Humanitarian aid to reduce acute child malnutrition and mortality in Niger.


Location of operation: NIGER
Amount of Decision: EUR 10,000,000
Decision reference number: ECHO/NER/BUD/2006/02000

Explanatory Memorandum

1 - Rationale, needs and target population.

1.1. - Rationale :

The spill over from the 2005 nutritional crisis resulting in the continuing unacceptably high rates of admission in early 2006 of severely malnourished children to feeding centres justify the maintenance of humanitarian aid operations in Niger in 2006.

Despite the adequate 2005 rains and the hope of a reasonable harvest (FAO projection of a small surplus of 21,000 tones), the very high levels of indebtedness incurred in 2005 by the poorest households and the continued abnormally high prices of millet on local markets continue to exclude many of the most vulnerable from access to food. Household coping mechanisms have been severely damaged and the government's food emergency stockpiles exhausted. There is a high risk of another major nutritional crisis in 2006.

The recently published UNICEF/CDC (Centre for Disease Control) national nutritional survey indicated a national average of Global Acute Malnutrition (GAM) of 15.3 % (far above the 10% emergency threshold). Four regions in particular showed very worrying figures with a GAM of 18% in Tahoua, 16% in Maradi, 16% in Diffa and 16% in Zinder. Nutritional surveys carried out by CONCERN, MSF (Médecins Sans Frontières), and ACH (Accion Contra el Hambre) confirm the negative indicators for nutritional status. Another survey carried out by CONCERN in Tahoua in December 2005 showed a GAM of 19.2% despite what had been considered an intensive food aid operation in the previous months in the area. Under- five mortality in particular is of great concern. The CONCERN survey showed a 3 month retrospective under-five mortality of 3.7/1000/day, when the accepted emergency threshold is 2/1000/day. UNICEF estimates are that 50% of infant mortality in Niger is caused by under-nutrition.

During the first 3 months of 2006, 53, 463 malnourished children, of whom 9,600 were registered as being severely malnourished, were admitted to nutritional centres(UNICEF figures). Current Commission humanitarian aid programmes have supported partners in the treatment of over 11, 500 of this caseload of 53, 463 (more than 20%). New admissions doubled in MSF F in Maradi from around 500 in mid- February to 1,000 in mid-March 2006. In south Zinder the French Red Cross hasreported an increased caseload from 250 to 350 between the beginning of March and mid April 2006. Many other partners have reported the same tendency. It should be noted that the big increase in the malnutrition caseload in 2005 started as of end of May.

Recurrent malnutrition with consequent high infant mortality has been a problem in Niger for years. The situation was aggravated in 2005 by drought and the effects of the locust invasion in 2004. The current scale of acute chronic malnutrition and infant mortality in Niger is abnormal and unacceptable under humanitarian principles and in the context of achieving the Millennium Development Goals.

An aggravating factor is the limited access for the poorest to good quality primary health care. Many of the health centres especially in rural areas are dysfunctional and the previous cost recovery policy of compulsory high consultation fees (relative to income levels) excluded many of the poorest. The extent of child mortality caused by the crisis in 2005 was hidden at first by the fact that many of the families could not afford to bring the children to health centres. An opportunity was therefore lost to spot the growing problem through data on admissions and consultation. Only where malnourished children were sick with some other pathology and were registered did the health system start to uncover the scale of the crisis. MSF and ACH surveys showed that the number of consultations at the public health centres was very low. The UNICEF/CDC survey showed the strong relationship between malnutrition and level of child mortality. MSF CH reported that 90% of the children registered in their feeding centres in 2005 tested positive for malaria.

A number of aid agencies are working closely with local health officials to facilitate free access to health care for the under 5 years and for lactating mothers. That this works can be seen from the fact that in Mayahi district, the number of primary health consultations multiplied by a factor of 5 and in some cases by a factor of 10 when an aid agency (HELP) worked with the local health workers to facilitate free access against in-kind support (medicines and equipment to health centres).

The need for free access to health care for infants from 0 to 5 years of age is one of the key lessons learned from the 2005 crisis. This has been fully taken on board by the Government who on 26th April 2006 decreed the right to free access to health care for all children up to the age of 5. However, the details of how to do this have yet to be worked out and much assistance is still needed at local level to facilitate this.

Family coping mechanisms were also very badly damaged as a result of the 2005 crisis. Many households incurred a massive debt burden to obtain food during the lean period. The replacement cost of one sack of millet purchased during the hungry period (peak prices) is three sacks after harvest. The traditional market mechanism is that traders buy up the harvest when prices are low, store the food and resell on the market when the prices rise during the hungry period. Decapitalisation also meant that households were forced to sell assets such as seeds and tools. Helping to restore local food self-sufficiency and improve revenue generating capacity is an important objective for aid agencies and for this decision. The families of children being treated in the feeding centres will be especially targeted for assistance to improve food security. Tracking the village of origin of the children registered as malnourished will facilitate identification of the regions hardest hit by the crisis. Distribution of seeds and tools and other agricultural inputs will improve food security and revenue generation.

Many of the poorest households in Niger were dependent on poultry as a source of protein and revenue. The recent massive non-compensated culling of chickens as a result of the outbreak of Avian Flu is another aggravating factor causing considerable hardship and stress.

The clear structural causes of malnutrition and mortality in Niger, one of the poorest countries in the world (officially classified at last position on the 2005 UN Human Development Index), are multiple and complex: acute poverty, mismanagement of natural resources, very low level of female literacy, limited family planning and changes in the pattern of regional trade in foodstuffs amongst others. Over 70% of the population of nearly 13 million are ranked at living below the poverty level. This situation calls for a comprehensive and articulated aid strategy linking short, medium and long term aid instruments.

The Commission has therefore drawn up an aid continuum policy linking relief, rehabilitation and development aid (LRRD) to respond to Niger's problems. This will use humanitarian aid through this decision to respond to the immediate life threatening circumstances, caused by short-term nutritional crises. Humanitarian aid will be followed closely by medium-term food security operations through the "B" envelope of the 9th EDF. In the longer-term, food security has been identified as one of the priority objectives in the programming of the 10th EDF.

Another major lesson learned from the 2005 crisis was the need to review the functioning of existing early warning systems. Data currently provided gives a quantitative picture of food security but does not adequately cover the nutritional status of the most vulnerable. Some of the highest levels of registrations for acute malnutrition in 2005 were in regions previously considered to be of low risk of food insecurity.

2005 also took the lid off the previous "tolerance" of recurrent acute malnutrition in the Sahel, and lead to an active discussion in the aid community about what could be accepted as a "normal" rate of malnutrition in the Sahel, bearing in mind the complex structural causes. While the solution is clearly through long-term aid interventions, the current aggregated acute malnutrition rate for the under 5 population at 15.5% GAM is far above the emergency threshold limit and in any other zone would have already triggered an appropriate humanitarian response. A continued humanitarian response is required in Niger in 2006 while the longer term instruments are put in place.