The politics of success in the fight against malnutrition in Peru

The dramatic reduction in children's chronic malnutrition in Peru observed in recent years has defied the patterns of stunting reduction worldwide. After nearly a decade of stalled progress, the government reported a reduction in stunting rates of nearly 10 points, from 29.8% in 2005 to 18.1% in 2011. The specialized literature has acknowledged the critical role that immediate (e.g. increasing breastfeeding promotion) and underlying (e.g. investments to improve household food security) interventions have played in reducing stunting (Black et al., 2013), as well as the contributing role of enabling factors related to economic performance. This paper offers an alternative explanation to success by looking at the shift in the government's nutrition strategy after 2006 with the formation of the Child Malnutrition Initiative (CMI), a civil society working platform, and the adoption of a national poverty reduction strategy prioritizing nutrition interventions (known as CRECER) and conditional cash transfers (JUNTOS). The paper uses veto players theory to explain how these changes effectively contributed to policy change by reducing the effective number of nutrition stakeholders involved and facilitating policy agreements around a common policy platform and established goals. The Peruvian case also highlights the importance of the government's public commitment to reduce chronic malnutrition in children under five by 5 percent in 5 years (5 by 5 by 5) and the accompanying role, advocacy and monitoring from civil society organizations. The paper looks at the success of implementing the nutrition strategy in three dimensions. Horizontally, it looks at the coordination between government and non-government agencies to converge around a common policy discourse;vertically, it looks at the implementation of the nutrition strategy across national, regional and municipal governments;and financially, it looks at the coordinated and conditional allocation of nutrition funding and how this created greater incentives for horizontal and vertical coordination. The paper draws some theoretical and policy implications for improving the effective and accountable delivery of nutrition interventions in Peru and other countries outside Latin America. (C) 2013 Elsevier Ltd. All rights reserved.