Four steps to deliver dramatic results for malnourished children
With 1 in 5 children under five living in urban areas of Afghanistan, UNICEF pioneers a cost-effective initiative to tackle malnutrition in partnership with the European Union
KABUL, AFGHANISTAN – More than 3,000 health facilities in Afghanistan reach around 85 per cent of the population, mostly in rural and semi-urban areas.
But in urban areas, it is the larger city hospitals that fill gaps in health and nutrition care. These hospitals are often supported by a patchwork of national and international NGOs.
This system sputtered along until, almost overnight, it failed, when the Taliban seized power on August 15, 2021.
Many national and international NGO staff fled, their organisations collapsing in the wake of uncertainty. Donor sanctions brought the health system to the brink of collapse, including nutrition services in urban areas.
Turning crisis to opportunity
The emergency in Afghanistan offered UNICEF the chance to re-examine nutrition services in urban settings. In partnership with the European Union (EU), UNICEF could address the grave gaps in nutrition care and design a four-part strategy to scale nutrition services in urban areas.
In response to overcrowded out-patient and in-patient facilities in urban hospitals, which were unable to cope with demand, the urban scale-up strategy provided more rooms, more equipment, and more staff. Initially, European Union funding covered 68 health facilities with out-patient departments for severe acute malnutrition services.
As the economy crumbled and poverty soared, in-patient care came into sharp focus. Parents do not have the money to stay in the hospital with their critically ill children. Many others have other children at home and live on infrequent daily wages. Although care is free, the cost of transportation or missed daily wages can still be high for many families. UNICEF's incentive scheme provided cash – US$ 100.00 per admission – for each referred child. This cash helps cover the cost of accommodation, food, or support to their families back home, and encourages them to complete treatment for their little ones.
In the most densely populated areas, in the heart of neighborhoods, UNICEF created day-care centres. These offer nutrition counselling, treatment, a playroom for children, hot lunches prepared following a cooking demonstration, and the opportunity for mothers to meet in a safe environment. These centres are cost-effective and successfully reach children who were previously overlooked.
The work by women inside the day-care centres is complemented by outreach during community gatherings, including weddings. Male social behaviour mobilisers advocate with fathers and community members to encourage mothers to take their children for screening of malnutrition, receive treatment when necessary, and learn about routine growth monitoring.
Nutrition day-care centres: An oasis of hope and respite
By the end of 2022, UNICEF opened 50 day-care centres across Kabul. The centres are bright, warm and welcoming. They are an oasis of hope and respite in communities.
Each centre caters solely to women and children, and each employs a female nurse and a female nutrition promoter. The centres receive around 30 mothers and 35 children every day. On average, each day around 4-6 children are identified with severe acute malnutrition and prescribed treatment.
For a maximum of 12 weeks, mothers bring their children each week for measurements, weigh-ins, and to receive ready-to-use therapeutic food until they are no longer malnourished.
UNICEF also helps ensure that ready-to-use therapeutic food only reaches the mouths of children who need it most. Mothers or caregivers come each week to receive the therapeutic food from the day-care centres, returning the empty sachets before receiving another batch. This ensures children receive the treatment and mitigates the sale of therapeutic food in local markets.
The results of the urban scale-up are remarkable.
In just 6 months in 2022 and 2023, over 200,000 children were screened for malnutrition in Kabul. Over 100,000 mothers received counseling on nutrition for mothers and infants. Over 22,000 children were admitted for treatment o malnutrition – 10 times the number reached in 2021 – in half the time.
"Yaser was only 200 grams when he was born and he is still malnourished. I came to this centre so Yaser can receive treatment, but I also learned to prepare healthy meals for him."
Nadia, a nutrition nurse at one of the day-care centres, reflects on the evolution of the urban scale-up.
"In the beginning, women would bring their children with their husbands. Now, they are confident and come alone with their children. It is the best indication that the centres have earned the trust of the elders and the community at large."
"This is a huge breakthrough."