Building Resilience and Tackling Undernutrition in Ethiopia

Across the globe, one in nine people (815 million) go to bed hungry, while one in three suffer from some form of malnutrition. Malnutrition is a term often used synonymously with undernutrition, but in fact malnutrition refers to both undernutrition and overnutrition.

Beyond the semantics, undernutrition is deadly. 45 % of all child deaths are linked to undernutrition. For the millions of undernourished children who survive their 5th birthday, they are robbed of the energy they need to develop their cognitive skills, organs and immune systems and are more vulnerable to diseases. For these reasons and more, evidence suggests that undernourished children perform worse at school and will earn less in adulthood. The data is staggering and the link between nutrition and an individual’s resilience is clear. Undernutrition negatively affects education, health and income, three critical areas that have an impact on an individual’s ability to cope, adapt and recover from shocks and stresses.

The WASH Factor

An important aspect of ensuring nutrition security is Water, Sanitation and Hygiene (WASH). People become undernourished because they do not consume the nutrients they need and/or because diseases hamper their effective absorption. The World Health Organization estimates that 50 % of undernutrition is associated with repeated diarrhoea and intestinal worm infections.

One of the ways in which People in Need (PIN) aims to decrease the prevalence of undernutrition among young children and women of reproductive age globally is by tackling this ‘WASH factor’ through strengthening local water, sanitation and hygiene systems.

Ethiopia

In late 2012, PIN pooled expertise with Alliance2015 partner Concern Worldwide and INGO International Medical Corps as part of an ECHO-funded project aimed at improving the nutritional status and resilience of vulnerable households in the Wolayita zone in southern Ethiopia. The Southern Nations, Nationalities, and Peoples’ Region of Ethiopia had been hit by a cycle of increasingly intense climatic disasters that led to the loss of livelihoods, depletion of assets and increasing food insecurity. Between 2012 and 2017, these partners jointly scaled up their response through two subsequent ECHO projects, incorporating more activities and adapting to the needs of the changing environment.

Undernutrition is the result of insufficient food intake or absorption. Undernutrition is evident when individuals are underweight for their age, too short for their age (stunted), dangerously thin (wasted) or deficient in vitamins and minerals (micronutrient malnutrition)

The partners brought the added value and technical expertise of their respective organisations. Where IMC provided strong medical and health expertise, Concern Worldwide employed their extensive experience in tackling hunger and supporting livelihoods, with PIN lending their expertise in improving access to water and helping change behaviours in order to improve sanitation and hygiene practices. It is precisely this multi-sectoral approach that building resilience requires, fostering partnerships and collaboration between different actors and institutions.

PIN’s Approach to WASH

A WASH assessment conducted by PIN in August 2012 revealed a number of shocking realities. Several kebeles (neighbourhoods) in the Wolayita zone had no access to safe drinking water. Of the established, protected drinking water sources, a significant number were reported to be non-functional, leaving communities with limited options. Many residents reported spending more than six hours walking to the nearest, unsafe water source during the dry season. An unreliable supply of safe water can have a devastating effect on the health, nutritional security and resilience of a household. Women and girls are most often the primary users, providers and managers of water in their households and are also the guardians of household hygiene. If a water system falls into disrepair, women and children are the ones forced to travel long distances for many hours to meet their families’ water needs. The assessment also revealed a critical situation in local schools, where over 70 % had no access to safe drinking water and 80 % were without a toilet.

Bugaletch: “Now, it takes me only 30 minutes to fetch water for cooking and washing" 

This is true for Bugaletch, a 27-year-old mother of three boys from Chereche, a mountainous kebele of Kindo Koysha woreda (district) in southern Ethiopia. She has lived her whole life in the remote, hillside village of Yanda Arbe in a house constructed out of mud and wood, sealed with a tin roof. Her daily work revolves around taking care of the children, cooking, cleaning the house and fetching water.

Every day after breakfast, the two older boys head out to the local Yanda Arbe primary school. Bugaletch, meanwhile, puts two jerry cans on a donkey, straps her baby to her back and goes to collect water.

Before PIN started providing support in her kebele at the beginning of 2013, Bugaletch had only two options. She could go to the mountains to fetch water from a spring, which was a three-hour round trip, or go to a river in the neighbouring kebele – a four-hour walk. The spring in the mountains, however, is seasonal and dries up between February and March, during which time the entire village can only fetch water from the river in the neighbouring ward. During the rainy season, Bugaletch would use surface floodwater for all her domestic needs. Bugaletch spent most of her day fetching water, sometimes asking her children to help, which interrupted their schooling.

In 2013, as part of the ECHO project aimed at improving the nutritional status and resilience of vulnerable households, PIN developed one of the existing springs by placing two water tanks along an existing  pipeline so that water could accumulate at night. PIN also repaired an existing water point and built a new one only ten minutes away from Yanda Arbe village: “Now, it takes me only 30 minutes to fetch water for cooking and washing. And when there’s enough water in the tanks, I can go for water a second time in the afternoon,” says Bugaletch.

Increasing families’ access to potable water in this way is just one example of PIN’s approach to tackling undernutrition and building resilience through WASH at the household level. As a result of this project, PIN increased the number of functional water and sanitation schemes through the rehabilitation, construction or extension of water systems such as water points, boreholes, springs, latrines and hand-washing facilities. These construction-focused projects were complemented by hygiene and sanitation promotion activities and the distribution of jerry cans, which enabled people to fetch and store water safely.

Wider Change

Beyond improvements made to hygiene and nutrition at the household level, PIN also aims at effecting wider change. At an institutional level, PIN secured permanent water supplies and roof catchment systems for schools and health facilities to support the provision of quality services. In the community, raising awareness of WASH-related issues was particularly important for ensuring longer-lasting change. To this end, among other things, PIN developed a communication strategy on sanitation marketing, implemented Menstrual Hygiene Management trainings in schools, organised hand-washing campaigns and established WASH clubs in schools. The communities and schoolchildren in the catchment areas benefitted from improved facilities, whilst the wider community gained from better disposal of liquid and solid waste and a reduction in open defecation.

Beyond the focus on WASH, PIN maintains that resilience can be built and nutrition insecurity tackled by implementing well-designed, multi-sectoral programmes that address the key causes and effects of malnutrition. Across all sectors, PIN prioritises the most critical period of a child’s life – the first 1,000 days – and particularly focuses on children’s nutritional needs from conception to their second birthday, during which time their brains develop, bodies grow and immune systems are built. Whilst recognising that maternal and child undernutrition is influenced by various causes addressed by other stakeholders, PIN’s nutrition projects primarily focus on supporting families with children under two years as well as new mothers like Bugaletch.

Donor: European Union Humanitarian Aid (ECHO)