It will continue to be a mere wish for Gombe State government in making a significant progress in the fight against malnutrition, if the current problem of poor funding of nutrition intervention programme in the state persists. Chuwang Dung writes
A lamed by the high number of malnourished children in Gombe State, the United Nations Children’s Fund (UNICEF) in 2009 introduced the Community Management of Acute Malnutrition (CMAM) programme in the state. The programme was piloted in three local government areas, Gombe, Dukku and Nafada local government areas of the state.
To start with UNICEF provided 96% of the cost through capacity building and supply of Ready-to-Use, Therapeutic Food, RUTF, while the state and local governments were expected to contribute the remaining four per cent for provision of structures, manpower and supply of essential drugs.
Though a national problem, the problem seems to be worse in the north with Gombe State in North-East being among the leading states.
The statistics showed that the total number of children affected by malnutrition in the South East in 2016 was 34, 889, while 6, 700 deaths were recorded. In the South South, 86, 304 children were affected, out of which 16, 700 died, while the South West had 84, 417 cases and 16, 300 deaths were recorded, North west had 1, 594, 462 cases and 308, 000 deaths, North Central 43,635 cases with 8, 400 deaths and North East 695,998 cases and 134, 000 deaths.
Record from the UNICEF office in Gombe shows that from September 2009 to November 2011, a total of 13,004 severely malnourished children were admitted to the 15 health facilities across the three local government areas. Out of them 4,913 were cured and discharged, but 79 came too late for any form of treatment.
In the agreement UNICEF support for the programme was to last for two years, thereafter the state government was expected to take over the funding and also expand the initiative to other areas by 2011. But investigations by our reporter revealed that the state government defaulted in their own part of the agreement. However considering the alarming statistic of malnourished children in the state, that still requires the treatment UNICEF decided to extend the dateline for the programme and the state government manage to release the sum of N17million only in 2016 for the programme.
And since then UNICEF has been working with the state government, other National and International donor agencies to treat and prevent malnutrition by giving children Ready RUTF, promoting infant feeding programmes, such as exclusive breastfeeding in the first six months, timely introduction of nutrient-rich complementary foods, proper hygiene and sanitation.
While UNICEF, along with many other non-profit organizations are raising money in funding this laudable initiatives in battling malnutrition in the state, there are evidence that poor funding is affecting the battle negatively, and there is the need for more allocation and release of funds from the Gombe state government to really make the programme a success.
Our correspondent gathered that, UNICEF spent an estimated sum of US$120 on every child at risk of malnutrition. According to UNICEF Nutrition Consultant Gombe, Funmilayo Adebambo, a carton of RUTF costs US$120 and each child needs a carton for complete treatment. “For a child to be fully healed, he needs at least a complete carton,” she said.
Adebambo who noted that simple interventions can save malnourished children said the gaps in financing would hamper efforts to reduce malnutrition cases, therefore Gombe State government needs to invest more in intervention services, such as CMAM and Infant and Young Child Feeding Counseling (IYFC) .
Although on many occasions Governor Ibrahim Hassan Dankwambo, has expressed his desire and passion in fighting the problem of malnutrition in the state, our correspondent’s findings revealed that currently nutrition intervention programmes are poorly funded in the state with no specific allocations and release of funds to key nutrition programmes, especially within the state Primary Healthcare Development Agency, also CMAM and the IYFC programme are not getting the desired funding from the state and local governments.
More worrisome it is the inability of the state government to sustain the provision of other routine drugs like, amoxylene syrup, abdenozole and dewormer to cater for the hundreds of malnourished children that visits the CMAM centers on a weekly basis as contained in the agreement with UNICEF, a situation that is forcing mothers to pay money, ranging from N150-N200 for such drugs.
Lack of serious commitment on the part of government in addressing the problem is raising serious concern among stakeholders who are of the view that the state needs an effective and sustainable nutrition funding mechanism if truly it wants to succeed in tackling the alarming rate of malnutrition.
According to recent statistics released by the Gombe State Nutrition Officer (SNO), Suleiman Mamman, he said in 2016 the number grew to 13,059 due the activities of insurgents, 11,031 children were cured with 105 deaths recorded while 149 were not cured due to other ailments and 803 defaulted.
Suleiman said in 2017, from January to May over 6330 children have been admitted into the programme with 4647 cured, 25 deaths recorded and 101 defaulted.
The state commissioner of agriculture, Dahiru Buba Biri, said. “Many factors contribute to malnutrition including lack of food diversification, lack of clean water, inappropriate feeding practice and local customs.”
The commissioner, who described malnutrition as a major problem in developing countries, explained that the problem of malnutrition especially in rural areas is not that of extreme poverty but that of lack of adequate education or enlightenment.
According to him, most people in the villages suffer in the midst of plenty because they lack awareness of the best ways of feeding and healthy living. “Imagine a local woman who may have plenty of chicken and grains but would only sale them to solve some other problems while her family eats poorly.”
He then emphasised the need for government to work hard in educating the people about the nutritional values of local foods, as well as providing access to water and sanitation, and increased spending on food security.
The state director of Primary Healthcare Development Agency, Ibrahim Bako Nafada, while speaking with our correspondent said there was progress in addressing malnutrition, citing reduced deaths. He however noted that the state is still struggling to achieve the high levels of programme coverage needed to beat the disease due to financial challenges.
While acknowledging that the agency is struggling with lack of funding and staff, he explained that, no reasonable money has been released for nutrition, which has not been enough to cater for the increasing cases of chronic malnutrition in the state.
Nafada, however disclosed that they are making efforts to see that the problems are tackled.
“We are looking deeply into the problems, and I am sure with the commitment and passion the governor is showing I am very sure we will overcome. We have captured everything in our budget, we are just waiting for the approval and release of the funds,” he added.
Also speaking on the challenges, the State project manager of Gombe State Agency for Control of HIV/Aids, GOMSACA, Dr. Suraj Abdulkarim, said despite the alarming rate of malnutrition cases among children living with HIV /AIDS, the state government is yet to release intervention funds to the agency.
He said in order to sustain the programme and manage the over 250 malnourished children that are living with the virus, the agency as resorted in soliciting for support and funds from individuals and donor agencies.
“So far no funds have been released to us, however some NGOs have been assisting a lot in funding the feeding of the over 250 malnourished children under our care,” he said.
Dr. Suraj appealed to concerned authorities to invest more funds in providing proper medical care and feeding to the malnourished children.
On his part, the state permanent secretary, Ministry for local government affairs, Ahmed Abubakar, said tackling this challenges is important from both a humanitarian, economic and political perspectives as such as parts of its obligation government is committed in ensuring the success and sustenance of the programme. But there is no adequate funds to cater for all the requirements under the programme.
He then expressed optimism that government was ready to give the programme the desired funding as soon as the financial situation improve.
“This is a program that directly affects the common man, as such I am sure the Governor will not allow it to go down the drain, even if there is no money, we will look for other means of sustaining and extending the programme.” He gave the assurance.
During a visit to one of the CMAM centers in Malala, Dukku local government area, the head of the facility, Ibrahim Tukur, said due to lack of funding they find it very difficult to transport the RTUF from the local government headquarter to the healthcare Centre.
“Despite lack of funding and inadequate staff we are here trying to help mothers and children by giving them treatment on acute malnutrition cases and help them understand the importance of breast-feeding and maintaining good hygiene,” he said.
He said that mothers are sensitised during weekly clinic visits on the importance of feeding their children with balanced diet and on hygiene.
Lamenting about the shortage of staff, he revealed that every week, 25 to 30 new children are registered for the Outpatient Therapeutic Programme (OTP) and most of them are from the neighbouring Bauchi and Yobe states.
“We have only three staff, we need more for effective and efficient services. Most of our patients are from the neighbouring Bauchi and Yobe states,” he said.
He also appealed to government to provide logistics for transporting the RUTF from the local government headquarter to the healthcare centres and also make provision for the routine drugs, noting that most of the women that visit the center are poor and asking them for money for the drugs adds to their pains.
While narrating her experience Hauwa, a 19 years old mother who hails from Darazo local government area in Bauchi State, said when she took her 12-months-old daughter, Hafsat to a hospital in Darazo, a health worker noticed her troubling symptoms and urged her to take her to seek treatment for malnutrition.
Hafsat was registered into an intensive therapeutic treatment programme, during which she ate ready to use RUTF and she was monitored by the nutrition center staff. After four weeks, she had improved dramatically gaining weight.
Hauwa who said she traveled a distance of over 150 kilometers weekly in order to access the treatment appealed to government to establish more of the centres in rural communities, noting that travelling such a long distance and paying much on transportation to access free treatment expose them to risk and adds more to their pains.
She said that, through the programme’s nutrition education sessions, she had gained very useful knowledge about how to provide an adequate and balanced diet for her children, which she will put in practice.
She also said she will actively share that knowledge with other community members, as she had seen the benefits first hand. “These programmes should continue, there are many children that needs these services,” she said.
It is in consideration of the significance of funding malnutrition programme that many advocacy groups are working tirelessly on ways to address the challenges. For example, Save the Children, a charity organisation working in the state since 2012 on the development of children, specifically on health and social welfare issues.
Altine Lewi, Gombe office field manager, said over the years the organisation has setup systems in ensuring there is provision for nutrition intervention activities in the state, unfortunately getting the funds release to implement the activities is the biggest challenge.
She said while the commitment being made by government in fighting malnutrition is noted through technical support, there is urgent need for increased financial commitment from the government and other stakeholders.
Altine who said though there was an increase on budget allocation concerning nutrition programmes, the non-release of the funds is worrisome, noting that malnutrition is a serious problem and there is need for all stakeholders to show adequate commitment to bring desired impact.
“We have held series of advocacy meetings with the state assembly, Ministry of Health, Ministry for Economic Planning, Ministry for Local Government Affairs and all other government agencies linked with nutrition intervention and they assured us that they will do their best to see that funds are release.”
As 2017 is gradually coming to an end, the big question on the lips of major stakeholders is, will these promises be translated into reality or it will end up as an empty government promises and pronouncements.