On December 12, 2019, A4NH jointly hosted the Ethiopian National Nutrition Conference, with partners the International Food Policy Research Institute (IFPRI), Policy Studies Institute (PSI), and the Ethiopia Public Health Institute (EPHI). The conference, held in Addis Ababa, brought together 150 delegates, from a wide range of sectors and roles, including policy makers, academics, development agencies, NGOs and the private sector. I attended and was able to share some thoughts during the closing panel. These reflected not only on what I had heard throughout the day, but also what issues, challenges, and innovations I have seen in other countries, where A4NH works, that might be relevant to Ethiopia.
The conference offered a thoughtful overview of food systems, diets, and nutrition challenges in Ethiopia. We heard evidence and discussed how critical the affordability of a healthy diet is – in fact, affordability is a prime determinant of what people eat in low-income countries. We had an important discussion on the barriers to ensuring people across the country can eat a healthy diet. Affordability, linked to inefficient supply of nutrient-dense foods, rang out as a key issue in achieving that ambition.
The conference also zeroed in on Ethiopia’s responses and actions to improve diets and nutrition outcomes. We learned from Prof Belachew, and then discussed, an impressive array of multisectoral policies and programs for nutrition in Ethiopia, and how they cover key areas of investment and intervention. Ethiopia stands out as a country that has been very thoughtful in its planning on multisectoral nutrition to which at least 13 ministries have committed and include efforts related to health, nutrition, agriculture, food fortification, water and sanitation, education, resilience, social development, and ongoing efforts that are developing food based dietary guidelines with sustainability considerations.
But what more is needed for moving from evidence to action? How, attendees asked, do you take these plans and research and move forward?
In my opinion, Ethiopia has done a great job in differentiating its agriculture, nutrition, and social development strategies and plans into two main geographic and development contexts. The first includes districts in growth corridors linked to urban areas. Here, policies, investments and actions focus on enabling market-oriented development linked to growing food demand, mostly domestic. The second includes those regions and districts not well connected to urban markets. In these areas, multi-sector development efforts are led by local governments and communities with strong emphasis on poverty alleviation and social inclusion. Despite good progress, I see opportunities in both these development contexts for Ethiopia to accelerate its progress to meet its poverty, health, and sustainability ambitions through multi-sectoral nutrition and food systems actions.
In the context of market-oriented development in growth corridors, Ethiopia, like most low- and middle-income countries, struggles to make the transition from an agriculture—staple cereals—food security perspective to a food system transformation perspective with sustainable healthy diets for all as the goal. This transition requires shifting to a demand-led, rather than supply-led, focus. Ethiopia needs to expand its emphasis beyond staple cereal production to ensure diversity and improved efficiency of food supply chains for vegetables, pulses, and animal source foods people need for good nutrition. Moving to this next step will require new policies and investments to support a more diverse food supply and shift distortions that could lead to artificially low costs for sugars, fats, oils, and highly processed, carbohydrate-dense foods that are fueling a global obesity pandemic that has already started to affect Ethiopia faster in urban settings but also in rural areas. Ethiopia is therefore not immune to recent obesity trends in low- and middle-income countries that are worrying in that they are affecting rural areas as well as urban, and the poor as well as the rich.
The pace of change in urban and peri-urban Ethiopia is amazing, particularly in food logistics, processing, marketing, and consumer demand and behavior. One country that is further along on this demand transition with a lot of relevant experiences – such as including food safety and quality demands from consumers and addressing the challenges of inclusion of poor producers, market agents, and consumers – is Vietnam. Other African countries also have relevant experiences for two of Ethiopia’s important food system transformation challenges: Kenya and Rwanda have made progress in enabling and aligning both the public and private sectors to accelerate food system innovation, from food processing and marketing innovations to sophisticated application of IT and digital services in connecting different food system components. Given its young and growing population, jobs should be targeted as a crucial food system transformation outcome in Ethiopia. One food sector with important potential is the dairy sector. Both India and Kenya have many examples of policy, regulation and investment innovations at multiple stages of dairy sector transformation, from informal dairy systems with smallholder cooperatives and small-scale market agents that proactively promote inclusive growth with millions of jobs, to modern commercial systems that meet the highest international milk safety and quality standards.
The second food system and nutrition context comprises the regions and districts that are not well connected to large urban markets. Ethiopia is to be congratulated for identifying the different policies, investments, and actions required in these areas through its Productive Safety Net Program (PSNP). More recently, the government has gone much further with its Seqota declaration, setting ambitious nutrition, health, and social development targets for regions and districts with high-levels of stunting. Even more impressive is the commitment to implementation by the Program Development Unit of the Seqota Declaration in the Ministry of Health. This includes careful consideration of multiple sectors in nutrition improvement, supported by modern program management and evaluation to implement, evaluate, and learn moving forward. An impressive nine sectoral ministries have committed to Seqota Declaration implementation.
Meeting the ambitious Seqota Declaration objectives will be challenging. Not only are interventions from multiple sectors required, but these interventions need to integrate humanitarian and resilience development approaches in parallel. We need more experiences in combining humanitarian approaches in remote and fragile areas with a medium- to long-term (5-20 year) development program horizon. Humanitarian approaches support the building of capital and sustainable livelihoods of households and communities. Development approaches can then support entrepreneurs and groups to create wealth through innovation. Carefully assessing different combinations of humanitarian and development approaches will be critical for much-needed learning.
As was highlighted throughout this conference, Ethiopia’s many regions are diverse – a one-size-fits-all approach cannot work. Communities can adapt more general approaches to their local contexts if empowered and supported. An interesting example of how poor communities with limited resources implemented nutrition-sensitive programs has been developed and successfully undertaken in Malawi and will soon be scaled up through support from the World Bank. As this experience has shown, communities are best placed to integrate inputs from multiple sectors and adapt them to their unique biophysical and social contexts.
To me, the fundamental issue in implementing good strategies and plans is the engagement and empowerment of all essential actors. In all food system and nutrition contexts in Ethiopia, government leadership and coordination are essential. Here Ethiopia has established a first, the Ethiopian Nutrition Leaders Network in 2019. Food system transformation is an attractive development pillar for most low- and middle-income countries since it provides a systematic approach to improve nutrition and health, creates jobs and economic growth, and considers longer-term sustainability issues. Mobilizing essential actors requires new thinking and practice.
One interesting way to engage and empower different actors that Ethiopia could adapt is the “Eat Right” model of the Food Safety and Standard Authority of India (FSSAI). Instead of making itself responsible for ensuring healthy, sustainable, and inclusive food system transformation, FSSAI developed a clear strategy for delegating responsibilities to public, private, academia, and civil society groups, coordinating and supporting them in a whole-of-society approach. An adaptation of this approach could be very powerful in grounding and accelerating food system transformation for healthier diets in Ethiopia.
This conference provided a great conversation about what to do, and these and other examples of what others have done elsewhere highlight options that can be adapted for how you do it. Attention must turn to engaging all actors and ensuring they are able to communicate and, where appropriate, coordinate, their actions to accelerate progress toward improving nutrition outcomes in Ethiopia.
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