‘We’re not just putting a band aid on things, we’re solving the root causes of malnutrition’

Haunting images of undernourished children hit our screens daily, innocent victims of an unjust world of bone-dry rivers and mounting climate challenges.

However, Concern’s frontline staff in five of the world’s poorest countries are working on an innovative EU-funded programme to tackle childhood malnutrition and its underlying causes, and so prevent it recurring.

Childhood malnutrition is one of the greatest injustices the world is currently facing, with 45.4 million children under five years of age acutely malnourished in 2020. “The scale of malnutrition is shocking and unacceptable,” the global coordinator of the Enhanced Responses to Nutrition Emergencies (ERNE) programme Aoife Black said. “Against this background the EU deserves major credit for funding an innovative response to the issue.”

Over the last three years, the programme has helped over 1.2 million people in five of the world’s poorest countries — Ethiopia, Niger, Republic of Sudan, South Sudan and the Democratic Republic of Congo.

Now is the time for a cohesive, age friendly healthcare system

---

How your legacy gift to Concern Worldwide leaves a better future for some of the world’s poorest families

---

Good governance is critical for effective healthcare investigations

---

Joined-up IT means medics have more time to focus on patient care

---

A multi-faceted approach

The multi-pronged approach adopted by ERNE combines lifesaving emergency nutrition treatment and prevention and preparedness activities to help make communities more resilient to malnutrition in the longer run.

“We’re not just putting a band aid on things — we’re trying to solve the problem and prevent it from recurring, so that eventually these communities can survive without humanitarian aid and be in charge of their own lives,” Aoife explains.

The multi-faceted approach ranges from providing practical and financial support to local health facilities (including training, equipment and renovating clinics), to providing emergency cash payments to vulnerable communities. It also includes training health workers to proactively monitor malnutrition and disease trends to pre-empt spikes in demand for healthcare by providing additional staff or medical supplies in advance.

Drought and crop failures

“I’ve been lucky enough to visit some of the programme areas and witness the incredible field work being done by our staff,” Aoife said. “One of the villages I visited in Ethiopia had a river running through the middle of it that has completely dried up. No rain has fallen and the community there have endured extreme drought conditions for the past three years.

“Their crops have failed, which is especially devastating as a lot of these communities would be highly dependent on pastoralism and raising livestock. They have herds of camels that they are dependent on for both milk and meat. But because those camels now don’t have any water to drink, they’re dying in huge numbers. The result is that families simply don’t have enough food, leading to high levels of child malnourishment.”

The point is hammered home by Concern’s use of a Family MUAC— a tape used to measure children’s mid-upper arm circumference (MUAC) for early detection of malnutrition. Many of the children being supported through the ERNE programme have such tiny arms that they fall into the MUAC’s red zone — a circumference of less than just eleven centimetres.

Despite the sad circumstances behind its use, the band is a source of optimism for those being treated through the ERNE programme. “MUAC is such a powerful tool that enables parents to manage their own children’s health,” Aoife explains.

Empowering communities

Empowering the local communities in the five countries involved is a key element of the ERNE programme. “What’s special about ERNE is that it does so much more than provide life-saving treatment and assistance — because it’s a three year programme with such a multi-sectoral approach, we’re able to look at some of the underlying root causes of malnutrition.”

Education has been one of the key steps in making these communities more self sufficient — specifically, education aimed at challenging existing gender norms.

“For many of the communities we work in, gender inequality is quite prevalent. Mothers and fathers might not share the same roles or the same level of responsibility within the household. Fathers would typically be quite hands off in terms of raising children and might not understand exactly how a child needs to be fed, so what we’ve tried to do with this programme is introduce an element of education for both mothers and fathers. We teach them that the first thousand days of a child’s life are the most critical period for their nutrition, as it aids their brain development and sets them up for life. It’s why we focus so much on children under five years of age, and why we’d recommend breast feeding in the first part of a child’s life.

“Once both parents are armed with that information, we’re seeing many families beginning to change their behaviour. Fathers are taking more responsibility for the child rearing, being more supportive to their wives, and in turn women feel able to speak up more within the home, contribute to decision making, and control resources so as they can feed their families and nourish their children well.”

Finding solutions

The programme has had to overcome many challenges since it began in 2020. Like everyone, the Concern Worldwide staff were forced to react at lightning speed when the Covid-19 pandemic began that year, and to change their ways of working practically overnight.

For the ERNE programme, which had been nailed down for 2020-2023 specifically under a Pilot Programmatic Partnership between Concern and the EU, the timing was challenging.

“The context in which we started this programme was incredibly difficult,” Aoife reflects. “At field level we were suddenly faced with all kinds of lockdowns and restrictions, meaning our staff couldn’t get out to work directly with communities. Local staff in health facilities were restricted from doing their jobs and were seeing people who were badly in need of health nutrition treatment.

“We found solutions, like everyone, we pivoted and worked really hard to adapt the programme to remote working. We linked in with local governments around their restrictions. At local level we were supplying masks to people so they could visit health facilities and supplying protective clothing to health workers, applying social distancing — all the things we were doing in Ireland, we were facilitating that in these five other countries too.”

The pivoting was more than worth it — as the ERNE programme draws to a close this year, it leaves behind a number of huge achievements. Over 100,000 acutely malnourished children have been successfully treated through the programme, while practical and financial support has been provided to 304 health facilities in the five countries involved. In addition, Concern have educated 16,000 mothers and 2,777 fathers about nutrition and good hygiene practices through community support groups.

“We hope there will be lasting impact from this programme, but we also know the scale of needs is huge and continues to grow,” Aoife says. “We’re facing very big challenges in terms of climate change, conflict, instability — profound global challenges. So we foresee this type of humanitarian aid will continue to be needed for some time to come, and we’re currently exploring options to continue the programme into the future.”

To find out more about ERNE, and how you can support Concern Worldwide with their future work, visit www.concern.net/knowledge-hub/ERNE.