Agwa; Eforiro; Acha; Ikire; Yalo; Anyara; Bitter leaf, Millet… the list is endless. No, this is not a cooking class and we are not about to share a recipe for a meal. On Tuesday, February 27, 2018, Nigeria Health Watch organized a health policy dialogue on nutrition with the title, “Our Nutrition Crisis: Considering Local Alternatives.” In attendance were policy makers, organisations working in the nutrition space and stakeholders with a broad interest in nutrition. The foods listed above are just a few of the examples delegates gave when asked what were some of the highly nutritious local foods we have in Nigeria that can help tackle malnutrition.
The aim of the policy dialogue was to discuss solutions to malnutrition, both preventative and restorative, and where funding should be prioritised. It was also to explore new models and other high impact interventions, with a focus on local alternatives for preventing the onset of malnutrition, looking at targeted interventions to address malnutrition.
The journey to this dialogue on malnutrition started in 2017 when Nigeria Health Watch began a campaign #FeedNaijaPikin, to draw attention to the issue of malnutrition among children under 5 in Nigeria. During the campaign, the team visited many locations to understand the issues including Community Management of Acute Malnutrition (CMAM) sites in Zamfara and Kaduna states. Our findings motivated us further to continue this important conversation, even after the initial project came to an end.
Dr. Ngozi Azodoh, Head, Health Nutrition Emergency Response, Federal Ministry of Health, Abuja, was the first speaker and set the tone of the conversation with a passionate talk, about the fact that Nigeria has an abundance of local food items that can work as solutions to addressing the onset of malnutrition in Nigeria.
She pointed out the need to be practical, “We need to provide food demonstrations to mothers and caregivers, showing them how to use food items like groundnuts, millet & soya beans to prepare nutritious meals”. Dr. Azodoh gave an example of how, in Enugu state, women talking to each other about the right foods to eat and what to feed their children helped combat the onset of malnutrition. She informed participants that, “The Government is putting measures in place to coordinate and prioritise nutrition in Nigeria”. She ended her introductory remarks by stating, “We must prioritise maternal, new-born and infant nutrition in Nigeria. There is an urgent need for action”.
Dr. Samson Egbunu, Pro-Health International, spoke about his experience in his work with Internally Displaced Persons (IDPs). “We work with IDPs to provide free medical care and we picked up on the urgent need for a malnutrition intervention.” He noted that, the IDPs, often driven by need, sell off all their produce, without saving some, “If a man needs to access healthcare services, he will sell whatever he needs to, including nutritious food, to pay for his medical needs. This is where Universal Health Coverage comes in.”
“Everything communities need to combat the onset of malnutrition can be found within their communities” Rev. Matthew Fanto, Center Manager, Peace Building and Trauma Healing Center, Little Ray Field, Jos, Plateau State, emphatically stated. He spoke about the need for people to eat what they grow and to grow what they eat. He had the view that “Curbing malnutrition doesn’t need much funding. All we need is education and demonstration farms in communities.” Rev. Matthew showed that he practices what he is preaching, “I grow most of the food I eat in my home garden. Every Nigerian should engage in backyard farming. It does not require large space.”
Malnutrition is multi-faceted; it is tied to issues such as women’s education/empowerment, access to quality reproductive healthcare services, food security and agriculture, access to clean water and sanitation. As a result, it needs to be tackled with different, quality, diverse and affordable interventions. Interventions need to tackle the root causes of malnutrition which often requires looking into the home the children come from and the general family circumstances. Otherwise children who have been treated for severe acute malnutrition, may relapse.
Another issue highlighted was the sustainability of health programmes targeted at malnutrition. Countries that typically fund foreign aid interventions are becoming increasingly inwardly focused (as seen by the rise of populist movements), and there is a growing community that wants development aid to be reduced and for national governments to use public spending on the local population. It was highlighted that we need to empower local communities to produce the foods they need to sustain themselves. Ayodele Fella of Global Alliance for Improved Nutrition (GAIN), emphasized the need to think local. “We need to think of local solutions to address our nutrition problems in Nigeria. Local problems. Local solutions.”
There are quite a number of small community projects across Nigeria where nutrition programmes are supported either with or without grants. Government and indigenous organizations need to seek opportunities for these community projects to be scaled up, where there is evidence that they are positively impacting local communities and they have been able to support agricultural diversification.
The importance of communicating the dire reality of malnutrition to Nigerians was emphasised at the dialogue. Nigerians are largely unaware of the seriousness and dire extent of malnutrition across the country. There are multiples issues and challenges in the country vying for attention in the media, which means that malnutrition often finds itself buried under other more seemingly pressing issues. The media plays an important role in ensuring that the conversation around malnutrition stays in the forefront of public health discourse.
To conclude the Health Policy Dialogue, there was a collective need to outline a few calls to action:
- Government must continue to be held to account to fully address the malnutrition issue, especially to provide the requisite finance to support interventions
- The National Policy on Food and Nutrition in Nigeria needs to be implemented
- Interventions need to be streamlined with a pointed focus on women of child bearing age
- Nutritional interventions need to be multi-sectoral, collectively involving all relevant stakeholders
- Business principles from processed food companies should be adopted to aggressively market and promote fortified and natural foods
- Behavioural change communication is a critical aspect of the fight against malnutrition, and the must be used at all possible avenues to affect attitudes
- Health workers, religious and traditional leaders need to be co-opted into the fight against malnutrition
- The private sector should be better engaged by both government and community organisations
- “Eat what you grow, grow what you eat”: We should teach communities to consume the healthy foods that they grow
This is our “rallying cry” to Nigerians. We need all Nigerians to engage fully in pressing for urgent action on the malnutrition crisis. We need to “invest in Nigeria’s future flagbearers”. What is your call to action? Share your own action points on how we can reduce malnutrition in Nigeria. What should the government be doing? What should private organisations be doing? What do you think communities affected by malnutrition can do? What can you do?
As Dr. Francis Aminu, Director of Health & Nutrition, Dangote Foundation said, “Solving malnutrition in Nigeria is a movement” This movement begins with everyone of us educating ourselves about the true state of malnutrition in Nigeria. When you know, you can fully engage, advocate and inform others… When you know, you can truly care.
it is a good initiative and with the ideas everyone of you has shared to fight malnutrition in our localities. in addition, if it will also good for us to look at targeting the 1000 days of life of the child up to 2 years of age, which is preventing malnutrition from conception by introducing the knowledge on nutrition to the care giver( Maternal health and child nutrition).
I will also suggest we include the influencers at home such as the husbands of the women and grandmothers/mother in-laws into the call to action.