The evaluation of the food and nutrition crisis which occurred in Niger in 2004-2005 was a real time evaluation (RTE) hinging on three critical objectives geared at assessing the performance of UNICEF and of its partners in the face of this crisis, namely:
• Assess UNICEF’s contribution to the monitoring of the food and nutritional status of the country before the crisis (Early Warning System and coordination / consultation mechanisms);
• Assess UNICEF’s contribution to the preparedness measures for a possible crisis that must be taken by the Government, civil society (families, communities, private sector, NGOs) and by external partners (United Nations System, international NGOs, donors);
• Assess UNICEF’s contribution to rapid humanitarian action during and after the crisis, i.e. after an immediate emergency has been declared (mobilization of human and financial resources, contribution to the coordination and the dispatching of food relief, management of malnourished children, fight against epidemic diseases, strengthening of capacities at all levels).
The RTE examines UNICEF’s performance first and foremost at the country level through the Programme of Cooperation entered with the Government of the Republic of Niger (2004-2007), but also with respect to the support provided by the West and Central Africa Regional Office (WCARO) and by New York Headquarters.
As UNICEF’s inputs are closely linked to those of the Government and of civil society, it goes without saying that they must be considered in their respective contexts. The same applies to partnerships with the other United Nations Agencies (UNDP, WFP, UNFPA, WHO, etc.) and other external aid agencies.
The food and nutritional crisis in Niger
For a number of years, Niger has had to deal with very high rates of acute and also chronic malnutrition among children under five. These rates were at between 14% and 20% for acute malnutrition and signalled an emergency situation. Acute severe malnutrition was also high (between 2 and over 3%). Chronic malnutrition was already up to 40%, which is a sign of long-term persistent nutritional and/or health stress. These rates would be considered alarming in other regions of the world but seem to be accepted as normal in a Sahel country like Niger. Malnutrition is also an important contributing factor in the high mortality rate of children under five (265‰ in 2000, one of the highest in the world).
Against this backdrop of malnutrition levels accepted as “normal” or “structural”, i.e. considered as customary for the country, alarming signs came up in increasing numbers in 2004-2005 and converged in the agricultural areas of Zinder and Maradi, along the Nigerian border. As it were, it is in regions considered as productive, in the granaries of the country, that the nutrition crisis gradually came to full strength, even though markets were well supplied. Millet price had reached record-high levels and, for five months, food grains were unaffordable for a large portion of the population. Meanwhile, the terms of food grains / livestock exchange were deteriorating and collapsing to the point of forcing the poorest to ruin.
Until May / June 2005, the nutritional crisis in the southern part of the country was not well understood. This phenomenon was being ignored by an analytical approach emphasizing the production and availability assessments of basic food grains while neglecting aspects connected to price increase, even though this restricted access to commodities for an important layer of a very vulnerable population devoid of any resources, for whom agriculture was the only income in a chronic indebtedness situation. Socio-economic data were insufficiently taken into account in the general poverty context prevailing in Niger, and indebtedness throws households with unreliable income into a vicious circle which they can no longer leave. The problem of low access to food is exacerbated by conspicuous deficiencies in terms of access to health services and parent education pertaining to good child care practices in hygiene, nutrition and health in general.
The Niger / UNICEF Country Programme of Cooperation 2004 – 2007
The Country Programme of Cooperation 2004-2007 aims at poverty reduction by improving living conditions for children and women. The health / nutrition budget was strongly focused on health. It was also more guided by the availability of funds – notably those that were earmarked for the eradication of poliomyelitis, to which other EPI immunizations and Vitamin A distribution could be pegged for efficiency purposes. Malnutrition has not gotten the attention it deserved on account of its importance as one of the major causes of child morbidity and mortality.
Crisis preparedness and resource mobilization
Although the UNICEF-supported Cooperation Programme has not provided many responses to child malnutrition which was described as serious, the emergency plans of UNICEF Country Office in Niamey mentioned important risks regarding the degradation in food and nutritional status which threatened the country in 2004 and 2005. In Niger, UNICEF was not equipped to properly define the malnutrition problem and to understand fully what the locations and the scope of the problem were. For lack of local expertise, UNICEF was not able, from the outset, to assume a leadership role in the area of malnutrition.
In 2004 the UNICEF Country Office in Niger and the Regional Office for Western and Central Africa realized that expertise in nutrition had to be rebuilt. No later than May 2004, the Regional Advisor voiced his concerns to the Regional Office and the Country Office with respect to the lack of human resources with nutrition skills in Niger and the country’s extreme weakness. However, the creation of posts, then the hiring of staff met with obstacles of an administrative nature, which hindered the understanding of the crisis and the timely start-up of a response, including resource mobilization and planning.
UNICEF’s Country Office in Niger made a number of efforts to mobilize resources for the therapeutic management of severely malnourished children, first of all by allocating Regular Resources (RR) to this objective, then by mobilizing the resources of UNICEF’s National Committees. It also contributed to communicating to the media what proved decisive in mobilizing resources to the level required by the magnitude of the crisis. Overall, the process was too slow, especially with respect to the international community’s response to the crisis. It proved necessary to broadcast on TV shocking footage of dying children to mobilize humanitarian action. Greater lucidity with respect to the nature and the location of the malnutrition problem, action of a more energetic and faster nature by all actors could have saved a lot of children’s lives.
During the first semester of the year 2005, the various agencies of the United Nations System in Niger did not show consensus on the nature of the crisis and sufficient coordination in the action to be taken. The sharing of responsibilities between WFP which would deal with moderately malnourished children and UNICEF which would take care of severely malnourished children was not clearly defined. Moderately malnourished children were in the end placed in UNICEF’s care, but this action only started off at a late time and at a high cost.
UNICEF’s contribution to humanitarian action since August 2005
In August of 2005, humanitarian action in favour of severely and moderately malnourished children was finally triggered on a wide scale. Thanks to support from the Regional Office for Western Africa and Headquarters, the Niamey Country Office has played an effective, decisive role in the process by assuming technical leadership and a coordination role in the area of nutrition through its support to the Ministry of Public Health and in cooperation with NGOs in the field.
The initial objective was to offer services best suited to the population that had not been available so far in order to save children’s lives. Quality assurance was developed through the adoption of a protocol for the management of malnutrition, the establishment of training programmes for its use, and the design of a monitoring system. Quality assurance has been in a state of constant improvement since September 2005, at which date a strengthening of qualified human resources clearly took place at the central as well as the decentralized levels.
In October 2005, the amount of contributions received by UNICEF was US$ 19,592,219, which exceeded by more than a third the volume of the aid that was sought at the outset. UNICEF positioned itself at the level of nutritional recovery, whether therapeutic (acute severe malnutrition) or supplementary (moderate malnutrition), by supporting the management of 226,929 malnourished children spread out in 806 centres: 23 CRENIs, 256 CRENAs and 527 CRENAMs (situation as at November 24, 2005).
In CRENI (Intensive nutritional rehabilitation care centres for severe acute malnutrition with complications) and CRENAS (nutritional rehabilitation outpatient centres for non complicated severe acute malnutrition), specific curative and preventive dietetic and medical treatments are offered. 64,924 severely malnourished children were admitted: 17,069 in 23 CRENI and 47,855 in 256 CRENAS.
162,005 moderately malnourished children are being treated in 527 CRENAM (nutritional rehabilitation outpatient centres for moderate acute malnutrition). Moderate malnutrition is the greatest provider of severe malnutrition, and the fact that so many children have been managed gives a measure of the number of avoided cases of severe malnutrition.
In actual fact, the total number of children managed is 302, 577, i.e. 226,929, to which we have to add 75, 648 children managed by the coverage operations that were made necessary for efficiency and effectiveness reasons by the all too strong prevalence of malnutrition in some villages, with a view to extend the safety net to children who are at risk of malnutrition.
A first estimate of performance indicators calculated on the basis of a reduced sample shows a recovery rate of more than 92.36%, a mortality rate of 2.93% and a drop-out rate of 4.71%. These results show the good quality of the implemented programme.
UNICEF has undertaken to ensure the availability of drinking water and sanitation services in the Centres. Some CRENI have been supplied with water and sanitation kits for use by the families of severely malnourished children. However, access to drinking water is not guaranteed for all CRENI/CRENAS, and even less so for CRENAM, as those structures can be mobile, which does not allow for a good initiation to basic hygiene habits.
The nutritional management of malnourished children is currently dissociated from the action taken by the IBS (Integrated Basic Services) programme, particularly with respect to the support to community-based growth monitoring promotion teams (EVPC) and to cereal banks. Clearly, these initiatives do not sufficiently benefit from nutrition expertise, close monitoring or good coordination with health centres.
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