In a career spanning four decades dedicated to tackling malnutrition around the world, few countries have shown as much promise for rapid reduction as Rwanda does today.
The reasons for this are manyfold.
Firstly, Rwanda has already made significant progress in reducing malnutrition, with stunting rates among children under the age of 5 decreasing by one percentage point per year. This demonstrates that the necessary infrastructure to combat malnutrition is already in place.
Secondly, President Paul Kagame has shown great vision and commitment to ending malnutrition in Rwanda. Recognizing the link between child growth and economic growth, President Kagame’s dedication to this cause is invaluable. However, it is crucial that this commitment is translated into action.
Thirdly, the Rwandan government takes data and evidence seriously. Government officials consistently seek guidance from experts in their efforts to tackle malnutrition. This evidence-driven approach is vital because the effectiveness of strategies to combat malnutrition varies depending on the context. Therefore, it is crucial to base decisions on solid evidence.
Fourthly, Rwanda’s entrepreneurial spirit and willingness to experiment, course-correct, and take calculated risks are crucial for successful malnutrition reduction. This spirit is reflected in Rwanda’s position as the best-ranked country in Africa on the World Bank’s Ease of Doing Business Index. This entrepreneurial mindset is particularly important for nutrition as small and medium-sized enterprises (SMEs) in the food system play a vital role in making nutritious and safe food more accessible, affordable, and desirable.
Fifthly, Rwanda boasts impressive gender equality scores, ranking among the best in Africa. This is crucial for nutrition due to a range of biological, social, and economic reasons.
Finally, Rwanda’s strong economic growth, enabled by a well-functioning government, provides a conducive environment for malnutrition reduction. While economic growth alone is not sufficient, it does play a significant role in improving access to clean water and sanitation, healthcare, and nutritious food for families.
Given these favorable conditions, what needs to be done to further accelerate malnutrition reduction?
First and foremost, we must ask whether it is actually possible to achieve a reduction in stunting rates from 33% in 2022 to below 20% by 2027. The answer is a resounding yes. Maharashtra, an Indian state with a population of over 100 million, managed to reduce stunting rates among children under two years of age from 39% to 24% between 2006 and 2012. Maharashtra achieved this by raising awareness about nutrition among the population, policymakers, development partners, and entrepreneurs, and by coordinating and intensifying efforts to combat malnutrition.
So, what elements are needed for Rwanda to achieve a similar level of success?
Here are my observations:
1. Comprehensive and multidimensional approaches: Malnutrition is the result of poor diets and infection. To overcome it, powerful alliances are crucial. This includes taking effective action in the health system (such as providing multiple micronutrient supplementation for adolescent girls and women, especially during pregnancy and breastfeeding), the food system (supporting SMEs and market systems that supply nutritious foods to consumers at the base of the pyramid), the school system (providing fortified whole grains in school meals), and the social protection system (designing income transfer programs that stimulate the production and consumption of safe and nutritious foods).
2. Operationalizing political commitment: High-level political leadership on nutrition needs to translate into action within the government. This requires establishing a direct link between operational leaders and the highest levels of government. A designated Nutrition Champion to lead a Nutrition “Mission” would be beneficial.
3. Ambitious yet realistic nutrition strategy: A strategy is needed under the Nutrition Mission to more than double the rate of stunting reduction from the current one percentage point per year to 2-3 percentage points over the next five years. This strategy should prioritize specific population groups, actions, and regions, aligning with the goals of the National Strategy for Development (NST2) and the Strategic Plan for the Transformation of Agriculture (PSTA 5), taking into account additional domestic spending.
4. Nationwide campaign: A comprehensive nationwide campaign is necessary to highlight the crucial role of nutrition in national development. It is important to raise awareness throughout society about the importance of nutrition as human capital. The media should play a vital role in this campaign, emphasizing that investing in nutrition action in Rwanda has a benefit cost ratio of 13:1. The concept of “Grow in Rwanda” should apply not only to the economy but also to the future generation of Rwandan children.
5. Mobilization of the private sector: Rwanda has significant private sector resources, including innovation, entrepreneurship, and financial capabilities. However, too few of these resources are directed towards the production, supply, and consumption of safe and nutritious foods for the people of Rwanda.
6. Coordination of donor efforts: Although donor funding is relatively small compared to domestic funding, it can play a catalytic role in combating malnutrition. To ensure greater impact, donor funding should be coordinated and harmonized. Establishing a multidonor nutrition fund is a potential solution to achieve greater coherence.
7. UN agency coordination: UN agencies possess specialized resources and technical expertise that can greatly contribute to the nutrition strategy developed under the Nutrition Mission. Greater alignment and accountability among the agencies is crucial to maximize their support.
8. Streamlining food system data: Developing a national and subnational food systems dashboard for nutrition, consolidating existing data and focusing on nutrition using near real-time data to monitor progress, would greatly aid in the fight against malnutrition.
Are these goals achievable? As an outsider to Rwanda and Rwandan nutrition, some of my observations may lack complete grounding. However, I am inspired by the ambition of the Rwandan leadership when it comes to nutrition. Based on my experiences, I firmly believe that with the right focus, intensity, and determination, Rwanda can realize its ambition of significantly reducing malnutrition. Time is of the essence.
The author is the Executive Director of the Global Alliance for Improved Nutrition.
