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

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system, surveillance and monitoring in order to enhance the emergency response capability of the country. The FSS document states that the real possibility of closing the food gap at the national level and the persistence of food insecurity at the household level implies the need to transfer resources to the vulnerable population. However, these resource transfers should involve shifting assistance from in–kind to financial flows, and shifting procurement of food for relief distribution from imports to domestic supply. The NCFS identifies interventions that make possible the transfer of resources, enhance the purchasing power of the poor, create offfarm income generating activities, and overall boost the access of poor people to food within three thematic areas – safety nets, disaster preparedness and emergency income diversification, and rural agricultural entrepreneurship. The interventions in this regard are asset creation through labor-based public works; household-level asset creation; human asset development, and other related crosscutting interventions. These are the pillars of the safety net program and related project initiatives under the NCFS (2003). Livelihood strategies are part of the FSS, and were intensely addressed in the NCFS document. A livelihood has been defined as ‘the activities, the assets and the access that jointly determine the living gained by an individual or household,’ (Masefield 2000) or “what people have and do in order to thrive and survive’ (CRDA 2001a). It is based on an inventory of assets or potentials embracing the human, natural, financial, social, and physical. Interventions that lead to income diversification are critical in reducing malnutrition and food insecurity. Broadly, the categories of interventions in this regard are community development funds; micro-enterprise development; access to income diversification inputs, agro-processing development, and spatial labor mobility enhancing services. Among the key interventions to secure livelihoods has been the use of Employment Generation Schemes (EGS). EGS has evolved into employment-based safety nets (EBSN) which received a ringing endorsement in the 2002 FSS. It has been government policy that all food aid should be distributed on the basis of 80 percent EGS and 20 per cent gratuitous distribution. In 1997, the DPPC issued guidelines for the management of the EGS (Robinson 2003). An EBSN ‘is a public works programme that provides employment at the same time as building productive assets and minimizing the risk to vulnerable households of dipping below the poverty line.’ In the 2002 FSS, it is stated “regular budgeted and multi-annually assisted EGS/EBSN can respond to the huge chronically vulnerable populations’ needs and therefore reduce emergencies to what they are normally and internationally defined as. EGS/EBSN should be cash-based wherever the situation would allow.” The performance of EGS in Ethiopia has been compared with the Employment Guarantee Scheme in Maharashtra, India. Weaknesses of the Ethiopian EGS identified by Middlebrook (2002) and others include the following: failure to enact and institutionalize the EGS policy, poor planning capacity, lack of clarity over targeting, failure to build productive assets, limited success in creating sustainable community assets, unreliable and late delivery of resources, and insufficient funds for tools and management. In Ethiopia, although food aid distribution in principle is calculated at 0.5 kg per person per day, EGS schemes normally pay 3 kg per worker per day, on the expectation that each worker has to feed a family (Robinson 2003). Self-targeting will work properly only if a below-market wage is paid, but the rate must also be above the wage based on minimum nutritional requirements. Raisin (2001a) argues that self-targeting below-market wages are ‘actually helping to keep beneficiaries in poverty.” She supports geographical community targeting (which she calls a livelihood systems approach as compared with household targeting, a livelihoods approach) because the household economy is not isolated from the dynamics of inter-household relationships, especially in relation to land, oxen and labor. Through, for example, price effects on non-beneficiaries, she argues, that relief targeting of the poorest households encourages asset depletion among the relatively better-off. Geographic targeting may bring its own risks of inclusion and exclusion; a study of food aid targeting in 56
1995-96 revealed that ‘the greatest differences in income targeting performance were observed between regions rather than between food aid programme types’ (Jayne, Strauss, Yamano, & Molla 2001). Many successful programs, particularly those focusing on diversified income generating activities, have employed the community-managed revolving fund mechanism, and this has proved practical and empowering for the community. A revolving fund represents a system whereby the credit is extended to a specific group within the community for a specific purpose. The group undertakes to repay the capital in to a common fund, similar to the idir system, and recycles the capital for reinvestment in additional income-generating activities. The group can accept members, who must contribute their own resources to the fund before they can gain access to credit opportunities. 3.5.3. Institutions Institutions are key elements of the policy formulation and implementation process. The NNS shall contain a clear institutional arrangement that explicitly identifies and lists the functional details of agencies working to coordinate and implement nutrition centered development programs. It has to evaluate the mandates and past structural and functional relationships within and outside the ministries of agriculture, health, water resources, education, labor and social affairs, and others related. Since the overall responsibility for food security intervention implementation is that of the Ministry of Agriculture and Rural Development (MOARD), a brief review of it institutional set up is given below. In preparing the NNS, the current structure of other concerned ministries needs to be assessed in order to identify the best possible institutional locations for the nutrition coordination body and to identify those in charge of existing nutrition security-related programmes. The policies that are stated in RDPS and SDPRP have brought changes in institutional arrangements in the agriculture and food sector of Ethiopia. The new MOARD replaced the former separate Ministries and Authorities namely Ministries of Agriculture and of Rural Development, Coffee and Tea Authority and the Livestock Marketing Authority, which were under the Ministry of Trade and Industry; as well as the National Agricultural Input Authority and the Wildlife Conservation and Development Authority. In addition to combining these institutions, the proclamation transferred to MOARD a set of functions that were formerly the responsibility of other ministries, most notably the Ministry of Trade and Industry (MOTI). MOARD is now responsible for the full agricultural value chain, from the supply of inputs to the sale of processed agricultural commodities. This expansion of functions and responsibilities was accompanied by an increase in the executive organs and public enterprises for which the Ministry is responsible. The Disaster Prevention and Preparedness Commission (DPPC) the Ethiopian Grain Trading Enterprise (EGTE), and the Ethiopian Agricultural Research Organization (EARO) are now accountable to MOARD. EGTE was accountable to MOTI. The Cooperative Commission is still accountable to MOARD. The powers and duties vested in the MOTI relating to the planned system of tradable warehouse receipts have also been re–allocated to MOARD. MOARD is also required, inter alia, to direct and coordinate the implementation of the food security programme, to monitor events affecting agricultural development, and to develop an early– warning system. At the federal level, MOARD is divided into three sections, each headed by a State Minister. The sections are Agricultural Marketing and Inputs, Agricultural Development, and Natural Resources. The Food Security and the Planning, Administration and Finance Coordination Bureaus report directly to the Minister of Agriculture and Rural Development. Regions have more or less a similar organizational set up. 57
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An assessment of the causes of maln
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• Bantirgu Hailemariam coordinate
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3.4. National and Regional Trends:
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LIST OF TABLES Table 2.1: Child stu
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LIST OF ACRONYMS ADLI AGOA AIDS BCC
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Figure 1.1: Stunting among children
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these underlying determinants of th
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Page 22 and 23: 2.1. Introduction In the early 1960
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Page 26 and 27: Table 2.3: Regional profile of stun
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Page 30 and 31: key tenet in the process of identif
Page 32 and 33: Basic Causes Major Features High im
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Page 36 and 37: Table 2.9: Gross primary enrollment
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Page 42 and 43: the other practices that need to be
Page 45 and 46: CHAPTER 3: FOOD SECURITY AND MALNUT
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Page 49 and 50: 3.1. Introduction The economic grow
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Page 63 and 64: Figure 3.3: Per capita food product
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Page 75 and 76: 3.6.3.5. HIV/AIDS This disease is w
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Page 85 and 86: 3.7.3.6. Improve rural market infra
Page 87 and 88: CHAPTER 4: CARE AND MALNUTRITION IN
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Page 97 and 98: Figure 4.1: Risk of death in infant
Page 99 and 100: Table 4.2: Present discount values
Page 101 and 102: Figure 4.3: Factors that affect the
Page 103 and 104: Box 4.2: Reasons why PLWHA are vuln
Page 105 and 106: Figure 4.7: Risk of mother to child
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Page 109 and 110: Figure 4.8: The extended model of c
Page 111 and 112: 4.3.1.2. Recognizing symptoms of il
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Page 115 and 116: Figure 4.13: Prevalence of stunting
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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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