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

unthinkable and the achievement of the Millennium Development Goals targets, such as a
reduction in the level of underweight, will be a mere dream. Better caring practices as an
underlying cause malnutrition is a key factor in addressing this development problem. Caring
is a cross cutting issue that cannot be addressed by any one development sector alone. It is at
the household that different sector must come together to promote and enhance better care
practices. There are gaps in the way policies and programs have been implemented with
respect to caring practices at the household level. This has been due partly to the lack of a
national nutrition strategy to guide necessary actions, roles, and responsibilities of the
different sectors and agencies related to caring practices.
Therefore, there is a need for policy and program modifications to ensure better
caring practices at the household level.
• The first important issue is that the role of better caring practice should be
mainstreamed into the development plan of each sector. This might productively done
by applying nutrition criteria to review the potential intended and unintended impact
of investments, define optimal nutritional inputs from each sector, and identify
potential opportunities to integrate nutrition initiatives across multiple sectors (i.e.,
the application of a Nutrition Lens to sectoral activities) (Micronutrient Initiative
2004).
• There should be a nutrition coordination body within government that operates to
ensure that better caring practices are taken into account in the nutritional activities
across the various sectors and implementing bodies. Therefore, sectoral policies and
strategies need to have caring practices as one of their performance indicators. In
particular, various sectoral strategies that seek to develop the cadre of kebele -level
development agents should insert improvements in local caring practices into the
terms of reference under which these agents will work. The performance appraisal
criteria for these agents should include the nutritional status of the populations of the
communities with which they work.
• Institutional frameworks have to be developed for monitoring and evaluation of
better caring practices and to establish accountability mechanisms from the grassroots
community to the federal level. A higher level government body can coordinate and
monitor the other sectors that have a role in promoting better caring practices –
Ministry of Health, Ministry of Education, Ministry of Agriculture, Women’s Affairs
Office, Ministry of Labor and Social Affairs, Food Security Bureau, HIV/AIDS
Prevention and Control Office, DPPC and NGOs.
Caring practices are built on community’s resources and the enhancement of
household level capacities for caregiving should be targeted. This requires partnership
creation between the community resource people (health animators, health promoters,
community volunteers) and the frontline development workers (Health extension workers,
community health workers, agricultural home economist agents, development agents)
reaching households in the community (facilitators). This will ensure the link between the
strategy, service delivery outlets, and implementation at the household level.
Figure 4.17 portrays the nature of the linkages between service delivery structures
and the community, mediated by the facilitators and mobilizers, and the type of work done at
the interface.
The selection and training of facilitators and community mobilizers are key elements
of the approach. Facilitators should not train mobilizers in what to do, but rather strive to
empower them. This requires both participatory training methods and a power shift from the
outside to facilitator and mobilizers. Outside support channeled through facilitators includes
advocacy, information, education, training and direct service delivery (Gillespie & Haddad
2003).
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