Effective Programmes in Africa for Improving Nutrition

Presented here is a summary of the proceedings of a Symposium entitled 'Effective Programmes in Africa for Improving Nutrition' which was held at the SCN's 23rd Session in Accra, Ghana in February 1996. This event appropriately coincided with the launch of the Ghana National Plan of Action for Nutrition. The major theme of the Symposium - effective programmes in Africa for improving nutrition - focused largely on household food security; a problem which is of major concern to African countries. The overall aim was to arrive at conclusions that will further enhance Africa's search for workable solutions to ensure food security and improved nutrition for all.

In general, the nutrition situation in Africa is deteriorating due to extreme poverty, severe drought and conflict. Diet quality in many parts of Africa is weak and inadequate, and there are underlying problems of chronic malnutrition due to marginal access to food, seasonality problems and the chronic lack of basic services in many countries. But there are successes, and many of these practical experiences were presented at the Symposium, with the hope that lessons learnt from the positive examples could be generalised to benefit every country, and particularly the poorest people in every country. The box on the next page lists all the presentations at the Symposium which will be presented in greater detail in the next issue of SCN News (No. 15). This article reports the summary of the main conclusions arising from the Symposium. In summing up the wide variety of important conclusions arising from the Symposium, Julia Tagwireyi from the Nutrition Department, MOH, Zimbabwe, discussed the emerging issues and the theme of success factors as cross-cutting issues from the different programmes presented.

“The importance of community involvement emerges again from the programmes described in this symposium. Programmes need to build on existing community knowledge and organisational frameworks. Local people have previous experiences and do not have empty minds. While most presentations focused on the special needs of women and their role in household food security and nutrition, the issue of a holistic approach, including the needs of men, also emerged. An integrated community development approach, in which nutrition may be an entry point, has facilitated success in many of the programmes. Where a minimum package has been introduced which is negotiable and flexible at the community level good progress is made. Growth monitoring and promotion seem to be the key elements within this minimum package.

Successes should be publicised, and within the community, awareness needs to be raised so that the communities themselves are empowered to begin to address their own problems and begin to make demands on the system.

There is a need to measure precisely what is meant by community involvement, and to determine how this might be assessed. Providing support and resources such that communities themselves are involved in assessing the problems encourages sustainability at the community level. Programmes need to be carefully monitored and there is a crying need for effective indicators to do this. These issues -community involvement and participation, and strengthening of monitoring supervision so that there is continuous support to the community level - emerged from most of the programmes discussed.

One of the key factors of success is capacity building -building capacity within the community but also across the whole support infrastructure. If capacity support at a higher level does not exist, the activities at a lower level may be jeopardised. Capacity building should be looked at holistically. There are situations where building capacity and supporting institutions at the national and regional levels may be needed, but dearly an accurate assessment of the situation is a prerequisite.

The training aspect of developing capacity also emerged. There is a need for programme-relevant or programme-driven training and making sure that the mobilizers are supported and strengthened in a relevant way. In those countries which have shown some degree of programme sustainability, strengthening a support infrastructure has been shown to be worthwhile investment.

Under the issue of long term sustainability, nutrition does not have too many magic bullets, except perhaps IDD in the micronutrient area. Even then the need for a long term look at the investment in nutrition emerged as one of the factors in successful programmes. This brings in the issue of political commitment, the role of national governments, and the question of institutional and policy framework for addressing nutrition. In many African countries, having a national food and nutrition policy will help to mobilise nutrition activities of different sectors. In this regard, the ICN process played a very crucial catalytic role. Encouraging different sectors to sit round the same table in dialogue may help ensure that nutrition be placed higher on the agenda and be considered in the longer term. The issue of a sustained support and partnership between key partners; governments, the private sector, NGOs and donor agencies, may facilitate long-term investment in nutrition.

There has been a lot of discussion about the scaling up and expanding on small successes. This hinges on how to mobilise governments to pay attention and be committed to successful programmes. In this regard, it is important to define success of a programme beyond simply the measurement of outcome indicators. The outcome is of course important - whether it be a positive impact on child growth or a reduction in malnutrition. However, the fact that the community is doing something and has adopted a certain activity or initiative, is a measure of success which also needs to be highlighted to donors and governments. In this respect, there are links between the issue of scaling up a programme, the long term investment in nutrition and the commitment to sustainability by governments.

There is also the issue of inter-agency, inter-collaboration and dialogue. The IDD story is a very good example of how inter-agency collaboration, involving international donors, the private sector or NGOs, really made a difference to a problem in Africa. One wonders whether this example, where different parties work towards a common goal, cannot be applied to the rest of the nutrition programme. Under the whole area of regional cooperation, African countries need to support and help one another in terms of capacity building and bringing different sectors together. There are experiences outside Africa which are so rich and which can help African countries to move the agenda further. Mechanisms - perhaps more effective documentation - need to be found in order to share those experiences.

Finally, the whole question of advocacy and raising awareness is a cross cutting issue. Information, education and communication strategies are a weak link even at the programme level. Successes should be publicised, and within the community, awareness needs to be raised so that the communities themselves are empowered to begin to address their own problems and begin to make demands on the system”.