PRESS CONFERENCE ON THE STATUS OF SEVERE ACUTE MALNUTRITION (SAM) TREATMENT IN NIGERIA AND THE HUMAN RIGHTS OF THE NIGERIAN CHILD ORGANISED BY CIVIL SOCIETY LEGISLATIVE ADVOCACY CENTRE (CISLAC) TO CALL THE ATTENTION OF FEDERAL AND STATE GOVERNMENTS TO TAKE ADVANTAGE OF DEVELOPMENT PARTNERS’ MATCHING FUNDS FOR NUTRITION BEFORE ITS EXPIRATION IN DECEMBER 31ST 2018.
DATE: 24TH DECEMBER, 2018
VENUE: BOLTON WHITE HOTEL, AREA 11 GARKI, ABUJA.
While malnutrition constitutes a serious setback to the socio-economic development of a nation, sustainable growth in Nigeria cannot be achieved without prioritized attention to scale-up and sustain investment for nutrition, with a focus on prevention and treatment of Severe Acute Malnutrition (SAM).
Malnutrition, by implication, increases susceptibility to infection, slow recovery from illness, low quality breast milk; retards physical and cognitive development. An estimated 2.5 million Nigerian children under-five suffer from Severe Acute Malnutrition (SAM) annually, exposing nearly 420,000 children under-five to early death from common childhood illnesses such as diarrhoea, pneumonia and malaria.
Apart from the challenges associated with poor domestication of policy, other shortcomings like weak nutrition governance, non-implementation of strategic plan of action, inadequate technical human resource and low coverage of proven intervention are prevalent across many states in the Northern part of the country.
It is against this background that Civil Society Legislative Advocacy Centre (CISLAC), along with other partners, is implementing a nutrition advocacy project focusing on prevention and treatment of Severe Acute Malnutrition (SAM) in nine (9) northern states and at the federal level.
The objective of the project is to engage the federal and state governments to promote and advocate for prevention and treatment of severe acute malnutrition by holding governments accountable for appropriate budgeting and release of funds commitments towards sustainable nutrition activities in the country.
Unfavourable indices from the states
The future of Nigeria seems bleak with the huge number of children under the age of five that are unlikely to see their fifth birthdays as shown by statistics from studies by National Bureau of Statistics (NBS) and other partners. The National Nutrition and Health Survey (NNHS) 2018 shows that the highest prevalence of global acute malnutrition based on Middle Upper Arm circumference (
MUAC) was reported in Zamfara (10,3%) followed by Katsina with 8.5% and Sokoto with 8.4%, while the lowest was recorded in Imo with 0.8%, followed by Anambra with 1.3%, Bayelsa with 1.9% and Delta 2% with zero percent Severe Acute Malnutrition (SAM) with very little variability; Kaduna with 2.4%, Jigawa 2.1%, Katsina, Sokoto and Yobe 2% recorded the highest SAM rates by MUAC (NNHS 2018).
For instance, Kano State records the highest number of stunted children with 1.4 million in the North. The devastating impacts of malnutrition in the state led to the scale-up of Community Management of Acute Malnutrition (CMAM) programme from six (6) to thirteen (13) LGAs (out of 44 LGAs) with most disturbing cases among children under-five and pregnant mothers. It is however, worrisome that the state’s CMAM facilities experience persistent out of stock of Ready to Use Therapeutic Food (RUTF) emanating from delay in the release of funding for the procurement of RUTF.
Similarly, in Katsina State, while it costs N21,300 ($160) to cure a Severe Acute Malnourished child, in 2017, no fewer than 13,676 Severely Acute Malnourished children were saved from the State-Government-UNICEF intervention through Community Management of Severe Acute Malnutrition (CMAM) activities in the state.
The state records 4.1% children with Severely Acute Malnutrition, 35% stunted, 14.9% wasting and 18.5% under-weight rates, as reported by Multiple Indicator Cluster Survey, 2017. With 19 out of 34 LGAs living without CMAM, more funds are required to cure yet-to-cover SAM children in the state.
In 2017, Kaduna State recorded 17,989 children admitted to CMAM out of which 11,324 were cured, 1515 defaulted, 214 not recovered; and 150 died, as reported by Multiple Indicators Cluster Survey, 2017. Similarly, this burden was confirmed at an event organized by CS-SUNN where the Kaduna state Nutrition Officer, Hajiya Hauwa Usman said, “132 children have died out of 12,858 hospitalized while 10,604 have been cured between January to October 2018 in the state.”
As confirmed at a recent policy dialogue on nutrition financing organised by Civil Society Legislative Advocacy Centre (CISLAC), lack of uniformity in data presentation across levels of government on nutrition budgetary allocation and utilization; inadequate legislative oversight on nutrition budget to ensure timely release and utilization of fund; persistent delay in budgetary release by the Ministry of Finance with resultant recycling of budget, hampers funding for nutrition interventions.
Also, lack of appropriate follow-up on the approved allocation to nutrition by responsible officers reportedly delayed release of nutrition funding, performance and intervention in Kaduna State.
Nassarawa State falls within the worst hit region on malnutrition with 37.2% stunting, 6.8% wasting and 20.7% underweight rates of children under-fve (NDHS, 2013). In 2017, no fewer than 33 children reportedly died from Acute Malnutrition in Nassarawa state.
Sokoto State ranks among the 12 northern states of Nigeria with high malnutrition prevalence, thereby putting the state at risk of socio-economic setback. The state lags in adequate fulfilment of its counterpart funding to match agreed UNICEF’s intervention to address malnutrition scourge. This unwary situation continues to create gaps in effective nutrition intervention in the state.
Gombe State had 3.9% SAM rate, 54.4% stunted rate. 13.4% wasting rate and 41.2% prevalence of underweight in 2017. This state has 36% CMAM coverage, with seven out of 11 Local Government areas still without a CMAM site. SAM burden in terms of figures shows 97,062 children. 15,685 of these children were admitted in 2017 and only 2,980 lives were saved.
The above statistics further buttresses the fact that a high percentage of Nigerian children are denied their fundamental right to life through inadequate provisions and releases of funds for treatment of Severe Acute Malnutrition.
Adequate nutrition status as a Child Right
Meanwhile, adequate nutrition status constitutes component of the rights of a child as enshrines under section 13 (1) of Child Right Act 2013 which provides for every child to enjoy the best attainable state of physical, mental and spiritual health.
More importantly, Section 3 of the Act mandates every Government in Nigeria to reduce infant and child mortality rate; ensure the provision of necessary medical assistance and health care services to all children with emphasis on the development of primary health care; provide for the child the best attainable state of health; ensure the provision of adequate nutrition and safe drinking water; ensure the provision of good hygiene and environmental sanitation; combat disease and malnutrition within the framework of primary health care through the application of appropriate technology.
On this note, adequate, accessible and affordable Primary Health Care system remains an essential mechanism for every Government to effectively deliver on suitable nutrition status for the children in Nigeria.
Failing Primary Health Care and malnutrition prevalence
While adequate and optimal health care delivery constitutes a component of governance and national development in Nigeria, adequate access to Primary Health Care services is hindered by unethical attitudes or dearth of healthcare personnel, low maintenance culture, ill-equipped and poor infrastructural services; exacerbating maternal and child mortality and morbidity across the country.
Despite the tremendous effort and resources allocated to reforms, effective Primary Health Care services still remain out of the reach in many communities across the country. This unwary situation without doubt back-pedals adequate coverage and delivery of nutrition interventions across the country.
With 5% level of funding, Primary Health Care centres are bedevilled by 80% disease burden as against 15% and 5% in Secondary and Tertiary Health Cares which are having 15% and 80% funding capacity respectively.
As part of the effort to holistically address the challenges bedevilling Primary Health Care service provision and delivery in the country, Section 11 of the National Health Act 2014 establishes Primary Health Care Provision Fund to be funded through the Federal Government’s annual grant of not less than 1% of its Consolidated Revenue Fund with 50% of the Fund to be used for the provision of basic minimum package of health services to citizens.
Actualising the implementation of Primary Health Care provisions as enshrined in the Act is paramount to achieving adequate coverage and sustainable nutrition investment and activities in Nigeria.
While Section 11(4) of the Act mandates the National Primary Health Care Development Agency to disburse the funds through State and Federal Capital Territory Primary Health Care Boards for distribution to Local Government and Area Council Health Authorities, Section 11(6) of the Act as well empowers the National Primary Health Care Development Agency to disqualify from accessing the fund, any Local Government Health Authority if it is not satisfied that the money earlier disbursed was applied in accordance with the provisions of this Act; on failure to contribute its counterpart funding; and; on failure to implement the national health policy, norms, standards and guidelines prescribed by the National Council on Health.
However, the delayed domestication of an Act enabling Local Government Autonomy by the State Governments constitutes a serious setback to existing efforts at securing adequate financing for Primary Health Care systems with resultant setback to adequate coverage of sustainable nutrition interventions in the country.
NUTRITION FUNDING LANDSCAPE
Funding for nutrition has been donor driven until recently when donors began to pull out. Those that are still available are in agreement with the government to commit financially to funding nutrition with the promise of a matching fund from the donor. Unfortunately, this commitment from government so far has been met with various levels of success. Some of the states that willingly committed to paying their co-financing fund are not serious about releasing all the funds, and in most cases in an untimely manner. Below is the statics of RUTF proposed budgeted/commitments and releases by state:
|Proposed budget for RUTF (₦)||Proposed budget for RUTF ($)||Release (₦)||Release $|
There is need for the government to take seriously this co-financing commitments for nutrition especially now that we have a factory in Nigeria that is producing RUTF. Government of Nigeria must show appreciable effort with sincere commitment in honouring the nutrition co-funding agreement to sustain nutrition investment, while galvanizing support for the newly introduced factory production of RUTF in Nigeria. Should the government wish, they should be encouraged to buy RUTF directly from the local manufacturer. By early 2019, there is hope that Dansa Foods Limited (The Largest Manufacturing Conglomerate in Nigeria that is 100% owned by Nigerian Company and a member of the Dangote Group) will be operational and additional RUTF will be produced and available in Kano.
Commitment of Government
While we commend Nigerian Government both at Federal and State levels for acknowledging provision of effective Primary Health Care as a “greater challenge” for the nation as a whole, we are not unaware of the government’s commitment to address the crisis bedevilling Primary Health Care through wide range of actions including: needs assessment, community inclusiveness and participation in processes leading to the creation of Primary Health Care Centres in the country; promotion of food supply and nutrition, safe water supply, sanitation in households and the environment health education; promotion of maternal and child care, prevention and control of endemic diseases routine care in hospital and clinics, and rehabilitation; there is, however, the need to take concrete actions before 31st December, 2018 to avoid missing out on the matching funds.
In order to address the malnutrition scourge across the country, we call on the government at all levels, especially in the nine states mentioned above, to take opportunity of the available matching funds by development partners before its expiration date of 31st December, 2018 by doing the following:
- Release the funds committed to treatment of SAM in the 2018 budget.
- Include treatment of SAM in the 2019 budget under consideration.
- Subsequently, prioritize the establishment of Community Management of Acute Malnutrition (CMAM) programmes in the state through existing policies implementation, adequate budgetary allocation, timely releases, cash backing and utilization of funds, as well as oversight activities.
- Expansion of existing CMAM programmes to additional prioritized Local Government Areas in various states for adequate coverage and timely intervention is paramount across the states.
- Strengthen relevant Committees at National and State Houses of Assemblies with special focus on nutrition to give desired attention to malnutrition with adequate and sustainable provision of resources to Ready-to-Use Therapeutic Foods (RUTF), routine drugs and complimentary commodities.
- Prioritise full implementation of the National Health Act 2014 to promote adequate, accessible and affordable Primary Health Care for effective delivery of CMAM and other nutrition services.
- Increase focus on prevention, such as community-based approach, while galvanizing curative effort towards addressing existing malnutrition status in the country.
- Support Early Child Development Centres across the country to sustain nutrition interventions in the presence of dwindling donor resources.
- Ensure full implementation of Child Right Act to effect adequate nutrition status as a Child Right.
We remain committed to monitoring government at all levels to ensure that she fulfils her promises to the citizens, especially the children of our great country.