世界银行-全面掌握甲板：通过撒哈拉以南非洲的多部门努力减少发育迟缓（英文）-2019.7-195页.pdf

All Hands on DeckReducing Stunting through Multisectoral Efforts in Sub-Saharan AfricaEmmanuel Skoufias,Katja Vinha,and Ryoko SatoAFRICA DEVELOPMENT FORUMAll Hands on DeckAll Hands on DeckReducing Stunting through Multisectoral Efforts in Sub-Saharan AfricaEmmanuel Skoufias,Katja Vinha,and Ryoko SatoA copublication of the Agence franaise de dveloppement and the World Bank 2019 International Bank for Reconstruction and Development/The World Bank1818 H Street NW,Washington,DC 20433Telephone:202-473-1000;Internet:www.worldbank.orgSome rights reserved1 2 3 4 22 21 20 19This work is a product of the staff of The World Bank with external contributions.The findings,interpretations,and conclusions expressed in this work do not necessarily reflect the views of The World Bank,its Board of Executive Directors,or the governments they represent,or the Agence franaise de dveloppement.The World Bank does not guarantee the accuracy of the data included in this work.The 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focus on issues of significant relevance to Sub-Saharan Africas social and economic develop-ment.Its aim is both to record the state of the art on a specific topic and to contribute to ongoing local,regional,and global policy debates.It is designed specifically to provide practitioners,scholars,and students with the most up-to-date research results while highlighting the promise,challenges,and opportuni-ties that exist on the continent.The series is sponsored by Agence franaise de dveloppement and the World Bank.The manuscripts chosen for publication represent the highest quality in each institution and have been selected for their relevance to the development agenda.Working together with a shared sense of mission and interdisciplinary purpose,the two institutions are committed to a common search for new insights and new ways of analyzing the development realities of the Sub-Saharan Africa region.Advisory Committee MembersAgence franaise de dveloppementGal Giraud,Chief EconomistTh omas Melonio,Executive Director,Innovations,Research and Knowledge DirectoratePie rre Icard,Director,Head of Knowledge Department on Sustainable DevelopmentSophie Chauvin,Head,Edition and Publication DivisionHlne Djoufelkit,Deputy Head,Research DepartmentWorld BankAlbert G.Zeufack,Chief Economist,Africa RegionMarkus P.Goldstein,Lead Economist,Africa RegionSub-Saharan AfricaZIMBABWEANGOLABURUNDIRWANDACHADNIGERUGANDAKENYASOMALIAETHIOPIAERITREASUDANSOUTHSUDANCENTRALAFRICAN REPUBLICREP.OFCONGONIGERIATOGOSENEGALLIBERIASIERRA LEONEGUINEACTEDIVOIREGUINEA-BISSAUDEMOCRATICREPUBLICOF CONGOSOUTHAFRICALESOTHOESWATINIBOTSWANAZAMBIAMOZAMBIQUEMADAGASCARCOMOROSSEYCHELLESMALAWITANZANIANAMIBIAMAURITIUSCAMEROONGABONEQUATORIAL GUINEASO TOM AND PRNCIPEMALIBENINBURKINA FASOMAURITANIACABOVERDETHE GAMBIAGHANAIBRD 39088|MAY 2019La Runion(Fr.)Mayotte(Fr.)viiTitles in the Africa Development Forum SeriesAfricas Infrastructure:A Time for Transformation(2010)edited by Vivien Foster and Cecilia Briceo-GarmendiaGender Disparities in Africas Labor Market(2010)edited by Jorge Saba Arbache,Alexandre Kolev,and Ewa FilipiakChallenges for African Agriculture(2010)edited by Jean-Claude DevezeContemporary Migration to South Africa:A Regional Development Issue(2011)edited by Aurelia Segatti and Loren Landau*Light Manufacturing in Africa:Targeted Policies to Enhance Private Investment and Create Jobs Lindustrie lgre en Afrique:Politiques cibles pour susciter linvestissement priv et crer des emplois(2012)by Hinh T.Dinh,Vincent Palmade,Vandana Chandra,and Frances Cossar*Informal Sector in Francophone Africa:Firm Size,Productivity,and Institutions Les entreprises informelles de lAfrique de louest francophone:Taille,produc-tivit et institutions(2012)by Nancy Benjamin and Ahmadou Aly Mbaye*Financing Africas Cities:The Imperative of Local Investment Financer les villes dAfrique:Lenjeu de linvestissement local(2012)by Thierry Paulais*Structural Transformation and Rural Change Revisited:Challenges for Late Developing Countries in a Globalizing World Transformations rurales et dvel-oppement:Les dfis du changement structurel dans un monde globalis(2012)by Bruno Losch,Sandrine Frguin-Gresh,and Eric Thomas WhiteThe Political Economy of Decentralization in Sub-Saharan Africa:A New Imple-mentation Model(2013)edited by Bernard Dafflon and Thierry MadisEmpowering Women:Legal Rights and Economic Opportunities in Africa(2013)by Mary Hallward-Driemeier and Tazeen HasanEnterprising Women:Expanding Economic Opportunities in Africa(2013)by Mary Hallward-DriemeierUrban Labor Markets in Sub-Saharan Africa(2013)edited by Philippe De Vreyer and Franois RoubaudSecuring Africas Land for Shared Prosperity:A Program to Scale Up Reforms and Investments(2013)by Frank F.K.Byamugisha*Youth Employment in Sub-Saharan Africa Lemploi des jeunes en Afrique subsaharienne(2014)by Deon Filmer and Louise Fox viii TiTleS in The AFricA DevelopmenT Forum SerieSTourism in Africa:Harnessing Tourism for Growth and Improved Livelihoods(2014)by Iain Christie,Eneida Fernandes,Hannah Messerli,and Louise Twining-Ward*Safety Nets in Africa:Effective Mechanisms to Reach the Poor and Most Vulnerable Les filets sociaux en Afrique:Mthodes efficaces pour cibler les populations pau-vres et vulnrables en Afrique(2015)edited by Carlo del Ninno and Bradford Mills*Land Delivery Systems in West African Cities:The Example of Bamako,Mali Le systme dapprovisionnement en terres dans les villes dAfrique de lOuest:Lexemple de Bamako(2015)by Alain Durand-Lasserve,Malis Durand-Lasserve,and Harris Selod Enhancing the Climate Resilience of Africas Infrastructure:The Power and Water Sectors(2015)edited by Raffaello Cervigni,Rikard Liden,James E.Neumann,and Kenneth M.Strzepek*Africas Demographic Transition:Dividend or Disaster?La transition demographique de lAfrique(2015)edited by David Canning,Sangeeta Raja,and Abdo S.Yazbeck The Challenge of Fragility and Security in West Africa(2015)by Alexandre Marc,Neelam Verjee,and Stephen Mogaka Highways to Success or Byways to Waste:Estimating the Economic Benefits of Roads in Africa(2015)by Ali A.Rubaba,Federico Barra,Claudia Berg,Richard Damania,John Nash,and Jason Russ Confronting Drought in Africas Drylands:Opportunities for Enhancing Resilience(2016)edited by Raffaello Cervigni and Michael Morris*Reaping Richer Returns:Public Spending Priorities for African Agriculture Productivity Growth(2017)by Aparajita Goyal and John Nash Mining in Africa:Are Local Communities Better Off?(2017)by Punam Chuhan-Pole,Andrew L.Dabalen,and Bryan Christopher Land Realizing the Full Potential of Social Safety Nets in Africa(2018)edited by Kathleen Beegle,Aline Coudouel,and Emma Monsalve Facing Forward:Schooling for Learning in Africa(2018)by Sajitha Bashir,Marlaine Lockheed,Elizabeth Ninan,and Jee-Peng Tan The Skills Balancing Act in Sub-Saharan Africa:Investing in Skills for Productivity,Inclusivity,and Adaptability(2019)by Omar Arias,David K.Evans,and Indhira SantosAll Hands on Deck:Reducing Stunting through Multisectoral Efforts in Sub-Saharan Africa(2019)by Emmanuel Skoufias,Katja Vinha,and Ryoko Sato*Available in French All books in the Africa Development Forum series are available for free at https:/openknowledge.worldbank.org/handle/10986/2150.ixcontentsForeword xviiAcknowledgments xixAbout the Authors xxiAbbreviations xxiiiOverview 1Motivation 1Design and Methods 5Results 6Policy Considerations 15Attention to the Incentive Structure 19Notes 20References 221 Introduction and Motivation 25Notes 31References 312 Methodology and Data 33The United Nations Childrens Fund Conceptual Framework 33Caveats and the Contributions of This Study 37Notes 42References 433 Stunting in Sub-Saharan African Countries 45Note 54References 55x conTenTS4 The Underlying Determinants of Nutrition 57Measures of Food Security and Child Care 57Measures of Water,Sanitation,and Hygiene 62Measures of Health 64Empirical Measures of the Underlying Determinants of Nutrition 66Access to Food and Care,Health,and WASH 68Simultaneous Access to the Underlying Determinants of Nutrition 76Notes 81References 815 Stunting and Access to the Underlying Determinants of Nutrition 83Stunting and Childrens Simultaneous Access to the Drivers of Nutrition 84Stunting and the Underlying Determinants of Nutrition 98A Brief Summary of the Country-Specific Estimates 102Testing the Sensitivity of the Findings 102Notes 105References 1066 An Application at the Country Level:The Case of Tanzania 107Stunting and the Underlying Determinants of Nutrition in Tanzania 108Correlation between Stunting and Access to the Drivers of Nutrition 112Monitoring Progress in Nutrition and Access to the Drivers of Nutrition 119Notes 123References 1237 Income Growth Is an Essential Element of a More Effective Multisectoral Approach 125Average Income 126Variability of Income 135Notes 138References 140conTenTS xi8 How Can a Multisectoral Strategy to Reducing Stunting Produce the Desired Results?143The Joint Targeting of Interventions by Different Sectors 144Attention to the Incentive Structure 147Notes 148References 149Appendix A Exploring the Relationship between Height-for-Age and the Three Drivers of Nutrition 151Appendix B In Search of Synergies 153Appendix C Stunting and the Three Drivers of Nutrition:Country-Specific Estimates 161Appendix D Stunting and the Three Drivers of Nutrition:Subpopulation-Specific Estimates 165Boxes1.1 Nutrition-Specific and Nutrition-Sensitive Interventions 274.1 Additional Questions in Surveys for Better Adequacy Measures 584.2 Access to and Utilization of Health Facilities 655.1 Tariffs,Trade,and Child Stunting 967.1 Agricultural Chemicals and Child Nutrition 127FiguresO.1 Differences in Access to Adequate Food and Care,Sub-Saharan Africa 7O.2 Differences in Access to Adequate WASH,Sub-Saharan Africa 8O.3 Differences in Access to Adequate Health,Sub-Saharan Africa 9O.4 Childrens Access to the Three Determinants of Nutrition in Sub-Saharan Africa 10O.5 Prevalence of Stunting in Sub-Saharan Africa,Based on ChildrensAccess to the Three Determinants of Nutrition 11O.6 Prevalence of Stunting in Sub-Saharan Africa,Based on Childrens Access to Zero,One,Two,or Three Determinants of Nutrition 12xii conTenTSO.7 Marginal Effects on the Probability of Stunting,Based on Childrens Access to Combinationsof the Three Determinants of Nutrition 13O.8 The Relationship between Height-for-Age Z-scores and Wealth by Percentile of Household Wealth among Older and Younger Children 141.1 Causes,Correlates,and Consequences of Stunting 262.1 Determinants of Child Malnutrition 342.2 Framework for Actions to Achieve Optimum Fetal and Child Nutrition and Development 353.1 Stunting Prevalence among Younger(023 Months)and Older(2459 Months)Children 463.2 Growth Faltering(Children 059 Months)473.3 Growth Faltering,by Socioeconomic Characteristics(Children 059 Months)483.4 Distribution of Height-for-Age for Different Populations 493.5 Stunting Prevalence,by Country(Children 023 Months)503.6 Stunting Prevalence in Urban and Rural Areas within Each Country(Children 023Months)513.7 Stunting Prevalence among Boys and Girls within Each Country(Children 023Months)523.8 Stunting Prevalence,by Wealth Quintile within Each Country(Children 023Months)533.9 Stunting Prevalence,by Mothers Education within Each Country(Children 023Months)54B4.2.1 The Nonrandom Allocation of High-and Low-Quality Health Facilities,Nigeria 654.1 Percentage of Children with Access to Adequate Food and Care within Each Country(Children 023 Months)684.2 Inequities in Access to Adequate Food and Care within Each Country(Children 023 Months)694.3 Percentage of Children with Access to Adequate WASH within Each Country(Children 023 Months)714.4 Inequities in Access to Adequate WASH within Each Country(Children 023Months)724.5 Percentage of Children with Access to Adequate Health within Each Country(Children 023 Months)744.6 Inequities in Access to Adequate Health within Each Country(Children 023Months)75conTenTS xiii4.7 Inequities in Joint Access to the Underlying Driver