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

Médecins
Sans
Frontières
Relief Society
of Tigray
Save the
Children Fund
USA
The nutrition activities of the five national MSF sections present in Ethiopia mainly focus
on small-scale therapeutic nutrition care. This includes screening for acute malnutrition
through mobile clinics where no formal health facility is available, community therapeutic
feeding, and blanket distribution of food and farming tools.
REST is implementing a community-based health care promotion in partnership with the
formal health services. This is based on six contact points with the health services and
on bringing services into the community through monthly outreach. It also conducts child
growth promotion. Supplementary feeding is used for demonstration and consists of the
provision of a monthly ration of FAFFA corn and soya blend.
Save the Children Fund (US) implements community-based therapeutic care including
supplementary feeding, an outreach therapeutic program, community outreach health
education, measles vaccination, and sick child consultation through community
volunteers and formal health staff.
World Vision World Vision has led the implementation of the Micronutrient and Health (MICAH)
network in Ethiopia, in coordination with five other NGOs. MICAH focuses on:
• vitamin A supplements to children from 6 months to 14 years of age;
• iron and folic acid supplementation for pregnant and lactating women;
• deworming;
• a revolving scheme for iodized salt;
• dietary diversification through an inputs distribution program to communities through
the Rural Development Office; and
• primary health care.
Steering committees involved in planning and monitoring & evaluation have been
established at each project site. Members include staff of line ministries and the woreda
or kebele adm inistration and community members.
Source: Compiled by author.
Children under five and pregnant and lactating women are the target groups for most
interventions. A few interventions specifically target adolescent girls as well or focus
exclusively on the under-two age cohort. Food aid and poverty reduction interventions
generally target food insecure woredas or households, regardless of age cohort or life cycle
stage of the recipients. In contrast to the national or regional scope of government nutrition
programs, NGO projects tend to be less extensive, being localized in a few woredas or health
zones, most often in Oromiya and Amhara; very few initiatives cover the more peripheral
lowland and pastoral regions.
Most of the non-governmental interventions are implemented through or in
coordination with formal health services (both facility-based and health extension workers),
food security programs, or emergency food aid and related services. Many interventions use
various types of community volunteers. However, there is little supervision or coordination of
volunteers across related initiatives. Moreover, the relationship between the nutrition projects
of NGOs and local formal health services is often problematic. Most notably, NGOs often
provide incentives to the formal health services staff for support. While this may be needed
realistically, it likely is unsustainable and may create negative externalities and increased
costs when local staff of the formal health services perceives NGO support to attaining
improved nutritional outcomes, not as a complement to their existing tasks, but as an
additional activity for which remuneration is needed.
A wide variety of training and IEC materials has been developed by both government
and non-government bodies. With regard to training, there is little joint planning and
coordination on training needs across agencies, little harmonization of training curricula and
methodologies, and little follow up of trainees (especially community volunteers). With
insufficient coordination and supervision, the impact of the training provided is only partial.
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