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2017 Mozambique: Reducing Stunting in Children Under Five Years of Age: A Comprehensive Evaluation of UNICEF’s Strategies and Programme Performance - REPUBLIC OF MOZAMBIQUE COUNTRY CASE STUDY



Author: Anna Tarrant from ICF. Krishna Belbase, Senior Evaluation Officer, EO.

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’.

Background:

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 recognised lessons learned and models to support multisectoral approaches to improvements in nutrition.

Purpose/Objective:

The purpose of publishing evaluation reports produced by the UNICEF Evaluation Office is to fulfil a corporate commitment to transparency through the publication of all completed evaluations. The reports are designed to stimulate a free exchange of ideas among those interested in the topic and to assure those supporting the work of UNICEF that it rigorously examines its strategies, results, and overall effectiveness.
This report for Mozambique constitutes part of a global evaluation titled “Reducing Stunting in Children Under Five Years of Age: A Comprehensive Evaluation of UNICEF’s Strategies and Programme Performance” which includes six country case studies. 

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.

The proposed evaluation will be the first formal attempt to assess UNICEF’s strategies and programme performance in reducing stunting in under-5 children.

  1. To contribute to improving the organization’s accountability for its performance and results; and
  2. To generate evidence and learning to guide effective action towards the sustainable reduction of stunting in the coming years.  

Taking into account multi-sectoral approaches as well as UNICEF’s focus on equity, children’s rights and gender equality at all levels, the evaluation will:    

  • Assess the relevance, appropriateness and coherence of UNICEF’s global, regional and country programme strategies and plans to address  stunting in young children taking account of the range of country contexts where stunting is widely prevalent, giving attention not only to development settings but also to contexts affected by fragility and humanitarian emergencies.  
  • 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 equity-focused results in reducing stunting in various programme contexts.    
  • Assess UNICEF’s leadership, guidance and technical support at all levels as well as the adequacy of UNICEF staffing/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. 
  • Provide forward looking lessons, conclusions and recommendations for strengthening UNICEF’s leadership and advocacy, organizational policies and strategies, country programme response and partnerships for reducing stunting in various contexts where it is prevalent.     

Methodology:

The evaluation is formative and its findings will inform the work of UNICEF and its partners in accelerating progress towards Target 2.2 of the 2030 Agenda for Sustainable Development which calls for ending all forms of malnutrition, including achieving, by 2025, the internationally agreed targets on stunting and wasting in children under 5 years of age.

The Management Response to the evaluation recommendations is being coordinated by the Director of UNICEF’s Programme Division. 

This case study examines UNICEF Mozambique’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 5 in Mozambique 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
  8. The design of this case study was reviewed by an Evaluation Reference Group. A list of reference group members is included as Annex 2.

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

Findings and Conclusions:

Conclusion 1: UNICEF Mozambique has been highly successful in advocating with government for attention to a multi-sectoral approach for stunting reduction;

Conclusion 2: UNICEF Mozambique has also been highly successful in providing formal and informal leadership to three key partnership fora, the Scaling Up Nutrition (SUN) Nutrition Partners Forum, the UN Nutrition Group, and the Technical Working Group for the PAMRDC (GT-PAMRDC [Grupo de Trabalho-PAMRDC]);

Conclusion 3: Longer-term stunting-related indicators are seeing stagnant or reversed progress;

Conclusion 4: Because of a lack of nutrition expertise in the country overall and an insufficient number of staff, UNICEF may be overextended in its nutrition work;

Conclusion 5: The concepts of multi-sectorality and integration are largely understood as the planned geographic convergence of interventions from different sectors;

Conclusion 6: There is a strong potential for UNICEF’s model for stunting reduction to be sustained, but this is subject to the external threats of a fiscal crisis, rapid urbanization, and lack of nutrition expertise.

Recommendations:

UNICEF Mozambique and partners should: 

  1. Develop a systematic approach to capacity development for SETSAN and implementing ministries of the PAMRDC; maintain its focus on capacitating SETSAN, provincial and district authorities in the 2 provinces where it has a physical presence. Identifying highly skilled nutritionists who are proficient in developing capacity and building relationships.
  2. Assume a lead role among the UN to document best practices of their partnership, including separating mandates and working towards concrete action items. They should closely evaluate whether their mandates are a logical split in terms of resource mobilization, logistics, and systems.
  3. Prioritise work in nutrition-specific sectors to focus on upstream policy work and developing robust evidence-generation systems. Should include aligning it country programme docs and approaches more fully with the PAMRDC. Approaches should clearly delineate which of the 17 nutrition interventions UNICEF is supporting, where this is being done, how UNICEF plans to support capacity building and coordination, and through which government ministries efforts will be focused. The evaluation notes that this was in progress as part of UNICEF’s new partnership with the EU.
  4. Lead efforts to improve subnational nutrition data availability and quality to more conclusively identify target populations. This would also improve evidence-generation systems.
  5. Build internal consensus around the concepts of multi-sectorality, integration and strengthen incentive, coordination, and accountability structures to facilitate multi-sectoral work. Allocating specific amounts of time to integrated efforts and creating a culture that supports these efforts is likely a first step. Externally, nutrition, WASH, and social protection staff at UNICEF should share guidance on how to design, implement, monitor, and evaluate multi-sectoral stunting-reduction interventions with partners.


Full report in PDF

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Report information

Year:
2017

Country/Office:
Republic of Mozambique

Region:
ESAR

Type:
Evaluation

Theme:
Emergencies

Language:
English

Sequence #:
2017/001

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