Salemwoit Negase, a Health Extension Worker, updates a chart at Galeto Health Post in SNNPR State of Ethiopia on April 2, 2013. Photo by Jiro Ose.

Breaking the Cycle of Malnutrition

Agriculture, education and other nutrition-sensitive sectors are essential parts of a sustainable nutrition strategy.

Nutrition is more than just one aspect of good health. Undernutrition has an irreversible effect on a child’s IQ and ability to concentrate in school, fight off disease and achieve economic advancement. In developing countries, malnutrition imposes a heavy burden on strained health systems and results in a significant loss to economic productivity. 

A smart investment

$1 spent on nutrition can produce up to a $30 return on investment.

A 2006 study by the World Bank estimated that malnutrition costs poor countries up to 3% of their annual GDP and that malnourished children risk losing more than 10% of their lifetime earnings potential. Conversely, nutrition is one of the best investments in human capital and economic growth: $1 spent on nutrition can produce up to a $30 return on investment.

This evidence provided the backdrop for the Micronutrient Forum in June in Addis Ababa, Ethiopia. UNICEF joined nutrition advocates there to share research, best practices and lessons learned.

One thematic undercurrent of the conference was the need to leverage funds outside nutrition programs to achieve nutrition targets. This strategy works by integrating nutrition into sectors such as agriculture, education and water, sanitation and hygiene (WASH)—all of which contribute to a child’s nutritional status. These indirect, “nutrition-sensitive” programs complement direct, “nutrition-specific” interventions.

Examples of nutrition-specific interventions:

  • Breastfeeding
  • Zinc supplementation
  • Managing moderate and severe acute malnutrition
  • Maternal balanced energy protein supplementation
  • Vitamin A supplementation
  • Maternal calcium supplementation

Examples of nutrition-sensitive interventions:

  • Family planning (healthy timing and spacing of pregnancy)
  • Water, sanitation and hygiene
  • Nutrition-sensitive agriculture
  • Food safety and food processing
  • Early childhood care and development

Source: USAID, Multi-Sectoral Nutrition Strategy 2014-2025

Ethiopia: a case study

Since the early 1990s, stunting prevalence in Ethiopia has fallen from 67% to 44%.

Two health extension workers prepare their monthly report on nutrition activities in their district. ©UNICEF Ethiopia/2014/Tsegaye.

Two health extension workers prepare their monthly report on nutrition activities in Machakel district, Ethiopia. ©UNICEF Ethiopia/2014/Tsegaye.

Following a history of recurring famines in the late 1980s and early 2000s, the government of Ethiopia launched an ambitious National Nutrition Program in 2008. The plan ties in closely with the national Health Extension Program, through which 38,000 health workers deliver door-to-door services in 300 districts. The comprehensive, community-based program treats 300,000 children with severe acute malnutrition in 11,000 sites every year. Over the last decade, UNICEF has supported the program by training health extension workers and managing supplies and logistics.

Ethiopia revised its nutrition strategy in June 2013 to include nutrition-sensitive objectives. The updated program continues to integrate closely with the Health Extension Program, combining direct nutrition interventions with a free package of related health services, including family planning. The strategy also targets education, agriculture, women’s affairs and social protection programs such as conditional cash transfers.

Since the early 1990s, stunting prevalence in Ethiopia has fallen from 67% to 44%, and it is predicted that Ethiopia will achieve Millennium Development Goal 4 to reduce child mortality by 2015.

Breaking the cycle

Throughout its work in more than 190 countries and territories, UNICEF promotes direct nutrition interventions, such as exclusive breastfeeding, while leveraging its programs in education, health, gender equality and WASH. UNICEF works closely with governments to address the multidimensional causes of undernutrition in the world's most vulnerable communities.

In the case of Ethiopia's National Nutrition Program, a multisectoral strategy can be a challenge to operationalize because of the diversity in administrative, agro-ecological, health and socio-cultural conditions across sectors, and the limited experience and capacity to identify effective nutrition-sensitive actions in each sector. UNICEF’s experience across a continuum of nutrition interventions adds important insight as the country tackles those challenges, helping to guide the National Nutrition Program from strategy to a successful implementation.


Read more about undernutrition in The Lancet.

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