“Children don’t vote,” said Dr Robert Mwadime, of Uganda Action for Nutrition, at a session on the subject before the three-day African Union (AU) meeting opened in Kampala, Uganda. This means that political leaders in Africa often pay scant attention to the millions of children who die every year of malnutrition-related causes. Most of the audience nodded in agreement; many clapped.
I was moderating a technical session on nutrition at the invitation of Boitshepo “Bibi” Giyose, Food and Nutrition Security Advisor to the African Union’s New Partnership for African Development (NEPAD), which ran the event on 24 July, a day ahead of the AU meeting.
Giyose, Prof Richard Mkandawire, head of NEPAD’s Comprehensive Africa Agriculture Development Programme (CAADP), Prof John Joseph Otim, senior presidential advisor to the Ugandan government, and various other ministers, government officials, NGO and UN representatives, were keen on drawing up a statement to spur action on nutrition during the AU meeting.
The theme of the AU meeting was “Maternal, Infant and Child Health and Development in Africa”, so it was an apt opportunity to wave the flag. “Nutrition is practically an orphan,” Mkandawire commented. About 40 percent of children younger than five in Africa are chronically malnourished.
Nutrition to the fore
The food price crisis of 2006-08 pushed the number of malnourished children to shocking levels and put a new focus on nutrition.
Africa’s efforts to deal with malnutrition and hunger have been dismal. Only nine African countries are on track to meet the UN Millennium Development Goal to halve hunger and malnutrition by 2015, according to a 2009 report by the UN Children’s Fund (UNICEF).
“Some leaders may not consider nutrition to be politically expedient because it requires investment over the long term, and the results are not always immediately visible,” the UNICEF report had said. Donors with limited budgets for aid often “focus elsewhere”.
More than 70 percent of Africa’s population is rural and depends on agriculture for food and income, so the solution to food security seems easy and logical: people can grow enough nutritious food to feed themselves.
Rémi Kahane, Executive Secretary of the Global Horticulture Initiative, a non-profit programme, said growing vegetables not only brought a better income for small-scale farmers but also improved their diet.
Yet Africa has some of the world’s highest levels of vitamin and mineral deficiencies, especially among pre-school aged children: about 68 percent suffer from anaemia caused by a lack of iron, found in green leafy vegetables like spinach; up to 40 percent lack vitamin A, found in vegetables like carrots and pumpkins.
Overall, around 40 percent of Africa’s population suffer from iodine deficiency, which can be corrected by adding a pinch of iodated salt to the diet. A lack of iron and iodine affect the mental growth of a child; vitamin A is critical to the immune system and can reduce the risk of dying from illnesses by nearly 23 percent, according to UNICEF.
Jan Low, a researcher at HarvestPlus, a joint programme of the International Centre for Tropical Agriculture and the International Food Policy Research Institute, said HarvestPlus had developed a sweet potato – a popular root vegetable in Africa – that could be grown already fortified with vitamin A.
HarvestPlus is working with 60 research organizations globally to produce beans, cassava, pearl millet, rice and wheat fortified with iron, or zinc or vitamin A.
Mary Shawa, Malawi’s permanent secretary for Nutrition, HIV and AIDS, said most of the country’s farmers grew maize, the staple crop. “We are getting our farmers to grow other crops.” Fortifying maize-meal with iron was another option.
Malawi not only has one of the world’s highest numbers of chronically malnourished children, but also suffers what UNICEF described as a “double burden” – high rates of stunted as well as overweight children.
In Guinea-Bissau more than 10 percent of children are overweight, and around half are chronically malnourished. Uganda’s Mwadime pointed out that surveys in parts of Uganda had found overweight mothers with undernourished children.
In 1989 Cote d’Ivoire started a home-grown school feeding programme, in which mothers grow food and sell it to the government to feed their children in school; Kenya is doing the same.
“The children not only get well-balanced meals – it also puts cash into their hands of their mothers, who are mostly small-scale farmers, and it helps the local economy,” said Odette Lago-Daleba, head of Cote d’Ivoire’s national school feeding programme.
Nancy Walters, of the UN World Food Programme (WFP), said the agency, which runs school feeding programmes in 63 countries, was trying to phase in the home-grown school feeding model across the continent.
Getting the job done
Knowing the problem and the solution is only half the job. Most experts at the event agreed that nutrition could not get the attention it deserved if it remained closeted in health ministries.
Elizabeth Madraa, until recently the head of nutrition in the Ugandan health ministry, said countries should create room for nutrition in four key ministries: education, gender and social welfare, agriculture and economic affairs.
“You need to educate the people, get them to grow the right kind of food, and you need to target women especially, who are the caregivers and the producers of food in most African countries,” she said. You also needed the help of the finance and economic affairs ministries to find the money and involve the private sector in initiatives like fortifying mass-produced staple foods with vitamins and minerals.
NEPAD’s Mkandawire said Ghana and Malawi already had a multi-sectoral approach to tackling nutrition, and Malawi had a nutrition head in 10 of its ministries.
In a reality check, Mafa Chipeta, sub-regional coordinator at the UN Food and Agriculture Organization (FAO), pointed out that before nutrition could be discussed, “There has to be food first.” Many African countries were still running 40-year-old food aid programmes, and there had to be a greater urgency in getting them to spend more on agriculture to become food self-sufficient.
Elhadj As Sy, UNICEF’s regional head, said countries also needed to strengthen nutrition information gathering systems.
At the end of the three-hour long session we had to put together the key messages for political leaders. When the AU assembly opened the following day, no political leader mentioned nutrition in their address. The main theme – maternal and infant health – got little mention. A substantial portion of the speeches were devoted to the conflicts raging in the continent.
Unfazed, Giyose said she had set herself the task of engaging key ministries in at least six countries over the next 12 months to focus on nutrition.
Mkandawire added optimistically, “We just need the political will to drive the process, and it can happen.”
[This report does not necessarily reflect the views of the United Nations]