Overall, the analysis highlighted the critical need for additional information on national health surveys. A systematic review of the data available in the current national health surveys in relation to the specific components of the three clusters of underlying causes of malnutrition considered as important by the nutritional scientific community reveals that these surveys contain information on only a small fraction of the ideal measures of food security, child care and environment and health. The collection of information on these additional variables currently missing from these surveys will enable a more robust understanding of the extent to which children have access to adequate care or adequate food security or environment and health. Panel data of young children between the ages of 6 and 18 months would also further our understanding of the relative contribution of the various components of the three pillars, and how access to different components of the three pillars at different ages of a child affects nutritional outcomes. In the sample of countries covered in this report it is found that the most complete information is collected on the components of environment and health, while there is much less robust information collected on the components of child care and food security. As pointed out by Barrett (2010) in his article on measuring food security, recognition that **“measurement drives diagnosis and response”** is critical for setting a renewed and higher standard in the effort to reduce child malnutrition worldwide.

Using all the information available, albeit incomplete, the analysis revealed that progress towards improved access to adequate food security and to adequate environment and health has been quite limited. It appears that access to adequate environment and health remains the greatest challenge relative to the other two pillars of food security and care. Access to improved sanitation both in the household and in the community as a whole were the lowest of all the other components of environment and health. In the countries covered in this report access to adequate environment and health in general is not surpassing 10% of the population of children. Access to adequate care has improved in some countries by more than 10 percentage points suggesting the success of campaigns on the importance of breastfeeding and complementary feeding which comprise the measure. However, this has to be viewed in perspective as this improvement is based only on the one or two child care variables that may be found in the surveys collected.

In spite of the limitations inherent in the available data, the report presented evidence of important synergies among adequate food, child care and environment and health. The econometric analysis carried out is aimed at summarizing simple correlations rather than causal relations, nor does it provide a formal test of the validity of the UNICEF conceptual framework. However, it does serve as useful evidence that access to adequate level of service in more than one pillar at the same time is associated with better nutritional outcomes compared to the “sum of its parts”. In other words, in the aggregate, the reductions in child malnutrition that can be accomplished are greater when some children are provided simultaneously with access to adequate food security, care, and environment and health compared to the reduction in malnutrition that can be accomplished by providing some of the children with adequate health environment and another group of children with adequate food security and another group of children with adequate care. The degree and the importance of the synergies varies from country to country but in general simultaneous access to the three clusters is associated with higher HAZ scores.

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