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This framework for action was developed to support the inclusion of nutritional considerations in the design of water operations and to help formulate nutrition-enhancing water policy. Chronic undernutrition early in life can cause cognitive and physical impairments that prevent children from achieving their full potential and have lasting consequences on the human capital that is essential for economies of the future to be competitive. The authors present an integrated water and nutrition framework to aid in understanding the various ways that water impacts early child nutrition, drawing on the three dimensions of water security: water quantity, adequate supply of water resources; water quality, water that is free of contamination; and water accessibility, reliable availability to all people, economies, and ecosystems. Each of these in turn affects the underlying drivers of poor nutrition outcomes in children. Challenges associated with water-related conflict and water resources in the context of fragility cuts across each of the drivers of undernutrition. The framework complements guidance notes that describe the evidence of how water sector investments across irrigation, water management, and water supply and sanitation impact early child nutrition and summarize recommendations on how to design interventions for greater impact.

Health --- Hygiene --- Stunting

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The 18th Amendment to the Constitution of Pakistan shifted the administrative paradigm from centralized to decentralized structures. The added obligations require major policy and institutional reforms in an otherwise weak social protection (SP) sector at provincial levels, generally characterized by limited planning, coordination, execution, and monitoring capacities. SP has become a salient feature of social policy, nationally as well as internationally. The basic components of a SP framework include safety nets or social assistance, social care for children and the elderly, social insurance and labor market interventions for productive employment generation. SP is conferred as an entitlement in the Pakistani Constitution, and the Government of Sindh (GoS) has demonstrated political commitments to this. This note outlines the key considerations of a policy on SP as part of the GoS commitment to reduce poverty, inequality, and vulnerability in the province. Section one gives introduction. Some of the key development challenges that a SP policy may need to consider prioritizing is described in section two. Sections three and four describes critical design principles of SP policies and programs, respectively. Section five reviews the current de facto SP programming in Sindh, while section six delineates a way forward for policy development.

Educational Attainment --- Labor Market --- Poverty --- Social Insurance --- Stunting --- Wasting

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Undernutrition begins early in life and has lifelong consequences. The cost of undernutrition both for the individual and the economy are substantial. Analyzing data from an Indian cohort, the New Delhi Birth Cohort, formed between 1969 and 1972, this paper provides evidence on the associations between attained human capital in the third and fourth decade of life and measures of growth from birth to adulthood. For the purpose of this paper, attained human capital is defined through three metrics: educational status, male occupation, and material possession score. Growth measures (height, weight, body mass index (BMI)) during five age intervals (0 to 6 months, 6 to 24 months, 2 to 5 years, 5 to 11 years, and 11 years to adulthood) were related to human capital metrics using multivariate regression models. Sensitivity analyses were also performed to assess the stability of associations. All three human capital metrics had a significant positive association with birth size and measures of physical growth in children under-five years of age, in particular for children under two years. Length at birth and height gain from 6 to 24 months were consistently associated with all metrics. Faster weight and BMI gain from five years onward significantly predicted material possession scores. Among socioeconomic and behavioral characteristics at birth, maternal and paternal education, and paternal occupation also had a consistent positive association with all three human capital metrics. The findings reinforce the focus on interventions during the first 1,000 days of life to promote larger birth size and linear growth and suggest an additional window of opportunity between 2 to 5 years to improve human capital. The benefits can be enhanced by simultaneous investments in parental (especially maternal) literacy, livelihoods, safe water supply and sanitation, access to health care, and enhancing incomes. These interventions also have a nutrition-sensitive effect to promote early life growth.

Health Indicators --- Health, Nutrition and Population --- Human Capital --- Nutrition --- Stunting

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Kiribati is among the first few countries in the world to have undertaken a national census of children's early health and development. This report presents data collected for 7,194 children aged 3 to 5 years across 21 of the country's islands. Data were collected on children's health and development, their learning environments at home, and their early childhood education experience, which together, provide a snapshot of how children in Kiribati are developing in their early years and highlights factors that are playing an important role in influencing children's outcomes. Overall, these results provide the country with valuable evidence to guide policy makers and service providers in their program planning and design, evaluation of interventions, and monitoring of children's outcomes. It is hoped that in future, the country will drive repeat census collections, as only with repeat data over time will policy makers, service providers, and communities be able to understand if their work to support children is making a difference.

Child Development --- Child Health --- Early Childhood Education --- Nutrition --- Stunting --- Wasting

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In the past two decades, Indonesia significantly improved its economic growth, poverty, and maternal and child health outcomes. Despite these notable achievements, the country's rates of stunting and malnutrition are among the highest in the world and threaten early childhood development as the stepping-stone of human capital formation. Though government guidelines, standards, and training have helped improve nutrition services in the health sector, there continues to be considerable variation in service quality across districts, between urban and rural areas, and among public and private facilities, with many mothers and children being provided suboptimal services. Malnutrition is a multisectoral issue that is not the "problem" of the health sector alone. However, many of the high-impact health interventions known to improve nutrition outcomes for children are not being implemented in Indonesia, calling for a higher-quality health system to produce better nutrition outcomes. This report analyzes the opportunities to improve the quality of frontline nutrition interventions in Indonesia's health sector as an element of achieving the National Strategy to Accelerate Stunting Prevention (2018-2021) (StraNas Stunting) goals. It uses a framework adapted from the Lancet Global Health Commission's report on High-Quality Health Systems in the Sustainable Development Goals Era, which explains that improving the quality of nutrition health care requires system-wide action. In specific, high-quality nutrition services necessitate both process and foundational reforms at the macro, meso, and micro levels. The paper outlines the challenges and proposes recommendations to improve quality nutrition care and services in the country. These are related to strong leadership, harmonized guidelines and targets, and robust regulatory and quality improvement mechanisms; improved monitoring and evaluation and data use; predictable, adequate, and timely financing; platforms for care; competent health workers and a sound supportive supervision system; adequate supplies and functional equipment; and systems that respond to clients' health needs and expectations.

Early Child and Children's Health --- Health, Nutrition and Population --- Malnutrition --- Nutrition --- Reproductive Health --- Stunting