Ethiopia: The case for increasing nutrition security not humanitarian response

By Jeremy Shoham and Carmel Dolan on 10 September 2019

We have just visited Ethiopia to understand how the country is succeeding in strengthening the ‘nexus’ between humanitarian and development actions. Both of us have a long history with Ethiopia, starting our careers working at the time of the 1984 famine in Ethiopia and with refugees in Sudan. Since then, we have been privileged to have worked in Ethiopia on numerous occasions, witnessing substantial change and progress. A memorable event was when we co-hosted a 3-day conference in 2011 with the Government of Ethiopia to share learning across many countries on how to scale up CMAM.

Ethiopia, as in 2011, has come a long way; infant and Child mortality have almost halved and in the past 15 years, stunting has reduced from 58% to 38% with wasting dropping to under 10%. In the same period underweight declined from 33% to 21% and exclusive breast feeding rose from 49-59%. This progress can be attributed to many things; Ethiopia is one of the fastest growing economies in Africa propelling Ethiopia to LMIC status by 2025. The strong economy has contributed to the largest social protection programme (PSNP) in Africa targeting 8 million people living in drought prone regions and a CMAM treatment programme available in 98% of health facilities.

However, in spite of all this progress, there is a sense that improvements in nutrition are stalling and there is a growing concern over the ever expanding humanitarian response programme budget – this has been over $1.4 billion dollars for the past three years with many of the same ’hotspot’ locations being prioritised each year for food assistance and CMAM.

There is a great deal of discussion within government and between development partners about the need to build resilience in Ethiopia by strengthening the humanitarian development nexus. Many policies, plans and frameworks have been developed with resilience at their core and strengthening the nexus as their modus operandi but it’s unclear to what extent these high level policies and frameworks are translating into meaningful actions on the ground that increase nutrition security and prevent malnutrition. 

It is certainly true that the 2015/16 drought didn’t end in famine in any of the affected regions. This is to be applauded. Anecdotally, the prevention of famine is partly attributed to a high functioning early warning system, the PSNP addressing the needs of a large chronically food insecure population and the extensive CMAM treatment programme. The ‘trickle down’ effect of substantial economic growth over many years is also implicated.

The question now is ‘how does Ethiopia take the next step to reduce levels of malnutrition and ensure that no increases occurs as a result of repeated and to some extent, predictable shocks that the country faces each year, e.g. drought, flood and conflict?’

Certainly, this is not going to happen through repetitive cycles of humanitarian programming which many view as being too short-term to meaningfully link with longer term development objectives. In Ethiopia, as in numerous other fragile contexts, the humanitarian system in government and amongst its partners, has evolved over many years and is well coordinated for nutrition but less effective, is the coordination of programmes that strengthen and build on multi-sector government systems and ultimately prevent malnutrition from occurring. 

It is not through lack of effort; numerous international and national agencies work with government to deliver programmes that aim to prevent malnutrition. These programmes comprise multi-sector/nutrition sensitive programmes targeted to the most vulnerable to shocks and linking vulnerable households (those with malnourished members) to livelihood programmes like the PSNP. Programmes geared to prevent malnutrition from occurring also comprise health system strengthening to ensure delivery of the full component of nutrition specific interventions. The key challenges seem to be coordination, collective appraisal of approaches and impact and carefully planned roll out. Interestingly, OCHA has recently mapped development programmes (all sectors) in Ethiopia and this mapping demonstrates the significant humanitarian and development geographic compartmentalisation across multiple sectors - it shows how hard it is to make the nexus a reality.

On the one hand, humanitarian response needs to build on and support existing systems like PSNP and health systems strengthening (rather than duplicate or operate in parallel) and, on the other, nutrition security building efforts need to be coordinated, mapped, and appraised through a collective and highly coordinated forum driving development investments to prevent malnutrition.

There must be a more sophisticated means of identifying those in need of humanitarian support in Ethiopia. The current case load of 8 million targeted by the overarching humanitarian response plan (these do not include 8 million PSNP beneficiaries) are reported to be largely made up of the same individuals that receive humanitarian aid each year. An increasingly loud voice in Ethiopia is arguing that this 8 million case load comprises many chronically vulnerable who need development resources rather than repeated short-term humanitarian interventions. The derivation of humanitarian case load is based on a hotspot process where districts are classified on the basis of three levels of need using a set of 6 sector-specific indicators including nutrition. What this approach does not allow for is the identification of the ‘case load’ that are chronically vulnerable and thereby needing developmental support.

It could, and perhaps should be argued that what is needed in Ethiopia is clarity and commitment to shrink humanitarianism safely (i.e. without loss of focus on saving lives) and as quickly as possible by channelling resources into resilience and systems building programmes and approaches such as the PSNP and multi-sectoral programming. It would certainly be more cost-effective and ultimately offer the prospect of greater reliability and sustainability where Government investments increasing orientate to the prevention of malnutrition and greater nutrition security.