GCRF Action against Stunting Hub

The global community aims to decrease the number of stunted children under five by 40% by 2025. While targeted and specific, we know that this is presently unachievable. Part of the problem is that over the last three decades, the search for the 'silver bullet' or the specific driver, which if addressed could solve this intractable problem, has narrowed praxis. This is not to say that gains have not been made, but rather our efforts have not been entirely impactful. While substantial disciplinary advances have occurred, often they have not been joined-up. And while systematic reviews abound, pan-disciplinary understandings, do not. Hence, child stunting is an intractable problem, waiting for a unified solution.

If we perceive child under-nutrition as a mosaic, we have knowledge of many of the individual elements. For example, biological advances demonstrate there is an identifiable 'epigenetic signature' of stunting. Children who are stunted also have immature gut micro-biomes and we also know a large proportion of the global malnutrition burden is caused (either directly or indirectly), by infectious agents ranging from viruses and bacteria to protozoa and helminths. Food-borne toxins also impact stunting. Equally, we know a range of elements can help to prevent stunting from animal source Foods (ASF) to behavioural elements from dietary choices to feeding practices to water, sanitation and hygiene (WASH). Yet overall, it may be argued that we are missing the shape and structure of the mosaic and the synergies between the component parts. In many quarters, the literature on child under-nutrition is viewed as 'siloed' and non-relational (Perkins et al., 2017). But equally importantly, 'integrated' nutritional programmes have often not had the expected impacts.

Herein lies the problem and the related solution: we urgently need to understand the 'cascade' of factors driving child stunting and the synergies and inter-relationship between drivers. And equally importantly, we need to better understand the 'tipping points' or the critical points along this cascade where healthy linear growth diverges to slow or no growth. To do this, we propose to transform our exploration of child under-nutrition from the component parts to the 'whole child'. Where the biological, social, environmental and behavioural context in which stunting occurs is understood in its entirety and where the strength and directionality of these drivers, inform related interventions. Based on this joined-up approach, we will explore the ability of a range of child-centred interventions to disrupt the cascade of factors that inhibit the ability of a child to grow. These actions and outcomes will then form the basis of a decision-making platform to enable users to identify the ex-ante and ex-post impacts of potential interventions. Embedded in this process, however, is a values-based approach that ensures that from the outset, our research directly connects to and betters the lives of the children, families and communities involved.

We will work across three countries: India, Indonesia and Senegal in over 50 communities. We aim to decrease child stunting by up to 10% our communities. Finally, to enhance our impact and legacy our Hub, we will engage a range of end-users in both our outputs and in the wider 'whole child' approach. We will support new regional platforms on maternal and child nutrition proposed by UNICEF linking the work of FAO/The World Bank/WHO at the country-level. We will also engage our network of over 100 civil society organizations in our findings. Over the course of the project, we expect to positively impact the lives of up to 1 million children.

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Our goal is to reach over 1 million children via both our outputs and outreach over the life of the Hub. Our specific aim is to reduce the prevalence of stunting by 10% across the communities we work in. We will measure progress toward this goal by identifying three 'control' communities participating in more traditional nutritional research/development projects. Additionally, we will work with our partner, 3iE, to develop a range of indicators to compare impacts and to assess our reach. To ensure we meet our targets, we have developed specific 'impact and engagement' strategies for the following stakeholder groups:

a. In-country actors including, but not limited to, decision-makers, practitioners, policy makers, clinicians and other health sector workers.
b. Multi-lateral, bi-lateral, UN agencies and national governments.
c. Children and their families across the three study sites.

In-country actors: We will invite end-user groups ranging from international and local NGOs, CBOs and local government officials to community-level meetings across the study sites. Utilising our shared-values lens, we will explore these actors' differing needs and priorities within a context of national-level policy priorities. We will share lessons and preliminary findings between and among all in-country stakeholder groups across the project cycle. Our aim is to enable policy and decision-makers to formulate predictive, rather than reactive, 'whole child' nutritional policies and actions. The development and dissemination of the decision-support tool is key to meeting this objective. By creating and publishing an open-source decision-support tool, policy makers will have access to a synthesis of existing, national-level data as well as project-level baseline and intervention data. Users will also be able to discern the ex-ante and ex-post impact of interventions. We will measure our success by the total number of users across key time periods: initial launch, after 12 months, after 24 months.

Global Agencies: Our Hub will directly inform and support nutritional programs at the global level as part of efforts to meet SDG 2 and the World Health Assembly (WHA) targets. As such, Hub indicators will align with those detailed by WHA (see WHO, 2014). Furthermore, we have created an End-User Committee to facilitate the uptake of our outputs across a range of international agencies such as UNICEF, WHO, the World Bank, IFAD, SUSTAIN, the Global Panel, EAT etc. Current members include Jonathan Wadsworth, Senior Advisor, World Bank; Rose Ndolo, Head of the Knowledge Hub, World Vision, Antonio Rota, Senior Advisor, IFAD, and Basil Rodriques, Senior Advisor, UNICEF, Fatiha Terki, Deputy Director Nutrition, WFP. We will embed our findings in these institutions' priorities and programmes and leverage committee members' wider networks. By linking this committee to our Flexible Fund, we will ensure that our impact at the local level will be both accelerated and durable.

Local children and their families:We anticipate that the impact on this community of Hub-users will be twofold. First, our engagement will enable the voices of children and families to inform stunting praxis. Second, our range of bespoke interventions, specific to the interplay of drivers involved, aims to break the intergenerational cycle of stunting. As such, we will put in place a number of impact and engagement strategies for the children and families who will directly participate in Hub-related activities. We will design and deliver the world's first Citizen Science project, which will empower women to identify linear growth issues in their own children and enable them to receive bespoke advice. Core Hub components from our work on shared values to our educational and behavioural components will enable us to better understand, listen and engage this community of users. We will use this learning to underpin a range of engagement exercises with our partner, Science made Simple.