In 2010, 44% of children under 5-years of age in Rwanda were stunted due to chronic malnutrition, with severe consequences for their cognitive and physical development, health, and productive capacity. This situation was due to a myriad of factors, including household food insecurity, inappropriate nutrition and care practices, food and water safety, and the number of infants and young children living in the same household [1].  In response the United Nations (UN) in Rwanda adopted a multisectoral, multi-stakeholder approach, uniting four UN agencies - namely the Food and Agriculture Organization of the UN (FAO), UN Children’s Fund (UNICEF), UN World Food Programme (WFP), and World Health Organization (WHO). This unified effort, funded by the Swiss Agency for Development and Cooperation (SDC), is known as the One UN project. The One UN project has contributed to the Government of Rwanda’s (GOR) success in reducing the prevalence of stunting in children under five years old, from 44% in 2010 to 33% in 2020 with each agency providing support to the GOR based on their comparative advantage [2, 3].

How did Rwanda, with the support of the WHO Secretariat, achieve this?

In an effort to improve maternal, infant, and child nutrition, a three-stage program was put into effect.  The first stage, running from 2014 to 2016, was implemented in two districts and saw success in reducing anaemia and stunting in children under two years old, as well as anaemia in pregnant and lactating women [4]. The second phase, from 2017 to 2021, saw WHO Rwanda providing technical assistance and guidance to the Ministry of Health and other stakeholders at the national level to influence nutrition policy. This included collecting evidence on nutritional care practices and health outcomes, advocating for increased government investment in nutrition, and reviewing and supporting adaption of policies, strategies, and guidelines in different sectors (health, nutrition, gender, and family promotion) for the strengthening of national nutrition plans and interventions, coordination of activities, and monitoring progress [5]. WHO Rwanda’s provision of technical expertise at the subnational level included developing and implementing trainings to build the capacity of new Community Health Workers (CHWs) and teachers, providing in-service trainings to health facilities to enable better nutritional care, and providing sensitization tools designed to change nutritional behaviour in communities.

“In partnership with the World Health Organization (WHO), we set an ambitious goal of reducing malnutrition in the Rutsiro District to 19 percent prevalence by 2025. To achieve this, we will implement a 'godparent' system, in which village heads, council leaders, religious leaders, and women-led committees will be appointed to monitor a designated number of children and report weekly on their health and nutritional status”

-          Triphose Murakatete, Mayor of Rutsiro District 

Rwanda has an extensive and well-developed CHW network, with three CHWs selected and trained in every village of approximately 50 to 150 households. To bolster the prevention and management of malnutrition, materials were developed for a competency-based training package, and new CHWs were trained on Maternal Infant and Young Child Feeding (MIYCF), growth monitoring, and the identification, prevention, surveillance, and management of malnutrition. Between 2018 and 2020, WHO Rwanda provided technical expertise and financial support to train trainers in 15 districts, whose expertise was then cascaded down to train 4,244 CHWs on MIYCF counselling in 30 districts.

Trainings of health care providers at the facility level were conducted to upskill them and bolster nutritional care for the prevention and management of NCDs. One NCD officer in every health facility and two officers in every public hospital were trained in all districts.