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

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The food-bias on nutrition in Ethiopia starts from the interpretation of the definition of food security. This indeed is the crux of the matter in linking the nutrition security strategy to food security strategy. Nutrition affects the availability of food and food in turn affects nutrition status of a household in rural farming families. The food side of the nutrition problem starts at the individual level but extends to household up to national level. Conceptual framework The conceptual framework for this study is based on both the nutrition in the lifecycle framework and the global framework of the determinants of malnutrition framework. These frameworks provide the understanding that to effectively tackle malnutrition a tri-adequacy of food, health, and care products is indispensable. At the immediate level, malnutrition results from interactions between inadequate dietary intake and disease, a vicious cycle that accounts for much of the high morbidity in countries like Ethiopia. The life-cycle perspective illustrates the complexity of building a nutrition secure society, as malnutrition can be compounded through the life cycle and across generations. The global framework demonstrates that resources must be brought from a number of sectors, levels, and partners to bear on the problem of malnutrition. Simply the conceptual underpinning is that food security goes beyond food production and distribution, and nutrition security is not a necessary outcome of successfully achieving food security, but an issue that must be explicitly addressed in its own right. Targeting is an important concept to have an effective nutrition-aimed food security intervention. Conceptually it is important to distinguish between the food security and nutrition security target groups in terms of their location specificity. Food security could be seen in the context of households, community, region, as well as national levels. Nutrition security requires priority target groups. Nutrition security is more focused on an individual, household and community levels. Most nutrition programs target infants, young children and women of childbearing age, while food security programs target households and communities. National and regional potentials and food security performance There is little doubt about the country’s natural resources potential for the production of food items (crops and livestock) in sufficient quantity and quality. Ethiopia is endowed with a large array of agro-ecological conditions that allow the production of various types of crops. Despite such potentials, it is sad to note that agriculture in Ethiopia has been unable even to produce enough to feed its population. Among the varied factors that account for this sad state of affairs, low land, animal and human productivity take the leading responsibility. It has often been said that Ethiopian agriculture, both crop and livestock, is characterized by low-input and low-output system of production. Since the country is dependent on agriculture, crop failure usually leads to household food deficits. Due to crop failure and disasters, millions of people annually rely on food distributed free or under food for work programme. For the fifteen years before 2002 Ethiopia annually imported 700,000 metric tons of food aid on average to cope with food insecurity in the county. Having peaked at about 26.2 percent in 1984/85, food aid imports amount to a significant proportion of the domestic production of food crops, often 10 percent or more. Nationally food security has been and continues to be a serious challenge. The major causes for food insecurity at individual or household levels, is related to high level of poverty (access) and inadequate national production of food items (supply). Between 2000 and 2004 on a regional level, per capita production of food crops was above the national average in three of the four major regions of the country (Tigray, Amhara and Oromia). The national average for this period was 145.46kg/person while the regional average was 164, 177 207, and 71 for Tigray, Amhara, Oromia, and SNNPR, respectively (EEA 2003/04). The regions with the highest food deficits, Afar and Somali, also have the highest level of child malnutrition. The prevalence of wasted and underweight children in 34
Afar in 2000 was 12.6 percent and 50.5 percent, while the national prevalence was 10.5 percent and 47.2 percent, respectively. Using the 225 kg/person food crop (grain) production as a benchmark for measuring food crop production deficit, the food deficit in drought prone regions in 2000 was high. In addition to the magnitude of malnutrition, the poverty level and the average per capita food production differ by region. Benishangul-Gumuz, for example, a region with the highest per capita food production in all the reported years – producing above the FAO recommended yearly per capita food intake – nevertheless has the highest poverty headcount of all regions. This indicates that high agricultural production does not guarantee poverty reduction or a reduction in malnutrition, since poverty is one of its basic determinants. Food security policy, strategy, and programs Agricultural Development Led Industrialization (ADLI) is a strategy formulated to implement the national economic development policy, which is a policy of building a market economy in contrast to the socialist economic policy of the Derge regime. It has sectoral strategy documents, of which for the agriculture sector is the Rural Development Policy and Strategies (MOI 2001). Currently, ADLI’s mid-term program based implementation is through the Sustainable Development and Poverty Reduction Program (SDPRP). The RDPS and SDPRP documents are quite detailed and very specific in describing the government’s overriding objectives and intentions in “transforming” the Ethiopian agriculture. It is government policy that, to the extent possible, the food insecure should exit from food aid. The Food Security Strategy (FDRE 2002) is the main document that, together with the documents prepared by the NCFS (2003), gives the policy direction and implementation modalities of various food security related programs and interventions, specifically for the coming five years. The core program of Ethiopia’s FSS is the Food Security Program (FSP), the implementation of which is the responsibility of the Federal Food Security Bureau, under MOARD. The goal of this program is to attain food security for five million chronically food insecure people, while at the same time, improving and sustaining the overall food security of an additional ten million people (NCFS 2003). This program has four broad areas of coverage with inter-linked objectives to achieve this goal. These are (a) food availability to be increased through improved crop and livestock production, (b) food access to be increased through expanded agricultural and non-agricultural incomes, (c) promotion of preventive and curative health services, and (d) access to land provided through voluntary resettlement for up to 440,000 chronically food insecure households. Safety nets – conditional transfers – are used as one of the approaches to improve food access. The first three coverage areas (a-c) are linked to the government’s capacity building effort and inter-linked through the enhanced extension system. The enhanced extension system is also designed to support the communitybased, multi-annual planning approach that, among other things, aims to mainstream health issues. The preventive and curative health care promotion component of FSP is to address the food utilization aspect of the FSS. It is important to emphasis that the safety net programs are biased towards rural areas. There is no place for the urban poor to be part of the beneficiaries of these programs. This also has implications for the design and targeting of food security programs. Moreover, nutrition is not a core component of the safety net programs. The food security strategy and nutrition gap Nutrition criteria applied to food security strategy and interventions production maximizes the positive impact of increased food production or wide range of food products on nutritional status of the people. In the FSS, NCFS and other related polic y documents the incorporation of such criteria is negligible, and as a result even in those areas where major food security interventions were undertaken, the incidence of malnutrition remains high. This gap has to be narrowed. In order to have a nutrition secure society, the FDRE and Regional 35
Page 1: An assessment of the causes of maln
Page 4 and 5: • Bantirgu Hailemariam coordinate
Page 6 and 7: 3.4. National and Regional Trends:
Page 8 and 9: LIST OF TABLES Table 2.1: Child stu
Page 10: LIST OF ACRONYMS ADLI AGOA AIDS BCC
Page 14 and 15: Figure 1.1: Stunting among children
Page 16 and 17: these underlying determinants of th
Page 18 and 19: experimental body of evidence that
Page 20 and 21: water can have significant impact o
Page 22 and 23: 2.1. Introduction In the early 1960
Page 24 and 25: violating the basic tenets presente
Page 26 and 27: Table 2.3: Regional profile of stun
Page 28 and 29: A rich food through popularization
Page 30 and 31: key tenet in the process of identif
Page 32 and 33: Basic Causes Major Features High im
Page 34 and 35: commodity trading is the most signi
Page 36 and 37: Table 2.9: Gross primary enrollment
Page 38 and 39: following and in alliance with the
Page 40 and 41: • Accept that agricultural develo
Page 42 and 43: the other practices that need to be
Page 45: CHAPTER 3: FOOD SECURITY AND MALNUT
Page 49 and 50: 3.1. Introduction The economic grow
Page 51 and 52: In a more technical way, it is diff
Page 53 and 54: differently, it is important to acc
Page 55 and 56: households will not be as difficult
Page 57 and 58: the drought prone areas, the rain f
Page 59 and 60: insecure, these activities will als
Page 61 and 62: viewed as a proxy for household foo
Page 63 and 64: Figure 3.3: Per capita food product
Page 65 and 66: Intermediate means of transport suc
Page 67 and 68: educated, environmentally conscious
Page 69 and 70: 1995-96 revealed that ‘the greate
Page 71 and 72: works are key instruments to lay do
Page 73 and 74: due to inappropriate land mismanage
Page 75 and 76: 3.6.3.5. HIV/AIDS This disease is w
Page 77 and 78: coordinates the different implement
Page 79 and 80: conception through early pregnancy
Page 81 and 82: households who depend on purchased
Page 83 and 84: • Improve rural radio infrastruct
Page 85 and 86: 3.7.3.6. Improve rural market infra
Page 87 and 88: CHAPTER 4: CARE AND MALNUTRITION IN
Page 89 and 90: household allocation; 5) workload a
Page 91 and 92: lack of national nutrition strategy
Page 93 and 94: children between 6 and 24 months. T
Page 95 and 96: Care was recognized as one of the u
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Figure 4.1: Risk of death in infant
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Table 4.2: Present discount values
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Figure 4.3: Factors that affect the
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Box 4.2: Reasons why PLWHA are vuln
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Figure 4.7: Risk of mother to child
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arely provide this kind of benefit.
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Figure 4.8: The extended model of c
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4.3.1.2. Recognizing symptoms of il
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the direction of the growth curve i
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Figure 4.13: Prevalence of stunting
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from poor exposure of children to l
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4.3.3.4. Response to food security
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4.3.6. Time and energy expenditure
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Table 4.3: Care focused initiatives
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together. This demands an integrate
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In an emergency, therefore, care an
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• Enhance women’s capacity for
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Table 4.4: Analysis of care conside
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Sector/ Office Strength Weakness Op
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International initiative Strengths
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• Rate of continued breastfeeding
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Figure 4.17: Community based nutrit
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There is a strong need for enhancin
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supplies. The available facilities
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5.1. Introduction 5.1.1. Conceptual
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access to a basic package of qualit
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Integrating nutrition interventions
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Although the coverage of ENA traini
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Box 5.1: Household and Community In
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The interventions that make up this
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conferences. To this effect, a nati
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with the engineering aspect of wate
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Table 5.1: Prevalence of diarrhea a
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Figure 5.3: Trends in latrine cover
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Institutional arrangements are also
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ehavior are integrated and supplied
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5.4.2. Programs and projects 5.4.2.
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made by NGOs for the affected child
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CHAPTER 6: INSTITUTIONAL FRAMEWORK
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interventions in Ethiopia, includin
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6.2. Challenges and Lessons Learnt
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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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