Demonstrating evidence of relevance, coherence, effectiveness, efficiency, impact and resilience of five years’ multisectoral investment in child nutrition in Nigeria – UNICEF’s Country Programme of Cooperation (2018–2022)
Authors: NDAMOBISSI Robert , KUTUNDO Edward , HODGE Mrs Annabel Judith , HAJEEBHOY Mrs Nemat , MOREY Mitchell , RING Mrs Hannah , WARREN Mrs Anna , OLUWASEUN Ariyo 
Published: July 2024

Abstract

Nigeria is the largest country in Africa in terms of its population and economy, and has innovative policies, strategies and investments to improve child survival and development. Despite these efforts, approximately 12 million Nigerian children aged under 5 years are stunted and 3 million are suffering from wasting. In response to this child malnutrition crisis, UNICEF partnered with the Government of Nigeria and public-private partners to develop and implement the Nigeria–UNICEF Country Programme of Cooperation (2018–2022), with nutrition as part of the child survival component. The Nutrition CPC was independently evaluated against six Organisation for Economic Co-operation and Development Assistance Committee criteria (relevance, coherence, effectiveness, efficiency, impact and sustainability), and two cross-cutting criteria (equity/gender and resilience). Key objectives were to determine the programme’s merit based on expected results and impact; and the effectiveness of multisectoral interventions for addressing child malnutrition. The evaluation methodology was a mixed methods’ design with two components: an impact and performance evaluation of nationwide nutrition programming; and an impact evaluation of multisectoral integrated interventions in seven pilot states. Methods included a document review, an analysis of existing survey data comparing outcomes in intervention and control states, an analysis of primary survey data from over 5,600 households, key informant interviews, focus group discussions and direct observations. The Nutrition CPC was found to be partially successful in terms of its relevance, coherence effectiveness, efficiency (value for money), impact and equity; highly successful with regards to resilience; and ‘unsuccessful’ for sustainability. The programme achieved targets across several expected results. At the national level, it reached 35 million children with vitamin A supplementation. In UNICEF supported states, over 2.5 million (80 per cent) of children suffering from severe acute malnutrition were treated. By supporting infant and young child nutrition services, the Nutrition CPC improved the likelihood and frequency of infants receiving breastmilk (extending duration by 0.33 months per child) and a more diverse diet. However, only 30 per cent of caregivers in treatment areas were aware of the programme’s key activities and less than 20 per cent of caregivers reported receiving counselling on multisectoral interventions (water, sanitation and hygiene, child nutrition or parenting). The programme contributed in measurable ways to improving nutrition knowledge and infant feeding practices and saving the lives of 2.5 million children aged under 5 years affected by severe acute malnutrition. However, it has not achieved its goal of significantly reducing child malnutrition, with nutrition outcomes still languishing at low levels. Prevalence of wasting has increased due to the negative impact of COVID-19 on household food insecurity, poverty and increased inflation, as well as physical insecurity in the north of the country. Delivering a multisectoral programme to support nutrition proved challenging, and many stakeholders have concerns about the government’s capacity to sustain the progress that has been achieved.