Feeding the Children of Afghanistan Together
Afghanistan’s rate of child mortality is the highest outside of Sub-Saharan Africa and believed to be fueled in large part by underlying conditions of malnutrition. Key nutrition indicators are estimated to be 52% stunting, 14% wasting, and 25% underweight in children under-5 (MICS, 2010-2011). Micronutrient deficiencies are also widespread. Undernourished children are more likely to die from common sicknesses and those that survive risk increased susceptibility to reoccurring illness and limited growth.
Household food insecurity and unfamiliarity with infant and young child (IFYC) feeding practices are both major contributors to malnutrition. Afghanistan has a history of cereal deficits, and production of livestock, fruits, and vegetables are low. The maintenance of home gardens is still uncommon. Limited access to nutrition education and counseling has contributed to just 54% of children who are exclusively breastfed in the first 6 months and inefficient complementary feeding practices (MICS, 2010-2011). Cultural and traditional beliefs also prevent uptake of optimal caring and feeding practices in some cases.
Since 2003, Afghanistan has had a national nutrition strategy that addresses both the direct and underlying causes of malnutrition, however human resource constraints and prioritization of other issues has prevented it from being fully implemented. With the support of UNICEF and FAO, there have been some recent improvements in coordination of nutrition efforts across government ministries, but overall integration of health and food security interventions remains low.
The Joint Programme (JP) began in late December 2009, with the intention of demonstrating an integrated and multisectoral approach to reducing malnutrition. It featured a comprehensive package of community food security and nutrition interventions, and institutional capacity building.
There were two major outcome areas in the JP. The first targeted the community level with actions around improving IYCF practices, screening and treatment of acute malnutrition, capacity development of health workers on nutritional issues, and increasing household food production, among others. The second targeted the provincial and central levels, providing policy advice and technical support to strengthen institutional frameworks and mechanisms for integrated, long-term nutrition strategies.
A large number of stakeholders were brought together under the programme, including UN agencies such as FAO, UNICEF, UNIDO, WHO, and WFP, government counterparts in the agriculture, health, education, and social service sectors, as well as 14 NGOs and CSOs combined. Activities aimed at the community level were carried out in five target provinces, including Badakshan, Nangahar, Daikundi, Bamiyan, and Kabul (two districts in each province).
• Extensive capacity building was conducted at the community level in IYCF practices, monitoring and screening of acute malnutrition, and food production, processing, and storage.
• Nutrition education was incorporated into the revised national curriculum for primary school students.
• Food-based dietary guidelines were developed and communication strategies for reaching people at the village and district levels were field tested.
The complexity and geographical scope of the programme were difficult to manage. Project delays were common due to the difficulty in moving around. Construction of a baseline survey for monitoring and evaluation was still incomplete at the time activities began. Collaboration between such a large number of stakeholders was also challenging, exacerbated by the programme design, which designated responsibility of outputs to individual agencies as opposed to shared responsibilities among multiple agencies. Food security and nutrition interventions were carried out in different target districts without much coordination or integration and in some cases, once JP funding ran out, the activities stopped.
Funding was raised to carry out a similar package of nutrition and food security interventions in a new province (Baghlan) and bee keeping activities in Daikundi are being expanded with the support of Green Way Organization. Other success areas from the JP are also moving forward, such as the initiative to integrate nutrition information into school curricula, which is exploring expansion beyond primary school, and the food-based nutrition guidelines, which have received funding for 2 more years to ensure the Ministry of Public Health is able to roll them out successfully and completely.