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

lack of national nutrition strategy to guide the actions, roles, and responsibilities of the
different sectors and agencies related to caring practices. The other reason for the low level of
better caring practices in Ethiopia is that most of the actions that the government can take to
improve caring practices have to take place at the household and community levels through
interactions with caregivers.
Therefore, there is a distinct need for policy and program modifications to ensure
better caring practices at the household levels.
• The most important issue is the need for better caring practices to be mainstreamed
into the development plan of each sector. This action would require applying nutrition
criteria to review the potential impacts (the intended and unintended impact of
investments), defining optimal nutritional inputs from each sector, and identifying
potential opportunities to integrate nutrition initiatives across multiple sectors.
• There should be a nutrition coordination body within the government that should
operate to ensure that better caring practices are taken into account in the nutritional
activities across the various sectors (implementing bodies). Therefore, sectoral
policies and strategies need to have caring practices as one of their performance
indicators. In particular, various sectoral strategies that seek to develop the cadre of
kebele-level development agents should be inserted into the terms of reference under
which these agents will work. The performance appraisal criteria for these agents
should include the nutritional status of the populations of the communities with which
they work. This process should include an institutional framework for monitoring and
evaluating better caring practices as well as accountability mechanisms from the
community to federal level. This action calls for a higher level government body that
can coordinate and monitor other sectors that have a valuable role in strengthening
caring practices (Ministry of Health, Ministry of Education, Ministry of Agriculture,
Ministry of Water Resources, Women’s Affairs Office, Ministry of Labor and Social
Affairs, Food Security Bureau, HIV/AIDS Prevention and Control Office, DPPC, and
NGOs).
• The caring practices are built on community’s resources and enhancement of the
natural household level capacities for caregiving should be targeted. This requires
partnership creation between the community resource people (health animators,
health promoters, community volunteers) and the frontline development workers
(Health extension workers, Community health workers, agricultural home economic
agents, development agents) reaching households in the community (facilitators).
This will ensure the link between the strategy, service delivery outlets, and
implementation at the household level.
There is a strong need for the strengthening of better caring practices at the household
level, in an integrated way and involving all concerned sectors. If this does not happen,
nutrition in Ethiopia may move from the current ‘food-bias’ to having a ‘health and foodbias’,
while neglecting the importance of proper care. Again, this will not alleviate nutrition
insecurity in Ethiopia.
The Way Forward
Drawing from this analysis, the following key care issues are submitted for
incorporation into the National Nutrition Strategy:
• Design an institutional framework for mainstreaming care from the household to the
national level by all sectors of development.
• Promotion of strong multi-sectoral household and community level caring practices.
• Enhancement of women’s capacity for caring.
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