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An Assessment of the Causes of Malnutrition in Ethiopia a Contribution to the Formulation of a National Nutrition Strategy for Ethiopia

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An Assessment of the Causes of Malnutrition in Ethiopia a Contribution to the Formulation of a National Nutrition Strategy for Ethiopia An assessment of the causes of malnutrition in Ethiopia A contribution to the formulation of a National Nutrition Strategy for Ethiopia Chapter 1: The Importance of Improving Nutrition for Sustainable Development in Ethiopia.................................................................................1 by Todd Benson Chapter 2: The Basic Causes of Malnutrition in Ethiopia.......................................9 by Solomon Bellete Chapter 3: Food Security and Malnutrition in Ethiopia.........................................33 by Demese Chanyalew Chapter 4: Care and Malnutrition in Ethiopia.........................................................75 by Tefera Belachew Chapter 5: Health Services, a Healthy Environment, and Malnutrition in Ethiopia.....................................................................................................131 by Ayele Gebremariam, Abera Kumie, Damene Hailemariam, & Fikru Tesfaye Chapter 6: Institutional Framework of Nutrition Interventions in Ethiopia ......163 by Eleonora Genovese edited by Todd Benson International Food Policy Research Institute Washington, DC, USA November 2005 FOREWORD Although efforts were made several times since the mid-1980s to formulate a National Nutrition Strategy (NNS) for Ethiopia , none was ever adopted by the national government. Without a strategy and without institutional leadership to guide and coordinate efforts to address malnutrition, isolated, piecemeal efforts across various programs resulted. This situation created ambiguity in the objectives of such efforts and led to confusion among various development partners. In late 2004, a new opportunity emerged for developing a comprehensive approach to address malnutrition when the federal government agreed to put in place such a strategy as part of the groundwork for the preparation of the second phase of Sustainable Development and Poverty Reduction Program, which is now called the Plan for Accelerated and Sustained Development to End Poverty - 2005/06-2009/10. At that time, the Council of Ministers of the federal government gave the responsibility for coordinating overall nutrition activities in the country to the Ministry of Agriculture and Rural Development (MOARD), and established its initial task as being the development of an NNS. Within MOARD, the Food Security Coordination Bureau (FSCB) was assigned the task of formulating the strategy. The FSCB established a national steering committee to draft the NNS in order that the Strategy be submitted to the Council of Ministers for approval in the third quarter of 2005. In addition to MOARD, the steering committee included government representatives from the Ministry of Health (Family Health Department), the Ministry of Water Resources, the Ministry of Finance and Economic Development, and the Disaster Prevention and Preparedness Commission. Several representatives from Ethiopia’s development partners also sat on the NNS steering committee – the United Nations Children’s Fund (UNICEF), the World Bank, the United States Agency for International Development, the European Union, and the Canadian International Development Agency. Under the overall oversight of the head of the FSCB, Berhane Gizaw, the steering committee was chaired by Beyene Haile. The UNICEF representative to the committee, Iqbal Kabir, served as secretary. MOARD approached UNICEF-Ethiopia to solicit technical assistance to facilitate the development of the NSS, particularly through the provision of both local and international experts to guide and contribute broader perspectives to the process. UNICEF agreed to do so and requested the International Food Policy Research Institute (IFPRI) to provide such assistance and to coordinate the efforts of local experts in contributing to the formulation of the NNS. In early May 2005, IFPRI research, Todd Benson, working with the assistance of Urban Jonsson, senior UNICEF nutrition advisor, drew up terms of reference for the technical assistance to the NNS steering committee. Drawing from the global conceptual framework of the causes of child malnutrition (Figure 1.2), it was proposed that a team of local experts be assembled to develop background documents on the basic and the three underlying causes of malnutrition in Ethiopia. These background papers would then be used to develop a detailed framework for the NNS itself. This document is a compilation of these background papers. By early June 2005, eight local experts had been hired using resources provided by UNICEF-Ethiopia. They were assigned the following topics and tasks: · Solomon Bellete – the basic causes of malnutrition in Ethiopia. · Demese Chanyalew – food insecurity as an underlying cause of malnutrition. · Tefera Belachew – improper care as an underlying cause of malnutrition. · Ayele Gebremariam, Abera Kumie, Damene Hailemariam, and Fikru Tesfaye – poor health services and an unhygienic environment as underlying causes of malnutrition. i · Bantirgu Hailemariam coordinated the efforts of all of the other experts and managed day-to-day relations and logistics with the NNS steering committee and with UNICEF-Ethiopia. Working with Dr. Benson’s supervision, the experts carried out extensive literature reviews and participated in field trips to several regions to meet with NNS stakeholders at regional and woreda levels. Assistance was also received from the World Bank. As part of this effort, a World Bank consultant, Eleonora Genovese, compiled an inventory of nutrition- focused programs and projects in Ethiopia. On 8 August 2005, a half-day workshop was held in Addis Ababa at which the team of experts presented overviews of the initial drafts of the background documents they were preparing. Extensive comments on the papers were received from the approximately 50 participants at the workshop. These were then used by the authors to develop the final versions presented in this volume. By late August 2005, a detailed NNS framework document was submitted to the NNS steering committee. The NNS steering committee used this framework document to draft the Strategy document itself. The framework document was written by Todd Benson working closely with the team of local experts. It is available as a companion document to this edited volume. The NNS steering committee finalized a draft Strategy document by late September 2005. After disseminating it widely for comment at federal and regional levels, a full-day workshop was held in Addis Ababa in mid-November to review the draft Strategy in preparation for its submittal for approval to the Council of Ministers. The work of the experts ended with the successful conclusion of this workshop. In finalizing these papers for wider dissemination, we gratefully acknowledge the editorial efforts of Noora-Lisa Aberman of IFPRI and Kevin Pepper, an intern with UNICEF- Ethiopia. Harold Alderman of the World Bank reviewed early drafts and made important suggestions to strengthen all of them. We also thank the national steering committee for the NNS for the comments its members provided on these papers and the spirited dialogue they provided in discussing the NNS framework document. In particular, we appreciate the leadership provided by Beyene Haile in guiding the NNS formulation process. Finally, these documents could not have been prepared without the financial and logistical resources provided by UNICEF-Ethiopia. In particular, we thank Iqbal Kabir, the Program Officer for Nutrition, and Bjorn Ljungqvist, the Country Representative. While the papers included in this edited volume have been edited extensively and expert comments have been received on them, they have not been subjected to a formal peer- review. They are circulated in order to stimulate discussion and critical comment and as documentation on the effort in 2005 to formulate a National Nutrition Strategy for Ethiopia. Moreover, the findings, interpretations, and conclusions in these documents are those of the author(s) and should not be attributed to the government of the Federal Democratic Republic of Ethiopia , MOARD, FSCB, the NNS steering committee and its members, UNICEF, or IFPRI. ii TABLE OF CONTENTS Foreword....................................................................................................................................................................i Table of Contents ..................................................................................................................................................iii List of Tables...........................................................................................................................................................vi List of Figures ........................................................................................................................................................vii List of Boxes ...........................................................................................................................................................vii List of Acronyms ................................................................................................................................................. viii Chapter 1: The Importance of Improving Nutrition for Sustainable Development in Ethiopia......1 1.1. The Global Conceptual Framework of the Causes of Malnutrition.................................................. 2 1.2. Nutrition as an Element of Public Policy Concern.............................................................................. 4 1.2.1. The economic consequences
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