Kenya has made significant progress in reducing stunting from 35.3% to 26% as of 2014, achieving the MDG target for underweight children, while disparities among counties persist. A multi-sectoral approach, supported by policies such as the National Nutrition Action Plan and substantial government investment, aims to further enhance nutrition outcomes. The country's focus on breastfeeding promotion and evidence-based interventions has led to improved health benefits and economic productivity.

1. Story of Change -
Stunting Reduction in Kenya
Gladys Mugambi
Head Nutrition & Dietetic Unit,
Ministry of Health Kenya
Transform Nutrition Consortium,
8th June 2017

2. 30.3
35.3
26
19.9
16.1
11
5.6 6.7
4
0
5
10
15
20
25
30
35
40
2003 2008 2014
%children
Trends of under nutrition in Kenya
(KDHS 2003-2014)
Stunting Underweight Wasting
Nutrition Situation in Kenya
• Reduction in stunting from 35.3% to 26%, however large disparities exist
among counties, with some rates exceeding 40%
• MDG target for underweight (11%) achieved.
• As per GNR 2015, Only 1 country—Kenya—is on course for all five WHA
undernutrition targets.
• Near doubling of Exclusive Breast Feeding from 32% to 61% in 5 years and
subsequent reduction in infant mortality from 52 to 39 per 1000 live births as
reported in the KDHS 2014
Percentage of children under 5 stunted,
2015 in East & Southern Africa*
Burundi 58%
Eritrea 50%
Madagascar 49%
Mozambique 43%
Malawi 42%
Ethiopia 40%
Zambia 40%
Rwanda 38%
Comoros 35%
Tanzania 35%
Uganda 34%
Lesotho 33%
Botswana 31%
South Sudan 31%
Angola 29%
Zimbabwe 28%
Kenya 26%
Somalia 26%
Swaziland 26%
Namibia 23%

3. While good progress at national level has been made – large
disparities exist across counties…..

4. What supported stunting reduction…..
Policy Environment & Legal Framework
Constitution of Kenya (2010), article 43 - every person has the right
to be free from hunger and article 53 - every child has the right to
basic nutrition.
 National Food and Nutrition Security Policy launched October
2012. (multi-sectoral)
 National Nutrition Plan of Action 2012 to 2017, launched during 1st
National Nutrition Symposium (November 2012). 11 Strategic
Objectives
 Breast Milk Substitutes (Regulation and Control) Act (2012) enacted
(October, 2012), Work place support Bill in Parliament right now
 Mandatory fortification of cereals and oils passed (October 2012)
• Signed up to SUN Movement in August 2012
Nutrition sensitive policies, strategies and plans:
 National Development and Poverty Reduction (Kenya VISION 2030;
and Economic Recovery Strategy for wealth and employment
creation 2003),
 Agriculture (Agriculture Sector Development Strategy 2010-2015),
 Education & Health (National School Health Policy 2009),
 Health (Kenya Health Policy 2012-2030)

5. • National Nutrition Action Plan 2012-2017
(NNAP) - provides a framework for coordinated
implementation of Kenya’s commitment to
nutrition
• The plan has 11 strategic objectives focusing on
e.g.
• high impact nutrition interventions
• prevention and management of non
communicable diseases
• monitoring and evaluation systems
• enhancing coordination mechanisms.
• Has a performance monitoring and evaluation
framework.
• Disseminated at national level; County level
dissemination & development of County Specific
Nutrition Action Plans is ongoing.
National Nutrition Action Plan

6. Increased Government Investment in Nutrition

7. • Scaling-up 11 key nutrition-specific interventions in all
counties of Kenya would cost $76 million in public and
donor investments annually, and produce tremendous
health benefits:
• 455,000 DALYs (disability-adjusted life years, or
years of healthy life lost due to a health condition)
averted,
• 5,000 lives saved, and almost 700,000 cases of
stunting averted.
• This investment could increase economic productivity
by $458 million per year over the productive lives of
the beneficiaries.
 Every dollar invested has the potential to result in $22
in economic returns in Kenya.
Investment Case for Scaling up Nutrition Specific Interventions in
Kenya (2016)

8. • Nutrition Sector previously dependent on short term
humanitarian funding and primarily on treatment of acute
malnutrition
• Opportunities in 2008 to optimize this funding towards systems
strengthening – conscious shift away from parallel programming
of NGO - increased focus from MoH on leadership and
coordination with all partners – MoU developed to standardize
efforts
• Now nutrition programme is fully MoH led system - full
adoption and integration of High Impact Nutrition Interventions
into health system
• Large investment on promotion of breastfeeding from 2008-
2012 – led to near doubling of EBF in 2014
• Strong investment by MoH and partners in nutrition information
system - now well integrated into the National Drought
Management Authority - quality evidence is leading to funding
allocation – e.g. WB loan in 2012 and Treasury in 2016
• Investment in surge model since 2014 - effective health system
response to deterioration in situation
• Efforts now on evidence generation for stunting reduction with
social protection, WASH and other sectors
• More focus on advocacy , planning, budgeting and strategic
partnerships at county level including full integration of nutrition
into the national Ending Drought Emergency framework
• First Lady as Patron for Nutrition in Kenya – several high level
advocacy events
Shifts in Nutrition Sector since 2007

9. • Evidence and
knowledge to guide
programmes to adopt a
context specific risk
based aproach to
nutrition resilience.
• Inclusion of resilience
and emergency
managment in nutrition
leadership and
governance structures.
• Expanded
CMAM Surge
Model
•Contextual risk
assessment for
household and
community
strategies for
mitigation,
adaptation and
transformation.
1. Community.
Prevention,
promotion and
referral
2. Facility Based
Services.
Supply, demand,
coverage and
quality of services
3. Knowledge
Management.
4. Leadership and
Governance.
SUN and Nutrition
Sensitive.
Development of a Risk Informed Programme following 2011
Nutrition Crisis for predictable shocks

10. Example of Health System Risk Informed Surge Programme –
currently in use in 2017 emergency
• Management of Acute
Malnutrition is fully
integrated in the MoH as
part of a package of High
Impact Nutrition
Interventions.
• From 2011 the MoH
nutrition sector invested
in a risk informed health
system - which is
responsive to crisis - using
Surge Model – allowing
the system adapt to
increasing cases of
malnutrition.
The Surge Model identifies the needs for different
types of response including integrated screening
& outreach activities when numbers of acutely
malnourished children reach thresholds beyond
the capacity of the facility

11. Proposed Multi Sectoral Governance Structure to
build on multi sectoral/ nutrition sensitive links
Figure 1: Ending Drought Emergency Pillars
Opportunities

12. Lessons Learned
• Importance of strong GoK/ MoH leadership and
coordination of partners – 2017 emergency fully GoK led
due to solid response plans and reliable evidence on
situation
• Strong policy environment is essential for accountability
• Importance of long term investment in M&E for monitoring
and evidence generation
• Support to Devolution Process – need to generate county
specific evidence and advocacy – also acknowledge that
change takes time
• Taking evidence to scale with other nutrition sensitive
sectors e.g. social protection and WASH
• Importance of expanding NNAP to include more nutrition
sensitive programming

13. Asante Sana!