DRC Multisectoral Nutrition and Health Project

active

The DRC remains one of the poorest countries in the world. With a population estimated at 89.5 million people, the DRC has the third largest population of poor globally (60 million people). While the poverty rate declined from 94.3 to 77.2 percent between 2005 and 2012 (using the international poverty line of US$1.90), the latest World Bank projections put poverty at 73.3 percent (2020) , an increase of 0.7 percentage points compared to 2019. This recent increase is primarily due to the COVID-19 pandemic. High population growth—at more than three percent (and a fertility rate of 6.2 children per woman )—coupled with subdued economic growth, means the number of poor is increasing by about 1.5 million every year, and recent economic growth has not been sufficient to reduce poverty. There are significant disparities in poverty. The highest poverty rates in DRC are found in the central and northwestern provinces largely covered by forest. The highest number of poor, however, are found in the provinces along the east-west corridor (Kongo Central to Haut-Katanga), including Kinshasa, and in the east bordering the Great Lakes (Ituri, North and South Kivu). These provinces are also areas most affected by conflict and violence. About 70 percent of the employed population is engaged in subsistence agriculture.The proposed AF supports the initial design of the MNHP, which was designed to build the DRC’s capacity to strategically respond to chronic malnutrition, to enable the country to move away from the current situation of mainly humanitarian responses to repeated nutrition and food security crises. The prevalence of chronic malnutrition among children under five remains alarmingly high, with important impacts on child survival and human capital development. Around 42 percent, or 6.3 million, of children under the age of 5 are stunted (DRC Multiple Indicators Cluster Survey (MICS) 2018), which is the third largest population of stunted children in Sub-Saharan Africa (after Nigeria and Ethiopia). While the prevalence of stunting has been declining on the African continent over the past decades, in the DRC it has remained nearly stagnant for the last twenty years. The MNHP builds on analytical work that shows the main determinants of chronic malnutrition in the DRC are repeated and untreated infections, poor birth outcomes, and inadequate dietary intake among women of childbearing age and young children. These in turn are caused by multiple factors: inadequate access to key maternal and child health services; inappropriate feeding practices; poor hygiene and lack of access to water; lack of production of and access to nutritious and diversified food throughout the year, and extremely low incomes. Thus, chronic malnutrition in the DRC can only be addressed through a combination of multi-sectoral interventions focused on improving maternal and child health and nutrition. The COVID-19 pandemic was declared in the DRC in March 2020 and has heavily impacted the DRC economy and livelihoods, especially among the poorest population. Structural underdevelopment, widespread poverty, and protracted conflict and insecurity have contributed to a context in which large numbers of the extremely poor population live on a knife’s edge between chronic and acute/emergency food insecurity. The combination of public health measures associated with COVID-19 and inflation contributed to a significant increase in acute food insecurity, and heavy rains and flooding and soil erosion also impacted agricultural productivity. An estimated 27 million people in the DRC are highly food insecure , with approximately 20.5 million at crisis levels (IPC Phase 3), and 5.4 million at emergency levels (IPC Phase 4). An additional 48 million people are moderately borderline/food insecure (IPC Phase 2) and are at risk of backsliding into IPC Phase 3 or worse. Within these figures 857,000 children and 468,000 women are suffering from acute malnutrition. The GoDRC requested an activation of the CERC on September 22, 2021 to respond to the acute food insecurity crisis, identified in the Integrated Food Security Phase Classification (IPC) 19 and validated in September 2021 . The World Bank reviewed the Government’s request and supporting documentation and will approve a US$50 million allocation to the CERC in April 2022. The food security situation threatens to compromise the impact of the MNHP and is projected to worsen as the Russia-Ukraine conflict drives food prices higher and destabilizes global food systems. The UN Conference on Trade and Development (UNCTAD) estimated that 60-70% of the DRC’s wheat imports come from Russia and Ukraine, which will have a crippling impact on food imports into the country. The DRC is one of the countries in Africa that is projected to be most affected by price increases in fuel and commodities, including oil, wheat, and fertilizer. DRC will face increasing food access issues in the next six months, which will worsen during the lean season, especially for poor households, due to reductions in imports and increases in transport costs. Poor availability and access to nutritious foods remains a critical constraint to improving nutrition, especially in food insecure zones. Nationally, only 8 percent of children 6-23 months consume a diet with adequate quality and quantity (DHS 2014). This is partially due to poor knowledge about nutritious diets for children, but another key driver of child malnutrition is poor availability and access to nutrition food. In the project areas this is due to poor agricultural productivity and low rural incomes that are a result of limit ed use of agriculture practices and technologies (e.g., improved seeds (including biofortified seeds), nutrition-smart agriculture, and fertilizers). Low agriculture productivity and diversity is a major challenge for rural households in food insecure zones where the parent Project is active, where most of the food consumed is locally produced and many households are subsistence farmers. The proposed AF would also address the high need for nutrition-sensitive interventions to promote longer term resilience and nutrition and food security through increasing vulnerable household access to biofortified crops and household food production kits. The additional financing will support the following activies:Component 1: Improving the Delivery of Community Interventions and Social and Behavioral Change (US$50 million IDA). The allocation of US$50 million from the CRW ERF to this component would fill a financing gap caused by the activation of the CERC. This would allow the initially planned activities, i.e., delivery of community-based nutrition services in the existing project areas (Kwilu, Kasai, Kasai Central, and South Kivu), to be implemented as envisioned and to reach 2.5 million children and 1.5 million women as planned. The activities, which will be facilitated by NGOs (contracts expected to be signed in June 2022) will focus on improving community engagement, linkages to health services, utilization of preventive and promotive health and nutrition services, and early identification and referral of children under five with severe acute malnutrition. Component 3 (US$8.5 million from GAFSP): Convergence Demonstration Project. The AF would enable the project to scale up the number of households receiving food production kits and biofortified seeds and crops to establish more nutrition-sensitive and resilient agriculture production. Tanganyika Province would be added as a new geographic area of support under the Project. In addition, new health zones in South Kivu Province that are not currently covered under the Parent Project would receive support under this component through the AF. These provinces were selected due to the high fragility because of conflict and insecurity and subsequent high rates of malnutrition. For the agriculture interventions, households with food production capacity and with ch