Tackling malnutrition – Lessons from other countries

Despite current efforts and progress, reducing malnutrition, undernourishment, micronutrient deficiencies, and overweight and obesity remains a challenge in Africa.

More needs to be done to achieve the Malabo Declaration targets of reducing the prevalence of stunting, wasting, and underweight, while ensuring a minimum dietary diversity for women and meeting minimum standards for infant diets by 2025.

For this to happen, a 2019 Malabo Montpelier Panel report said “agricultural and economic growth and transformation in Africa must be nutrition-sensitive and lead to sustainable food system development, creating jobs, improving livelihoods, and providing more diverse and nutritious diets”.

Without the political will to prioritise nutrition across all areas of government, including agriculture, health, and rural development, and without increased investments in infrastructure and public goods and services, the report said “malnutrition will persist, contributing to continued poverty and a reduced quality of life for millions of people across Africa”.

Eliminating malnutrition in Africa is also an economic policy decision, as the cost of undernutrition to African economies averages 11 percent of Gross Domestic Product annually. At the same time, the economic returns from investing in nutrition are high: for every $1 invested, $16 is generated.

Yet, several countries across Africa have been able to dramatically reduce malnutrition over the past 20 years. Based on the Global Hunger Index, seven countries — Senegal, Ghana, Rwanda, Togo, Cameroon, Angola, and Ethiopia — were able to substantially reduce the level of malnutrition between 2000 and 2016, when compared to other African countries.

Some of the countries had initial high rates of malnutrition due to conflicts and socioeconomic instability. In addition to recovered political and economic stability, government commitment to programmatic and institutional reforms played a key role in improving countries’ nutrition status – a lesson Nigeria could learn.

In each case, the governments developed ways of spotting nutrition problems early on and implemented cutting-edge programmes at scale, to prevent people from reaching crisis points. Many are also developing policies that mean their health, nutrition and agriculture ministries have to work closely together, and this is yielding results.

Senegal

Between 2000 and 2016, Senegal made remarkable progress on undernutrition reduction. The GHI score fell from 38 in 2000 to 17 in 2016. The prevalence of stunting decreased from 30 percent to 19 percent over the same period. These improvements in nutrition have been driven in large part by significant institutional and programmatic commitment by the Senegalese government.

The Cellule de Lutte contre la Malnutrition, situated within the prime minister’s office, provides technical assistance in the definition and implementation of the national nutrition policy.

While the health sector remains the lead sector tackling malnutrition in Senegal, there is evidence that making agriculture more nutrition-sensitive can improve nutrition outcomes.

A study among pastoralists in northern Senegal has shown that using a dairy value chain approach to promote access to more nutritious food, in this case, a micronutrient-fortified yoghurt, can improve the nutritional status of preschool children.

With the introduction of the micronutrient-fortified yoghurt, anaemia prevalence dropped from a very high 80 percent to close to 60 percent. Furthermore, after one year, haemoglobin concentration increased by 0.55 g/dL more among children consuming micronutrient-fortified yoghurt. However, this latter impact was greater for boys than for girls.

Rwanda

Following the conflict in the 1990s, Rwanda’s nutrition situation worsened dramatically. However, between 2000 and 2016, Rwanda made significant progress in terms of undernutrition reduction due to recovered stability, on the one hand, and the government’s institutional and programmatic commitments, on the other hand. The GHI score decreased from 59 in 2000 to 28 in 2016, while stunting rates fell from 48 to 38 percent over the same period.

The implementation of the national nutrition policy is led by an inter-ministerial coordination committee based within the prime minister’s office. In 2009 the President’s Initiative to Eliminate Malnutrition was launched, led by the Ministry of Local Government with the technical leadership of the Ministry of Health.

More than 30,000 community health workers (CHWs) were trained over a two-month period in 2009 to carry out community-level actions outlined in the National Protocol for the Management of Malnutrition. Over five months, CHWs used circumference tapes to screen more than 1.3 million children across the country; more than 65,000 were referred and treated for moderate or severe acute malnutrition.

There is a strong recognition that making agriculture and the food system more nutrition-sensitive is an effective strategy to reduce malnutrition. The Girinka programme (One Cow, One Family) provides evidence that agriculture is a key sector in malnutrition reduction in Rwanda.

Within six months of the programme’s introduction in 2006, 248,566 cows had been distributed to poor households. Girinka has led to a significant improvement in the nutritional status of children under the age of five, with fewer children found to be wasted, stunted, and underweight than in 2012.

Stunting, which remains the main nutritional challenge in Rwanda, decreased from 43 percent in 2012 to 37 percent in 2015.

In addition, as beans are the predominant staple crop in Rwanda, the Rwanda Agriculture Board, with the support of HarvestPlus, scaled up the availability of bio-fortified beans. The beans are iron-enriched and can be grown by rural communities, and their benefits are not limited to the nutritional outcome.

Read also: Nigeria, others need support to curb food insecurity – IMF

Ghana

In 2008, Ghana was ranked among the 36 countries globally with the highest burden of chronic childhood undernutrition. However, the reduction of undernutrition levels since then has been substantial compared to other countries in West Africa.

In 2006, Ghana was the first African country to achieve the target of cutting the proportion of the population living in extreme poverty by half, and by 2015 had halved the number of hungry people.

This is backed up by the GHI score, which decreased from 30 to 14 between 2000 and 2016. Ghana also made significant progress in reducing the proportion of stunted, wasted, and underweight children during the same time.

A multi-sectoral approach bringing together the ministries of health, education, and agriculture has been shown to be successful in malnutrition reduction.

Nutrition is well-integrated in government programmes and clearly highlighted in human development objectives under government policy frameworks such as the Ghana Poverty Reduction Strategy issued in 2003, the Growth and Poverty Reduction Strategy for the period 2006–2009, and the Ghana Shared Growth and Development Agenda for 2010–2013.

Although the policies have been largely donor-driven, the government has provided policy backing, personnel, facilities, and logistical support for their implementation. The minimalised level of corruption in the country has helped to ensure the success of accessing nutrition and reducing malnutrition.