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As a child growing up in England, I used to love ‘milk time.’ The teacher would read my favourite stories; there’d be a break from the arduous task of learning to write straight and of course there was a free bottle of milk, courtesy of the government’s attempt to boost the nutritional intake of under-5s at school.
The UK milk scheme dates back to 1946, introduced by a Labour government at a time of post-war food rationing. Though greatly reduced, it still exists for the under-five year olds. So I was surprised when I heard that, today, a proposal to use the same kind of logic to prevent malnutrition in the Sahel is meeting resistance.
In the coming weeks, the United Nations will launch its funding appeal for the Sahel in 2014, where an estimated 16 million people are at risk of hunger and around 5 million children face malnutrition.
Donations are expected to fall short of the amount needed, so aid agencies of all types and sizes are jostling for influence over how the funds are to be spent – a kind of humanitarian aid version of The Hunger Games.
Put simply, malnutrition is linked to poor food and water intake, often exacerbated by disease. The traditional approach to the problem has been to improve access to food and safe water, teach parents the importance of hygiene, build better sanitation and immunise children against disease.
This approach has helped control malnutrition, but hasn’t reduced it. This year, the United Nations estimates there will be slightly more malnourished children than there were in 2013. It’s clear we need to tweak the response if we want more positive results.
SAHEL MILK SCHEME
One new idea, Sahel-wide year-round supplementary feeding, is showing promise. Boosting children’s nutritional intake throughout the year with high-energy ready-to-use foods alongside their normal diet can help them remain healthy during the lean period, when diseases are most likely to strike and kill malnourished children.
“If children are healthy going into the lean period, they are much less likely to become severely malnourished, or stricken down by diseases that prey on hungry children with low immune systems,” said Augustin Augier, CEO of ALIMA, a charity working on malnutrition in the Sahel.
Augier says trials conducted in Niger in 2006 show that giving children ready-to-use milk-based foods as part of their normal diet reduced severe acute malnourishment (SAM) – the most dangerous form of malnutrition – by 57 percent in six months for children under five. For children under two, who represent 80-85 percent of the SAM caseload in Niger, the reduction was close to 75 percent.
Despite these impressive results, the idea of providing free milk-based food for all under five year olds in the Sahel is not proving popular. Why?
Kinday Samba, head of nutrition at the World Food Programme (WFP) regional office, told me it’s a good idea and that the WFP already has a relatively small-scale blanket feeding scheme. But realistically, blanket feeding all the children at risk of malnutrition in the Sahel all year round would take an immense amount of money and resources.
“The current ‘treatment’ approach specifically targets children who are severely malnourished, around 1.4 million, so the medicine reaches those who need it the most, so that high-cost resources can be spent efficiently,” said Samba.
Augier is critical of this view: “The international community says that we can’t afford to distribute preventative food as the milk to make it costs too much and it’s not sustainable. But it isn’t sustainable to cure 1.4 million severely malnourished kids every year in the Sahel either.”
PART OF THE SOLUTION
Samba believes the best way to tackle malnutrition in the Sahel has to be multi-sectoral, incorporating agricultural extension, safe water, hygiene, sanitation and vaccinations, but says the current system doesn’t allow the sectors to team up.
Essentially, the FAO may work on agricultural extension in the north, MSF on treatment of malnutrition in the east, ACF on water and sanitation in the west and UNICEF on vaccines in the south. But unless these direct aid programmes overlap in one geographical area, the aid is inefficient.
“In any one country, there might be different regions that have different reasons for malnutrition, so they need different responses by different organisations whose work may not overlap and reinforce each other like it should,” she said.
Augier proposes a move away from separate, vertical aid programmes that bypass the government to horizontal programmes using the national health structures and says that supplementary feeding has to become part of the new solution.
Increasing supplies of locally made supplementary milk-based food, much cheaper than the branded and imported equivalents, and establishing strong links between the medical sector and agro industry so that supply meets demand, would also ensure sustainability.
“If blanket feeding is used in targeted areas known to have high prevalence of malnutrition, like southern Niger, in combination with the traditional approaches, it could prove to be a game changer,” said Augier.