While significant progress has been made in reducing hunger and food insecurity in Africa in recent decades, around one in five people in the region continue to face chronic undernourishment. In a new report from the Malabo Montpellier Panel, “Nourished: How Africa Can Build a Future Free from Hunger and Malnutrition”, researchers take a systematic country-level approach to identify where progress has been achieved and how to replicate and scale up successful policies. The roadmap set out in the report can help further progress toward the nutrition targets set out by the Malabo Declaration and the Sustainable Development Goals.
According to the report, nutrition has become a top priority at both the continental and the international level. Nutrition indicators have been included in the continent-wide CAADP Results Framework, and the G20 launched a new Africa Partnership in 2017 to focus on sustainable and inclusive economic growth and development in the region. To continue this progress, agricultural and economic growth and transformation must be scaled up in ways that are both sustainable and nutrition-sensitive; in addition, policymakers need to view nutrition through a multi-sectoral lens, taking into account a wide range of factors including infrastructure, education, social safety nets, and WASH (water, sanitation, and hygiene) programs.
The report covers case studies from seven countries (Senegal, Ghana, Rwanda, Togo, Cameroon, Angola, and Ethiopia), as well as a regional overview of malnutrition. The importance of political commitment was a common thread running through all of the case studies, as was the importance of addressing malnutrition using a multi-sectoral approach.
In Senegal, malnutrition fell significantly between 2000 and 2016. The country’s Global Hunger Index (GHI) score dropped from 38 to 17 during this time period, and the prevalence of child stunting fell from 30 percent to 19 percent. According to the report, this progress can be credited largely to increased political commitment and investment from the Senegalese government. In 2001, the Prime Minister’s office created the Cellule de Lutte contre la Malnutrition (CLM), which coordinates activities among seven ministries, as well as the National Association of Rural Advisors and various civil society organizations; the CLM aims to foster cooperation and coordination among the various actors, as well as to help monitor implementation of community-level nutrition intervention programs. Programs launched through the CLM’s Programme de Renforcement de la Nutrition (PRN) include monthly weighing of children from birth to age three; education efforts to improve child feeding practices; and provision of fortified foods and potable water. According to the report, wasting rates declined by 34 percent in villages where PRN programs were implemented, compared to a 21 percent reduction in non-intervention villages.
In 2008, Ghana was ranked among the 36 countries in the world with the highest rates of child malnutrition; since then, the prevalence of malnutrition and extreme hunger have both fallen significantly. Ghana’s GHI score declined from 30 to 14 between 2000 and 2016. Over this time period, nutrition has become well-integrated into the government’s policy agenda, with the National Development Planning Commission successfully overseeing the implementation and evaluation of the National Nutrition Policy. The country has taken a multi-sectoral approach to malnutrition reduction, involving the Ministries of Health, Education, and Agriculture. As a result of these integrated programs in central and northern Ghana, child stunting rates decreased fell from 43 to 25 percent and exclusive breastfeeding increased from 63 to 75 percent between 2009 and 2012.
Strong political will has also played an important role in reducing malnutrition in Rwanda following years of conflict in the 1990s. The country’s GHI score fell from 56 to 28 between 2000 and 2016, while child stunting rates decreased from 48 to 38 percent over the same period. Rwanda’s National Nutrition Policy, launched in 2007 and revised in 2013, focuses on coordinating national and local efforts and brings together a range of government ministries, including the Ministry of Health, Education, and Agriculture and Animal Resources. Key programs implemented in the country over the past decade include education efforts to improve child feeding practices, scaling up community-based nutrition programs in every district, mapping of food-insecure zones, and promotion of the production and consumption of nutritious foods like fruits and vegetables at the household level.
Angola’s GHI score fell from 58 to 33 between 2000 and 2008. While the Ministry of Health runs most of the country’s nutrition interventions, the government has taken a more multi-sectoral approach to reducing malnutrition in recent years. For example, the Ministry of Agriculture developed a National Food Security and Nutrition Strategy in 2009. Over the past decade, Angola’s food and nutrition focus has shifted from emergency and humanitarian interventions to development-oriented programs. These include supplementation programs for women and children; the creation of Community Infant Centers for the distribution of nutritious food to malnourished infants; and the creation of a National Surveillance System to monitor and collect primary nutrition-related data throughout the country.
In Cameroon, the GHI score fell from 40 to 23 between 2000 and 2016. Starting in 2001, Cameroon’s government took coordinated steps to address hunger and malnutrition in the country, culminating in the creation in 2009 of the Interdepartmental Committee for Food Security, which brings together 19 government ministries across a range of sectors. Programs implemented include the promotion of breastfeeding; training and employment programs in the field of nutrition; and nutritional support and supplementation for vulnerable groups. Cameroon’s mandatory food-fortification program, which requires the addition of vitamin A to refined vegetable oil and the addition of iron, zinc, folic acid, and vitamin A to wheat flour, succeeded in lowering micronutrient deficiencies in women and children and anemia in women.
Ethiopia’s GHI score fell from 59 to 33 between 2000 and 2016, while child stunting rates declined from 57 to 40 percent during the same period. In 2008, the Government of Ethiopia created the National Nutrition Coordination Body (NNCB), which includes government ministries, development partners, civil society actors, researchers, and the private sector. Programs enacted under the NNCB include the use of therapeutic feeding units to treat severely malnourished children, monthly weighing and community-based programs to improve child feeding, and biannual vitamin A supplementation. Initial analysis of data from 1.5 million children under the age of two showed a decline in underweight from 30 percent in January 2009 to 20 percent in March 2010. The report also highlights the important role that the country’s Protective Safety Net Programme (PSNP) can play in reducing household-level malnutrition and food insecurity, particularly in conjunction with efforts to better educate parents and caretakers about appropriate child feeding practices.
Finally, Togo has seen significant progress in efforts to reduce child wasting over the past decade – the country’s GHI score fell from 39 to 22 between 2000 and 2016. During the same period, child wasting rates fell from 11 to 7 percent. In 2007, the government created a Nutritional Emergency Response Unit within its Service National de Nutrition (SNN); in addition, the government has passed a number of food fortification laws, including for salt, oil, and wheat flour. The country’s Plan Stratégique National d’Alimentation et de Nutrition, which was in effect from 2012 to 2015 and was led by the Ministry of Health, created and implemented a number of successful nutrition programs, including the promotion of nutrition education to improve child feeding practices, school feeding and nutrition programs, and the training of community health workers to prevent and manage acute malnutrition.
The Malabo Montpellier Report highlights the crucial role that policymakers play in reducing malnutrition. Particularly in the face of rising challenges like climate change and population growth, strong political will is needed to ensure that economic growth and transformation is inclusive and nutrition-sensitive.
By: Sara Gustafson, IFPRI
 The Global Hunger Index measures and tracks four indicators of hunger (undernourishment, child wasting, child stunting, and child mortality), using a standardized score of 0-100.