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

The interventions that make up this “essential package” for nutrition are relatively
inexpensive and proven to be effective in a range of different settings. They need to be
incorporated into both child and maternal health services within the primary health care
framework.
To date, only a limited number of health facilities and health personnel in Ethiopia
have been involved with implementation of ENA. Thus, the effectiveness or costeffectiveness
of ENA in the Ethiopian setting is yet to be evaluated.
5.2.4. Nutrition in emergencies
The DPPC along with its regional bureaus and district offices are the principal bodies
for coordinating health, nutrition, and other interventions during nutritional emergencies
within their respective localities. USAID, WFP, and other bilateral and international
organizations play an active role in generating surveillance information through the Famine
Emergency Warning System (FEWS) and in the provision of food aid and other commodities.
The extent of involvement of local health offices and bureaus is largely limited to the
provision of curative and preventive health services. Supplementary feeding programs and
therapeutic feeding centers are often established and run by NGOs with little involvement or
integration with the local health authorities. Likewise, documentation, recording, and
reporting activities are rarely channeled to local health offices or to the MOH. Thus, the
information and experience of such intervention activities fails to be shared with the health
sector. This will further compromise the potential of the health sector to be actively involved
in the analysis of nutrition emergencies and in the planning and implementation of nutrition
interventions during emergencies.
There is an apparent shift of balance by the government in favor of ensuring food
security rather than an integrated approach towards ensuring good nutrition for the nation.
This is reflected by the levels of attention and resources devoted to the food security program
and the policy commitment towards it. While the country has never had a food and nutrition
policy, it has had a food security strategy for some time.
Nutrition emergency interventions are traditionally limited to the provision of food
items and some other commodities. The need for providing appropriate nutritional care for
mothers and children in particular, along with the provision of health and sanitation facilities
is often considered secondary. This bias is partly revealed in the composition of emergency
response teams, which rarely include expertise in the area of health. The protection and
promotion of breastfeeding and appropriate infant and young child health and feeding
practices are commonly undermined during nutrition emergencies, as both the donors and
beneficiary populations focus mainly on food aid. Mothers tend to substitute breastfeeding
with the meals and flours that they receive as part of the food aid intervention.
However, there have been some encouraging progresses in recent years. Health teams
from professional health training institutions have been mobilized along with food aid
organizations to serve drought-affected populations in the provision of preventive and
curative health services, as well as establishment of water and sanitation facilities. Similarly,
in connection with resettlement programs underway in the country, the necessary
infrastructure, including water and health facilities, are built prior to deployment of settlers
into a new environment.
Although the parallel deployment of health professionals in drought and famine
interventions could have considerable advantages, there is a need for close communication
and integration between the various actors in such settings. The best way to ensure that the
care and health aspects of nutrition interventions are properly addressed would be to build-in
such interventions in the design of emergency interventions, rather than through a parallel
deployment of teams with different expertise. As depicted in the conceptual framework on the
causes of malnutrition in Figure 1.2, food security is but one of the three groups of underlying
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