Rwanda has achieved remarkable success in reducing child hunger, and nutrition experts believe there may be lessons here for other countries in Africa.
The UN Children's Fund (UNICEF), in a 2013 report on progress in tackling malnutrition, noted that in 2005 more than half of Rwanda’s children under five years of age - about 800,000 - were stunted. "Just five years later, stunting prevalence had decreased from an estimated 52 percent to 44 percent," the report said.
The Rwandan approach has been to try and find home-grown solutions.
It scaled up community-based nutrition programmes in all 30 of the country’s districts, and has also been setting up an almost universal community-based health insurance scheme. "This was all done with the help of food grown locally, and not packaged interventions provided by donors," said Fidele Ngabo, director of Maternal Child Health. “There are thousands of local solutions for hunger…
“Each village comes up with community-based approaches to tackle malnutrition and food insecurity that don’t cost money - we are at the centre to provide support and play a monitoring role,” she said.
Examples include the setting up a communal grain reserve to which each household contributes at least 20 percent of their harvest during a good season, with the stored grain being used during the lean season; or the expansion of kitchen gardens with shared information on the vegetables to be grown.
Suggestions and proposed solutions are debated in working groups comprising aid agencies, researchers, academics and government officials.
Research needs to be led by Africa, not donors
The Rwandan model could be used in other African countries, where foreign donor-driven initiatives tend to focus on treatment and technical solutions.
Change will only come when nutrition research is led by Africa, and interventions are designed to meet a country’s priorities, according to the findings of a two-year European Union-funded SUNRAY (Sustainable nutrition research for Africa in the years to come) project, published recently in PLOS Medicine, a peer-reviewed journal.
“We need to shake up nutritional research in Africa and turn it upside down,” said Patrick Kolsteren, of the Institute of Tropical Medicine in Antwerp, Belgium, the coordinator of the SUNRAY project.
“Currently, researchers from developed countries search for African partners for joint research, based on funding and research priorities defined outside Africa. Instead, the research agenda should be based on needs identified within the continent. Calls for research proposals of donors should match this agenda.”
“We did not look at the portfolio of interventions but rather looked at the research agenda. The overall feeling was that this agenda is mainly donor driven and not [always] in line… with the locally identified needs and priorities,” he said.
“Another reality is that donor aid must have tangible results,” he added. “Results must be measurable,” something that is not always possible with community-based interventions.
Researchers and policymakers in Benin wait for “the dictate of donors before taking action. Hence, donor-funded programmes aren’t sustainable. As soon as they end, all activities are stopped, and acquired benefits and good practices are lost,” said Eunice Nago Koukoubou of the Université d'Abomey-Calavi in Benin, an author of the published findings.
“In addition, nutrition researchers are not autonomous, creative and proactive enough to define their own agenda in line with real nutritional problems of our populations,” she added. So, “despite enormous amounts of money spent on nutrition research and interventions”, malnutrition rates have not fallen in Benin.
“If African governments were funding nutrition on the continent adequately, donors wouldn't dictate their agenda to us,” said Nago Koukoubou. “In Benin there is already a kind of political will to make nutrition… including nutrition research, a priority in development policies, and to fund it.”
Benin has recognized that “nutrition should be central in development”, and has a strategic plan for food and nutrition development. It has also created a national council for food and nutrition, headed by the office of the president of Benin. “The government is trying to raise funds for the [strategic plan],” Nago Koukoubou notes.
Another author of the published findings, Joyce Kinabo, an academic at Sokoine University of Agriculture in Tanzania, said her country had set up a nutrition desk in the office of the president. “Nutrition is getting more prominence,” she said.
Priority research areas
The SUNRAY project consulted over 100 stakeholders in 40 sub-Saharan countries and identified the following priority areas of research: The impact of community interventions; what influences the quality and quantity of food a child eats; and the effectiveness of promoting traditional foods and whether this helps people through periods of climatic shock.
Priority actions that would help create a good environment for funding nutrition research in Africa include better governance of research, ensuring it is aligned with priorities identified in sub-Saharan Africa; helping countries develop technical capacity; and sharing findings with each other.
Respected nutrition expert Lawrence Haddad, director of the UK Institute for Development Studies, said the study is important as it the “first systematic listening exercise about what the African nutrition research community thinks”.
“Most of the research on African nutrition is defined outside the region. I don't think this is imperialism - just the lack of opportunity [and] support-band resources to African researchers to publish, profile and share their work.”
A partnership between African researchers, “who have more credibility and knowledge of the context”, and Western researchers with the resources and opportunities, would be key. Haddad cites the African Economic Research Consortium as an example of an African-led model built on such partnerships, but with the agenda set by Africans. “I would like to see something along these lines tried in nutrition.”
Call for an African-led “knowledge hub”
The food price crisis of 2006-08 pushed the number of malnourished children to shocking levels and put a new focus on nutrition. Greater political stability after various conflicts ended, an improvement in economic growth, and advances in the fight against HIV/AIDS, have all helped reduce mortality rates and malnutrition since 2000, says the 2013 Global Hunger Index (GHI), published by the International Food Policy Research Institute (IFPRI), but most countries with the highest GHI scores, or with alarming hunger levels, are in Africa. The three countries at the bottom of the GHI scale are Burundi, Eritrea and Comoros.
The Agricultural Science and Technology Indicators Initiative (ASTI), run by IFPRI, monitors spending on agricultural research and development (R&D). It paints a dismal picture of R&D funding in Africa; and finds that among countries for which data is available, half recorded negative growth in spending on agricultural R&D between 2000 and 2008.
To change the face of nutritional research in Africa, the SUNRAY project proposes an African-led “knowledge hub” that will assess and build on existing knowledge and present effective solutions for major nutrition problems in Africa. It will help foster relationships between researchers and policymakers, and also incorporate mechanisms to ensure optimal uptake and use of nutrition research findings for policy development, implementation and programming.
Ultimately it is about political will. "We are a poor country too, and we are making a difference,” said Rwanda's Ngabo. Countries like Niger, who feel they lack resources to tackle their long-standing battle with chronic malnutrition have to realize that “your children are not the donors' children, they are yours."