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In the past two decades, Indonesia significantly improved its economic growth, poverty, and maternal and child health outcomes. Despite these notable achievements, the country's rates of stunting and malnutrition are among the highest in the world and threaten early childhood development as the stepping-stone of human capital formation. Though government guidelines, standards, and training have helped improve nutrition services in the health sector, there continues to be considerable variation in service quality across districts, between urban and rural areas, and among public and private facilities, with many mothers and children being provided suboptimal services. Malnutrition is a multisectoral issue that is not the “problem” of the health sector alone. However, many of the high-impact health interventions known to improve nutrition outcomes for children are not being implemented in Indonesia, calling for a higher-quality health system to produce better nutrition outcomes. This report analyzes the opportunities to improve the quality of frontline nutrition interventions in Indonesia’s health sector as an element of achieving the National Strategy to Accelerate Stunting Prevention (2018–2021) (StraNas Stunting) goals. It uses a framework adapted from the Lancet Global Health Commission’s report on High-Quality Health Systems in the Sustainable Development Goals Era, which explains that improving the quality of nutrition health care requires system-wide action. In specific, high-quality nutrition services necessitate both process and foundational reforms at the macro, meso, and micro levels. The paper outlines the challenges and proposes recommendations to improve quality nutrition care and services in the country. These are related to strong leadership, harmonized guidelines and targets, and robust regulatory and quality improvement mechanisms; improved monitoring and evaluation and data use; predictable, adequate, and timely financing; platforms for care; competent health workers and a sound supportive supervision system; adequate supplies and functional equipment; and systems that respond to clients’ health needs and expectations.

Malnutrition continues to be one of the world's most critical health and human development challenges, threatening countries' Universal Health Coverage (UHC) goals and the achievement of the Sustainable Development Goals (SDGs). Given the complex, multifactorial, and interlinked determinants of nutritional status and well-being, multisectoral nutrition programming has been widely promoted as the most effective way to address the direct and indirect determinants of malnutrition and to improve nutrition outcomes. Robust governance systems are essential for implementing multisectoral nutrition interventions and creating cost-effective and sustainable programs. The objectives of this report are to (i) document and synthesize implementation experiences, challenges, and opportunities from seven countries supported by the World Bank and Global Financing Facility (GFF) in operationalizing large-scale multisectoral nutrition projects that emphasize and strengthen governance (Cambodia, the Democratic Republic of Congo, Guatemala, Indonesia, Malawi, Nigeria, and Rwanda); and (ii) facilitate cross-country learning. Given that the seven countries used as examples in this report are still implementing their multisectoral programs, the report focuses on documenting progress and lessons learned on implementation modalities and innovations, rather than highlighting impact at this stage. The report uses a multisectoral governance framework, adapted from Gillespie, Van Den Bold, and Hodge (2019), to synthesize the implementation experiences across the World Bank/GFF–financed multisectoral nutrition projects. The report provides eight lessons learned, organized under three broad categories: (1) Advocacy, leadership, and institutional support for multisectoral nutrition; (2) Management capacity and financing; and (3) Results measurement, monitoring, and accountability.

The main purpose of this Guiding Framework document is to present the key elements of a Nutrition Public Expenditure Review (NPER) and offer guidance, practical steps, and examples on carrying out an NPER. It targets a wide-ranging audience, including country nutrition policy makers, development partners (DPs), government technical staff, and advocates and practitioners who are tasked with carrying out NPERs (who are also the main target audience). The Guiding Framework draws upon good practices from the growing body of NPERs as well as common practices and expertise from Public Expenditure Reviews (PERs). However, given the limited number of existing NPERs, this document should be considered as a starting point, or a ‘living document,’ and is not meant to provide a comprehensive coverage of a standard methodology for NPERs, as this would require further work and analysis. Specifically, this Guiding Framework aims to be a useful tool for practitioners involved in developing an NPER. It does this by: (i) situating NPERs within the context of other similar efforts such as a nutrition budget analysis or sector-specific PERs; (ii) presenting the literature of existing NPERs and related literature to serve as reference; (iii) providing guidance on preparatory work before beginning an NPER (i.e., defining the scope, setting up an NPER team, and identifying data sources); (iv) providing guidance on conducting the core analysis (i.e.,framing the analysis, analyzing the institutional framework, and linking the analysis to the policy dialogue); and (v) clearly identifying knowledge gaps and necessary additional work to enhance the robustness of future NPER analysis.

This paper builds on global experience and Zambia's specific context to identify aneffective nutrition approach along with costs and benefits of key nutrition interventions. It isintended to help guide the selection of the most cost-effective interventions as well as strategiesfor scaling these up. The paper considers both relevant "nutrition-specific" interventions, largelydelivered through the health sector, and multisectoral "nutrition-sensitive" interventions, delivered through other sectors such as agriculture, education, and water and sanitation. We estimate that the costs and benefits of implementing 10 nutrition-specific interventions would require an annual public investment of $40.5 million and would avert over 112,000 DALYs, save over 2,800 lives, and prevent 62,000 cases of stunting. Economic productivity could potentially increase by $915 million annually over the productive lives of the beneficiaries, with an impressive internal rate of return of 32 percent. However, because it is unlikely that the Government of the Zambia or its partners will find the $40.5 million necessary each year to reach full coverage, we also consider scale-up scenarios based on considerations of their potential for impact, burden of stunting, resource requirements, and implementation capacity. The two scenarios that scale up the nine most cost-effective nutrition-specific interventions (excluding the public provision of complementary foods) are the most advantageous in terms of cost-effectiveness and resource requirements and would require $11 million to scale up to partial levels and $23 to scale up to full coverage levels. Among the 8 nutrition-specific interventions we consider, school-baseddeworming is low cost and effective. The interventions we reviewed in the agriculture sector areexpensive when compared to nutrition-specific interventions, although very little cost effectiveness data are available for the nutrition-sensitive interventions to make carefulcomparisons. These findings point to a powerful set of nutrition-specific interventions and acandidate list of nutrition-sensitive approaches that represent a highly cost-effective approach toreducing child malnutrition in Zambia.

This paper builds on global experience and Uganda's specific context to estimate costs,benefits, and cost-effectiveness of key nutrition interventions. It is intended to help guide theselection of the most cost-effective interventions as well as strategies for scaling these up. Thepaper considers both relevant "nutrition-specific" interventions, largely delivered through thehealth sector, and multisectoral "nutrition-sensitive" interventions, delivered through other sectors such as agriculture, education, and water and sanitation. We estimate that the costs and benefits of implementing 10 nutrition-specific interventions in all regions of Uganda would require a yearly public investment of $68 million. The expected benefits are enormous: annually over 8,000 lives would be saved, while at least 375,000 DALYs and 8,700 cases of stunting among children under five would be averted. Economic productivity could potentially increase by $280 million annually over the productive lives of the beneficiaries, with an impressive internal rate of return of 18 percent. However, because it is unlikely that the Government of Uganda or its partners will be able to find the $68 million necessary to reach full coverage, we also consider scale-up scenarios based on considerations of their potential for impact, burden of stunting, resource requirements, and implementation capacity. The most cost-effective scenario considered would provide a subset of key interventions in regions with the highest rates of stunting and would cost between $19 and $60 million, depending on how many regions are covered. We then identify and cost five nutrition sensitive interventions relevant to Uganda for which there is both evidence of positive impact on nutrition outcomes and some cost information. These findings point to a powerful set of nutrition specific interventions and a candidate list of nutrition-sensitive approaches that represent a highly cost-effective approach to reducing child malnutrition in Uganda.

Food is one of the most basic needs for human survival. Access to it is a basic human right. Moreover, the pursuit of the Millennium Development Goal to cut hunger requires a sound understanding of the related food security issues. For these reasons, accurate measurement of the food security status of populations—or their ability to gain access to sufficient high-quality food to enable them to live an active, healthy life—is imperative to all international development efforts. It is necessary for effectively targeting food-insecure populations, researching and planning appropriate interventions, and monitoring progress. As past efforts have shown, accurately estimating the amount of food people eat is costly in terms of time and money, and such measurements have thus been carried out mostly in small populations. Where measurement has been extended to large populations, such as entire countries, it has been necessary to rely on less accurate, indirect techniques based on the availability of food at the national level. This technical guide presents a new avenue for measuring food security, for both small and large populations, based on the data collected as part of household expenditure surveys on the quantities of food acquired by households. It shows how these data can be used to measure a variety of food security indicators, including the prevalence of food energy deficiency and indicators of dietary quality and economic vulnerability to food insecurity. In keeping with the approach of IFPRI's Food Security in Practice series for practitioners, the manual guides readers step by step through the process of assessing the food security status of a population. It begins by offering guidance on choosing an appropriate strategy for calculating quantities of foods acquired by households, given time constraints, financial constraints, and the nature of the population's diet. The guide then leads the practitioner through the steps of collecting the data, processing and cleaning the data, and calculating the indicators. It concludes by illustrating how to conduct some basic food security analyses. I hope that this guide will assist practitioners in increasing the accuracy of the measurement of food insecurity for a greater number of populations, including those at the country level. Greater accuracy at the country level will provide the necessary foundations for overcoming food insecurity globally

Achieving universal health coverage (UHC) is a top global priority, and nutrition actions are a critical part of meeting that goal. When delivered within key windows of opportunity to improve health throughout the life-course, essential nutrition actions play an important role in reducing the burden of disease and preventing permanent physical and cognitive impairments, ultimately staving off future health care costs for both individuals and health systems. Coverage and quality of nutrition service delivery remains low, despite robust evidence of cost-effective interventions. The health system, and most especially primary health care (PHC), is essential for delivering high-impact, cost-effective, nutrition-specific interventions at scale. There are gaps in knowledge on how to deploy resources more effectively to improve the delivery of nutrition services as part of preventive and promotive health care. A shift in focus is needed from the “what” and “why” of scaling-up nutrition to the “how” of improving nutrition services coverage and quality of nutrition services delivered through the health system, and especially PHC. Parts 1, 2, and 3 of this paper introduce the thesis that health financing arrangements can be optimized to ensure that distribution and utilization of health system resources are aligned with nutrition objectives. Parts 4, 5, and 6 of the paper explore the financing challenges and options to address key financing and service delivery challenges.