Africa's Stories of Change in Nutrition
IFPRI’s “Stories of Change in Nutrition” series of publications examines evidence from countries with high burdens of malnutrition in order to better understand how nutrition policies are made and how these policies are implemented on the ground. In Africa south of the Sahara, the series thus far covers Ethiopia, Zambia, and Senegal.
Since 2000, the Ethiopian government has established several key programs to address agricultural production, social protection, and nutrition security, including the Growth and Transformation Plan, the Productive Safety Net Program (PSNP), and the National Nutrition Program (NNP). These programs have paid off – stunting rates fell from 57 percent in 2000 to 40 percent in 2014, and the government has pledged to end child undernutrition by 2030.
The latest version of the PSNP, established in 2015, provides a good example of the Ethiopian government’s multisectoral approach to nutrition. The PSNP targets nutritionally vulnerable households; includes a special focus on pregnant and lactating women; provides includes nutrient-rich pulses in food transfers; promotes nutrition-sensitive livelihoods strategies and public works; and links with the health sector and closely monitors nutrition-sensitive program provisions. Recent proposals to the program include the development of a nutrition-focused behavior change communication program to replace portions of the public work requirements, meaning that households could receive food and cash transfers for participating in nutrition education.
Despite progress at the national level in developing multisectoral programs and in mainstreaming nutrition strategies across national ministries, the “Stories of Change” report points out that much of the work remaining in Ethiopia will need to take place at the local level. The capacity of woreda-level administrations to adapt and implement national program varies widely, and this ability has a significant impact on how, and if, programs reach local beneficiaries.
In addition, local communities may feel that there are more pressing matters to address, such as the threat of climate change to agricultural livelihoods. The report emphasizes that the importance of nutrition needs to be better communicated at the local level and that nutrition-based programs need to be integrated with existing programs to reduce poverty. This improved communication should include training of nutrition extension agents to better engage with communities and monitor nutrition status at the household level.
In Zambia, nutrition is deeply impacted by a range of macro-level factors, including large-scale weather patterns like El Niño, droughts, fluctuating copper prices, widespread income inequality, and changes in the global food industry. These factors have led to an interesting dichotomy in Zambia’s nutrition status: On one hand, stunting fell by around 1 percent per year between 2002 and 2014 (due in large part to investments in the health sector and improvements in water and sanitation). However, on the other hand, Zambia’s growing global integration and increasing wealth has led dietary patterns to shift away from traditional foods toward more processed products, increasing the prevalence of overweight and chronic disease. The “Stories of Change” report emphasizes the need to address this dual burden of over- and under-nutrition.
In recent years, the government of Zambia has taken several steps to build coherent national nutrition programs, starting with joining the SUN movement in 2010. However, funding for these policies and the technical capacity to implement them throughout the country is still lacking, according to the report. For example, only specific districts and wards have been targeted by the pilot phase of SUN’s 1000 days of nutrition program, aimed at improving child feeding practices during the crucial first 1000 days of life. In addition, while funding from international development partners has grown exponentially in recent years, the same cannot be said of government funding for nutrition; national budget allocation for nutrition programs remains quite limited. This can be partially attributed to falling international copper prices, upon which Zambia’s government depends for revenue.
Nutrition in Zambia has fallen under the auspices of a “triad of leadership”, according to the report, which includes government, nutrition professionals, and civil society at the national level; these organizations have started working more closely with the international community. The report emphasizes that the roles of these various stakeholders need to be clearly defined and properly aligned in order to increase capacity, properly utilize funds, and design and target efficient programs. Finally, data collection regarding nutrition status at the local and household level needs to be significantly improved in the country, combining important health and agricultural factors and covering different sections of the population.
Senegal has been particularly successful in reduction stunting rates in recent years; according to USAID, stunting among children under the age of 5 fell from 27 percent to 19 percent in only three years (2010-2013). Increasing wealth and improved healthcare services and parental education appear to be behind this improved nutrition indicator. In addition, over the past 15 years, awareness of the importance of nutrition has increased across multiple sectors, including agriculture, health, and education. Beginning in the early 2000s, the government of Senegal increased its commitment to nutrition, establishing a new national nutrition coordinating body (CLM) and launching a national nutrition program (PRN). These initiatives have focused on bringing together stakeholders across multiple sectors and on increasing the engagement and education of local communities. The PRN established an extensive network of volunteer health development relays, who conduct monthly screenings to detect acute malnutrition in children, refer malnourished children to proper health services, and educate parents regarding proper child feeding. These efforts have increased parental knowledge regarding nutrition, particularly the importance of breastfeeding in the first six months of life. Challenges remain, however, in terms of providing these services in more remote rural areas, as well as in properly funding the program to ensure its long-term sustainability.
The report for Senegal indicates that this issue of financing will remain the major hurdle to further improvements in nutrition indicators. Nationally, the health, education, and agriculture sectors need to incorporate nutrition into their strategies; this will call for increased budgets. At the community level, local governments will also need to increase their budgets to properly incorporate nutrition programs into their broader development strategies; this will include shifting extension services from the current volunteer basis seen in the PRN to paid employees in order to ensure sustainable delivery of nutrition services throughout the country.
By: Sara Gustafson