# **5 Concluding Remarks and Policy Considerations**

This study provided one of the first comprehensive investigations of the data availability and data constraints associated with a more systematic application of the UNICEF conceptual framework emphasizing the interrelationship among access to adequate food security, environment and health, and child care practices in the prevalence of malnutrition rates among children in developing countries. Using detailed demographic and health survey data from Bangladesh, Bolivia, Cambodia, Ethiopia, Indonesia, Nepal and Zimbabwe, a comparison is carried out of the ideal variables summarizing the various dimensions or components of food security, environment and health, and child care against the measures available from current household surveys. These comparisons serve to highlight the limitations of most data sets and the potential gains associated with the collection and availability of additional information.

Bearing in mind the limitations imposed by the data available, the report also provided a practical diagnostic framework of the main correlates of child malnutrition that could be applied to identify potential “binding constraints” towards the effort to reduce child malnutrition. Specifically, the UNICEF conceptual framework is “operationalized” by serving as a guide for investigating the relationship between the prevalence of malnutrition in the country and inadequate levels and access to the three pillars summarizing the underlying causes of malnutrition. Next, for each indicator available from the survey used in country, a definition of “adequacy” is constructed using thresholds based on accepted international standards. The report aims to provide a “helicopter view” of the extent to which nutritional outcomes, as measured by a child’s height‐for‐age Z score (HAZ) at any given point in time, as well as over time, are associated with inadequate food security, inadequate environment and health, and inadequate child care practices. In consideration of the complexity of the linkages between the underlying causes of malnutrition and the economic situation of the family, the analysis is also carried out separately for resource‐rich (top 60%) and resource‐poor (bottom 40%) households based on an asset index constructed for that purpose.

The report also provided some of the first empirical evidence on the synergies at work in combating malnutrition in the set of countries used in this study when there is simultaneous access to adequate levels in two or more of the three pillars of the underlying causes of malnutrition. While intuitively appealing, the synergies among the three clusters of malnutrition have received little empirical validation. The recent emphasis on sector‐specific nutrition sensitive interventions (World Bank, 2013) rightly emphasizes the synergies that can be exploited _<u>within</u>_ specific sectors such agriculture, water and sanitation, or social protection. The analysis in the report underscores the point that the success of these sector‐specific nutrition‐sensitive initiatives may be constrained by the slow progress in taking advantage of the synergies among the three broad clusters of the underlying determinants of malnutrition: food security, child care, environment and health. Given that the synergies _<u>among</u>_ these three pillars are beyond the scope of any specific sector such as agriculture or social protection, the simultaneous progress towards in all of the three pillars is either taken for granted or underemphasized. As a consequence, nutrition sensitive interventions in specific sectors run the risk of being a sectoral priority in contexts where the chances of significant success may be limited because of no or very low access to improved infrastructure water and sanitation facilities.

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