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

supplies. The available facilities are unable to provide the optimum level of services required
to address the nutritional problems of mothers and children. Although its full implementation
will be challenging, the HSDP III has been planned in a comprehensive manner that will
prioritize malnutrition issues as part of integrated decentralized and community-level
packages for health service delivery.
At present, food and nutrition issues are positioned within the sectors of Health and
Agriculture. Issues of food shortage and adult nutrition are to be handled by the Ministry of
Agriculture and Rural Development, while issues of deficiency diseases and the nutritional
problems of children and mothers of childbearing age, in particular, are to be addressed by the
health sector. Nutrition in the health sector administratively is placed in a recently established
unit within the Family Health Department of the Ministry of Health. This Nutrition Unit is
currently engaged in activities related to child nutrition, micronutrient deficiency control, and
infant and young child feeding (IYCF) strategies and programs that has been adopted through
the Essential Nutrition Actions (ENA). The ENA represent an action-oriented approach that
focuses on promoting seven clusters of nutrition behaviors that have been empirically proven
to reduce morbidity and mortality. The main beneficiaries of these actions would be infants
and young children under the age of two years, as well as women of reproductive age. The
other key health sector interventions for addressing the problems of malnutrition are outlined
within the Child Survival Strategy that has specified detailed nutrition related activities to be
performed at each of the various levels of the hierarchy of health institutions in the country.
Activities related to human resource development in the area of nutrition are also very
limited, and the very few nutrition experts in the country have been trained elsewhere. The
only institution where there is a concentration of nutrition experts is the Ethiopian Health and
Nutrition Research Institute (EHNRI) that focuses on basic nutritional research issues.
Therefore, the capacity to analyze household and community nutrition problems in the health
sector, in particular, is very limited.
At the service delivery level, the clinical capacity as well as the overall management
of nutrition related programs, such as growth monitoring and promotion, is considerably
weak. Food aid or other food security related interventions are conducted at the district level
by the respective disaster prevention and preparedness offices or NGOs independently, with
little participation of local health sectors. The implementation of nutritional activities at the
level of primary health care services is also besieged by a lack of trained personnel in both
clinical and managerial fields
Evaluation of water and sanitation issues with regard to nutrition also indicates their
significant importance for improving nutrition through contributing to the reduction of
communicable diseases, such as diarrhea, since malnutrition and these infections are closely
inter-related. In Ethiopia, access to safe water and adequate excreta disposal facilities is still
low at 37.3 percent and 28.9 percent respectively. Overcrowded living conditions in urban
slums and poor management of both liquid and solid wastes in these areas also contribute to
the prevalence of both diarrhea and acute respiratory tract infections that again exacerbate the
nutritional status of children.
At present, drinking water development activities are mandated to the Ministry of
Water Resources, while other sanitation activities are the functions of MOH, even though the
situation of waste management in all its aspect, whether solid or liquid waste, is very poor.
The water sector development program of the SDPRP consists of various programs and
projects grouped into water supply and sanitation, irrigation, hydropower, etc. According to
the targets of the program, water supply coverage of urban, rural, and national was expected
to reach 82.5 percent, 31.4 percent and 39.4 percent, respectively, by the end of 2005.
Human resource development in the area of water supply and sanitation is also
problematic. The training of sanitarians does not seem to go with the quality and quantity of
workers needed for the task. There is a hope that the National Health Extension Package will
improve the level of equity in the distribution of decentralized level environmental health
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