Roadside billboard erected by Mekelle University, Ethiopia

Supporting the Government of Ethiopia to end child undernutrition: Seqota Declaration

The Seqota Declaration is a bold national commitment by the Government of Ethiopia to end child undernutrition in the country by 2030. Working alongside the federal ministers and regional leaders most central to addressing the challenge, Big Win Philanthropy is supporting the upgrading of plans and the quality of program delivery.

40% of children under five are stunted
51% of child deaths are associated with undernutrition
$4.7bn cost to the Ethiopian economy in 2009 (16.5% of GDP)
20% earning shortfall for adults malnourished as children
2030 Government target date for eliminating child undernutrition

The Need

In Ethiopia, 40% of children under the age of five suffer from chronic malnourishment or ‘stunting’. Almost half of all child deaths in Ethiopia are associated with undernutrition. For those that survive, stunting reduces cognitive and physical development and diminishes the education, health, productivity and earning potential of millions of young people.

The Investment

In 2015, the Government of Ethiopia made a historic and ambitious commitment to eliminate child undernutrition by 2030: the Seqota Declaration. The Declaration  was launched by Ethiopia’s Deputy Prime Minister, Demeke Mekonnen, and the then Health Minister, Dr. Kesetebirhan Admasu. Naming the declaration after the town of Seqota in northern Ethiopia has a powerful symbolism. The area around Seqota historically suffered during the 1983-84 famine, and even now there are pockets where stunting levels reach 80%. While the declaration applies to the whole country, its name sends the message that no area, not even the most challenged, will be left behind.

The government intends to implement the Seqota Declaration in three phases. The first phase, from 2016/17 to 2018/19, will be focused around the Tekeze river basin in the regions of Amhara and Tigray, which in 2011 had stunting rates of around 52%. Two further phases running to 2030 will eventually encompass the whole country.

Undernutrition is caused by multiple factors, such as not enough key nutrients in the diet compounded by poor hygiene and sanitation causing diseases which make the body actually lose nutrients. It is therefore very important that different sectors work together in tackling undernutrition. Effective action needs sectors such as agriculture, water, sanitation and education to become “nutrition smart”. While nutrition-specific services run by the health sector are a necessary part of reducing undernutrition, they are not sufficient. Big Win is working closely with the multiple ministries responsible for these various sectors, as well as the offices of the Amhara and Tigray Regional Presidents, to enhance this cross-sectoral effort.

The Seqota Declaration Implementation Plan could be a long-term game changer for Ethiopia by helping to unlock the economic boost of a demographic dividend. With mortality and fertility both falling, Ethiopia is on the path to a population structure that may enable a demographic dividend because the ratio of working-age people to dependents is rising. Under-five mortality has fallen from 205 deaths per 1000 live births in 1990 to 59 in 2015, and fertility has fallen from over 7 children per woman in 2000 to 4.1 in 2015. But an economic boost from the increasing youth population will only happen if the right human capital investments – including in nutrition – are made so that young people grow up healthy and productive.

Start-up stage

The first stage of the work supported by Big Win Philanthropy, starting in late 2015, focused on drawing up a costed multi-year implementation plan and securing funding. This first stage reached a successful conclusion in March 2016 with a plan costed at $211m and commitments to fund it from USAID, UNICEF, the World Bank, the World Food Program and other donors, as well as from the Ethiopian government itself. The preliminary work was also successful in engaging ministries beyond the health ministry, such as the ministries for agriculture and water, by proposing ways in which nutrition-smart approaches could be built into their plans.

Implementation stage

In mid-2016 the work supported by Big Win moved on to a second stage involving five key areas of implementation:

Delivery units to double the rate of stunting reduction. The national targets set by the Ethiopian government require undernutrition to be reduced around twice as fast as was achieved during 2000-2014. Given that this historical rate was already the fastest in Africa, the new targets are very ambitious. Big Win has supported the government to establish three delivery units (one national and two regional) to drive performance across multiple government departments. The units are substantial in size and expertise, each consisting of at least five staff. As well as being backed politically at the highest federal level, they also have the backing of the regional President of Amhara, Ato Gedu Andargachew and the regional President of Tigray, Abay Weldu, who have both seconded their own political advisors to maximize the authority of the units.

Community laboratories to drive innovation. The “community labs” concept (of establishing closely monitored innovation pilots at local level) will be used to develop new approaches for tackling undernutrition and assess their suitability for scaling up.

Technical assistance to enable a ten-fold increase in irrigation. Ethiopia has 290,000 hectares of land that is irrigated to improve crop yields, but this could be increased to 2.7m hectares (almost a ten-fold increase) with modern irrigation techniques. Ethiopia could learn much from Israel, which has a climate and terrain similar to those of Ethiopia yet has far higher levels of irrigation. Big Win has arranged study tours to Israel for Ethiopian ministers and officials and the involvement in Ethiopia of Israeli advisors who are expert in the development of water and irrigation systems in arid environments. They are assisting the government to prepare a plan to demonstrate in an initial series of local areas that a ten-fold increase in land under irrigation can in fact be achieved. If this proves possible and is rolled out nationally it would give a massive boost to nutrition in Ethiopia (as well as to other important needs such as food security and economic growth).

There are other reasons besides irrigation why water management is crucial for improving nutrition. Clean water for drinking and hand-washing prevents the intestinal infections that stop nutrients being absorbed by the gut. Improved water availability also boosts livestock and fisheries production. The program will improve water management for these purposes as well as for irrigation.

Evidence and evaluation. A multi-sectoral baseline assessment will be conducted in Amhara and Tigray, led by the Ethiopian Public Health Institute together with the Amhara and Tigray Public Health Institutes. The Lives Saved Tool (LiST) will be used to model impacts on nutrition and to set targets, and a process evaluation will help refine the methodology of implementation.

A social movement to end stunting.Widespread child undernutrition cannot be successfully tackled without behaviour change at the individual and family level, for example regarding which foods are grown or bought, how food is prepared, whether priority is given within the family to nourishing pregnant and breastfeeding women and young children and whether these same groups are exempted from religious fasting requirements.  To bring about such profound changes in behaviour requires a shift in attitudes and cultural expectations which in turn requires campaigns to mobilize local communities and key organizations, to generate a social movement for the ending of child undernutrition. Big Win has supported the government in the preparation of a campaign strategy named “1,000 Days” – referencing the period from conception until the age of two when nutrition is most important. The campaign will involve the Office of the First Lady of Ethiopia, who is a champion for improved nutrition.