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Evaluation database

Evaluation report

2017 Haiti: Reducing Stunting in Children Under Five Years of Age - Haiti Case Study

Author: Pepe Monroy and Rachel Kagel

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 five 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 non-optimal physical growth and cognitive development. In recent years, the global nutrition community has increased its focus on stunting. Developments in science 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 second 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 recognised lessons learned and models to support multi-sectoral approaches to improvements in nutrition.


Given the global commitments, the United Nations Children’s Fund (UNICEF) contracted with ICF to conduct an evaluation of UNICEF stunting-reduction efforts. The evaluation is the first formal, global attempt to assess UNICEF’s global strategies and country programme performance in reducing stunting among children under the age of five years. The evaluation consists of three related studies: a desk review of documents from 24 globally representative countries, in-depth case studies of UNICEF’s stunting reduction efforts and activities in six countries (which is the focus of this report), and a global synthesis of UNICEF efforts. 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.

The case study addresses three UNICEF objectives:

  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 organisation is expected to play at the field level in contributing to the sustainable and equitable reduction of stunting.


This case study examines UNICEF Haiti’s efforts to address stunting at the national and subnational levels. It considers the extent to which the country programme and related plans support the effective implementation of programme actions at the national and subnational levels, and the alignment and achievement of outputs to improve nutrition.

This report provides an overview of stunting among children under five years of age in Haiti and findings from the case study in seven areas:

  1. Relevance, appropriateness, adequacy, and coherence of strategies and plans
  2. Effectiveness of the country programme in addressing stunting
  3. Efficiency of management and operations
  4. Sustainability and scale-up
  5. Leadership and leveraging partnerships
  6. Equity and reach of disadvantaged children
  7. Knowledge/data generation, management, and use

This report provides conclusions and recommendations for strengthening UNICEF Haiti’s approach to reducing stunting. This report may also be useful to other UNICEF country offices interested in adopting parts of UNICEF Haiti’s approach.

Findings and Conclusions:

Conclusion 1: The country program included some elements related to stunting reduction; however, upstream approaches were excluded and details on specific strategies and interventions were often limited.

Conclusion 2: While progress in addressing stunting has been achieved, the levels of funding and staff were insufficient to adequately address stunting.

Conclusion 3: Multi-sectoral approaches need strengthening.

Conclusion 4: UNICEF Haiti implemented relevant data collection activities using innovative technologies, but data and knowledge gaps remain.


1. Country programme planning:
Develop a TOC for addressing stunting through the UNICEF country programme.
Include nutrition-specific and nutrition-sensitive approaches and interventions to intentionally impact stunting
Clarify approaches and indicators specific to relevant vulnerable groups
Utilise results of geographic mapping of WASH and nutrition needs to identify how geographic convergence of WASH and nutrition can be incorporated in the next country programme document (CPD) and existing activities under the current CPD

2. Use of multi-sectoral approaches:
Conduct capacity-building activities with external stakeholders and partners to build consensus on the multi-sectoral nature of stunting and eliminate conflation of all nutrition interventions with SAM treatment
Continue to refine the approach to integrating work across sections within UNICEF Haiti and across UN agencies (e.g., participate in Food and Nutritional Security Technical Group (GTSAN) meetings)
Stunting efforts would likely benefit from multi-sectoral advocacy efforts, translating lessons each organisation has learned into concrete ideas for government stakeholders

3. Resource leveraging and staff capacity:
Leverage the expertise of nutrition staff to focus on behaviour change for stunting interventions. Central to leveraging is the ability to mobilise adequate funding to maintain staff with expertise in stunting-related activities
Mobilise global attention on stunting and the new integrated approach to increase funding for stunting research. The scaling-up nutrition (SUN) business network offers a potential opportunity to garner commitment from the private sector.
Continue to build staff capacity in the areas of policy, advocacy, and integrated approaches to stunting
Mobilise development funding for more long-term planning of nutrition and stunting-related activities

Full report in PDF

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