Launching National Nutrition Strategy
Realities and Expectations

By Abiy Demilew

Recently Ethiopia launched a first-ever National Nutrition Strategy (NNS) bringing together concerned bodies including ministerial offices, in a coordinated channel under the leadership of the Ministry of Health.
State officials, observers and local and international experts regard the Ethiopian National Nutrition Strategy as unique among its kind in it’s over all vision. For some, this strategy could be seen as exemplary not only for African nations but also internationally, for all countries that still have generations suffering from food insecurity and malnutrition.
As the top six Millennium Development Goals (MDGs) are underpinned essentially in the progress of improving nutrition, experts agree that malnutrition and food security issues are extensions of poverty.
According to some studies, there is evidence to suggest that good nutrition status reduces poverty by boosting productivity throughout the life cycle and over generations, that it leads to improved educational outcomes. Moreover, malnutrition is the cause of over half of all childhood mortality world wide, and that maternal malnutrition is a direct contributor to poor maternal health; as presented by Hanna Nekatibeb of the Academy for Educational Development, speaking at the NNS launch ceremony.
For a country such as Ethiopia where according to the 2005 demographic and health survey 47 percent of children under five are stunted or chronically malnourished (one of the highest rates in Africa, and unacceptably high by any standards) the NNS will be a key instrument.
Malnutrition puts a heavier impact on child survival, education and overall economic development.
According to the overview of the National Nutrition Strategy, a number of closely linked and reinforcing programs in Ethiopia are already helping to increase agricultural production and food security, improve access to basic health services and the health and survival of women and children and to improve nutritional status. These include the Food Security Program / FSP, Programme of Sustainable Nutrition / PSN and Health Extension Program / HEP.
The overall goal of the National Nutrition Strategy has been mentioned as being to sustainably ensure that all Ethiopians secure an adequate nutrition status, which is an essential requirement for a healthy and productive life.
“Most of the elements in the NNS are or have been implemented in various efforts and strategies of sector offices,” says Theodros Adhanom, Minister of Health and head of the strategy. “What’s new about this strategy now is that “we have brought all sector offices in one package to build and establish a coordinated effort towards achieving a meaningful success in poverty mitigation” Theodros affirms.
Taken the already established regional and rural infrastructures which are closer now to families on the ground, most observers are optimistic on the prospects of the strategy and also, consider it symbolic internationally.
Robert E. Black, M.D., M.P.H, is Edgar Berman Professor of International Health Chairman, Department of International Health, Institute of International Programs at Johns Hopkins University, USA. Dr Black represents The Lancet Series, the world’s leading journal of medical science. He and Cyndi Lewis, Program Officer, Global Health Advocacy, Bill and Melinda Gates Foundation, were among the instrumental figures behind the launching of the NNS in Ethiopia.
Capital’s Abiy Demilew met with Dr. Robert E. Black and Cyndi Lewis for an exclusive double interview. Excerpts

Capital: Describe to us your involvement in the NNS?
Cyndi Lewis: The Bill and Melinda Gates Foundation is a philanthropic foundation that looks at global health and development issues. Nutrition is a new priority for us particularly the malnutrition of pregnant women and children up to 2 years of age.
We are here in partnership with many of the donors and organizations that are supporting the already successful nutrition programs and looking to see how we can be supportive further.

Capital: What kind of are you expecting with the implementation of the NNS?
Cyndi Lewis: Well that’s what we are looking to learn now especially through the government led Health Extension Program, which is really a model to the world. We believe that, if scaled nationally, it could dramatically reduce malnourishment, particularly among children. So we are hopeful Ethiopia will be a leader in this and as already shown, we want to promote this not only in Africa but in the world; how to cut malnourishment.

Capital: What is the distinction of the Ethiopian strategy?
Cyndi Lewis: Ethiopia was chosen as one of the five countries by the Lancet, to launch this nutrition series and that’s why we are here.
This is because of the leadership of the government nutrition technical working groups, the health extension program and the government’s commitment to address the malnourishment issue. We think it could create a sort of domino effect in which one country takes the lead and others follow.
We absolutely believe in this strategy which will soon turn to be a policy and attract more donors to the already successful package.

Capital: How do you see the level of malnourishment in Ethiopia?
Cyndi Lewis: I was so struck by the fact that so many children under five are malnourished in Ethiopia, and children who are not malnourished but are still not getting enough food or the right kind of food, where mothers and fathers feel comfortable with enough time recommended for breastfeeding.

Capital: What are the social and economic impacts of malnourishment?
Cyndi Lewis: It has a great impact on education, joy in life and on the economic productivity of the country and on the overall health issues of the country. It affects the future dramatically.

Capital: Malnutrition is considered as one of the extensions of poverty. In a situation where hunger is a major threat, how can we prioritize better nutrition?
Cyndi Lewis: Wow! That must be the world’s toughest question. We don’t just think about nutrition programs as verdict programs; yes, eradicating poverty is essential and we support programs around the world.
I completely agree with you that it’s absolutely true we cannot talk about the food issue without addressing the poverty issue. I also think the two should be addressed in parallel.

Capital: What is your Foundation’s profile in this context?
Cyndi Lewis: This is a brand new strategy for us which has been just developed by the leadership of the foundation. We are in a process of doing a landscape analysis to see what already exist so that we don’t recreate the wheel and to find gaps where we feel we could be more supportive in filling them.
One of the areas that we have invested heavily in is the global alliance for improved nutrition, which is undertaking food fortification programs in private and public partnership around the world, promoting breastfeeding and others. It also encourages donors to be more supportive of these programs internationally. So you’ll see more of us in late 2008 and 2009. This is new for us. We are here to support and learn at the same time, which are the issues that stand out for each country. Ethiopia is such a unique country that we may probably be making some mistakes here but we really want to hear from our partners on how to fix them as everything we do here is based on partnership.
A foundation we try to find programs that are working and we will see about how to support those programs.

Capital: Ensuring good nutrition is a long process. What are the benchmarks to measure success / failure of the NNS
Cyndi Lewis: We have to build benchmarks with our partners because as partners of this strategic program, we are not expecting the evaluations to come from outside, but from the people who are on the implementation row.
As far as for the long term, we know it is marathon. While there may be a quick race to come up with like AIDS vaccine or eradicating malaria, that’s what we are going to see in the next ten years. We do believe in those results and we are in it for the long haul.

Capital: What is the Lancet’s and yours involvement in this strategy?
Robert E. Black: ‘The Lancet’ is a medical journal which had a number of series on health problems of low and middle income countries. In 2003 we had a series on child health, maternal health, child development, reproductive health and at the same time we had a series on maternal and child under-nutrition. So we took on that task and spent two years to look at all the evidences accumulated globally to see how big was the problem, what interventions and programs could work and how they could be best implemented both on national level with the support of international agencies.

Capital: How do you incorporate this to the Ethiopian context?
Robert E. Black: I think The Nutrition Strategy I have seen in Ethiopia in this visit seems much more consistent with what we have recommended as far as the global experience and the global literature. The national nutrition strategy is multi-sectoral and it has a substantial involvement of community level workers who are providing services and it focused on the right age group and target groups such as pregnant women and people living with HIV/AIDS.
The strategy targets on specific age groups casting with specific interventions that we know are proven and successful and could be implemented.