Photo: Jaspreet Kindra/IRIN

Home-grown solutions are cheap and effective: Children in Namibia eat a meal made from products sourced from their field

Call for shake-up in Africa nutrition research

 

Photo: Jaspreet Kindra/IRIN Home-grown solutions are cheap and effective: Children in Namibia eat a meal made from products sourced from their field

Photo: Jaspreet Kindra/IRIN
Home-grown solutions are cheap and effective: Children in Namibia eat a meal made from products sourced from their field

Rwanda has achieved remarkable success in reducing child hunger, and nutrition experts believe there may be lessons here for other countries in Africa.

The UN Children’s Fund (UNICEF), in a 2013 report on progress in tackling malnutrition, noted that in 2005 more than half of Rwanda’s children under five years of age – about 800,000 – were stunted. “Just five years later, stunting prevalence had decreased from an estimated 52 percent to 44 percent,” the report said.

The Rwandan approach has been to try and find home-grown solutions.

It scaled up community-based nutrition programmes in all 30 of the country’s districts, and has also been setting up an almost universal community-based health insurance scheme. “This was all done with the help of food grown locally, and not packaged interventions provided by donors,” said Fidele Ngabo, director of Maternal Child Health. “There are thousands of local solutions for hunger…

“Each village comes up with community-based approaches to tackle malnutrition and food insecurity that don’t cost money – we are at the centre to provide support and play a monitoring role,” she said.

Examples include the setting up a communal grain reserve to which each household contributes at least 20 percent of their harvest during a good season, with the stored grain being used during the lean season; or the expansion of kitchen gardens with shared information on the vegetables to be grown.

Suggestions and proposed solutions are debated in working groups comprising aid agencies, researchers, academics and government officials.

Research needs to be led by Africa, not donors

The Rwandan model could be used in other African countries, where foreign donor-driven initiatives tend to focus on treatment and technical solutions.

“Most of the research on African nutrition is defined outside the region. I don’t think this is imperialism – just the lack of opportunity [and] support-band resources to African researchers to publish, profile and share their work”  Change will only come when nutrition research is led by Africa, and interventions are designed to meet a country’s priorities, according to the findings of a two-year European Union-funded SUNRAY (Sustainable nutrition research for Africa in the years to come) project, published recently in PLOS Medicine, a peer-reviewed journal.

“We need to shake up nutritional research in Africa and turn it upside down,” said Patrick Kolsteren, of the Institute of Tropical Medicine in Antwerp, Belgium, the coordinator of the SUNRAY project.

“Currently, researchers from developed countries search for African partners for joint research, based on funding and research priorities defined outside Africa. Instead, the research agenda should be based on needs identified within the continent. Calls for research proposals of donors should match this agenda.”

“We did not look at the portfolio of interventions but rather looked at the research agenda. The overall feeling was that this agenda is mainly donor driven and not [always] in line… with the locally identified needs and priorities,” he said.

“Another reality is that donor aid must have tangible results,” he added. “Results must be measurable,” something that is not always possible with community-based interventions.

Benin example

Researchers and policymakers in Benin wait for “the dictate of donors before taking action. Hence, donor-funded programmes aren’t sustainable. As soon as they end, all activities are stopped, and acquired benefits and good practices are lost,” said Eunice Nago Koukoubou of the Université d’Abomey-Calavi in Benin, an author of the published findings.

“In addition, nutrition researchers are not autonomous, creative and proactive enough to define their own agenda in line with real nutritional problems of our populations,” she added. So, “despite enormous amounts of money spent on nutrition research and interventions”, malnutrition rates have not fallen in Benin.

“If African governments were funding nutrition on the continent adequately, donors wouldn’t dictate their agenda to us,” said Nago Koukoubou. “In Benin there is already a kind of political will to make nutrition… including nutrition research, a priority in development policies, and to fund it.”

Benin has recognized that “nutrition should be central in development”, and has a strategic plan for food and nutrition development. It has also created a national council for food and nutrition, headed by the office of the president of Benin. “The government is trying to raise funds for the [strategic plan],” Nago Koukoubou notes.

Another author of the published findings, Joyce Kinabo, an academic at Sokoine University of Agriculture in Tanzania, said her country had set up a nutrition desk in the office of the president. “Nutrition is getting more prominence,” she said.

Priority research areas

The SUNRAY project consulted over 100 stakeholders in 40 sub-Saharan countries and identified the following priority areas of research: The impact of community interventions; what influences the quality and quantity of food a child eats; and the effectiveness of promoting traditional foods and whether this helps people through periods of climatic shock.

Priority actions that would help create a good environment for funding nutrition research in Africa include better governance of research, ensuring it is aligned with priorities identified in sub-Saharan Africa; helping countries develop technical capacity; and sharing findings with each other.

Respected nutrition expert Lawrence Haddad, director of the UK Institute for Development Studies, said the study is important as it the “first systematic listening exercise about what the African nutrition research community thinks”.

“Most of the research on African nutrition is defined outside the region. I don’t think this is imperialism – just the lack of opportunity [and] support-band resources to African researchers to publish, profile and share their work.”

A partnership between African researchers, “who have more credibility and knowledge of the context”, and Western researchers with the resources and opportunities, would be key. Haddad cites the African Economic Research Consortium as an example of an African-led model built on such partnerships, but with the agenda set by Africans. “I would like to see something along these lines tried in nutrition.”

Call for an African-led “knowledge hub”

The food price crisis of 2006-08 pushed the number of malnourished children to shocking levels and put a new focus on nutrition. Greater political stability after various conflicts ended, an improvement in economic growth, and advances in the fight against HIV/AIDS, have all helped reduce mortality rates and malnutrition since 2000, says the 2013 Global Hunger Index (GHI), published by the International Food Policy Research Institute (IFPRI), but most countries with the highest GHI scores, or with alarming hunger levels, are in Africa. The three countries at the bottom of the GHI scale are Burundi, Eritrea and Comoros.

The Agricultural Science and Technology Indicators Initiative (ASTI), run by IFPRI, monitors spending on agricultural research and development (R&D). It paints a dismal picture of R&D funding in Africa; and finds that among countries for which data is available, half recorded negative growth in spending on agricultural R&D between 2000 and 2008.

To change the face of nutritional research in Africa, the SUNRAY project proposes an African-led “knowledge hub” that will assess and build on existing knowledge and present effective solutions for major nutrition problems in Africa. It will help foster relationships between researchers and policymakers, and also incorporate mechanisms to ensure optimal uptake and use of nutrition research findings for policy development, implementation and programming.

Ultimately it is about political will. “We are a poor country too, and we are making a difference,” said Rwanda’s Ngabo. Countries like Niger, who feel they lack resources to tackle their long-standing battle with chronic malnutrition have to realize that “your children are not the donors’ children, they are yours.”

Photo: UNICEF/NYHQ2010-3063/Giacomo Pirozzi

A woman breastfeeds her baby in Garin Badjini village, Niger (file photo)

Niger’s “remarkable” progress in reducing child deaths

 

Photo: UNICEF/NYHQ2010-3063/Giacomo Pirozzi A woman breastfeeds her baby in Garin Badjini village, Niger (file photo)

Photo: UNICEF/NYHQ2010-3063/Giacomo Pirozzi
A woman breastfeeds her baby in Garin Badjini village, Niger (file photo)

Niger has made remarkable progress in cutting under-five mortality over the past decade, and it looks set to meet the Millennium Development Goal (MDG) on reducing child mortality rates by two-thirds by 2015. But high maternal mortality, skyrocketing population growth and low government capacity are still impeding progress, say partners and health practitioners.

Child and infant mortality figures have dropped year-on-year for the past decade. The infant mortality rate – deaths has among children under age one per 1,000 live births – dropped from 133 in 1992 to 66 in 2011, according to the latest figures from the UN Children’s Fund (UNICEF).

“This is an exceptional performance. If we compare this to others – like Burkina Faso, Mali, Nigeria – Niger has done much better,” said Isselmou Boukhary, the UNICEF deputy head in Niger.

Part of this progress can be attributed to a government push, since 2006, to provide free healthcare to children under age five. Particular focus was placed on addressing the biggest child killers (malaria, diarrhoea and respiratory diseases), giving women free pre- and post-natal consultations and Caesarean sections, and extending healthcare coverage in rural areas, with some 1,000 rural clinics set up in 2013.

The strategy has also involved efforts to reach at least 88 percent of children with vaccination campaigns targeting measles and other childhood diseases, and to distribute insecticide-treated mosquito nets to families.

Since the 1990s, major partners, including the European Commission’s humanitarian aid department (ECHO), the Office of US Foreign Disaster Assistance (OFDA), the UK Department for International Development (DFID) and UNICEF, have increased their funding to infant health by 77 percent, according to the study Niger: A Countdown to 2015.

UNICEF channelled US$25 million on fighting child mortality in Niger in 2013, said Boukhary.

But while Niger is expected to meet the MDG for child mortality, many challenges remain, he said, notably in women’s health.

Healthcare fails to keep pace

Some 590 women per 100,000 live births die of pregnancy-related causes, and just 18 percent of births are accompanied by a skilled attendant, according to UNICEF’s 2013 State of the World’s Children report. “Without bringing this figure down, we won’t make enough of a dent on child mortality,” Boukhary told IRIN.

On average Nigerien women each have seven children according to government statistics. Government health structures are unable to keep up with population growth, which, at 3.4 percent according to UNICEF, is one of the world’s highest.

The government built 1,000 new health clinics in rural areas in 2013, but that has failed to keep up with needs, said Oumarou Maigari, head of the doctors’, dentists’ and pharmacists’ union (SYMPHAMED).

Further, while the elimination of healthcare user fees has had a huge impact on infant mortality rates, the system is facing problems, with many clinics in arrears as the state fails to reimburse their costs on time. According to Maigari, health centres are in arrears of $50 million.

After user fees were eradicated for children under age five, health clinics provided drugs and care and then billed the state and awaited reimbursement, either in the form of money or medicines. But inefficient supply chain management creates payment lags. Many of the medicines are subsidized or provided directly by partners such as UNICEF, but even their efforts cannot fill the gap, said Maigari. “The state must re-stock indebted health clinics,” he told IRIN.

The government reallocated $18 million to children’s health in 2014.

According to Issoufi Harouna, the head of the regional hospital in the capital, Niamey, each day the hospital registers about 50 sick children and performs around a dozen C-sections.

Before, the hospital would have charged $45 to register a child, and a Caesarean section would have cost $167. Now, they charge nothing, but they do not recoup this money as quickly as they need to, said doctors.

Malnutrition

To further reduce infant mortality, on top of addressing maternal mortality and improving health clinic performance, infant malnutrition prevention must be improved, said Boukhary. Over one million Nigerien children will be malnourished in 2014, predicts the UN Office for the Coordination of Humanitarian Affairs.

Malnutrition prevention efforts are being stepped up by the World Food Programme and others, but effectively preventing malnutrition involves not just eradicating healthcare user fees but also integrating disease prevention into nutrition monitoring and water treatment. Such integrated programmes are only being trialled on a small scale.

Still, with donors shifting their focus from treatment to prevention, malnutrition prevention progammes might soon see a boost.

And the government is finally starting to face up to problems associated with high population growth. It will soon hold a meeting to discuss the issue with UNICEF and the UN Population Fund (UNFPA). “This was a taboo subject before, but there are more and more discussions about this,” Boukhary told IRIN.

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