An assessment of the causes of malnutrition in Ethiopia: A ...

Care focused initiatives in
Ethiopia
• MOLSA (Tigray)
Components of caring practice
addressed
• Child rights committee, child rights
clubs , psychosocial committee, birth
registration.
• Street children and HIV/AIDS orphans:
Reunification, skills training,
sponsorship programs, behavior change
communication, & counseling on
HIV/AIDS, informal education, foster
parent program.
• Senior citizens and disabled -
rehabilitation, skills training, organizing
them in associations.
• House to house care of PLWHA.
Components not very well
addressed (Gaps)
• Integration with the other sectors
is poor.
• No mechanisms for delivering
household level assistance to the
vulnerable in the urban areas,
since there are no health
extension workers and health
promoters.
However, this is not to undermine the integrated efforts to address the vulnerable
segments of the population through both emergency interventions and food security
interventions. That is to say, there is a targeting element, in most cases at woreda and kebele
levels and occasionally at the household level, in the selection of beneficiaries for asset
building and resource distribution. In the safety net program there is a free transfer of cash or
food to the vulnerable people like pregnant women, disabled persons and lactating mothers
rather than conditioning it with a public work requirement.
However, one key question remains to be answered; who is receiving the cash
transfer for the household (men or women)? Do women have access to the cash? Is the
assistance going to the beneficiaries? There is no well-organized monitoring & evaluation
system in normal circumstances to answer these questions. There are no “care” indicators to
be tracked by all these agencies. It is conspicuous that household income positively affects the
nutritional status of women, children, and other household members when women have
autonomy to decide on the resources (Woldemariam & Timotiwos 2002; Micronutrient
Initiative 2004).
All these care initiatives address one or more aspects of care of the vulnerable groups,
whether fully or partially. The gap observed while analyzing the activities of these initiatives
is that there is rarely any integration, frequently activities overlap, and there are missing parts
in the caring interventions. If systematically integrated, some of them could complement one
another.
The National Nutrition Strategy has to draw from the experiences and success stories
of these different initiatives and apply them in an integrated way at the household level that
takes into account the existing realities of the country and envisions emerging issues in the
future. For example, community IMCI, being implemented at the household level using
community mobilizers (health promoters, health animators, community volunteers), can be
integrated with child growth promotion (CGP) by strengthening the key messages through the
incorporation of essential nutrition actions (ENA) content. Community level child growth
promotion can also be integrated with community therapeutic care or with the regular health
care services. Children screened by this program can be referred to the health care facilities
for community therapeutic care (CTC) or for outreach therapeutic care (OTC). This requires
strengthening of the referral chain and feedback systems between health care facilities and
household level caring services.
The activities of the agricultural home economic agents can also be integrated to
improve household caring practices. From experiences in the Tigray region, it is possible to
establish kebele level development teams to improve caring practices at the household level.
This is a scenario where the health extension workers (community health workers),
agricultural home economic agents, and teachers in the elementary school are working
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