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

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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). 126
Figure 4.17: Community based nutrition operational nexus Service delivery & support system Minimum basic services (Health, education, agricultural extension) Financing, training, supervision FACILITATORS Interface Planning, using ‘basic minimum needs’ goals & indicators. Implementation, Monitoring & Evaluation MOBILIZERS Community Community leaders, households, individuals Selection of ‘basic minimum needs’ goals & indicators Source: Tontisiron & Gillespie 1999. Empowerment of community mobilizers is enhanced by the existence of community organizations, an important contextual success factor identified in South Asia. If such organizations do not exist they need to be created to represent the nutritionally vulnerable people in the community. Woman’s groups or organizations are often the most committed and efficient in addressing nutrition problems. Indeed, the involvement of women is another prevalent contextual success factor, although it is important to combat the perception that solving nutrition problem is the sole responsibility of women. Successful program are thus 'gender focused’ and not 'woman focused'. Community participation is an essential factor of successfully sustaining community-based nutrition intervention programs. However, the sustainability of such programs needs to be thoroughly thought through when it comes to the issue of remuneration and incentives to the mobilizers. The experience of ESHE in SPNNR, and community IMCI in Tigray and Amhara regions are very good lessons to learn from. These communit y mobilizers are trained volunteers, respected residents of the community supported by the community level health workers (facilitators). There is a monthly meeting with the community level health workers and a quarterly meeting with the district health offices. The mobilizers perform behavior change communication for better caring practices using a mobilizer to household ratio of from one to 15 to one to 50. Development of community support groups for better caring using positive deviant caretakers from within the community must be done by all development 127
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An assessment of the causes of maln
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• Bantirgu Hailemariam coordinate
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3.4. National and Regional Trends:
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LIST OF TABLES Table 2.1: Child stu
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LIST OF ACRONYMS ADLI AGOA AIDS BCC
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Figure 1.1: Stunting among children
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these underlying determinants of th
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experimental body of evidence that
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water can have significant impact o
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2.1. Introduction In the early 1960
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violating the basic tenets presente
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Table 2.3: Regional profile of stun
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A rich food through popularization
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key tenet in the process of identif
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Basic Causes Major Features High im
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commodity trading is the most signi
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Table 2.9: Gross primary enrollment
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following and in alliance with the
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• Accept that agricultural develo
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the other practices that need to be
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CHAPTER 3: FOOD SECURITY AND MALNUT
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Afar in 2000 was 12.6 percent and 5
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3.1. Introduction The economic grow
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In a more technical way, it is diff
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differently, it is important to acc
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households will not be as difficult
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the drought prone areas, the rain f
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insecure, these activities will als
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viewed as a proxy for household foo
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Figure 3.3: Per capita food product
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Intermediate means of transport suc
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educated, environmentally conscious
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1995-96 revealed that ‘the greate
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works are key instruments to lay do
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due to inappropriate land mismanage
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3.6.3.5. HIV/AIDS This disease is w
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coordinates the different implement
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conception through early pregnancy
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households who depend on purchased
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• Improve rural radio infrastruct
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3.7.3.6. Improve rural market infra
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Page 93 and 94: children between 6 and 24 months. T
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Page 97 and 98: Figure 4.1: Risk of death in infant
Page 99 and 100: Table 4.2: Present discount values
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Page 105 and 106: Figure 4.7: Risk of mother to child
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Page 109 and 110: Figure 4.8: The extended model of c
Page 111 and 112: 4.3.1.2. Recognizing symptoms of il
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Page 115 and 116: Figure 4.13: Prevalence of stunting
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Page 119 and 120: 4.3.3.4. Response to food security
Page 121 and 122: 4.3.6. Time and energy expenditure
Page 123 and 124: Table 4.3: Care focused initiatives
Page 125 and 126: together. This demands an integrate
Page 127 and 128: In an emergency, therefore, care an
Page 129 and 130: • Enhance women’s capacity for
Page 131 and 132: Table 4.4: Analysis of care conside
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Page 141: There is a strong need for enhancin
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Page 146 and 147: 5.1. Introduction 5.1.1. Conceptual
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Page 150 and 151: Integrating nutrition interventions
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Page 154 and 155: Box 5.1: Household and Community In
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Page 162 and 163: Table 5.1: Prevalence of diarrhea a
Page 164 and 165: Figure 5.3: Trends in latrine cover
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Page 170 and 171: 5.4.2. Programs and projects 5.4.2.
Page 172 and 173: made by NGOs for the affected child
Page 175 and 176: CHAPTER 6: INSTITUTIONAL FRAMEWORK
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Page 179 and 180: 6.2. Challenges and Lessons Learnt
Page 181 and 182: Training Post-secondary training is
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Table 6.6: (continued) Agency Inter
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Achievements Challenges Sustainabil
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Berhane G. 1995. Nutrition surveill
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Ethiopian PROFILES Team & AED/Linka
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Middlebrook, P. 2002. Social protec
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Raisin, J. 2001b. Improving food se
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Yamano, T., H. Alderman, & L. Chris
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