Ethiopia’s Nutrition Project brought community-based nutrition services to 55.8 million people between 2008 and 2014, beating its 44.1 million target, the World Bank’s Independent Evaluation Group found in a 2019 assessment.
Health extension workers at a government health post in Ethiopia register women and their families for services, April 2012 (USAID Ethiopia, Wikimedia Commons, CC BY 2.0) [file photo]
The project was approved in April 2008 and closed on May 31, 2014. It spent $26.73 million from an IDA grant of 18.8 million special drawing rights, worth about $30 million at appraisal, and the government added the equivalent of $9.6 million. It targeted pregnant and breastfeeding women and children under five in 238 woredas with high malnutrition and food insecurity in Oromia, Amhara, the Southern Nations region and Tigray.
Working through the Health Extension Program, it offered growth monitoring and counselling, micronutrients, deworming, treatment of severe malnutrition, basic health care, behavior-change messages and community conversations.
Exclusive breastfeeding, iron supplements for pregnant women and vitamin A for children all increased, use of iodized salt became almost universal, and government policy made zinc widely available. Stunting and underweight among children improved, the assessors found, and after the project closed the community-based model spread from 238 to 386 woredas by 2017.
The evaluators rated the project satisfactory and its efficiency substantial. They rated both World Bank and government performance moderately satisfactory, mainly because of early delays. Funding for nutrition from partners and the government grew to $1.1 billion for 2016–20. An IEG team visited Ethiopia in February 2019, including Gobesaye kebele in Oromia and Haben kebele in Tigray.
Problems remain, the report said: overburdened health extension workers, limited water supply and infrastructure, little food diversity, and financing. A 2018 World Bank study estimated that Ethiopia would need to invest about $220 million a year for a decade in direct nutrition interventions to meet its targets for stunting, wasting, anemia and breastfeeding.
Sources: ReliefWeb (World Bank Independent Evaluation Group)