Nutrition

Situation

Bolivia is on-track to achieving many of its Millennium Development Goals (MDG) Targets. To date, the ones pertaining to extreme poverty, malnutrition, literacy, gender equality, institutional delivery coverage, protected areas, and consumption of chlorofluorocarbons have already been reached. Despite this progress, important objectives related to nutrition will not be reached by 2015.

Despite the Government of Bolivia’s efforts to strengthen social programs, Bolivia continues to struggle with inequity and has very significant disparities in many social indicators by geographic area, gender, ethnicity and economic quintile (GINI coefficient = 0.56, 2008). Families in the top income quintile earn 24 times more than families in the lowest quintile. Although public spending grew on average 18% between 2006 and 2008, institutional capacity to absorb the budget and provide public services at decentralized levels is still limited . Social services institutions are significantly weak due to the institutional and political culture involving high turnover, the hiring of technical staff with little or no public management experience, and the lack of knowledge to develop innovative approaches at a time when the Government is expanding.

The prevalence of acute malnutrition in under-five year olds is 1,4%, with the highest prevalence in the department of Potosí (2,6%). Recent data also show that the national prevalence of chronic malnutrition among children under-five is 22% and that 46% of children under five years of age suffer from chronic malnutrition in the country.

The probability that a child under-three suffers from chronic malnutrition is 1.8 times higher in rural areas (25.9%), rather than urban (14.6%) . One-third of children in rural areas are chronically malnourished. Among the poorest populations in Bolivia, nearly 46 % of children are malnourished compared to 6.5 % of children among the richest populations.

A significant gap in maternal health exists between the Departments where the population is predominantly indigenous and those where the population is mostly non-indigenous. Rural indigenous women are four-times more likely to die from pregnancy, childbirth and postpartum complications compared to urban women (64 % and 15 %, respectively) . 49% of pregnant or breastfeeding women have anemia in the country

In Bolivia, as in the rest of the world, various strategies have been developed to improve the nutritional state quality of life of children and mothers, but the continued existence of gaps reflects that they are insufficient and require higher-impact, evidence-based actions to achieve value-added results in the country.

In order to adequately and effectively steer policies directed at improving nutritional outcomes for Bolivian children and mothers, the Government of Bolivia, through the technical assistance and institutional building offered by UNICEF, needs the continued support and cooperation of international networks made up of the international donor community and the United Nations.

UNICEF in action

To improve equitable use of nutritional support and improved nutrition practices for reducing stunting, as well as fulfilling UNICEF’s nutrition in emergency preparedness and response mandate UNICEF Bolivia focuses on key actions:

  • Promoting social mobilization, participation and behavior change towards healthy practices with a intra/intercultural approach involving families and communities
  • Developing institutional capacities at national and subnational level for strengthening equitable nutritional policies in favor of INA
  • Strengthening surveillance of nutritional indicators, and advocating for authorities investment in SMARTs in departments with chronic malnutrition > 20%
  • Producing evidence and innovations for implementing practices, services and policy interventions for the prevention and treatment of stunting and other forms of undernutrition throughout the life cycle
  • Strengthening strategic partnerships and collaboration with private sector for promoting social responsibility
  • Documenting lessons learned to improve governance, services and resource allocation; including South to South Cooperation
  • Advocating at different levels for ensuring implementation of effective nutrition interventions for achieving equitable results for girls, boys, adolescents, mothers and communities
  • Increase the government of Bolivia’s capacity and delivery of services to ensure protection of the nutritional status of girls, boys and women from the effects of humanitarian situations.

With human rights, gender- mainstreaming and equity as overarching approaches, the programme will use a mix of the above-mentioned key actions.

Additionally, UNICEF will use innovative strategies and models such as situation analyses for equity (using UNICEF’s Monitoring Results for Equity System), to better identify implementation constraints that should be removed in order to optimize expected outcomes.

Impact

Outcome: Improved and equitable use of nutritional support and improved nutrition and care practices for reducing stunting, as well as fulfilling UNICEF’s nutrition in emergency preparedness and response mandate.

Output 4.1: Children, parents, families and communities apply key proven practices for preventing and treating stunting and other forms of under-nutrition

Output 4.2: Selected health networks provide quality nutrition services

Output 4.3: Subnational governments identify bottlenecks and allocate resources for cost effective key nutrition interventions.

Output 4.4: Increased Bolivia’s capacity to ensure protection of the nutritional status of girls, boys and women from effects of humanitarian situation.

Strategic Approach

In line with its Strategic Plan 2014-2017 UNICEF supports the health sector in Bolivia through providing equitable delivery of key proven and cost effective nutritional interventions ; increasing access to lifesaving and preventive interventions,; improving the quality and use of nutritional surveillance system for decision making processes; promoting policy dialogue and advocacy, as well as communication for development; harboring innovative approaches; and strengthening partnerships at all levels. The strategy is based on equity principles including a social commitment to the vulnerable population living in rural areas. It seeks to sustainably scale-up implementation approaches to ensure improved nutritional results.

Partnerships

Being able to partner effectively and efficiently to enhance results for children, based on the UNICEF comparative advantage and shared commitments to common principles and results, has never been more important. Strategic partnerships will continue to play a central role in advancing results for children with equity and UNICEF will continue its long-standing practice of building capacity through partnerships with national and local governments, civil society, academic institutions and the private sector, reducing the dependence of governments and other actors on development assistance over time.

The main partners supporting the Nutrition Component of the YCSD Programme are:

  • Ministry of Health
  • Departmental and Municipal Governments
  • Rural and indigenous community organizations
  • Bilateral and multilateral cooperation agencies

Global programme partnerships, such as Scaling-up Nutrition, will also continue to be a cornerstone of UNICEF programmatic engagement, advocacy and leveraging of funds.

Budget estimate

Strategic Lines of Action 2016 2017 Total
Promoting social mobilization, participation and behavior change towards healthy practices with a intra/intercultural approach involving families and communities 12,900 0 12,900
Developing institutional capacities at national and subnational level for strengthening equitable nutritional policies in favor of INA 241,619 0 241,619
Technical assistance at municipal level for ensuring WASH services sustainability by local service delivery entities 29,425 0 29,425
Strengthening surveillance of nutritional indicators, and advocating for authorities investment in SMARTs in departments with chronic malnutrition > 20% 12,900 0 12,900
Producing evidence and innovations for implementing practices, services and policy interventions for the prevention and treatment of stunting and other forms of undernutrition throughout the life cycle 19,375 0 19,375
Strengthening strategic partnerships and collaboration with private sector for promoting social responsibility 0 0 0
Documenting lessons learned to improve governance, services and resource allocation; including South to South Cooperation 0 0 0
Advocating at different levels for ensuring implementation of effective nutrition interventions for achieving equitable results for girls, boys, adolescents, mothers and communities 131,000 81,810 212,810
Increase the government of Bolivia’s capacity and delivery of services to ensure protection of the nutritional status of girls, boys and women from the effects of humanitarian situations. 12,900 0 12,900
Total required budget $1,333,334 $666,666 $2,000,000
Total Available $218,500 $81,810 $300,310
Funding Gap $1,114,834 $584,856 $1,699,690