Tackling Malnutrition in Zimbabwe

Zimbabwe has long suffered from high levels of chronic malnutrition among its population, which have led the government and international organisations to launch several initiatives over the years to tackle the problem. Two of the largest programmes have been the Community Food and Nutrition Programme and, most recently, the government's Food and Nutrition Security Policy, neither of which has succeeded in reducing malnutrition, which continues to rise.

The challenge

Malnutrition is one of the most serious problems affecting the world’s poorest people, and it remains a dominant issue in the health of the world’s poorest nations. Nearly 30 percent of people in the world, of all ages, currently suffer from one or more of the several types of malnutrition.[1]

Zimbabwe is a low-income country, ranked 154 out of 188 on the 2016 UNDP Human Development Index.[2] "According to the 1995 annual Poverty Assessment Survey Study (CSO, 1995), 42 percent of the citizens were classified as 'very poor' (earning less than the level of income which people need to meet their basic food needs) with communal area residents having the highest level of poverty (71 percent). In a sample survey conducted in 2000 (Agri-Optima, 2000), 89 percent of the interviewed households reported food shortages for almost the whole year."[3] It is no surprise, then, that the incidence of malnutrition is on the rise in Zimbabwe.

There are several factors that have exacerbated Zimbabwe’s food security situation. The 2016 Global Hunger Index quoted "widespread poverty, HIV/AIDS, limited employment opportunities, liquidity challenges, recurrent climate-induced shocks and economic instability all contribute to limiting adequate access to food".[4]

Low-productivity agricultural practices and lack of access to markets also affected the food security of most rural Zimbabweans, whose livelihoods depend on their own production.  In turn, the country's food production deteriorated dramatically as a result of land reforms and redistributions implemented by the government in the early 2000s, which resulted in a "lost decade" for the country – from 1998 to 2008 – where  agricultural output slumped by more than 60 percent.[5]

The initiative

There have been several initiatives by the government of Zimbabwe (GOZ) and international organisations such as the Food and Agriculture Organization of the United Nations (FAO), the World Health Organization (WHO), and United Nations Children's Fund (UNICEF), among others, to tackle the various sources of hunger in Zimbabwe.

The Community Food and Nutrition Programme (CFNP) was initiated in 1988 by the GOZ, with the help of the Swedish International Development Cooperation Agency (SIDA). Its main targets were to improve food production and link this to feeding children at both community and household levels. The National Nutrition Unit of the Zimbabwean Ministry of Health and Child Welfare (MOH-CW) was responsible for the coordination of the programme, with support from multisectoral committees at all administrative levels (from central government to individual villages).[6]

The national Food and Nutrition Security Policy (FNSP) was launched by President Mugabe in 2013. Its main goal was “to promote and ensure adequate food and nutrition security for all people at all times in Zimbabwe, particularly amongst the most vulnerable and in line with our cultural norms and values and the concept of rebuilding and maintaining family dignity”.[7] It later became part of the GOZ's overarching National Nutrition Strategy (NNS) 2014-2018, which aimed to ensure nutritional security for all people in the country through the implementation of interventions within a broad public health framework, including health services, water and sanitation.[8]

Most recently, in July 2015, the World Food Programme (WFP) Zimbabwe and the GOZ launched a combined "Zero Hunger Strategic Review" to provide an overview of the food and nutrition security situation in the country and establish an understanding of the country’s demographic and socioeconomic context.[9]

The public impact

There has been very little, if any, positive impact from the policies implemented since 1988 in Zimbabwe:

  • In the period from 1988 to 2014, there was actually an increase in the percentage of children presenting severe wasting (from 0.4 to 0.7 percent) and wasting (from 1.7 to 3.3 percent); the proportion of underweight children also increased from 8 to 11.2 percent in that period.[10]
  • As of 2016, Zimbabwe faced its worst malnutrition rates in 15 years, with nearly 33,000 children in urgent need of treatment for severe acute malnutrition. With El Niño-induced drought sweeping across large parts of the country, the number of hungry families in the country quickly doubled in a period of eight months that year.
  • According to UNICEF, approximately 2.1 percent of Zimbabwean children under five had severe acute malnutrition, as of 2016; the international threshold required for an emergency response is 2 percent.
  • "The proportion of hungry households had more than doubled from 16 percent in May 2015 to 37 percent in January 2016...
  • "On average, 35 per cent of households have inadequate water supply for domestic use. Water scarcity is forcing children, especially girls, to walk even longer distances in search of water. Inadequate water is also exposing children to higher risks of diarrhoea, typhoid and other waterborne disease including cholera."[11]

What did and didn't work

All cases in our Public Impact Observatory have been evaluated for performance against the elements of our Public Impact Fundamentals.

Legitimacy

Public Confidence Weak

There is very little coverage of the opinion of local residents regarding the initiatives of the GOZ and the international community. Overall, there seem to be low expectations regarding change.

Farmers commenting on initiatives for food and land reform mentioned that the problem with food crops is the lack of commercial incentive for businesses to assist small farmers. For products like cotton or tobacco, there is financing available from buyers for fertilizer and seed, but for crops that are for home consumption or the informal market there are no loan facilities. “It’s a long time since government helped with inputs for farming, but that’s how it is these days.”[18]

Corruption is also a big issue in the country, and it appears to affect the economic development agenda. Some experts say that it is even viewed as an acceptable fact of life at all levels of society. "There is a general saying in Zimbabwe that one 'has to pay' police, local authorities, schools, hospitals, births and deaths registry, passport office, judiciary officers and so on to get things done. The Global Corruption Barometer (2013) shows that about 60 percent of Zimbabweans who accessed public services paid bribes to access the services or speed up transactions."[19] This shows a lack of trust in the country's institutions and initiatives.

Stakeholder Engagement Good

There were many stakeholders involved in the policy to reduce malnutrition in Zimbabwe, including the GOZ, international donors such as SIDA, several NGOs, and UN agencies such as the FAO. “Institutions such as SIRDC [Zimbabwe's Scientific and Industrial Research and Development Centre], FNC Zimbabwe, government ministries, UNDP, WFP, WHO, UNICEF, various NGOs, the private sector and various other stakeholders were commended for their contributions towards the realisation of the policy.”[12] The GOZ developed the Zimbabwe NNS for 2014 to 2018, "following a consultative process of all stakeholders to food and nutrition issues in government, the private sector, NGOs, the UN, community-based organisations and the community at large".[13]

The community nutrition programme made an active effort to involve local community and civil society organisations in the development of the programme, with some of the programme's activities appearing to have been suggested by extension workers from the Agricultural Technology and Extension Service. However, little evidence is reported of community-initiated actions, although the NNS has been instrumental in reviving the concept of the zunde – "a Shona word, which commonly means an informal, in-built, social, economic and even political mechanism. The original Zunde concept centred on ensuring food security for a village during normal times as well as times of stress, whether natural or induced by man. A chief designates a piece of land for cultivation by his subjects. The harvest is stored in the chief's granary (Zunde raMambo) in his compound."[14]

Political Commitment Fair

The FNSP is one of the GOZ's main attempts to date to demonstrate their commitment towards the nutritional challenges in the country. However, historically it has been mainly international donors and NGOs who have created most initiatives in Zimbabwe.

Soon after Zimbabwean independence in 1980, a number of NGOs initiated a nationwide Supplementary Feeding Programme. The GOZ gradually became more involved in the management of feeding programmes, particularly when the MOH-CW took over their management with major financial support from the SIDA around 1988.[15]

President Mugabe stated in 1996: "My government has, in the recent past, set up a task force on food and nutrition to provide us with strategies for increased food nutrition security without compromising economic growth. The proposed FNSP for Zimbabwe will be an important tool for my government in harmonising economic growth, agricultural production, industrialisation and improved food and nutrition security.”[16] However, major economic programmes appear to have achieved the opposite. "Zimbabwe's real GDP fell 40 percent from USD6.6 billion in 2000 to USD4.1 billion in 2010, while real per capita incomes in 2011 were 37 percent lower than when Zimbabwe finally gained independence from Britain in April 1980, according to the World Bank."[17]

Policy

Clear Objectives Fair

The goals of the initial CFNP were clearly established but were relatively generic and there were no specific goals or measurement mechanisms set up to keep track of the programme's impact. Also, the GOZ's later NNS lacked detailed targets, making the initiative rather vague.

The CFNP had the goal of engaging and assisting communities in high-risk areas in identifying their food and nutrition problems and implementing appropriate actions to address those problems, with the following objectives:

  • "Promote the production of food crops with particular focus on legumes and vegetables;
  • "Promote improved methods of food processing, preservation, preparation and consumption;
  • "Strengthen intersectoral mechanisms to enhance food security and nutrition interventions;
  • "Develop appropriate indicators for monitoring and evaluation of interventions;
  • "Organise a feeding programme for children under five years in vulnerable areas."[20]

The GOZ developed the NNS 2014-2018 with the main objective of implementing Commitment V of the FNSP. "Commitment V (5) of the FNSP states that the GOZ is committed to ensuring nutrition security for all through the implementation of evidence-based nutrition interventions that are integrated within a broad public health framework including health services, water and sanitation."[21] No further details of these objectives are covered in the official NNS document.

Evidence Fair

There is no direct evidence of positive examples, pilots, research or other programmes being used in the design of policies in Zimbabwe. The use of evidence is strongly promoted by the GOZ in its NNS, and it stresses the importance of evidence as one of its guiding principles. "The NNS will prioritise investments in proven and universally accepted high-impact nutrition interventions to maximise results from limited resources. Evidence generation on barriers to the uptake of optimal maternal and child nutrition behaviours will be a top priority."[22] However, there are no specific examples of such "evidence generation".

According to the FAO's report on the CFNP, "there is evidence from a few mini-projects within the programme that demonstrate that the production and access aspects have been realised where the group farm approach has been successful... but there is lack of quantitative information to show the effects of changes in access on improving the food consumption and nutritional status of children of such families, compared to children of families who did not engage themselves in such ventures."[23]

Feasibility Weak

There have been ongoing funds allocated for efforts to combat malnutrition, from both the GOZ and the international community. However, neither has established the legal elements and infrastructure necessary to make these efforts successful. This, coupled with the declining food security in the country after the government's land reforms, has made the nutritional initiatives difficult to achieve.

The availability of food in Zimbabwe has become increasingly sparse over time. It was reported by the FAO in December 2001 that "the already tight food situation has deteriorated as a result of reduced cereal production and general economic decline... 705,000 in rural areas are at risk of food shortages. In addition, 250,000 people in urban areas are experiencing food difficulties due to a sharp increase in food prices, while some 30,000 farm workers have lost their jobs and are left without means of assistance."[24]

The Commercial Farmers' Union also estimated that nearly 20 percent of the national commercial herd of cattle had been forcibly "destocked" by late 2001, and that over 1.6 million hectares of grazing land had been burnt out, while commercial maize planting was down to 45,000 hectares from 150,000 hectares in the 1999-2000 season. Such problems exacerbated food shortages already created by droughts. The first consignment of donated maize arrived in Zimbabwe (previously a maize exporter) in January 2002, and the WFP began emergency food distribution in February 2002.[25]

Funds to support nutritional programmes have historically been provided by international organisations. The CFNP was first funded by SIDA, and the GOZ continued to pay for activities once the original funds came to an end – within its given economic limitations and constraints. "The budget allocated from the government treasury for operational cost for nutrition (excluding salaries, and supplementary feeding in emergencies) amount to about USD37,000 for the central level and USD44,000 for each province. In addition, there are special funds from other sources channelled directly to the provinces. Given the economic situation of the country, the allocation made for nutrition is commendable."[26]

UNICEF has also contributed on this account: “With funding from the European Commission Director-General for Humanitarian Aid and Civil Protection (ECHO), UNICEF, the MOH-CW and the Ministry of Women, Gender and Community Development have partnered to reach out to more than 80,000 children under the age of two.”[27] However, this support has come under strain recently, as UNICEF requested USD21 million to meet the humanitarian needs of children in Zimbabwe in 2016, claiming that without additional funding the organisation would be unable to continue to respond to the humanitarian needs of children in nutrition, health, water and sanitation, HIV and AIDS, education, and child protection services.[28]

In terms of legal and human resources, the initiatives have been generally unstable. The CFNP has noted that its Task Force was initiated by a group of concerned professionals from various ministries, but with no legal recognition. "This ultimately led to the establishment of a National Food and Nutrition Council with its Interim-Secretariat in the Ministry of Economic Planning and Finance. Discussion is currently under way to place it higher up in the hierarchy. Progress is slow, but appears to be solid."[29]

Action

Management Weak

Overall, the programmes discussed here have had a broad management structure in place for their implementation, but rather unclear mechanisms to achieve progress.

The National Nutrition Unit of the MOH-CW was responsible for the CFNP. It managed the coordination of the programme with support from multisectoral committees at different administrative levels (central to village). The task force running the programme was formed by several ministry representatives, which also included the Ministry of Agriculture and Economic Planning and Finance, but it had no legal recognition, which probably limited is efforts.

At the provincial and village levels, Food and Nutrition Management teams were also formed and recognised as subcommittees. They included the heads of the relevant sectoral offices, the NGOs, and traditional chiefs, with the main function of coordinating plans and programmes, mobilising communities and resources, and monitoring implementation. The programme reports that committees were effective for the first few years, but gradually declined, giving the following reasons:

  • "Staff turnover and lack of continuity of training;
  • "Lack of financial support for the mobility of the committee members to visit projects and 'sensitise' communities (previously they were supported from SIDA funds);
  • "Lack of an effective monitoring system to provide information for committees’ discussions, amendments and recommendations;
  • "Reluctance of sectors which do not perceive themselves as having a direct contribution to make to improving nutrition."[30]

Measurement Weak

The approach to monitoring the progress and impact of food programmes in Zimbabwe appears to be rather weak, with very little evidence of measurement and evaluation, apart from official health statistics.

The CFNP review was critical of the programme's measurement component. "The monitoring and evaluation aspect is weak. Sectoral ministries routinely submit an annual plan and an annual report. The provincial health units have plans and annual reports well arranged in the form of a logframe matrix. However, lacking is a comprehensive analysis that would allow monitoring of processes, and feedback to implementing units and communities.”[31]

The NNS did define better measurement components, but it is unclear whether they have been fully implemented. Core indicators for the NNS include: the proportion of under-fives who are stunted, by age group (stunting expected to be reduced by 1 percent annually); the proportion of low birthweight babies; the incidence of type II diabetes and hypertension among adults; the infant mortality rate; the maternal mortality ratio; and the child mortality rate.[32]

Alignment Weak

It appears that the collaboration between different organisations worked well among international agencies and NGOs, but less so with the GOZ and other local administrative entities.

The community nutrition programme has reported a successful partnership with NGOs, which enabled it to work at the grassroots level. Plan International, an NGO that had worked in Manicaland and Zimbabwe for many years, implemented a community-based approach to manage acute malnutrition and improve feeding practices. The work was financed by the Norwegian Refugee Council and ECHO.[33]

However, there is evidence of a misalignment between the government and civil society on their priorities and activities in the country. "Only three major nutrition assessments took place in 2002 due to competing priorities amongst the various stakeholders, most notably between the government and the humanitarian community. Resisting pressure for more assessments, the government argued that the priority was getting food assistance to the communities (particularly when it wasn't being delivered) and that there was a risk of survey fatigue. The government's position was undermined by 'hearsay' amongst members of the humanitarian community, suggesting that results of the May 2002 assessment (involving the MOH-CW) were unreliable. However, no hard evidence was produced to substantiate claims that the methodology was flawed, or that there was 'tampering' during the data cleaning process."[34]

The nutritional crisis in Zimbabwe has been acknowledged to be complex and – at least in part – man-made, although there is some disagreement between the international community and the GOZ on this. "The argument by the humanitarian and international community that the crisis of governance is a major contributor to the humanitarian crisis has met with a lot of resistance, if not outright denial, by the GOZ. This, in turn, has contributed to what can be described as the politicisation of data, with the outcome of assessments contested by both donors and government, depending on who conducted the assessment. Attempts to create broad consensus around assessment findings has meant the assessment process has been slow, and in some instances painful, with technical considerations swept away in favour of pragmatic political ones."[35]