New National Nutrition Programme II envisions an Ethiopia free of malnutrition

By Fanna Minwuyelet and Eric-Alain Ategbo

Last week, Ethiopia launched the second National Nutrition Programme (NNP) II focusing on the first 1,000 days of life to eradicate chronic malnutrition by 2030.  State Minister of Health and Chairperson of the National Nutrition Coordination Body (NNCB), Dr Kebede Worku, recognized 13 ministries[1] that represent the Federal Democratic Republic of Ethiopia to support the achievement of the targets laid out in the National Nutrition Programme II.

The ministries have recognised that high malnutrition rate in Ethiopia is unacceptable and have stressed the need for strengthened collaboration to reduce the impact of malnutrition in the country. The findings of ‘The Cost of Hunger in Africa,’ study revealed that Ethiopia loses 55.5 billion birr annually due malnutrition.

Ethiopia launched the second National Nutrition Programme
As malnutrition remains to be the underlying cause of more than one in five child deaths in Ethiopia, the goal of the NNP II is to provide a framework for coordinated and integrated implementation of multisector nutrition interventions.

The NNP II is developed taking into account past experiences and lessons learned from the implementation of the NNP I and integrating new initiatives from the second Growth and Transformation Plan (GTP II).

The updated aims of the NNP II include reducing the prevalence of three crucial indicators for children under five: stunting from 40 per cent to 26 per cent; underweight from 25 per cent to 13 per cent and wasting from 9 per cent to 4.9 per cent.

With the following five strategic objectives, the NNP II envisions Ethiopia free of malnutrition and diet-related non-communicable diseases by 2050.

  1. Improve the nutritional status of women (15 -49 years) and adolescent girls (10 – 19 years)
  2. Improve the nutritional status of children from birth up to 10 years
  3. Improve the delivery of nutrition services for communicable and non-communicable/lifestyle related diseases
  4. Strengthen the implementation of nutrition-sensitive interventions across sectors
  5. Improve multisector coordination and capacity to implement the national nutrition programme

The Government of Ethiopia has demonstrated policy commitment to streamline nutrition efforts by incorporating indicators into the Government’s five-year Growth and Transformation Plan II (GTP II; 2016-20).

UNICEF contributed to this important signing through technical support as a National Nutrition Technical Committee (NNTC) member and played a leading role in supporting the Government of Ethiopia to establish and nurture multisectoral coordination bodies at both federal and regional levels.

The event was attended by representatives from civil society organizations, academia, the Addis Ababa Chamber of Commerce, donors and UN agencies.


[1] Ministry of Health,  Ministry of Education, Ministry of Agriculture and Natural Resources,  Ministry of Livestock and Fisheries,  Ministry of Industry,  Ministry of Water Irrigation and Electricity,  Ministry of Trade,  Ministry of Finance and Economic Cooperation,  Ministry of Labour and Social Affairs,  Ministry of Women and Children Affairs,  Ministry of Youth and Sports, Government Communication Affairs Office as well as National Disaster Risk Management Coordination Commission

Five in six children under two not getting enough nutrition for growth and brain development – UNICEF

 NEW YORK/ ADDIS ABABA, 14 October 2016 – Five in six children under two years old are not fed enough nutritious food for their age, depriving them of the energy and nutrients they need at the most critical time in their physical and cognitive development, according to a new UNICEF report.

“Infants and young children have the greatest nutrient needs than at any other time in life. But the bodies and brains of millions of young children do not reach their full potential because they are receiving too little food, too late,” said France Begin, Senior Nutrition Adviser at UNICEF. “Poor nutrition at such a young age causes irreversible mental and physical damage.”

UNICEF data show that poor nutritional practices– including the delayed introduction of solid foods, infrequent meals and lack of food variety – are widespread, depriving children of essential nutrients when their growing brains, bones and bodies need them the most. The findings reveal that: 

  • Young children wait too long for their first bites. One in five babies hasn’t been fed any solid foods by the age of 11 months.
  • Half of children aged six months to two years are not fed the minimum number of meals for their age, increasing their risk of stunting.
  • Less than one-third of children in this age group eat a diverse diet – meaning from four or more food groups daily – causing deficiencies in vitamins and minerals.
  • Almost half of pre-school aged children suffer from anaemia.
  • Only half of children aged six to 11 months receive any foods from animal sources – including fish, meat, eggs and dairy – which are essential to supply zinc and iron.
  • The high cost of foods from animal sources makes it difficult for the poorest families to improve their children’s diet. In Sub-Saharan Africa and South Asia, only one in six children from the poorest households aged six to 11 months eats a minimally diverse diet, compared to one in three from the richest households.
  • Improving nutrition for young children could save 100,000 lives a year.

Making nutritious foods affordable and accessible to the poorest children will require stronger and more targeted investments from governments and the private sector. Cash or in-kind transfers to vulnerable families; crop diversification programmes; and fortification of staple foods are key to improving nutrition for young children. Community-based health services that help caregivers learn better feeding practices, and safe water and sanitation – absolutely critical in preventing diarrhoea among children – are also vital.

“We cannot afford to fail in our fight to improve nutrition for young children. Their ability to grow, learn and contribute to their country’s future depends on it,” Begin said. 

Ethiopia has experienced rapid, sustained improvement in under-nutrition during the past 15 years. For example, the country has seen a steady reduction in stunting – the fastest rate of improvement in Africa – and a decline in the percentage of underweight and wasted children. Yet, Ethiopia remains in a precarious situation, with large absolute numbers of affected children: 5.3 million children are stunted and 1.2 million children suffer wasting. UNICEF’s nutrition programme collaborates with the Government of Ethiopia to reduce these numbers further, working on multi-sectoral coordination to improve the nutrition of all children, pregnant and lactating women and their families

The Government of Ethiopia recognizes that addressing malnutrition is essential to achieving sustainable development. It therefore has issued the Seqota Declaration to end child malnutrition by 2030. The Declaration lays out a plan to stop the cycle of under-nutrition by bringing together all sectors of the Government, paying particular attention to the importance of nutrition during pregnancy and in the first years of a child’s life. 

Over the past decade, Ethiopia has seen a steady reduction in stunting from 58 per cent in 2000 to 40 per cent 2014, in the percentage of underweight children from 41 per cent to 25 per cent, and in wasting from 12 per cent to 9 percent (Mini EDHS: 2014) 

These trends indicate an improvement in chronic malnutrition over the past 15 years. Yet, 28 per cent of child deaths in Ethiopia is associated with under-nutrition. In addition to this high contribution to the under-five mortality rate, high prevalence of various forms of malnutrition among vulnerable groups in Ethiopia has serious implications for social development and economic growth. In a study conducted in 2009, the total annual cost of under-nutrition was estimated at US$2,775,000, equivalent to 17 per cent of the country’s GDP in 2009.

UNICEF’s strategies for nutrition ensure the achievements of results in four areas: 1) upstream nutrition policy support and multi-sectoral engagement; 2) improved nutrition knowledge and caring behaviours; 3) strengthening of systems for nutrition service delivery; and 4) strengthening partner capacities to respond to nutrition in humanitarian crises.

To accelerate the reduction of chronic and acute malnutrition, UNICEF is working in partnership with sectoral government counterparts, including in health, agriculture, education, social protection, trade and industry, and women, children and youth affairs.

UNICEF also works with United Nations agencies such as the Food and Agriculture Organization (FAO), United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA), World Food Programme (WFP) and World Health Organization (WHO); UNICEF National Committees; donors such as the aid agencies of Canada, Ireland, Japan, the Netherlands, Spain, the United Kingdom and the United States, as well as the European Union; civil society organizations; and local and international academic institutions.

El Niño Driven Emergency in Ethiopia

In June, The Government declared the failure of the spring Belg rains affecting smallholder famers and pastoralist. In October a Government –led multi-agency Meher assessment was conducted and concluded that the expected harvest was far below expectation due to poor and erratic rains as a result to El Niño. This led to the increase in the number of priority 1 woredas from 142 in August to 186 and the estimated number of people in need of food assistance rose to 10.2 million with and an estimated 400,000 children with severe acute malnutrition.

In response to this, UNICEF has been supporting the Government in scaling up its response to the emergency by increase the number of health facilities capable of treating severe acute malnutrition, at present 14,788 facilities now fully equipped to treat severe acute malnutrition with supplies such as Ready to Use supplementary food and essential medicines.

Currently 291,214 cases of severe acute malnutrition have already been treated with monthly admissions nearly doubling since then beginning of the year from 20,000 new cases in January to 35,000 -40,000 new admission since August-October. 

See below infographics for more.

El Nino Driven Emergency in Ethiopia

A UNICEF immunisation campaign helps combat deadly outbreaks of measles and polio

By Elissa Jobson

Chou San Kote watches as her son Oratine Rase as he receives polio vaccination from Lemmi Kebede, supervisor of supplementary immunisation
Chou San Kote watches as her son Oratine Rase as he receives polio vaccination from Lemmi Kebede, supervisor of supplementary immunisation 24, June 2014 Pagak South Sudanese refugee reception centre, Gambela Ethiopia. ©UNICEF Ethiopia/2014/Ayene

GAMBELA, ETHIOPIA, 24 JUNE 2014 – At Pagak entry point, on the border between Ethiopia and South Sudan, a long line of parents and their children wait patiently in the intense heat of the refugee registration tent. They anxiously watch as four health workers swiftly administer life-saving vaccinations to the children ahead of them.

UNICEF, in conjunction with the Gambela Region Health Bureau, has rolled out a programme of vaccination for South Sudanese children seeking asylum in Ethiopia as a result of the deadly civil conflict currently raging in their home country. Since fighting began in December last year and the first refugees crossed into Ethiopia at the beginning of January 2014, UNICEF has helped vaccinate 91,785 children against measles and 74,309 against polio. A further 41,333 children have been given vitamin A supplements to help combat malnutrition.

“Registration and screening is done by ARRA (the Ethiopian Administration for Refugee and Returnee Affairs) and UNHCR,” says Lemmi Kebede, supervisor of supplementary immunisation at Pagak entry point and Kule refugee camp. Priority, he adds, is given to pregnant women and lactating women with children less than six months old. “After registration, the children come to the vaccination point. Because levels of immunisation are low in South Sudan, eligible children are given vaccinations irrespective of whether they have had them in South Sudan or not. They are given an immunisation card which they take with them when they are transferred to the refugee camps,” Lemmi explains.

Health and nutrition
Meaza, a health professional gives a measles jab to a South Sudanese refugee baby being comforted by his mother in Pagak South Sudanese refugee reception centre. Gambela Ethiopia. ©UNICEF Ethiopia/2014/Ayene

Tesluoch Guak, just two and a half weeks old, is one of the beneficiaries of this programme. He cries as the health assistant gives him his measles injection. Despite her baby’s discomfort, his mother, Chuol Gadet, is pleased that Tesluoch is receiving his vaccination. “I understand that this is important for the health of my child,” she says.

So far, all the refugees have been willing to have their children immunised. “There is no resistance from the parents,” Lemmi confirms. “They are informed before they register as asylum seekers that their children will be vaccinated and why this is needed. There have been no refusals even though the parents haven’t previously received much health education. They have faced many challenges on the way to Ethiopia and they are open to our help.”

Chuol was heavily pregnant when she left her home in Malou county. She travelled on foot for days with her three children, aged 10, 7 and 4, to reach safety in Pagak where she delivered Tesluoch. Her husband, a solider in the government army, doesn’t even know that he has a new-born son. “The journey was hard for me. It wasn’t easy to find food and water. I don’t have words to express how difficult it was.”

The health situation of the newly arrived refugees is very poor. “In general, most of the asylum seekers are malnourished when they come from South Sudan. They have walked long distances without much food. Many have malaria and respiratory tract infections. They are really in a stressed condition,” says Bisrat Abiy Asfaw, a health consultant for UNICEF Ethiopia. This makes them highly susceptible to communicable diseases like measles and polio, he continues.

In February and March there was an outbreak of measles in Pagak – at the time more than 14,000 refugees were waiting to be registered and transferred to refugee camps within Ethiopia. UNICEF quickly rolled out a vaccination programme and helped ensure that children with signs of infection were quickly diagnosed, quarantined and treated.

“We were detecting new cases every day,” says Bisrat. “We tried to vaccinate all the children. We did a campaign on measles to increase and develop immunity within the refugee community.

The focus of the vaccination programme has been on the registration sites, although immunisation also takes place at the refugee camps. “Our strategy is to vaccinate the children as soon as possible after they enter the country, and that means working seven days a week. We are aiming for 100% coverage,” Bisrat says. And the strategy appear to be working. “The cases of measles has significantly decreased and we have had no reports of measles during the last 6 weeks,” Bisrat affirms.

Ethiopia hosted the 3rd Africa’s Nutrition Security Partnership Annual Review Meeting

By Selamawit Negash

Ten month old Hanan Mohammed Ibrahim has her mid upper arm circumference measured
Ten month old Hanan Mohammed Ibrahim has her mid upper arm circumference measured ©UNICEF Ethiopia/2012/Getachew

Malnutrition in Africa is at present one of the leading causes of mortality among children under five. Data indicate that malnutrition including intra uterine growth restriction, stunting, wasting and micronutrient deficiencies contribute to up to 45per cent of all child deaths in Africa.  In sub-Saharan Africa, 40 per cent of children under 5 years of age are stunted. Food and nutrition security in Africa, in particular in Sub Saharan Africa has hardly improved over the last decade, despite many initiatives at global and regional level.

There are evidences that all global advocacy initiatives need country examples – champions that can show in practice, and not just in theory, how to achieve results when resources are scarce and the challenges are great. The European Union (EU) and UNICEF partner to improve nutrition security in Africa at regional level and in a total of four target countries Burkina Faso, Mali, Uganda and Ethiopia. The Africa Nutrition Security Partnership (ANSP) programme that is being implemented in 2012-2015 is a multi-donor initiative of in total €21 million with the support from the EU amounting to €15 million. The programme aims at increasing the commitment to nutrition in terms of policies, budgets, and effective programming and implementation. The programme fosters high-level policy engagement to nutrition at continental, regional and national levels and contributes to scaling up of high-impact nutrition interventions in the four target countries by integrating nutrition goals into broader health, development and agricultural efforts.

Ethiopia hosted the 3rd Africa’s Nutrition Security Partnership Annual Review Meeting from 14 to 15 October 2014. Participants from the government of Ethiopia EU, UNICEF as well as Cornell University from continental, regional and country level organisations discuss accomplishments, bottlenecks to implementations and sharing experiences and best practices among ANSP beneficiary countries.

Group Photo: African Nutrition Security Partnership (ANSP) 3rd Annual Review Meeting
Group Photo: African Nutrition Security Partnership (ANSP) 3rd Annual Review Meeting ©UNICEF Ethiopia/2014/Ayene

Good progresses is made towards the achievements of the ANSP objectives in all of the four ANSP result areas of policy, capacity, information system and programme scale up. It is clear that during the meeting, that ANSP is helping to improve the political environment for nutrition with strong continental, regional and national leadership, multisectoral coordination and joint accountability scale up community level nutrition interventions.

2015 will be the last year for ANSP support and partners must work to integrate the efforts being made with the local structures and systems to ensure sustainability. It will be very important to work on synergising continental level activities which aim to create enabling policy environment with community level programmes to scale up key high impact multisectoral nutrition interventions.

The meeting emphasised, the support for nutrition in Africa should continue within the framework of the Post 2015 Nutrition Action Plan.

A Day in the Life of a Well-fed Child: Ethiopia

By Frehiwot Yilma

AMHARA REGION, 05 June 2014 – Kossoye Ambaras is a small lush green village within Wogrea woreda in northern Gondar where it is relatively cold. Amarech Ashager, a 28 years old mother of two, is used to the weather as she lived her whole life here. At the top of her daily agenda is making sure that her family, especially her youngest son, Metages Birhanu of 9 months, is well fed.

Like many of the residents, Amerech does not rise out of bed before 7 a.m., as it is too cold to leave the house. She begins her day by breastfeeding Metages and cooking breakfast for the rest of the household. Her husband, Birhanu Tagel, is a businessman and her eldest son, Muluken, 10, is a third grader. After saying ‘good day’ to Birihanu and Muluken, Amarech will cook breakfast for Metages. Since he was introduced to solid food only three months ago, Metages eats exclusively porridge. Preparing highly nutritious porridge for a child is a technique that Amarech has recently learnt. The base of the porridge, the flour, contains various grains and legumes. For breakfast the added ingredient besides the flour is an egg and minced cabbage. As well as cooking the food, feeding the child to achieve best results is also a discipline. Amarech has learnt to feed her child while also playing and talking to him to keep him engaged.

It takes a village to raise a child

Health Extension workers in Amhara region provide preventive and curative health service to the community
Health Extension workers in Amhara region provide preventive and curative health service to the community ©UNICEF Ethiopia/2014

Amarech and other mothers in the village get support from Health Extension Workers (HEWs) on how to properly raise their children. Today, HEWs Habtam Dese and Yeshiwork Tesfahun are weighing the children in the village to monitor their health and development. They too receive assistance from Gebeyaw Alamerew, the woreda Nutrition and Child Health Officer. In a typical session with a HEW, a six-month-old child will receive a vitamin A supplement, while those aged above one year will additionally receive deworming tablets. With the support of UNICEF, this has become a routine service in the woreda.

Out of 18 children weighed by the HEWs , 16 are in the average weight range. Amarech is one of the happy mothers to learn that her son, Metages, weighs 8.6 kilograms, well in the range of a healthy baby’s weight. “I am so happy that he has gained a few more grams since last time,” she says, smiling. After weighing babies in the community, Habtam and Yeshiwork demonstrate how to make a child’s diet balanced and about the importance of using iodised salt. As the child-friendly food preparation simmers over a fire, the two mothers, whose children’s weight was under the average limit, get counselling on how to improve their baby’s weight. Gebeyaw believes the woreda has come a long way. “In previous years, there were up to eight children per month in Kossoye suffering from Severe Acute Malnutrition (SAM), but this year there have been no cases,” he says. “This is because we monitor the children’s growth and give counselling and other packages of support to the mothers at the earliest stage possible, as we did with the two mothers today.” When the food has finished cooking, Habtam and Yeshiwork let the mothers feed the warm nutritious preparation to their children.

Bridging the nutrition gap before sunset

Amarech Ashager breast feeds Metages Birhanu, 9 months old
Amarech Ashager breast feeds Metages Birhanu, 9 months old © UNICEF Ethiopia/2014

The afternoons in Kossye Ambaras are usually foggy this time of the season. Amarech has subsequently decided to do her laundry the following day and so turns to preparing dinner as well as other domestic chores. For Metages, she has a new menu in mind: adding mashed potatoes and carrots to the porridge. She says she will also never forget adding iodised salt to the food. “Habtam has told us that iodised salt is key to a child’s mental growth. She also told us that we have to put in the salt after the food is cooked and out of the oven so that the iodine does not evaporate with the heat,” she says.

Habtam is one of 38,000 government salaried HEWs currently providing nutritional and other support to mothers and children across all regions of Ethiopia. Development partners such as UNICEF are committed to support this initiative. “Nations will face critical bottlenecks to economic growth if a large proportion of their working-age people’s IQ and productivity are limited by under-nutrition,” says Dr Peter Salama, UNICEF representative in Ethiopia.

As the day draws to an end, Amarech’s house becomes lively as the family come together and discuss their experiences. While breastfeeding Metages, Amarech tells her husband about the importance of investing in their children’s diet to ensure their healthy future. “I will feed my children a variety of foods so that they will have a bright mind,” she says with confidence. “And I will be happy if Metages becomes a doctor.”

On the recent Micronutrient Global Conference (June 2-6, 2014), researchers, policy-makers, program implementers, and the private sector has been discussing ways of overcoming micronutrient malnutrition. The forum has been held under the theme of “Building Bridges”, thus emphasising scientific advances and multi-sectoral programming on adequate micronutrient intake. Read more

Health Extension Workers: Key to Reducing Malnutrition in Ethiopia

Eneayehu Beyene and Tena Esubalew, helth extention workers Amhara rigion of Ethiopia.
Eneayehu Beyene and Tena Esubalew, Health Extension Workers in Delma kebele of Machakel woreda Amhara region of Ethiopia. Preparing their monthly report on community based nutrition activities to submit to the health. ©UNICEF Ethiopia/2014/Tsegaye

AMHARA REGION, 3 April 2014- Tena (meaning health in Amharic) Esubalew, 25, and Eneayehu Beyene, 27, are the heroines of Delma kebele as they have become the health confidants of the community. Delma Kebele (sub district), which is located in Machakel woreda (district) in the Amhara Region in northwest Ethiopia. Delma is a community 10 kilo meter from an asphalt road with a population of 4,733. As part of the EU funded Africa Nutrition Security Project (ANSP), UNICEF launched a community health programme (2012-2015) in 20 districts across three regions of Ethiopia to help the Government boost the nutritional status of children under two in communities like Delma where child malnutrition has been alarmingly high.

Key to the programme’s success has been the role of community Health Extension Workers (HEWs). From Delma, Tena  and Eneayehu have received intensive training with the support from UNICEF on nutrition so they can effectively carry out health extension duties.

“It is clear to us that three years ago no-one in this community could identify if a child was malnourished or not, this problem has been recently solved through the programme’s awareness strengthening on nutrition,” says Eneayehu

Breast Feeding-Tena Esubalew Health Extension Worker coaches Etenesh Belay positioning of the child for effective breast feeding
Tena Esubalew Health Extension Worker coaches Etenesh Belay positioning of the child for effective breast feeding Amhara rigion of Ethiopia. ©UNICEF Ethiopia/2014/Tsegaye

Eneayehu and Tena spend most of their days walking between households in Delma, visiting young mothers in the community and engaging them about the importance of child nutrition. They are trained to identify mild and moderate malnutrition and also growth faltering – based on which they provide age-tailored counselling. Additionally, they can diagnose if a child has Severe Acute Malnutrition (SAM) with or without complications. If a child is suffering from SAM with complications then the health extension workers will quickly have them referred to a health centre in the nearest town.

The health post where Tena and Eneayehu  work is  situated on top of a hill surrounded by open fields and grazing livestock. It is a busy hub frequented by the community’s young mothers, who are eager to learn about their children’s health status. The walls are plastered with graphs charting the health and development of the community’s under-five children. It is here that growth monitoring of all the community’s children under-two-years is conducted on a monthly basis and compared with World Health Organisation growth standards.

Breast Feeding-Yedeneku Aynalem 38 with her son Barkelegn 10 month
Yedeneku Aynalem 38 with her son Barkelegn 10 month, who is benefiting from community based nutrition Machakel woreda Amhara region. ©UNICEF Ethiopia/2014/Tsegaye

Yideneku Aynalem, 38, reaches up to a mud shelf in her hut and retrieves an illustrated booklet. “This is a very important document”, she says carefully opening the page to reveal a colourful chart. The HEWs have distributed  the materials printed with the support of UNICEF throughout the community to enable lactating mothers to track their child’s weight. Yideneku points to a graph and traces with her finger a green upward curve signifying the trajectory of a healthy child’s development based on optimum height and weight measurements. She explains with a smile how her 10 month old child Barkelegn Walelign’s growth has started to correlate with the green line on the chart. “I have been given the knowledge and it is now my responsibility to keep putting this learning into action so that my child can remain strong and healthy”, she says. Yidenku’s child is one of 270 children under-two years of age that have benefited from the EU-UNICEF supported package of high impact interventions in Delma.

The community results are encouraging: the rate of underweight young children has reduced from six per cent to one per cent in two years. “At the start of the programme, six children in the village were diagnosed with Severe Acute Malnutrition (SAM) – this year only two children suffered this extreme health condition”, says, Tena.