Ethiopia is committed to attaining lower middle-income status and achieving global development goals.

However, Ethiopia is challenged by its slower rate of improvement in reducing childhood stunting. If the trend continues, Ethiopia may not reach the World Health Organization Global Nutrition Target of a 40% reduction in the number of children under five who are stunted.

One of the main challenges to achieving this goal is Ethiopia’s minimal progress on reducing the prevalence of stunting in children under 23 months.

Interventions that contribute to reducing stunting in children under five

• Reducing incidences of diarrhoea and infection with twice-yearly doses of vitamin A to children under five
• Preventing and controlling anaemia in pregnant women through daily iron-folic acid supplementation for at least 90 days during pregnancy to:
  • Reduce neural tube defects
  • Reduce the number of low birthweight babies and preterm deliveries

Barriers to effective interventions

• Underfunding of key nutrition interventions, such as vitamin A and iron-folic acid supplementation
• Critical weaknesses in cost-effective delivery of lifesaving interventions
• Low capacity of staff in the health system, particularly at the state level

This investment, spearheaded by the World Bank and made possible by The Power of Nutrition, Nutrition International, and partners, uses a payment-for-results mechanism, which fills the gap in nutrition financing and integrated delivery.

This mechanism assesses results in maternal and child health and nutrition using disbursement-linked indicators (developed by the World Bank and the Government of Ethiopia) to measure success in:

• Improved coverage targets for health and nutrition interventions
• Development of strategic policies and guidelines

This investment uses two financing instruments:

• Performance for Results
• Investment Project Financing to get back on track to achieving targets to reduce childhood stunting in Ethiopia

This combination of financing instruments creates an investment model that:

• Supports the integrated delivery approach of nutrition and health interventions
• Ensures government at all levels supports better results in nutrition through technical and financial commitment and good governance
• Increases government budget allocated to nutrition and good governance of nutrition financing
• Decreases costly vertical approach through Performance for Results financing

Performance for Results

This instrument finances:

• Delivery of recommended annual two doses of vitamin A to children under five
• Growth monitoring and promotion (GMP) for children under two
• Provision of daily iron-folic acid supplements to pregnant women for at least 90 days
• Scaling up low-cost and effective approaches to deliver vitamin A supplements and GMP

Investment Project Financing

This instrument finances:

• Critical technical assistance for multisector nutrition coordination and strengthening of the Civil Registration and Vital Statistics systems
• Capacity building to improve multisectoral coordination and data management for nutrition
• Transitioning the provision of vitamin A supplementation from extended outreach campaigns to health facilities and community-based routine mobile health days
• Operational research activities on:
  • Effectiveness of growth monitoring and promotion
  • Supply and demand issues related to iron-folic acid supplementation