Mobilizing and Strengthening Civil Society Organizations To Scale Up Nutrition in Nigeria

1. Mobilizing and
strengthening Civil Society
Organizations to scale up
nutrition in Nigeria:
A Call for Action
by
Dr. Philippa Momah
Network Coordinator
Civil Society Scaling Up Nutrition in Nigeria
(CS-SUNN)
…….Working together to attain a country where every citizen has food and nutrition is secured

2. Presentation outline…
• Introduction
• The Crisis of Under-nutrition in
Nigeria
• Stopping Child under-nutrition
• Mobilizing Civil Society
Organizations to scale up Nutrition
in Nigeria
• A call to action to PAPHNON
…….Working together to attain a country where every citizen has food and nutrition is secured

3. Introduction ..(1)
• Food is an important resource to human development
and survival.
• Food security exists when all people, at all times, have
physical and economic access to sufficient safe and
nutritious food that meets their dietary needs and food
preferences for an active and healthy life.
• Health implications of food insecurity include
malnutrition, impaired mental development, diminished
learning ability, increased prevalence of chronic diseases,
morbidity and mortality.
• An adequate diet consists of all classes of food in the
right proportion e.g. staple foods, legumes, animal
source foods, fruits, vegetables, fats and oils .
…….Working together to attain a country where every citizen has food and nutrition is secured

4. Introduction ..(2)
• Nutrition is the process involved in taking in, absorbing
and utilizing nutrients for tissue growth, repairs and
maintenance of body systems.
• Adequate nutrition is essential throughout the lifespan
especially within the first 1000 days of life that
begins with conception, through the mother’s
pregnancy and up till the child is aged two years.
• Good nutritional practices such as exclusive breast
feeding, complementary feeding, family dietary
diversification and improved hygiene practices
contribute towards the protection of the first 1000 days.
• The effects of poor nutrition during the 1,000 day
window period are often irreversible. It can result in
brain damage, poor growth and development problems .
…….Working together to attain a country where every citizen has food and nutrition is secured

5. Introduction ..(3)
• Malnutrition is a condition that occurs when people
consistently do not consume or absorb the right amounts
and types of food and essential nutrients.
• Malnutrition among Nigeria’s children is a serious
problem : each year about 1 million Nigerian children die
before their 5th birthday and malnutrition contributes to
nearly HALF of these deaths.
• Dimensions of malnutrition in children:
– Under-nutrition : Stunting, Wasting, and Micronutrient
deficiencies (Hidden Hunger);
– Over-nutrition : Overweight / Obesity
• Nigeria has the highest burden of stunting in Africa,
with over 11 million children less than 5 years old,
stunted ( NDHS 2013).
…….Working together to attain a country where every citizen has food and nutrition is secured

6. The Crisis of Under-nutrition
in Nigeria…
Trends in Childhood under-nutrition(NDHS 2013):
Stunting (short for their age):
• Stunting reflects failure to receive adequate nutrition
over a long period of time (i.e. chronically malnourished)
Trends: The proportion of children who are stunted
declined from 41 % in 2008 to 37 % in 2013.
Wasting (thin or acutely malnourished).
• Wasting describes current nutritional status and
represents the failure to receive adequate nutrition in the
period immediately preceding the survey.
Trends : Wasting has increased from 14% (2008) to
18% (2013), indicating recent nutritional deficiency
among children in the country.
…….Working together to attain a country where every citizen has food and nutrition is secured

7. The Crisis of Under-nutrition
in Nigeria…Trends 2003 – 2013 (NDHS)
2003 2008 2013
Stunting 42% 41% 37%
Wasting 11% 14% 18%
Underweight 24% 23% 29%
EBF 17% 13% 17%
…….Working together to attain a country where every citizen has food and nutrition is secured

8. The Crisis of Under-nutrition
in Nigeria…
Zonal Distribution (NDHS 2013):
NAT./ZONES STUNTING % WASTING %
NATIONAL 37 18
North Central 29 12
North East 42 20
North West 55 27
South South 18 11
South West 22 10
South East 16 12
…….Working together to attain a country where every citizen has food and nutrition is secured

9. The Crisis of Under-nutrition
in Nigeria: Trends in 10 states & FCT
S/No States
Height- for
-age (stunted)
in %
weight-for-
height
(wasted) in %
weight-for-age
(under-
weight) in %
1Anambra 18.4 17.3 14.1
2Akwa-Ibom 22.4 10.5 15.1
3FCT 20.6 13.8 12.6
4Kwara 27.1 6.5 13.8
5Adamawa 34.3 14.5 23.1
6Gombe 47.5 14.2 32
7Kebbi 60.6 18.1 39
8Sokoto 51.6 19.3 37.7
9Enugu 11.7 8.9 7.1
10Delta 14.9 17 15.4
11Lagos 17 11.3 12.9

10. Trends of GAM, Stunting, Underweight and MUAC<125mm by age in months , Nigeria 2014
Trends in under-nutrition in Nigeria by age – 1000 days

11. The Crisis of Under-nutrition in
Nigeria…the Drivers of the burden..
A. Immediate causes:
• Inadequate dietary intake: NDHS 2013 states
that only 17% of babies (0 – 6 months) were
exclusively breast fed & only 10% of children
aged 6 – 23 months were fed appropriately.
• Infectious diseases e.g. diarrhea, malaria.
B. Underlying causes: Food insecurity, poor
child and maternal care; poor access to health
services; unhealthy environment; Emergencies.
C. Basic causes: Poverty; Population ; failure in
governance; gender inequality.
…….Working together to attain a country where every citizenhas food and nutrition is secured

12. Table 1: Drivers of Malnutrition: Magnitude of the problem in Nigeria
Cause Indicator Natio
nal
Sources
ImmediateCauses
Inadequate
dietary intake
Exclusive Breastfeeding of children until 6 months of age
(%)
17 NDHS
2013
Prevalence of
Diarrhoea
Percentage of children under age 5 who had diarrhoea in
the two weeks preceding
the survey
10.2 NDHS
2013
Prevalence of
Malaria
Percentage of children under age 5 with a fever during
the two weeks preceding the survey
12.5 NDHS
2013
UnderlyingCauses
Food Security Households in poorest wealth quintiles with poor or
borderline food consumption (%)
29 IFPRI
2013
Global Hunger Index Score Rank (2013) 15 GHI 2013
Health &
Sanitation
Women 15-49 years with problems accessing health care
(%)
53.3 NDHS
2013
Household access to an improved water source (%) 60.6 NDHS
2013
Household access to improved sanitation (%) 30.1 NDHS
2013
Care and
Feeding
Practices
Exclusive Breastfeeding of children until 6 months of age
(%)
17 NDHS
2013
Timely initiation of breastfeeding percent (within the first
hour)
33.2 NDHS
2013
Compliance to recommended infant and young child
feeding practices
10% NDHS
2013
Education Females that completed primary school or higher (%) 62.2 NDHS
2013
BasicCauses
Population Total Fertility Rate (%) 5.5 NDHS
2013
Gender Women’s intra-household decision-making power (%) 31.3 NDHS
2013
Poverty Population living under the national poverty line (%) 54.7 UNDP
2013

13. normal wasted stunted

14. If not addressed,
malnutrition is
transmitted from
generation to
generation.

15. However, the
implementation of key
Nutrition interventions by
Government and Non-
state Actors at all levels
will enable Nigeria break
this vicious cycle and stop
the Crisis!!...
…….Working together to attain a country where every citizen has food and nutrition is secured

16. Stopping Child under nutrition(1)
Government’s Role:
• Nigeria joined the Scaling Up Nutrition (SUN) Initiative
in November, 2011.
SUN is a global movement which is led by governments
and comprises of civil societies, business, donors and UN
organizations in a world-wide effort to reduce hunger
and malnutrition.
• Developed the National Strategic Action Plan for
Nutrition ( NSPAN, 2014- 2019) , for implementation at
all levels.
Goal of the NSPAN: Improve the nutritional status of
Nigerians, with a particular focus on vulnerable groups
especially women of reproductive age and children under
five years of age.
…….Working together to attain a country where every citizen has food and nutrition is secured

17. NSPAN Targets….
• To reduce the number of under-five children who are
stunted by 20% by 2018
• To reduce low birth weight by 15% by 2018
• To ensure no increase in childhood overweight by 2018
• To reduce and maintain childhood wasting to less than
10% by 2018
• To reduce anaemia in women of reproductive age by 50%
by 2018
• To increase exclusive breastfeeding rates in the first six
months to at least 50% by 2018
…….Working together to attain a country where every citizen has food and nutrition is secured

18. Estimated unit costs
Cost of key nutrition interventions –
World Bank 2014 – Basis for:
MOH national strategic plan of action for nutrition 2014-2019
Intervention Cost per child (units vary)
Promotion of Breastfeeding, appropriate
complementary feeding, handwashing
US$ 5 per participant / year
Vitamin A supplements US$ 0.44 per child through
MNCHW
Micronutrient powders US$ 3.60 (6-24 months)
Deworming US$ 0.44 per child through
MNCHW
Iron-folic acid supplements for pregnant
women
US$ 1,79 per pregnancy
MNCHW
US$ 2.00 per pregnancy
Community
Iron fortification of staple foods US$ 0.20 per person / year

19. Stopping Child under-nutrition..(2)
1. Exclusive Breast Feeding: support early initiation of
breastfeeding within 30 minutes after birth and
exclusive breastfeeding for the first six months of life of
the baby:
– An estimated 13% of child deaths could be averted if 90%
of mothers exclusively breastfed their infants for first 6
months;
1. Complementary feeding: Give children the right
quantity and variety of foods from 6 months of age with
continued breastfeeds until 2 years;
– If 90% mothers provided adequate and timely
complementary feeding for 6 to 24 months olds, additional
6% of child deaths could be prevented.
• …….Working together to attain a country where every citizen has food and nutrition is secured

20. Stopping Child
Under nutrition…(3)
3. Nutrition
education:
• Provide parents &
caregivers with
information and
support on EBF,
care & feeding
practices for young
children.
• Babies must be fed
very frequently and
on demand because
of the small stomach
size. Key:- 1 oz = 30 ml; 1 cup = 240 ml

21. Stopping Child
under-
nutrition..(4)
4. Food
Security:
Ensure mothers
and their
children have
access to
essential
vitamins,
minerals, and
nutrients.
…….Working together to attain a country where every citizen has food and nutrition is secured

22. The Government has
taken major steps, so
what are the roles of
Non- state Actors?...
…….Working together to attain a country where every citizen has food and nutrition is secured

23. Mobilizing Civil Societies to scale up
Nutrition in Nigeria….(1)
• Civil Society Scaling Up Nutrition in Nigeria (CS-
SUNN )is a non-governmental, non-profit
making coalition, made up of organizations with
a shared vision to transform Nigeria into a
country where every citizen has food and
nutrition is secured.
• CS-SUNN was launched on August 7, 2014.
• Membership is multi- sectoral including human
rights, agriculture, health, community
development, education, water, sanitation,
planning and financing.
…….Working together to attain a country where every citizen has food and nutrition is secured

24. Mobilizing Civil Societies to scale up
Nutrition in Nigeria….(2)
CS-SUNN objectives are to:
• Engage state and non-state actors for nutrition action;
• Mobilize and strengthen CSOs in Nigeria to scale-up
nutrition through advocacy and public awareness;
• Support existing policy, legal and budgetary frameworks to
be more accountable to meet the nutritional needs of
Nigerians , with focus on maternal and child nutrition;
• Enhance experience sharing and learning between and
within organizations , nationally and globally.
CS-SUNN has mobilized CSOs in 10 states and Federal
Capital Territory (FCT) to establish Volunteer Local
Working Groups for nutrition advocacy.
…….Working together to attain a country where every citizen has food and nutrition is secured

25. Mobilizing Civil Societies to scale
up Nutrition in Nigeria….(3)
Key roles:
• Create awareness on the crisis of malnutrition;
• Advocate for the domestication of the National Strategic
Plan of Action for Nutrition (NSPAN, 2014 -2019) with
focus on maternal and child nutrition at the state & LGAs;
• Organize the communities to identify their nutrition
priorities / “asks” to be presented to the relevant decision
makers;
• Mobilize stakeholders, interest groups and citizens to
participate in budget work;
• Advocate for a culture of accountability.
…….Working together to attain a country where every citizen has food and nutrition is secured

26. Mobilizing Civil Societies to scale up
Nutrition in Nigeria….(4)
Key roles:
• Mobilize communities to participate in Community
maternal nutrition and IYCF services implementation.
• Monitor nutrition services delivery ; share reports and
circulate relevant information to stakeholders including
community groups and the media;
• Organize public dialogue meetings for the members of
the community to interact with local leaders, discuss key
issues that affect them, and to demand action from the
decision makers;
• Use data for advocacy: e.g. Maternal, Newborn & Child
Health Week (MNCHW) data provides evidence to equity
gaps, coverage and accountability for services provision.
…….Working together to attain a country where every citizen has food and nutrition is secured

27. Mobilizing Civil Societies to scale up
Nutrition in Nigeria….(5)
CS-SUNN ASKs to Government..
• Domesticate the National Strategic Plan of
Action for Nutrition (NSPAN, 2014 -2019) with
focus on maternal and child nutrition;
• Allocate Budget with timely release of funds to
implement nutrition interventions that target
Adolescents, mothers and young children;
• Extend maternity leave to 6 months for working
mothers, to protect Exclusive Breast Feeding;
• Provide maternal nutrition and IYCF services,
through Health Facilities and Community based
structures.
…….Working together to attain a country where every citizen has food and nutrition is secured

28. 1. Utilize extensive network to :
• Promote Exclusive Breast Feeding;
• Advocate for the provision of Community
maternal nutrition and IYCF services;
• Provide sustained community nutrition
education.
2. Partner with CS-SUNN, so that
together we can make a difference
and contribute to stopping child
under-nutrition in Nigeria .
CS-SUNN Call to Action to
PAPHNON:
…….Working together to attain a country where every citizen has food and nutrition is secured

29. .
THANK
YOU…
…….Working together to attain a country where every citizen has food and nutrition is secured

30. Acknowledgements..
• CS-SUNN Coalition Members
• SUN MPTF Team
• UNICEF Nigeria Country Office Nutrition Team
…….Working together to attain a country where every citizen has food and nutrition is secured