Taking stock of ingredients for success in joint fortification programmes in Chad

Climate change, conflict-induced migration, glaring gender inequities, a limited health system, narrow birth intervals, and poor infant and young child feeding practices are some of the causes driving high levels of malnutrition in Chad. According to the 2021 Global Nutrition Report (GNR), the country is ‘off course’ to meet all of the global nutrition targets. Some indicators warrant particular concern. For example, the latest GNR cites the exclusive breastfeeding rate at a mere 0.1%1, while the 2021 SMART survey reported 11.4%. Despite this data discrepancy, exclusive breastfeeding ‒ a fundamental ‘triple duty’ action ‒ in Chad lags behind neighboring countries, including those of comparable income status such as Central African Republic (28.8%) and Niger (23.3%). According to the SMART survey, dietary diversity among children aged 6–23 months doubled from 7.3% in 2018 to 14.5% in 2021, yet remains very low. Furthermore, the same survey indicated that three in ten children under five years old are stunted, compromising human capital and the country’s development trajectory.

Building on comparative advantages of diverse UN agencies

To respond to the pressing nutrition situation, four UN agencies ‒ FAO, UNICEF, WFP and WHO ‒ joined forces in a multi-sectoral programme, Local Production of Fortified Complementary Foods (Production Locale d’Aliments de Complément Fortifiés,), known to many as PRO-FORT, in collaboration with the Republic of Chad. Fortification heightens the vitamin and mineral content of a given food and is a cost-effective, evidence-based intervention strategy. It is particularly relevant for young children in low resource settings, as it helps them meet special nutrient requirements to support their rapid growth and development, taking into consideration their small stomachs.

PRO-FORT was undertaken between November 2016 and June 2021 thanks to generous funding from the European Union. Essentially, the programme worked towards two complementary goals: (1) preventing child malnutrition; and (2) fostering economic growth of local communities, targeting the provinces of Mayo-Kebbi Est and Mayo-Kebbi Ouest with a fortified complementary food, called MANISA.

It was built on four main components that straddle nutrition-sensitive agriculture, governance and behaviour change. These include: (1) capacity building of farmers’ organizations on good agricultural practices to produce raw materials (maize, cowpeas, soya and groundnuts), supported by FAO; (2) capacity building for the production and marketing of fortified complementary foods, with assistance from WFP; (3) social marketing to promote recommended infant and young child feeding (IYCF) practices, using mass media and new communication technologies, spearheaded by UNICEF; and (4) strengthening the legal framework with regard to the marketing of breastmilk substitutes and foods for children aged 6 to 24 months, leveraging the expertise of WHO. The social marketing element was guided by a socio-anthropological study on the determinants of malnutrition, carried out by UNICEF at the beginning of the project in the targeted provinces, which showed the major role grandmothers play in children’s food choices and a low level of knowledge on IYCF. Moreover, the latter two components served to contextualize fortification within a broader framework to promote good nutrition among infants and young children.

Distinguishing factors

What sets PRO-FORT apart from other fortification projects is the emphasis it placed on knowledge management and the involvement of four UN agencies. The conception of the project was sparked by the UN Nutrition-REACH project, which helped to bring the agencies around the table and leverage their respective strengths to maximize the impact of this EU funding. From day 1, the joint programme called for learning from fortification experiences of other countries as one of the objectives. It also foresaw sharing success factors, challenges, innovative solutions and lessons learned through PRO-FORT with other countries in the region, in turn, contributing to a two-way knowledge flow. This pushed the project team to hold a knowledge capitalization workshop on 13‒14 October 2021, organized by the World Food Programme’s (WFP) Country Office with support from UN Nutrition-REACH and the Regional Centre of Excellence against Hunger and Malnutrition (CERFAM) based in Abidjan, Côte d’Ivoire.

Achievements and areas for improvement

PRO-FORT has helped to improve access to nutritious complementary foods and address nutrient gaps among young children, while simultaneously, spurring economic growth in the targeted areas. Thanks to the programme, over 120,000 children consumed MANISA and more than 16,000 smallholders were able to increase their productivity per hectare by 125%. Additionally, the fortification units and small traders earned income by selling MANISA.

“Through the joint UN efforts, Chad has adequate fortified complementary food for young children and an enabling environment supportive of infant and young child feeding through the adoption of the IYCF strategy and the law on the marketing of breastmilk substitutes,” added Mariana Stirbu, UNICEF Deputy Representative. In addition, PRO-FORT raised awareness among Chadian communities on the health benefits of integrating fortified complementary foods as part of a balanced diet for children aged 6-24 months.

The workshop was an opportunity to reflect on critical success factors and lessons learned, that can guide replication in other areas. “Some challenges remain in terms of production and distribution capacity, that require further joint support and stronger private sector involvement,” said Mariana. This is in part due to the limited private sector in the country, but also opportunities to further engage the such actors to improve outreach and distribution capacity. “Better coordination of efforts and synergies, involving all stakeholders, is needed to accelerate progress on fortification,” explained Mohamed Levrak, regional REACH facilitator.

Furthermore, recommendations were put forth to the Government, the United Nations, civil society and the private sector about how to combine their efforts in the fight against malnutrition in Chad. For instance, the government was encouraged to exempt duties on imported fortificants as part of greater efforts to improve policy and programming across the vast nutrition landscape. Another recommendation urged the UN agencies to continue exploring successful models of food fortification in the context of South-South cooperation and facilitate technical support.

Looking ahead

FAO and WFP are now planning a new project that will capitalize on the learning from PROFORT (and other fortification projects). The new project will address the production and distribution issues to boost sustainability although the details are in the process of being finalized. Furthermore, it will continue to leverage the social marketing materials on IYCF practices and technical assistance on marketing regulations provided by UNICEF and WHO in PRO-FORT. Claude Jibidar, the WFP Country Director, sees partnership as crucial for advancing the nutrition agenda and achieving impact on the ground. “Thanks to the collaboration between the Government of the Republic of Chad, the European Union, the United Nations and civil society, Chad succeeded in developing for the first time a fortified complementary food made from local products in order to promote local socio-economic development,” said Claude who also chairs UN Nutrition in the country. With just 11.5% of children ages 6‒23 months benefitting from a minimum acceptable diet in Chad,10 there is still much work to be done to make nutritious complementary foods more accessible to vulnerable groups.

Photo credits:
Photo 1: ©UN Nutrition-REACH/Himeda Makhlouf
Photo 2: © WFP/Djimta Monelmbaye

1 https://globalnutritionreport.org/resources/nutrition-profiles/africa/middle-africa/chad/
2 Republic of Chad, UNICEF and WFP. 2021. Enquête nationale de nutrition SMART 2021: Note de synthèse.
3 https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups
4 https://globalnutritionreport.org/resources/nutrition-profiles/africa/middle-africa/central-african-republic/
5 https://globalnutritionreport.org/resources/nutrition-profiles/africa/western-africa/niger/
6 Republic of Chad, UNICEF and WFP. 2021. Enquête nationale de nutrition SMART 2021: Note de synthèse.
7 Ibid
8 Compendium of Actions for Nutrition. 2016. Available at https://bit.ly/2Jb4ksN.
9 REACH refers to Renewed Efforts Against Child Hunger and malnutrition, which is currently being mainstreamed into UN Nutrition’s wider programme of work.
10 Republic of Chad, UNICEF and WFP. 2021. Enquête nationale de nutrition SMART 2021: Note de synthèse.

 

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