Nigeria Health Watch

Defying the odds, one nutritious meal at a time: The Story of Yalwa

Sitting in a small room outside the chief’s residence in the tiny village of Yalwa in Jigawa State, a group of Fulani women have gathered to chat. A fair-skinned boy, about a year old, is in his mother’s arms, smiling and kicking around with both his hands and feet. He has adorably chubby cheeks and playful eyes. At first glance, he could easily pass for a child living in the heart of a wealthy metropolitan suburb in Abuja, where three square meals are not a luxury. He is well-fed and well-kempt. His mother, herself looking quite healthy, is quick to smile at her energetic baby boy, who she calls Ibrahim.

Little laughing Ibrahim and his mother are not the only healthy ones. After their group discussion the women, one after the other, go inside the Village Head’s residence, to get their babies. It is difficult to differentiate which of the children are more nourished than the other. Unlike many communities in Jigawa, the children under 5 years old appear to be healthy and thriving. Their mothers were looking equally well-nourished. While this should not be surprising, the healthy children in Yalwa, sadly compound the reality in the state.

Yalwa is a rural village community in the northwest state of Jigawa. It lies four kilometers north of the town of Buji, approximately 80 kilometers from the state capital, Dutse. The dusty road leading to Yalwa from Buji is surrounded on both sides by large water melon and millet farms. The community is predominantly Fulani, and cows, goats and sheep are sparsely scattered around, feeding on scorched brown grass. There is a primary school, a small clinic, a borehole and surprisingly steady power supply. The ruler of the community is known as the ‘mai gari’ and like many rural settings in Northern Nigeria, his house is in front of the Juma’at Mosque.

“About 1200 of the 2600 children that die every day in Nigeria die due to malnutrition.”

The pervasive scourge of malnutrition in Nigeria

The fact that little Ibrahim and his mother are both healthy and thriving in Yalwa flies in the face of malnutrition statistics for Jigawa and northern Nigeria as a whole. Jigawa bears the highest burden of malnourished children in Nigeria, where 62.7% of children under-five are stunted, 11.9% are wasted and 40.2% are underweight. UNICEF estimates that a staggering 2.5 million children suffer from severe acute malnutrition in Nigeria, with an alarming 2.2 million (88%) of those children in Northern Nigeria.

These numbers are large, and the reasons behind them are many. The continued insurgency in the North-East, ravaging poverty, and illiteracy have all played their part in entrenching the malnutrition crisis in Northern Nigeria. Compounding the already dire situation is the consistent lack of nutrition funding by state governments in Northern Nigeria, lack of political will to implement existing policies, continued reliance on donor agencies and international partners to finance nutrition interventions, and to a large extent utter negligence of the growing malnutrition problem by local and state political office holders.

Defying the statistics… one meal at a time

In the face of these challenges, little Ibrahim’s community of Yalwa seems to have found a way to beat the odds when it comes to nutrition. Ibrahim’s mother is full of smiles when asked how she has managed to keep Ibrahim so boisterous and healthy. She speaks Hausa haltingly, but is eager to share her story. “My son Ibrahim has been eating healthy foods since he was in my womb,” she says, then laughs as she continues to explain that when she was pregnant, she made sure she followed the advice given to her by the health workers in the Yalwa Community Clinic, as well as attending ante-natal clinic days. She and other pregnant women in Yalwa also received training on nutrition and hygiene from a special group of volunteers.

I ate vegetables, carrots, water melon, soya beans, groundnuts,” she says, adding, “I used to buy meat and fish once in a while. I cooked eggs, and made sure my soup was full of tomatoes, spinach and palm oil. I also drank malt and milk.” She says that after the baby was born, she fed him with only breast milk for the first six months after which she introduced him to lighter foods such as pap made from moringa or groundnuts, eggs and soya beans.

Ibrahim has a brother who is four years older. His mother says that Ibrahim at his current age is healthier and smarter, compared to his older brother at the same age. She says this is because her older son was born at a time the community had no knowledge about child nutrition and how to keep their children healthy.

Five years ago, in the Yalwa community, most children were fed mainly with fura, a traditional cereal made from millet flour and cow’s milk. While it contained nutrients, it was not enough to provide a child with all the essential nutrients required for development, especially in their first 1000 days of life. In children under six months, this diet resulted in constant diarrhea, and later many developed developmental deficiencies such as stunting and under-nutrition became apparent.

A knowledge-rich, homegrown nutrition approach

Ibrahim’s mother says the knowledge of the types of food to eat and where to source them, came to her and other women from the training provided by special community volunteers. These volunteers spent time helping the women in Yalwa understand that they could find nourishing foods to feed themselves and their children right in their communities, without having to travel to the town of Buji. The volunteers also encouraged women in Yalwa to breastfeed their children exclusively for six months and taught the women that before they could have healthy children, they too would need to be healthy, which also meant that they had to learn proper hygiene practices for themselves.

Women in Kokura gather in front of the village head’s house to discuss what they have learnt about nutrition and hygiene practices. Photo credit: Nigeria Health Watch/Ifeanyi Nsofor

The community volunteers in Yalwa were engaged under a combined nutrition intervention project by Save the Children International (SCI) and Action Against Hunger (AAH). The project, titled the “Child Development Grant Program (CDGP)”, was designed to build the capacity of community volunteers in selected communities in Jigawa and Zamfara states in nutrition and hygiene practices targeted specifically at improving the nutrition of children under 5 years old and their mothers. It was implemented in three Local Government Areas (LGAs) in Jigawa – Buji, which includes Yalwa community, Krikasama, and Gagarawa; and two LGAs in Zamfara – Tsafe and Anka.

The CDGP Program began in April of 2014 and engaged 7-10 volunteers in each of the communities. Volunteers were trained by the program staff in nutrition and hygiene practices. Pregnant women in the community were eligible to be enrolled in the CDGP Program, and community volunteers raised awareness about the importance of both mother and child nutrition, teaching them proper nutrition practices using locally sourced foods. In addition to the training, women enrolled in the program received a monthly allowance of four thousand Naira (N4,000), on the condition that they would attend the health clinic for antenatal and post-natal visits, take their child for immunization, and breastfeed exclusively for the first six months of the child’s life. The N4,000 was intended specifically to allow the pregnant woman to purchase food items that would nourish her and her unborn child.

An answer to Nigeria’s nutrition crisis?

Evidence suggests that using community volunteers to both sensitize and teach pregnant women proper nutrition from locally sourced foods, combined with a nutrition-focused conditional cash transfer system may give communities like Yalwa added advantages in the fight against child malnutrition in Northern Nigeria.

According to the Director of Primary Healthcare in Buji LGA, an estimated 4,000 women are benefitting from the program in Buji LGA alone. “We knew malnutrition is the cause of many problems, but we never thought a program would come from either the state or local government or any organisation that could address this issue like this one is currently doing,” he said.

Three women listen intently during a discussion about nutrition in Kokura. Photo credit: Nigeria Health Watch/Ifeanyi Nsofor

A health worker in Madabe, another community in Buji, which has also benefited from the CDGP intervention, highlighted the critical role that volunteers play in the success of the Program. “Community volunteers are the backbone of this program,” she said. “Even me, I’m benefitting from them because they help in creating awareness about my work especially in routine immunization and Antenatal care. Most times when I enter the community to give awareness talk they tell me the community volunteers have already told them.”

A staff member of Buji LGA pointed out enthusiastically that “because of this program if you go to our villages the children are as strong and healthy as the children in Abuja. As a result of this program, disease rates among children has reduced drastically.”

Critical gaps in the CDGP Program

Save the Children International in 2017 conducted an evaluation of the CDGP Program as implemented in Jigawa and Zamfara states, to allow them to understand the impact of the program on the selected communities, and more importantly, on the rate of malnutrition in the selected states.

Kokura is a rural community, much like Yalwa, in the Northern State of Jigawa whose women and children are well nourished due to a nutrition intervention. Photo credit: Nigeria Health Watch/Ifeanyi Nsofor

While we await the outcome of this evaluation, questions about this approach remain. Most readily is the question of sustainable financing. Given that the CDGP Program, like many others, is being funded by an international donor, when funding for the program ends, as it may in 2019, who will take up the void in the payments of the conditional cash transfer to the women enrolled in the program? Hopefully the evaluation will show that states and LGAs are ready and willing to take up support when the CDGP program officially ends.

Another potential trouble-spot is that currently the community volunteers who are crucial to this intervention are not being paid salaries for their work. Instead they receive a N3,000 transport stipend each month, regardless of how far they travel. What is the likelihood that these volunteers would continue to raise awareness and teach women about proper nutrition without the existence of their stipends, if the CDGP Program were to end? Will local or state governments be willing to cater for these volunteers in a way that allows them to continue providing these services without the Program?

Finally, as innovative as Yalwa’s women are, most of them are not involved in any form of trade or work which can earn them the money they will need to afford some of the foods essential for good nutrition, because even though most foods are easily sourced, some like malt drinks, milk and meat all require money to purchase. Without a plan for empowering community women to sustain their nutrition needs, the reliance on donor-funded support is unlikely to end.

A good starting point to fight malnutrition

Despite these gaps, still, today in Yalwa, children like little Ibrahim are exclusively breastfed for six months, then gradually introduced to semi solid nutrient-filled foods like ground nut pap, soya beans, and moringa. Their mothers access most of these foods locally and keep themselves properly nourished while pregnant, with the help of a cadre of knowledgeable health workers, community volunteers and a conditional cash transfer system that provides them funds to purchase nourishing foods for themselves and their children. This is a significant achievement in light of the prevalence of malnutrition in northern Nigeria, and is an important reference point for others, be it state or local governments looking for models with which to tackle their community’s under-5 nutrition concerns in Nigeria.

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