On Friday the new set of ‘Global Goals’ will  be signed at the U.N. General Assembly, and of the 17 goals, Goal two is fundamental for achieving many others. The aim of Goal two will be to “End hunger, achieve food security and improved nutrition and promote sustainable agriculture”.

Caption Community Health Workers in Adda Berga  teach villagers the nutritional value of local crops
Caption Community Health Workers in Adda Berga
teach villagers the nutritional value of local crops
That undernutrition contributes to 45% of all child deaths itself warrants global momentum to tackle it, but poor nutrition also hinders growth and development of children who survive. So as nutrition is improved globally this will drive down the levels of child deaths and also lead to improvements in school achievement, productivity, and economic growth. Progress on combatting undernutrition has been mixed in the period of the Millennium Development Goals (MDGs)– 2000 to 2015 – with some countries stagnating and some countries moving ahead. I wanted to visit a country that has shown what can be done. When RESULTS visited Ethiopia in 2013, with a RESULTS parliamentary delegation, we were impressed with the progress being made confronting tuberculosis, but we hadn’t time to learn what was being done in the struggle against undernutrition. In June this year I was fortunate enough to visit the health system again, this time with Dr Richard Pendame, regional director for the Micronutrient Initiative in Africa,  one of the leading development organisations providing nutrition expertise, micronutrient interventions, and capacity building support for developing countries bearing a high burden of undernutrition around the world. As we left Addis Ababa early in the morning I explained to Richard my memories of the infamous TV footage of the 1984/85 ‘biblical famine’, which led to the engagement of Bob Geldorf, BandAid, and LiveAid. Eight million people were affected by that famine, and one million died.  “Visitors to Ethiopia expect to see dry parched landscapes”, said Richard, “but much of Ethiopia is highly fertile. That famine was caused more by war and political mismanagement. There is sufficient food in Ethiopia to ensure that sort of famine never happens again”. As we drove through green rolling hills, with large fields and a constant supply of donkeys hauling crops to the roadside, I could see that lack of food is not the main cause of undernutrition now. Ethiopia has made impressive progress in nutrition.  Between 1992 and 2014, Ethiopia reduced stunting in children from 67% to 40% (GNR 2014, GNR 2015) The achievement in nutrition, couple with other improvements such as rising immunisation rates, has meant child deaths have been halved between 2000 and 2015. Since 1990 the Infant Mortality Rate has fallen from 122 per 1000 in 1990 to around 42 per 1000 today, a major success in the story of the MDGs.
Caption It is estimated that 40% of women of child-bearing age are anaemic
Caption It is estimated that 40% of women of child-bearing age are anaemic
“The nutrition challenge now is more complex” explained Richard, “not lack of food but hidden hunger – the lack of the right food, and the absence of essential vitamins and micro-nutrients”. This became apparent as we visited a health centre in Enchini village, in Adda Berga Woreda (district). Here 37% of children are stunted (too short for their age), significantly high number, given that this will have an irreversible impact on their physical and cognitive development. Most children are deficient in vitamin A, and most women of child-bearing age are either anaemic (mainly due to iron deficiency) and deficient in other essential micronutrients. Micronutrient Iniatiative (MI) is  helping the health system in Ethiopia to tackle these challenges. Globally MI has provided more than 75% of the vitamin A delivered to developing countries for supplementation programmes since 1997. In Ethiopia, MI is helping train health workers and has helped move vitamin A supplementation from sporadic campaigns in some high-risk areas into a national ongoing regular health care programme. To combat anaemia and high rates of maternal mortality MI is supporting community-based grain banks, encouraging the fortification of oil with Vitamins A & D, and providing technical support to fortify flour with iron, folate, zinc and six other micronutrients. MI is mainly financed by the Canadian government but recently, at the 2nd anniversary of the Nutrition for Growth summit, DFID entered into a partnership with the Canadian government which will be used to facilitate MI’s work in providing technical assistance to countries within the Scaling Up Nutrition movement.
Signboard showing budget from Health Ministry and user-fees. Figures shown are up to date. 2007 is this year in the  Ethiopian calendar.
Signboard showing budget from Health Ministry and user-fees. Figures shown are up to date. 2007 is this year in the Ethiopian calendar.
From our visit to Adda Berga we could see the progress being made on undernutrition. We did come away with some doubts however on the financing approach. A large sign outside the health centre shows the budget contributed by national government and that contributed by user fees. While this is to be applauded in terms of transparency, the heavy reliance on ‘out of pocket’ payments discriminates against the poor. WHO evidence from around the world has shown clearly that user fees prevent the poor from attending for treatment, or they delay visiting a health centre until a sickness or fever has got significantly worse. Research by RESULTS and KANCO  has shown that most African countries could increase their own funding of healthcare from domestic resources. From statements made by senior government figures during the recent ‘Financing for Development’ conference in Addis Ababa it is clear the government would like to move away from this unhealthy reliance on user fees, and increase funding from taxation and other forms of domestic resources. We came away from the country having seen successes in achieving many of the MDGs, and convinced that it is on track to achieving the next set of Global Goals by 2030. Having seen the progress in Ethiopia we thought this news should be better understood in the UK. RESULTS will be returning to Ethiopia soon with a number of UK parliamentarians, to see nutrition and child health work in greater depth. I am looking forward to learning more about this impressive country. By Steve Lewis Head of Policy at RUK @owstonlewis