Undernutrition has, fortunately, risen on the policy agenda in Africa in recent years. In 2004, an international IFPRI 2020 conference held in Kampala on food and nutrition security in Africa drew attention to the issue, and high-level policymakers noted the problem and the need for action much more than they had before. Still, undernutrition remains a fundamental challenge to achieving improved human welfare and economic growth in Sub- Saharan Africa. To address that challenge, national governments must undertake appropriate policies and actions. Politically, however, a high prevalence of undernutrition is not seen as anomalous and indicative of the inability of governments to fulfill their duties to their citizens. This report examines the findings from a qualitative institutional study in Ghana, Mozambique, Nigeria, and Uganda to determine what it is about national-level policymaking, nutrition, and the issue of nutrition in policymaking circles that makes it difficult for governments to target undernutrition as a national development priority. The underlying determinants of improved nutritional status fall across several sectors. Consequently, much more so than for most other development challenges, the routine operations of government through sector-specific action are unlikely to succeed in comprehensively eliminating undernutrition. Given this poor fit between nutrition and government operations and the consequent problems for establishing leadership on the issue of undernutrition within government, the absence of effective nutrition advocacy coalitions in all of the study countries turns out to be a key constraint to building national commitment to overcoming undernutrition. As such, there is little demand to hold government agencies in each sector accountable for assisting the undernourished. Although the challenge of building advocacy efforts should not be minimized, this study suggests several actions that advocacy coalitions can take to raise the profile of undernutrition as a national development problem. This report provides guidance on how national governments can be encouraged to address the needs of the undernourished so that such individuals can enjoy long, healthy, productive, and creative lives. It suggests that development actors continually highlight for political and bureaucratic decision-makers the fundamental constraint that undernutrition poses to achieving key development objectives, including economic growth and poverty reduction. Moreover, it should be made clear that governments can support the implementation of relatively low-cost solutions that enable all to meet their nutritional needs. Undernutrition is a solvable problem that requires public action and commitment. IFPRI is committed to the task of comprehensively eliminating undernutrition globally and will continue to examine the policy processes through which such public action can be fostered and maintained.