Agenda Nutrition situation in Ethiopia Ethiopia Country Assessment - Methodology - Observations

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Egbert Murphy
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1 April 2010

2 Agenda Nutrition situation in Ethiopia Ethiopia Country Assessment - Methodology - Observations - Proposed recommendations Discussion Conclusion and next steps

3 Agenda Nutrition situation in Ethiopia Ethiopia Country Assessment - Methodology - Observations - Proposed recommendations Discussion Conclusion and next steps

Child malnutrition Stunting - 50.7% Underweight- 34.6% Wasting 12.3% LBW 20.

4 Child malnutrition Stunting % Underweight- 34.6% Wasting 12.3% LBW 20.3% Anaemia 53.5% Data from Nutrition Landscape Information System (NLIS)

5 Maternal malnutrition Underweight 26.5% Anaemia 30.6% VAD 22.1% Data from Nutrition Landscape Information System (NLIS)

6 Underlying factors Health services Attended births 5.7% Child VitA suppl dose 1 88%, dose 2 86% Measles immunisation 65% Improved water 42%, sanitation 11% Food security Pop <$1/day 39% Pop < min kcal 46% Iodized salt 20% Caring practices ORT and continued feeding in diarrhoea 15% Teenage pregnancies 16.6% Exclusive breastfeeding 49% Data from Nutrition Landscape Information System (NLIS)

7 Basic factors Commitment Government expenditure on health 10% Maternity leave 90 days Int. Code monitoring and enforcement no Capacity Nurse density 2/10,000 GDP/capita 1,055 LIFDC Meta-indicators Women in parliament 21.9% Girls/boys in primary school 0.9 HDI Data from Nutrition Landscape Information System (NLIS)

8 Agenda Nutrition situation in Ethiopia Ethiopia Country Assessment - Methodology - Observations - Proposed recommendations Discussion Conclusion and next steps

9 Agenda Nutrition situation in Ethiopia Ethiopia Country Assessment - Methodology - Observations - Proposed recommendations Discussion Conclusion and next steps

10 Components Desk analysis of country readiness Comprehensive analysis of secondary data indicators in 36 highburden stunting countries. The analysis uses multiple statistical methods to define country typologies in order to guide where and how to best invest in nutrition. (WHO, forthcoming) In-depth Country Assessments (more on next slide ) Nutrition Landscape Information System (NLIS) Online country profiles with indicators on nutrition and underlying factors (data from WHO and partner agencies) Online user-defined customized data with nutrition data from WHO

11 Country assessment tools and common analytical framework Country assessment tools for "readiness analysis" Planning for country assessment National level assessment tool Regional/Provincial level assessment tool District level assessment tools Facility manager interview tool Health Worker/health service provider Facility Checklist NGO key informant ART sites Private sector assessment tool (being considered)

12 Country assessment tools and common analytical framework Common analytical framework to enable country comparisons Willingness to act (i.e. Commitment) Political commitment, focused policies (and regulation), resource mobilization, organization and management, policies/protocols in support of the nutrition programmes, budget provision Ability to act (i.e. Capacity) Distribution of staff with appropriate skills, quality of services in facilities, staff motivation, follow-up and enhanced care plan, management systems, information systems, supplies and IEC materials, client knowledge/satisfaction, involvement of community organizations

13 Sites

14 Teams Team Team members Agency National and Addis Ababa SNNPR Oromiya Afar Dr. Belaynesh Yifru* Dr. Ephrem Teferi Firew Tekabe Eleni Asmare Berhanu Hailegiorgis Dr. Chizuru Nishida FMOH* Teshome Desta Themba Nduna Shishay Tsadik Dr. Anwar Yibrie Dr. Trubswasser Ursula FMOH* Getaneh Abrha Ahmed Mohammed Abdul Jirga Israel Hailu Dr. Dominic Schofield FMOH* Girmay Ayana Alisha Ali Girma Mamo FMOH IFHP WB/FMOH FAO MI WHO/HQ FMOH UNICEF/FMOH SC-UK ACF WHO WHO/ICST FMOH EHNRI/PHEM WB IFHP Concern GAIN/HQ FMOH EHNRI MI SC-USA

15 Questionnaires completed national level National level and Government: 5 (FMOH, MOE, MOARD, EHNRI, MOWR) Donors: 5 (USAID, CIDA, DFID, MI, JICA) UN Agencies: 5 (UNICEF, FAO, WHO, WFP, WORLD BANK) NGOs: 8 (SC-USA; SC-UK; CONCERN; GOAL; IMC; IFPH; ACF; ALIVE & THRIVE) Private sector: 1 (Helina) Addis Ababa Admin. Addis Ababa: 1 (RHB) Health facilities: 2 (HC & Hospital)

16 Questionnaires completed sub-national level SOUTHERN NATIONS AND NATIONALITIES PEOPLE S REGION [25] REGIONAL: = 13 ZONE/ DISTRICT: = 4 HEALTH FACILITIES: = 8 OROMIYA [21] REGIONAL: = 6 ZONE / DISTRICT: = 8 (2 ZHB; 2 ZDPPC; 1WOHO; CARE; IFHP; GOAL) HEALTH FACILITIES: = 7 (2 HOSPITAL; 2 HC; 3 HP) AFAR [5] REGIONAL: = ZONE/ DISTRICT: HEALTH FACILITIES: 4 (RHB; MOARD; UNICEF; SC-UK) 1 (DUBTI HOSPITAL)

17 Agenda Objectives and expected outcomes Nutrition situation in Ethiopia Lancet Nutrition Series Landscape Analysis overview Ethiopia Country Assessment - Methodology - Observations - Proposed recommendations Discussion Conclusion and next steps

18 Willingness to act strengths (1) In Ethiopia, there is political commitment for nutrition. To this end, the NNS/ NNP, known by most national level respondents, was developed and launched in Nutrition also included in HSDP IV The presence/ existence of coordination forum/ body, which is inclusive and interactive between sectors & development partners, was highly commended and attracted a lot of attention from stakeholders.

19 Willingness to act strengths (2) The total financing requirement for the NNP over the next five years is estimated to be USD 365 million. The Government s (circa USD 96 million) covers salary, operational costs and pre-service training of health workers (HEW). There is already commitment from development partners like the World Bank, UNICEF, MI, CIDA, Embassy of Japan and JICA, to support part of the total financial requirement. Total budget allocated for nutrition is showing increasing trends.

20 Willingness to act strengths (3) UN agencies and donors have assigned manpower and resources for the support and implementation of the NNP Nutrition identified and included as one of the main task of HEW (public health interventions), and is also included in child survival strategies such as IMNCI, etc Decentralization of Outreach Therapeutic Program (OTP) into Health Extension Program (HEP).

21 Willingness to act strengths (4) Very good and promising Community based nutrition program started through HEP, which also includes; EOS/ TSF/ TFP/ CHD. Good coordination/ plan at grass-root level, that is, kebele and woreda level, where nutrition is covered by respective development committees.

22 Willingness to act weaknesses (1) Some coordination which was strong is losing momentum. The coordination at Regional and Zonal level is not as strong as kebele and woreda level. Coordination focuses mainly on emergencies and government capacity is limited to ensure timeliness of information sharing Deliberations at coordination meetings should be action oriented. There is lack of follow up and monitoring as well as no feedback

23 Willingness to act weaknesses (2) High staff turnover and poor perception of what nutritional problems are, as well as interventions needed at Regional level. Agencies limited to acute malnutrition and emergency responses together with sub-optimal coordination of emergency food response. Limited coverage of Community Based Nutrition (CBN), Productive Safety Net Program (PSNP).

24 Willingness to act weaknesses (3) Malnutrition/ under-nutrition seen as humanitarian problems. Moreover, maternal under-nutrition not given due emphasis. Most national stakeholders stated that insufficient financial resources are being directed at tackling nutritional problems

25 Ability to act strengths (1) 1. Human resource: There are more than 30,000 HEWS. In-service training is ongoing (Eg. CBN) Most health facilities have staff trained in SAM, ENA, etc National training materials are continuously updated

26 Ability to act strengths (2) 2. Management systems: The existing multi-sectoral coordination at national level is highly appreciated Nutrition is integrated with primary healthcare services CBN data is collected at local, woreda and regional levels. OTP data are used for planning in some woredas.

27 Ability to act strengths (3) 3. Supplies: Most essential nutrition drugs are available RUTF is readily available in most facilities Equipments for anthropometric measurements are available in most health facilities

28 Ability to act weakness (1) 1. Human resources: Lack of adequate staff at regional/ sub-regional levels as well as high staff turnover Very few training provided on nutritional support for PLWHIV Post-training supervision is not always available Knowledge of health workers in health facilities is not satisfactory in hospitals and health centers.

29 Ability to act weakness (2) 2. Management systems: Nutrition activities are not integrated into other sectors (except MOARD) besides health Nutrition information system is lacking Poor information flow and feedback NNS/ NNP is not well disseminated

30 Ability to act weakness (3) 3. Supplies: Protocols and guidelines are not available in all health facilities BCC materials are in short supply Supplementary food is not available in some areas

31 Agenda Objectives and expected outcomes Nutrition situation in Ethiopia Lancet Nutrition Series Landscape Analysis overview Ethiopia Country Assessment - Methodology - Observations - Proposed recommendations Discussion Conclusion and next steps

32 Recommendations (1) 1. Strengthen nutrition coordination and leadership across sectors/ partners and clarify roles and responsibilities of different actors 2. Nutrition capacity in operational health system should be strengthened, with better orientation of resources and increased national budget contributions.

33 Recommendations (2) 3. Expand the coverage of CBN activities, in areas where it has not started and to include all woredas 4. Rationalize the collection and use of nutrition information for decision making purposes at central, regional, woreda and commune level.

34 Recommendations (3) 5. Institute and strengthen consistency of nutrition communication and advocacy by linking with other activities such as WASH/ Safety Net/ etc. 6. Integrate nutrition in non-health sectors, particularly in agriculture/ education/ etc where increased food production/ knowledge/ etc must reach mothers and young children in food insecure areas.

35 Next steps

CMAM rollout: ingress to scale up nutrition

CMAM rollout: ingress to scale up nutrition ETHIOPIA CMAM/ SUN Conference 14 th - 17 th November 2011 Addis Ababa, Ethiopia Scaling up Community Management of Acute Malnutrition and Scaling up Nutrition