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

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governments in Ethiopia should apply the Nutrition Lens (NL) in all their developmental activities, including investing in agriculture and food production. A decade ago Pelletier et al. (1995) argued that the nutrition policy documents of the government, donor strategy statements, and consultant reports, in which primary emphasis is given to achieving one or several food-related objectives (self-sufficiency, increased production, more efficient distribution, or food security at national, regional, or household levels), with the implicit assumption that nutritional improvement will follow indicates the existence of a “food-first” bias in the way malnutrition is implicitly viewed by decisionmakers and in the content of many nutrition programmes. The situation is not much different today. The food-bias is still there as the consultant team noticed during the regional meetings. Most experts working in agriculture and food security bureaus believe that if the utilization aspect of FSS is well implemented then the nutrition issue will be no longer be an issue that requires a separate strategy. Perhaps it is because of this that the reviewed policy and strategy documents are indeed food-biased. It is also important to note that, although preventive and curative health care is one of the four major components of the FSP, in reality it is not adequately addressed by the FSP implementing agencies. This again reflects the gap created since a food-secure, but not necessarily a nutrition-secure, household has been the target of the FSS as formulated thus far. Improvement in agricultural production is not and cannot be a stand-alone effort. It requires an integrated holistic approach involving various sectors and sub-sectors. There is adequate evidence that agricultural research, extension as well as health, education, infrastructure, and so on play a major role in the ability of farmers and herders to be effective and efficient. Currently these are not handled in an integrated manner to solve the national malnutrition problem. The way forward: recommendations Based on assessment and analysis of the linkages and the gaps between food and nutrition, twenty-one interventions and issues are proposed for the formulation and implementation of Ethiopia’s NNS. These have been categorized into three broad categories: institutional (organization and relationship), technical, and capacity building. Within each category the list is made by order of priority. Out of the twenty-one issues, the top three priorities that should be addressed during the drafting and implementation of Ethiopia’s NSS are the following: 1) Improve institutional arrangements; 2) Advocacy and awareness to address the severe malnutrition of infants, children and women, as well as to eliminate the food-bias; and 3) The need to plan together with communities and execute interventions through community participation. 36
3.1. Introduction The economic growth and development of any nation depends on the use of its human capacity, both physical and intellectual. Human capacity, to fully reach its personal and economic potential, depends to a large degree on the individual’s nutrition security status. A nutritionally secure people can fight poverty and pave the way to development. Ethiopia is not an exception in this regard. Whether it is to achieve the Millennium Development Goals (MDGs) or to efficiently and effectively implement the Sustainable Development and Poverty Reduction Program (SDPRP), nutrition should be at the center, since a nation that is not nutritionally secure achieves nothing in its socio-economic growth and development undertakings. To put nutrition at the center of economic growth and development endeavors, a well studied and formulated national nutrition policy and strategy is indispensable. A National Nutrition Strategy (NNS) can address strategic issues of food, together with maternal and child care, health services, and a healthy environment. Drafting such a strategy for Ethiopia is a challenging task. Past attempts at formulating such strategies were food-biased. Consequently, any new attempt has to prevail over the problem of oversimplification that nutrition is exclusively a food issue and, hence, the belief that the presence of a Food Security Strategy (FSS) is sufficient to address issues of nutrition in the country. Even during the preparation of this technical report, this problem manifested during consultation visits to regional bureaus associated with agricultural production and food security. Several experts in these bureaus believe that if the food security strategy is fully implemented in all aspects of its definition – availability, access, and utilization – then malnutrition will be contained and the problem resolved. However, available data and indepth discussion suggest that food security is not nutrition security. A food secure household or community can be abjectly nutritionally insecure and be exposed to death due to malnutrition. Natural resources should be managed for the production of agricultural products. Availability of agricultural products alone, however, may not ensure availability of adequate and nutritionally sound food to households and communities. First, the available food must also have an adequate dietary density. Secondly, adequate health servic es and a healthy environment, together with adequate maternal and child care, are required for nutritionally secure households and communities. Four technical reports on key aspects of nutrition – food-security, care, and health, as well as the basic macro-level determinants of nutritional status – were commissioned to lay down the conceptual underpinnings for Ethiopia’s NNS. This report on food security is one of the four. The report presents several normative and factual explanations to assert that a food secure society may not necessarily be well-nourished, even if all components of food security are fulfilled. A household achieves nutrition security only when it has secure access to food coupled with a sanitary environment, adequate health services, and knowledgeable care to ensure a healthy life for all household members (Benson 2005). This study used a triple-A approach (Assessment-Analysis-Action) to address food related nutrition issues and problems. The first part of the assessment, sections two and three, deals with clarification of definitional and conceptual issues that have created confusion and have led to the erroneous perception of nutrition as a food issue. Ethiopia’s natural resource potentials and the actual situation in terms of feeding its growing population with an emphasis on food and nutrition issues and nutritional indicators, both nationally and region-wide, is assessed in sections four and five. Core policies and strategies, as well as programs related to food security are reviewed in section six. The Agricultural Development Led Industrialization (ADLI) strategy, the FSS, the Rural Development Policies and Strategies (RDPS), the SDPRP, The New Coalition for Food Security (NCFS) and other related strategies and programs are briefly reviewed and discussed in this section. Section seven presents the nutrition gap and food-bias of the reviewed policy, strategy, and program documents, 37
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 and 46: CHAPTER 3: FOOD SECURITY AND MALNUT
Page 47: Afar in 2000 was 12.6 percent and 5
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
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Page 75 and 76: 3.6.3.5. HIV/AIDS This disease is w
Page 77 and 78: coordinates the different implement
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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
Page 97 and 98: 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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