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In the past 15 years, Senegal has made considerable progress in the fight against child undernutrition. To better understand how this was achieved, we reviewed 11 national policy documents published between 2001 and 2015, and interviewed 25 key-informants from the government, donor community, civil society, as well as 24 local service providers and 18 community members. We explored the commitment of actors and coherence between and within sectors. We linked this to changes in nutrition services experienced by communities . The key theme that emerged was the critical role of increased political commitment, materialized and maintained by a high-level national coordinating body for nutrition. The body actively facilitates multisectoral coherence in action for nutrition, overseeing the implementation of a national nutrition program, the effects of which are seen at the community level.

Changes in the immediate, underlying and basic determinants of nutritional status at the community- and household-level are a logical and empirical prerequisite to reducing high levels of undernutrition in high burden countries. This paper considers these factors directly from the perspective of community members and frontline workers interviewed in six countries in South Asia and sub-Saharan Africa. In each country, in-depth interviews were conducted with mothers, other community members and health workers to understand changes in health and nutrition practices, nutrition-specific interventions, underlying drivers and nutrition-sensitive interventions, and life conditions. Overall, the need for basic improvements in livelihood opportunities and infrastructure are solidly underscored. Nutrition-specific and -sensitive changes represented in most cases by deliberate government or NGO supported community interventions are rolling out at a mixed and uneven pace, but are having some significant impacts where solidly implemented. The synthesis presented here provides an invaluable source of information for understanding how community-level change occurred against a wider backdrop of national level progress.