21 November 2017

The State of Nutrition in Nigeria: From Security Threat to Economic Imperative

Last week I spent some time in Lagos and Abuja with the GAIN Nigeria Office. We met with government officials, entrepreneurs, civil society, reporters and development partners. It was a stimulating visit set against the devastating backdrop of a mounting malnutrition crisis, especially in the North East of the country where a famine has been declared. In fact one of the officials I spoke to told me it had gone beyond a crisis to being a clear and present danger to national security.
Nigeria certainly has too much malnutrition. Stunting rates are 33 percent and declining too slowly, wasting rates were 7 percent in 2015 and are now surely significantly higher given the situation in the North East. In addition, anaemia rates and overweight rates for adult woman are, respectively, 49 percent and 55 percent. Unfortunately, the double burden is booming in Nigeria.
It should not be like this. Nigeria has an abundance of natural resources, a vibrant entrepreneurial spirit, and was an early member of the Scaling Up Nutrition (SUN) Movement (2011).  It is true that the economy has been stagnant for the past few years and levels of poverty remain around 50 percent, but you get the feeling that the country has the potential to actually live up to the “economic powerhouse of Africa” tag it once had. The challenge is to enable the dynamism of the South of the country and elsewhere to drive nutrition improvement, livelihood generation, resilience and growth, especially in the more remote and conflict affected North East.
So where are the weak links in the nutrition improvement chain? As the excellent SUN Country Dashboard for Nigeria notes (above), the country does well on enabling environment and on legislation, relative to the other 60 SUN members. But it does less well on scaling of interventions and quality of food supply and on the SDG drivers of nutrition (such as WASH, women’s empowerment and age of marriage).
When we delve further into the aggregate scores and look at all 75 indicators, we can see that some areas of relatively good performance don’t actually look so good. For instance, the relatively good score on finance is due to development partners providing 99 percent of the total nutrition-specific funding. As for government spending, the SUN dashboard says that the Government of Nigeria spends only 0.8 percent of its 2014 budget on nutrition specific interventions. The Global Nutrition Report of 2017presents even more bleak statistics: it says the Government spends only 0.2 percent of its budget on nutrition sensitive AND nutrition specific interventions. Clearly the government needs to step up and invest its own resources in nutrition. Another example of hidden weak performance is the relatively good score for infant and young child feeding, but in absolute terms only 10 percent of infants meet the minimum diet adequacy score; this is shockingly low but only slightly below the SUN member median of 11 percent.
But for me, the most striking gap highlighted by the SUN dashboard is the Government’s apparent lack of appreciation that nutrition is a driver of development. For example, Nigeria’s national development plans barely mention malnutrition (in any of its forms); the orientation of agriculture to nutrition is low, as measured by the SUN dashboard (although there is the promise of some change here); and, of course, there is the low spending on nutrition programs from the Governments own budgets, which is always the firmest test of commitment.
During my trip, I was struck (as in other GAIN country office trips) by how dynamic the small and medium enterprise CEOs are. Take the two partners in the Postharvest Loss Alliance for Nutrition (PLAN).  This programme, conceived of and managed by GAIN and partners supports small and medium businesses that are trying to improve packaging and crating for transport and display, as well as their cold chains in fresh (and nutritious) produce so they can reduce their postharvest waste and grow their businesses.  The two CEOs from Best Foods Nigeria Ltd. and Alyx Ltd. were restless, energetic, driven, focused and in constant problem solving mode. Ironically, they could see the bigger picture better than many policy analysts – because they are a part of that picture.

Alyx Ltd. Mobile cold chain. Abuja, Nigeria
For example, the CEOs noted several ways in which the government could help them better provide low cost fruits and vegetables to low income populations. Specifically, they pointed out that: (a) import tariffs on insulation materials for the portable cold chain collection points (that can be taken out into the fields) are around 30 percent, (b) as are the tariffs for solar panels and batteries that will allow the portable and fixed cold chain points to be off the grid and (c) reused materials (the companies repurpose existing metals and other materials) do not count as collateral when applying for formal finance loans.
So the policies and rules that could make a food system more nutrition sensitive are not always obvious to those working outside the system, that’s why GAIN strives for the duality of being both a participant within, and an analyst of, food systems: it gives us a wealth of insights as to how to work with partners to help fix the systems.  The SUN Business Network which GAIN convenes in Nigeria (and which the World Food Programme convenes in other countries in the region) is also a fantastic platform for the nutrition community to forge new alliances and partnerships with businesses who are acting responsibly to improve nutrition.
In conclusion, there were several things that made me hopeful that more rapid progress on reducing malnutrition in Nigeria can be made: the profile the media is giving nutrition at the moment—this is an opportunity to get the message out that nutrition is an investment in resilience and development; the Dangote Foundation’s new US$100 million commitment to nutrition which should leverage even more external funding for development; the Federal Ministry of Agriculture and Rural Development’s ambition to scale up the availability of biofortified crops; the dynamism and thoughtfulness of the Chair and Vice Chair of the Healthcare Services Committee in the House of Representatives (just like the US system) and their commitment to malnutrition reduction; the development partners we met who were more passionate, informed and action oriented on nutrition than in many other places I have visited; and the enthusiasm of small and medium enterprises to develop their businesses in ways that make nutritious foods more available and affordable.
And the best way to sustain optimism and deliver on it is by strengthening nutrition accountability mechanisms to hold our feet to the fire. For example, I would like to see an annual Nigerian Nutrition Report, similar to the Global Nutrition Report (GNR) or the India Health Report, where outcomes, legislation, policy and investment could be tracked for all 36 states, highlighting successes, bottlenecks and solutions.
GAIN Nigeria will certainly play its part in supporting the government’s efforts to meet the Sustainable Development Goals. During my stay in Abuja, we hosted an event to mark our 15th anniversary (one of 15 events around the world). Fifty or so partners from a range of organisations were present. Together, we explored the malnutrition challenges in the country and the opportunities to make good nutrition a reality for all Nigerians. As Michael Ojo, our strong new Country Director put it: let’s remember who the real “boss” is here: those whose lives, livelihoods and lifecourses are at risk because of malnutrition. Remembering this will make us less likely to be complacent. He also said that working together we are more than the sum of our parts and that together we can accelerate reductions in malnutrition in Nigeria. Exactly.
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