Amid rising hunger due to COVID-19, conflict and climate change, the African Union (AU) has declared 2022 as the Year of Nutrition.

Before 5am, Nigerian fishermen living in Lagos’s floating slum, Makoko, have paddled their wooden boats several kilometers into the main river for fishing activities. Their harvests are largely influenced by how far out they manage to paddle, seasonal changes, prevailing economic situations and other factors that are beyond the reach of individuals in the community. 

Fishing is the main source of food and livelihood for Makoko, but the dwindling fish supplies makes it hard for this community to get enough nutrition.

Some 155 million people in 55 countries – mostly in Africa – experienced a food crisis in 2020, representing an increase of around 20 million people on the previous year, according to the Global Report on Food Crises 2021.

Two-thirds of these people lived in 10 countries, namely the Democratic Republic of  the Congo (21.8 million), Yemen  (13.5 million), Afghanistan (13.2 million), Syrian Arab Republic (12.4 million), Sudan (9.6 million), Nigeria (9.2 million), Ethiopia (8.6 million), South Sudan (6.5 million), Zimbabwe (4.3 million)  and Haiti (4.1 million).

In his foreword for the report, António Guterres, Secretary-General of  the United Nations, decried the rising number of  people facing acute food insecurity and requiring urgent food, nutrition and livelihoods assistance. While noting that conflict is the main reason, combined with climate disruption and economic shocks, and is also aggravated by the COVID-19 pandemic, he noted the need to tackle hunger and conflict together. 

“Hunger and poverty combine with inequality, climate shocks and tensions over land and resources to spark and drive conflict,” Guterres said. 

“Likewise, conflict forces people to leave their homes, land and jobs. It disrupts agriculture and trade,  reduces access to vital resources like water and electricity,  and so drives hunger and famine. We must do everything we can to end this vicious cycle. Addressing hunger is a foundation for stability and peace.”  

The UN’s blueprint to address global problems is its 17 Sustainable Development Goals (SDGs) due to be achieved by 2030 – and SDG 2 aims for zero hunger, calling for the transformation of food systems to make them more inclusive, resilient and sustainable.

Addressing the issues

While under-5 mortality in Africa has decreased by more than 50% between 1994 to 2019, malnutrition remains high in Africa and undernutrition is particularly an underlying cause of almost half of child deaths, according to the AU.

The findings of the 2019 Continental Accountability Scorecard launched by the African Union and the Africa Leaders for Nutrition (ALN) also showed that in Africa, in 2019, 150.8 million children under the age of five years are stunted globally, and 58.7 million of these are in Africa.

Only seven member states have stunting rates below 19%, while 15 member states have child wasting prevalence below 5%, 38 countries have women’s anemia prevalence rates of more than 30%, only 18 member states have at least 50% of infants exclusively breastfed for six months, and only 20 member states have more than 70 percent prevalence rates for vitamin A supplementation.

At the recently held AU Summit, the theme for the AU in 2022 was officially launched. In her remarks at the launch, Dr Monique Nsanzabaganwa, Deputy Chairperson of the AU Commission said the aim of the theme is to maintain a strong political momentum on nutrition across the African continent. 

“It is a unique opportunity to strengthen political commitment to end malnutrition in all its forms and to further improve food and security through the implementation of Malabo commitments, and the goals and objectives of the Africa regional nutrition strategy for the years 2016 to 2025,” she told the summit.

In addition to securing greater political commitment, she added it is also expected to be used to secure investment in nutrition and to address the ongoing nutrition and food security challenges.

Multipronged approaches

The wordings of the theme showed it is geared towards strengthening resilience in nutrition, and food security on the African continent, strengthening agro food systems, health and social protection systems for the acceleration of human social and economic capital development. 

The vast multiple issues that the AU wants to bring attention to with its theme, critics say, are too ambitious for the commission to be asking countries to address, especially considering the pressure that the COVID-19 pandemic has had on the countries’ systems.

“I personally think the AU itself knows that the countries cannot squeeze out major substantial new investments on their own to address nutrition considering COVID-19 has badly hit member states and there is not much that cannot be done, including the attention it hopes to give the issues, when COVID-19 vaccine uptake is not yet optimal,” a Kenyan public health expert told Health Policy Watch.

But initiatives aimed at addressing issues in Africa had been ongoing prior to the decision to make the issue the theme of 2022, and in her remarks at the AU Summit, Nsanzabaganwa mentioned several of them are being championed and financed by the Africa Development Bank’s (AfDB) “significant investments through the Africa Leaders Initiative in support of the continent’s policy, on nutrition and food security.”

A few days before the AU Summit approved the prioritization of nutrition in 2022, Babatunde Olumide Omilola, Manager for Public Health, Security and Nutrition Division at the AfDB told Health Policy Watch that the bank is ensuring nutrition smartness in its investments in a number of sectors including agriculture, social protection, health, water, sanitation and hygiene, and education. 

“It means that we mainstream, we integrate nutrition into these investments so that we have what we call a nutrition marker that says what is going into the nutrition component of all of these investments across these different sectors,” he said. 

Considering the enormous nature of nutrition-related issues coupled with the short duration that the continent has to achieve the set goals, Omilola said the best approach is not to focus on food security through agriculture alone, but to also mainstream and focus on food and nutrition security, so that investments in the agriculture sector also have nutrition components that address malnourishment in the targeted areas.

“There is [also] a big focus on nutrition-specific interventions which are those direct interventions that can deal with the underlying determinants of malnutrition and these include issues such as exclusive breastfeeding, supplementations, dietary supplementation, both for mothers and their children. It will also include issues that we see around making more finance available in the sector,” Omilola added.

Interplay between the private sector and governments to promote good nutrition

The Food and Agriculture Organization of the United Nations (FAO) was instrumental in the emergence of AU’s 2022 theme on nutrition. 

David Phiri, FAO Sub-regional Coordinator for Eastern Africa and FAO Representative to the African Union (AU), told Health Policy Watch that one of the aims of the theme is to ensure that African governments play more active roles in ensuring that food products that being produced and marketed by the private sector are healthy and do not cause or drive nutrition crises that could overburden the public health sector.

“The private sector will provide products that make money but may not be nutritious. People will engage and buy these products, then the health costs related to these products then become the problem of the government — of the public sector,” he said. 

“I think it is important that governments provide an environment with a regulatory framework, where even the private sector provides to the consumer products that will not be bad on the population and on the government. Having said that, the private sector is very important for agriculture and I think we need to actively engage them.”

Optimism despite uphill battles for nutrition

While African countries are responding to  multiple health, development, social and other categories of crises that project a less enthusiastic and pessimistic outlook for the plan to focus on nutrition in 2022, Prof Wasiu Afolabi, President of the Nutrition Society of Nigeria, told Health Policy Watch that progress is already being recorded in several areas, especially the initiatives that localize strategies to respond to peculiar local initiatives. 

“I must say that more than any other time in history, attention is being drawn to the importance of nutrition as a foundation to development in Africa,” he told Health Policy Watch.

“We have come to realize that yes, there is food. We are producing food. People are consuming food [but] it is not translating into improvements in the nutritional status of the populace, especially, as shown by statistics of malnutrition among children. Attention is now focused on how we can reduce the level of malnutrition,” he added.

Aside from the attention, there is also the existence, emergence and development of several policies, policy guidance and documents. 

Afolabi noted that most African countries now have a multi-sectoral plan of action arising from their food system policy to solve nutrition problems across sectors, not just in agriculture, but in health as well as in education and other relevant sectors of the economy.

“We now have an enabling environment and some level of political will on the part of policymakers to want to solve the problem. These are the things that I considered as the achievements so far in our country, in our sub region, as well as the African continent,” he told Health Policy Watch. 

Going forward, to quickly meet the targets, Afolabi enjoined African countries to quickly scale up interventions that they know are low cost and have impact in reducing the problem of malnutrition. By doing this, he said the continent will be able to meet the ambitious nutritional targets including ending hunger by 2030.

“Countries are supposed to redirect their efforts with support of development partners and international agencies, civil society organizations, and research universities. It is a movement for stakeholders to join us to get out to promote and invest in those interventions that will bring about change, change that will deliver the changes that we require in operational improvements to be able to reach the goals in 2030,” he told Health Policy Watch.

Image Credits: Paul Adepoju.