Seqota Declaration Program achieves a critical milestone, averting stunting in nearly 100,000 children annually

In 2015, the Government of Ethiopia made a bold commitment to end childhood stunting by 2030—known as the Seqota Declaration. In the years since, it has rolled out a set of ambitious, multi-sectoral interventions aimed at achieving this goal. Now, analysis carried out by Johns Hopkins University has revealed the transformative impact of the Seqota Declaration Program, showing that stunting was averted in 95,000 children under five years old in 2022 alone.¹ The analysis also projects that the children brought into the program in 2021 will complete an additional 7,126 years of schooling and earn an additional $48 million over their lifetimes as a result of the interventions.

These impressive results were driven by the most dramatic drop in stunting rates ever recorded worldwide. Through a coordinated, multi-sectoral approach, the government was able to improve stunting reduction from a steady 1 percent drop per year to a staggering 3 percent.

Lessons from Ethiopia’s approach could have significant implications for other governments across the continent that are seeking to combat stunting in their countries. More than 30% of African children are stunted²—prevented from growing or developing properly—due to malnutrition and other underlying causes such as wasting, anemia, and low birth weight. Stunting is largely irreversible, leading to lifelong negative impacts. Stunted children generally fall sick more often, perform less well in school, attain lower adult wages, and are more likely to suffer from chronic diseases. For the continent to achieve its broader development goals, it is essential to accelerate progress on stunting.

Three key ingredients that have been critical to Ethiopia’s success include:

1. Proactive and systematic growth monitoring to enable early detection

Identifying and intervening at the early signs of stunting is essential for avoiding permanent damage to children’s health and brain development. A study carried out by the Government of Ethiopia in 2021 indicated that growth monitoring and promotion—which is designed to catch and address these signs—was only being implemented among 54% of children under five years old in the areas assessed.

In response, the government proactively moved to scale up routine growth monitoring for all children, designing and implementing a program to upskill health extension workers. More than 1,400 workers and their supervisors were given training on how to effectively carry out growth monitoring and promotion.

Parents and caregivers now bring their children to a community health post every month so that they can be weighed and measured. This data is then plotted against the World Health Organization’s growth reference chart, which notes the healthy ranges at each age. When a child shows signs of being underweight or below the expected measurements for their age³, the health extension worker consults with parents to identify and remedy the potential causes. As needed, children are provided with nutrition-dense food, medical care or social safety net services. Compared to waiting for children in dire need to be identified during routine vaccination appointments or ad-hoc visits to health clinics, this has revolutionized the government’s ability to detect and treat at-risk children.

The results have been remarkable. By the end of 2023, coverage of monthly growth monitoring had risen to 77%. By June 2025, the government aims to increase this further to 85%.

2. Focus on the regions with the highest levels of stunting and develop context-specific solutions

The government decided to concentrate interventions explicitly on regions of the country where the stunting rates were the highest. This enabled them to develop a deeper understanding of the root causes of stunting within each region and design and deliver context-specific interventions, whether that be addressing the lack of food diversity, adapting childcare practices, or managing problematic health issues such as malaria or diarrheal diseases.

Across all regions included in the Seqota Declaration Program, a general lack of access to water, compounded by a lack of clean water for consumption, was identified as among the top underlying drivers of stunting that needed to be addressed if a sustainable fix to stunting was to be achieved. The water issues were causing both a scarcity of nutritious foods and a prevalence of water-borne illnesses, both of which can have a devastating impact on stunting. Having identified this problem, the government moved quickly to expand water accessibility at scale, and dramatically improve water quality through both point-of-use filtered water and piped water.

The Johns Hopkins analysis revealed that a context-specific approach has been critical to Ethiopia’s success. The top five measures that contributed to stunting reduction across the regions in the program were management of moderate acute malnutrition, point-of-use filtered water, nutrition smart agriculture, age-appropriate breastfeeding practices, and management of severe acute malnutrition. However, the importance of each of these interventions varied by region; therefore, determining which intervention would drive the most dramatic improvements in each specific region was essential for quickly moving the needle. The rapid results achieved in these regions have in turn driven an impressive reduction in stunting nationwide.

3. Undertake a coordinated response across all sectors

Finally, the government has worked from the ministerial level to coordinate and ensure interventions are integrated and delivery is cost-effective.  A team of ten ministers and presidents of regional governments, convened by the deputy prime minister, regularly set and review overall targets, work from one collective budget, and streamline interventions.

Teams now also work systematically at the community, household and individual levels.  When a child is identified as being at risk of stunting through growth monitoring, they are not only treated based on their individual and immediate needs; the underlying causes of stunting are traced back to the community and household levels so these can be addressed both for the specific child, and to anticipate needs of other children also likely to be affected. This has required close coordination between government ministries and agencies at the regional and federal levels.

Looking ahead, in 2025 the Government of Ethiopia plans to expand the program to 700 districts, which collectively account for 70% of the cases of childhood stunting nationwide. The sectors will also begin to report their progress to the Federal Parliament, using the coverage of growth monitoring as a key indicator to demonstrate how the program is scaling up.

Image source: Ministry of Health – Ethiopia

¹ The analysis used the Lives Saved Tool (LiST), a mathematical modelling tool that allows users to estimate the impact of scaling up maternal, newborn, and child health, and nutrition interventions in low- and middle-income countries. LiST was developed by the Institute for International Programs at Johns Hopkins Bloomberg School of Public Health. Coverage data comes from large-scale household surveys including the Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and verified data provided by the government.

²Source: https://globalnutritionreport.org/resources/nutrition-profiles/africa

³ This is based on a measurement of the mid-upper circumference of the child’s arm.