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percentage points per year. This implies the
need to intensify and scale-up known high
impact nutrition interventions and those that
address wasting. Figure 1 describes the
changes in malnutrition prevalence from
2000-2010.
The Government of Ethiopia (GoE) has
developed a five-year development plan, the
Growth and Transformation Plan (GTP), for
the period 2010/11 to 2014/15. The main
objectives of the GTP include:
i) Maintain an average real Gross Domestic
Product (GDP) growth rate of 11% and
attain the MDGs
ii) Expand and ensure the quality of education
and health services and achieve
MDGs in the social sector
iii) Establish suitable conditions for sustainable
nation building, through the creation
of a stable democratic and developmental
state
iv) Ensure the sustainability of growth by
realizing all of the above objectives within
a stable macro-economic framework.
Under the umbrella of the GTP, the GoE
launched the fourth Health Sector
Development Programme (HSDP-IV). The
new (and final) HSDP IV (2010 – 2015) places
a strong focus on maternal health issues and
has considerably more focus on nutrition than
the three previous plans. There are 16 nutrition
indicators within HSDP-IV, examples of
which include reducing the stunting prevalence
from 46% to 37%, reducing the
prevalence of wasting from 11% to 3%, and
increasing household utilisation of iodised
salt from 4% to 95% 3 .
During the course of implementation of
the previous health sector development
programme (HSDP-III 2005/6 – 2009/10), a
National Nutrition Strategy (NNS) was developed
and launched in 2008. The NNS is
operationalised through the National
Nutrition Programme (NNP), a 10- year
initiative aiming to reduce the levels of stunting,
wasting, underweight and LBW infants.
The first phase is for five years (2008–2013), at
an estimated cost of 370 million USD and
consists of two main components:
‘Supporting Service Delivery’ and
‘Institutional Strengthening and Capacity
Building’. The overall objective is better
harmonisation and coordination of the various
approaches to manage and prevent
malnutrition.
The service delivery arm of the NNP has
four sub-components: a) Sustaining Enhanced
Outreach Strategy (EOS) with Targeted
Supplementary Food (TSF) and transitioning
of EOS into the Health Extension Package
(HEP), b) Health Facility Nutrition Services,
c) Community Based Nutrition (CBN) and d)
Micronutrient Interventions.
A process of revision and extension of the
NNP has recently commenced (October 2011)
for two main reasons:
i. To align the end of the first phase with the
HSDP IV and MDGs, i.e. extend the first
phase by 2 years to 2015
ii. To strengthen initiatives that were not
adequately addressed in the original
document and include initiatives that
have emerged since the NNP was
devised. For example:
• Accelerated Stunting Reduction
Initiative (ASRI) - inclusive of maternal
nutrition, Infant and Young Child
Nutrition (IYCN)
• Food Fortification Alliance (FFA), goals
and objectives for improving micronutrient
status
• Strengthening of multi-sectoral linkages
– key sectors include; agriculture, education,
water and energy, labour and social
protection, finance and economic development,
women’s children and youth
affairs
• Social protection policy and nutrition
related indicators
• Moderate acute malnutrition (MAM)
programming and the development of
improved linkages between preventive
and treatment programming
• School health and nutrition (SHN)
CMAM/TFP roll-out in Ethiopia
The term Therapeutic Feeding Programme
(TFP) is used in Ethiopia to describe the treatment
of Severe Acute Malnutrition (SAM).
Much has already been written about
Ethiopia’s scale up experience to date 5 , so the
history and development of the TFP in
Ethiopia is only briefly summarised here.
Community based management of acute
malnutrition (CMAM) in Ethiopia traditionally
does not include the management of
MAM. Hence the discussion below focuses on
SAM management only.
A small pilot for CMAM was first
conducted in Southern Ethiopia in 2000. A
research programme in three countries
(Malawi, Ethiopia and South Sudan)
followed, implemented from 2002 by Valid
International and Concern Worldwide, to test
the efficacy and safety of the CMAM
approach.
A food security crisis due to drought
developed across many areas of the country
during 2003/4. This crisis was the catalyst for
many international non-governmental organisations
(INGOs) to adopt the CMAM
approach of treating the majority of cases as
outpatients, as they became overwhelmed
trying to manage the high caseloads of
malnourished children arriving at the
Therapeutic Feeding Centres (TFCs). 6
From 2004/5, the Federal Ministry of
Health (FMoH), alongside partners including
UNICEF and others, commenced scale-up of
SAM treatment services. This involved developing
guidelines and establishing more
in-patient and out-patient services across the
country. In 2007, following international
endorsement of the CMAM approach, 7 the
national protocol for SAM treatment was
revised to include detailed guidance for the
Outpatient Therapeutic Programme (OTP)
and community mobilisation activities.
3
Recalculated by Tulane University.
4
As the DHS 2010 was not out during the HSDP-IV
preparation, DHS 2005 was used as a benchmark.
5
Field Exchange issue 40. Emergency Nutrition Network.
http://fex.ennonline.net/40/contents.aspx
6
TFCs were often established in a health centre compound
with erection of a large tent, and heavy presence of
NGO staff to manage the cases on a daily basis.
7
WHO/WFP/UNSCN/UNICEF. Community-Based Management
of Severe Acute Malnutrition. A Joint Statement by the
World Health Organization, the World Food Programme, the
United Nations System Standing Committee on Nutrition and
the United Nations Children’s Fund, 2007. http://www.who.
Figure 1: Nutrition indices EDHS 2000*, 2005* and 2010
Percentage
70
60
50
40
30
20
10
0
57.8
42.1
12.9
51.5
34.9
12.4
2000 2005 2010
44.4
28.7
Underweight Stunting Wasting
* Recalculated using World Health Organisation (WHO) Growth
Standards 4 for 2000 and 2005
Box 1. Overview of the TFP in Ethiopia
The TFP combines in-patient and out-patient care for
children suffering from SAM (mid upper arm circumference
(MUAC) 50% in rural communities, >70% in urban populations and
>90% in a camp situation. The Sphere Project. Humanitarian
Charter and Minimum Standards in Disaster Response. Geneva,
2011 Edition. Sphere Project.www.sphereproject.org
9.7
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