkages to agriculture), which is not traditionally seen as UNICEF’s niche
  3. Lessons on joint programming between UN agencies learned from the SDC-funded project implemented by the One UN Joint Nutrition Programme


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