Multi-Sector Convergence Approach to Reducing Malnutrition in Lao PDR

Chronic undernutrition (stunting) levels remain high in the Lao PDR, with about 32.8% of children under five years stunted, 24.3% percent underweight, and 10.7% wasted. Undernutrition mostly affects the poor, ethnic minorities, and rural and upland areas.

Stunting can cause long-term damage that lasts far beyond childhood, including slower learning ability, poor academic performance, and lower productivity and wages in adulthood. Stunted children cannot develop to their full potential, and this has negative consequences for national labor market productivity and economic growth. In Laos, the persistence of high levels of childhood undernutrition presents a huge, yet avoidable, loss of human and economic potential.

Action is needed across various sectors to address chronic malnutrition. The World Bank is working with the Lao government and development partners to help ensure nutrition and food security through social assistance and livelihood options, improve childcare practices and access to health services, and to provide clean water, sanitation, and hygiene. This is known as the multisectoral convergence approach and has been shown to bring rapid improvements in child health and development in other countries.

The nutrition convergence approach targets 882 villages across 12 districts of the 4 northern provinces where stunting levels are highest: Xieng Khouang, Houaphan, Phongsaly, and Oudomxay. Activities are carried out under six main World Bank projects:

• Reducing Rural Poverty and Malnutrition (II);
• Health and Nutrition Services Access (II);
• Additional Financing to the Poverty Reduction Fund (III);
• Scaling-Up Water Supply, Sanitation, and Hygiene;
• Learning and Equity Acceleration;
• Community Livelihood Enhancement and Resilience.

Results so far

In 2023 the Nutrition Convergence program moved into Phase II with the launch of a second Reducing Rural Poverty and Malnutrition project and the new Community Livelihood Enhancement and Resilience project. A second Health and Nutrition Services Access project also opened in early 2024 to scale up various activities from the original 12 districts to 25 districts across 7 provinces. Below are some results from the Phase I of the program.

Phase 1 Results

• Farmer nutrition groups providing simple, practical, and productive nutrition advice to over 9,000 households.
• Water, sanitation, and hygiene activities are underway in over 100 villages carried out in 450 villages. 
• Water, sanitation, and hygiene facilities upgraded for 71 schools and 19 health centers in Oudomxay and Phongsaly.
• Children aged 3-5, in 376 target villages, enrolled in early education programs increased from 12% to 63%.
• Nutrition-sensitive conditional cash transfers have benefited almost 43,600 beneficiaries, including poor and vulnerable pregnant women and children aged 0-2.
• In 95% of households, the female head of household manages the cash received and spends it mainly on food for children and the household.
• In a 2022 village survey, 98% of participants declared themselves well satisfied with the cash transfer system.
• A condition of the cash transfers is participation in essential health service and in the target areas around 99% of children under 2 years now receive regular growth monitoring, and 94% of pregnant women have attended at least four ante-natal care sessions.
• Antenatal care (ANC) attendance at least four times during pregnancy occurred for 79% of mothers of children under two, with a slight improvement from baseline.
• 73% of pregnant women report taking iron supplements regularly during their term, up from 55% before the program.
• Postnatal care for mothers and babies improved from 58% at baseline to 71% at midline.
• The social registry to identify poor and vulnerable households has recorded almost 1,240,000 households nationwide. The government and development partners use the registry to identify families and areas for support.
• Gradual improvements are being recorded in sanitation, access to clean water, and regular washing of hands with soap.

An Impact Evaluation Surveys of the nutrition convergence approach were conducted in 2020 and 2022 to assess, to the extent possible, how the delivery of interventions has been effective in mitigating the impacts of COVID-19 and high inflation on child nutrition. These shocks have greatly affected economic conditions, leading to worsening child nutrition. However, the convergence program has helped beneficiaries ensure that their children get at least the minimum dietary requirement. Additional selected results include:

• In the project area, the incidence of stunting and wasting among children under two would have been 7.7% and 3.4% higher and the incidence of underweight among children under five would have been 3.7% higher if the nutrition convergence program had not been put in place before the onset of COVID-19.
• The proportion of children under two whose growth is adequately monitored improved by 4.6%.
• Among children 6-23 months of age, dietary diversity (consuming foods from four or more recommended food groups) has increased by 12.7%.
• Immunization among children under two years of age improved slightly from 78% in baseline to 80% in midline.
• Deworming for children 6-24 months increased from 54% in baseline to 61% in midline.
• 514 villages were declared open-defecation free.

Last Updated: Mar 05, 2024