Striving to invest in people: Peru’s success in overcoming its stunting crisis
By Jose Carlos Ferreyra
Claudia and Olga have reasons to be proud. These two women, together with several parents in their community, started a revolution 16 years ago. They made clear that a child’s fate does not have to be determined by her birth place or socioeconomic status. All of their efforts were guided by one mandate: Defeat chronic malnutrition and ensure that children get off to a good start in their first 1000 days.
And while Claudia and Olga might have started the movement, Peru’s success in reducing stunting was made possible through the tireless and strategic efforts of the government and countless partners.
Right now, around the world, 155 million children are stunted (low height for age) and as a result they are being robbed of their right to grow, thrive in school and ultimately help their countries prosper economically. However in some remote villages of Andean regions of Peru, hundreds of thousands of children are growing taller and healthier than ever before.
A recent World Bank report, Standing Tall: Peru’s Success in Overcoming its Stunting Crisis, tells the story of how Peru, in less than a decade, halved its rate of chronic malnutrition among children under five from around 28% in 2008 to around 13% in 2016.
The Peruvian government, in coordination with civil society organizations, and the international community, made the reduction of chronic malnutrition its business. Realizing that no country could prosper without sustained investments in its people, Peru made the fight against stunting its first and national priority by involving everyone: children, families and communities.
Political Commitment
Stunting became a sustained political priority. It was treated as a serious human development issue. It was recognized as a social, economic and health challenge. Successive governments showed their commitment to tackling the problem by setting a series of new and ambitious targets.
During several election campaigns (from 2006 to 2016), civil society organizations convinced presidential candidates to invest more in human capital by establishing specific targets for the country and taking significant steps to ensure that children get a good start in their first 1000 days of life.
Smart Policies
Historically, parents in poor households in remote and rural communities were often unaware that their children were chronically malnourished. Believing that height was purely hereditary and not influenced by diet and care practices, many Peruvians accepted it as a fact of life. This belief perpetuated for generations, holding back the development of children and the country.
As a result, conquering the stunting prevalence in the heart of the Andean highlands was not a small feat.
By 2002, Peru had been spending an estimated $250 million a year into food and nutrition programs.
Much of that expenditure, however, went to children older than two years of age, resulting in little movement in the needle. It became clear that other policies were needed.
While the country was enjoying an economic growth by a boom in foreign investing, improved infrastructures, and access to water, the stunting crisis was still prevalent.
Looking at the global evidence of what caused chronic malnutrition, the Peruvian government begun prioritizing its investments in key areas. It targeted social spending towards pregnant women and children in these first two years of life, when nutrition, hygiene and health also play a vital role.
The Conditional Cash Transfer program (CCT) known as Juntos (Together) provided cash to mothers while requiring them to take their young children regularly to health, growth monitoring and promotion check-ups at the health centers and for ensuring their older children attended school. In addition, the regional governments were given incentives to create a strategic road map for reducing stunting rates, and establishing a system that guarantees money was well-spent.
The whole idea was to align resources with results. The Ministry of Economy assigned resources to specific target areas where it was most needed according to the stunting rates.
So as Health centers started to thrive with activity and demand for services, and more mothers and children came to monitor their health, all the results were precisely monitored so communities and state governments could receive incentives to provide better health and nutrition services.
Because results were open and everybody could see them, they create a sort of friendly competition between communities to try to eliminate chronic malnutrition.
Sonia Girón García, a nurse in the community of Nueva Esperanza that monitored progress from 2006- 2016, was told that when she arrived in 2006 stunting was at 79%. When she left in 2016, the percentage was reduced to 19%.
All those smart policies combined forged a convergence in the government’s approach to reducing stunting.
Communication and Behavior Change
For political commitment and smarter policies to make a lasting impact, parents had to be educated and empowered. In addition, they needed the government to provide health and social services to ensure their children grew at a healthy rate.
A superb communications strategy led by NGOs, the government and international partners created widespread understanding and awareness about the devastating impact of chronic malnutrition. As more mothers met more regularly with doctors, nurses and nutritionists in clinics, their habits started to change and with it the health of millions of Peruvian children.
Peru’s Lesson
Today Peru stands out globally for tackling stunting. It has welcomed several governments facing similar situations from Cameroon, Ecuador, Guatemala, Indonesia, Madagascar, Mozambique and Tanzania to learn from this success.
Peru offers us an exceptional example of how, through a cross -sectoral and timely investments in its people, a nation can turn political commitment, good policies and governance into better health, education and social services for the poorest communities.
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