NGOs and Governments Need to Fix Barriers to Nutrition Programs in Africa: U of T Study

Lack of political will and under-resourcing are just two barriers faced by vital nutrition programs in Africa, a study from the University of Toronto has found.

“Malnutrition is a complex issue and there’s no simple, blanket approach that will address it,” says Obidimma Ezezika, the lead author on the study who is an assistant professor in the department of health and society at U of T Scarborough and a scientist affiliated with the Joannah & Brian Lawson Centre for Child Nutrition.

“There is an abundance of evidence pointing to the importance of these programs, yet governments and other stakeholders continue to fall short in implementing them,” Ezezika said. “Overcoming these barriers can drastically reduce the complex health issues facing the continent.”

Large-scale nutrition programs are often coordinated by NGOs or national and state governments in response to specific nutritional deficits such as malnutrition, undernutrition or in some cases overnutrition resulting from the excessive intake of one particular type of food.

These programs can include fortifying certain foods with vitamins or nutrients, planting crops that are high in a particular nutrient, education programs promoting crop diversity or dietary information, as well as the wide-spread distribution of vitamin pills.

Ezezika and his team looked at 34 studies on large-scale nutritional programs delivered in Africa between 2010-2019 and identify several key barriers. Often the programs lack political support and effective leadership to ensure they’re properly monitored and evaluated. A lack of resources, including mobilizing enough health care and volunteer staff, is also a significant barrier.

Another major challenge is tailoring programs to meet local or cultural needs. Ezezika says if a program is trying to supplement vitamin A through sweet potatoes for example, it may be difficult or impossible to grow the crop in certain areas due to soil conditions. It might also be too costly for farmers to plant, or culturally it might not be part of the regular diet.

“One program that works in a rural area of Kenya may not work in a rural area of Uganda – or even in a different area of the same country,” says Ezezika, an expert on global food security and nutrition who also holds an appointment at U of T’s Dalla Lana School of Public Health.

“Successful programs need to take into account the cultural food preferences of a particular population, so it’s important to have community involvement in the planning and implementation phase.”

He says successful approaches may also involve partnering with successful health initiatives that communities are familiar with, such as immunizations programs, or fortifying crops that are both locally available and valuable and available with a particular vitamin.

Having people on the ground collecting relevant information and continually adapting and updating the programs is also important, as well as collecting current data.

“It’s a big challenge because if you’re trying to develop a nutrient program for particular area based on data collected a decade ago, it may not be accurate or even relevant.”

Ezezika, who has decades of experience working and consulting with organizations committed to global health and food security, says there are examples of successful large-scale programs. He points to the Grainbank project in Ethiopia, a two-year education and food program where community members were involved in decision-making and creating activities. One highlight included using health care workers who also happened to be respected community members.

The stakes for not delivering these programs are high, he says. Vitamin and nutrient deficiencies are directly linked to higher rates of mortality and levels of disease, and is a major public health challenge in low-income countries.

“I personally know people who have gone blind because of vitamin deficiencies they experienced as a child,” he says.

Quite often the leading causes of death in countries will be communicable diseases like malaria or diarrhea, but the underlying cause is poor nutrition. Ezezika says it’s a big reason why the WHO have placed an emphasis on nutrition programs in low and middle-income countries.

“With poor nutrition your immunity is compromised and you become more susceptible to disease, not just as a child but as you age. So getting these programs right is be a matter of life or death for many.”