Nigeria: beating malnutrition in Gombe State

With a prevalence rate of 8.1% severely malnourished children, Gombe State in north-east Nigeria was just the right place to pilot the Community Management of Acute Malnutrition (CMAM) programme.

The programme was piloted in three local government areas. UNICEF provided 96% of the cost through capacity building and supply of ready-to-use, therapeutic  food, while state and local governments were expected to contribute the remaining 4% for provision of structures, manpower and supply of essential drugs.

UNICEF’s support to the programme was to last two years, thereafter, the state government was to take over the funding and expand the programme to other areas by 2011.

Did it work?

Yes it did –  for two years.

From September 2009 to November 2011, a total of 13,004 severely malnourished children were admitted to the 15 specialist centres.

Out of them 4,913 were cured and discharged, but 79 came too late for any form of intervention to be administered.

While the remaining 8,012 were still being treated, the centres ran out of therapeutic food. This was because the local and state government were not delivering on their promises, as contained in the terms of agreement.

Gombe should be a model CMAM state by now for the following reasons:

1. Staff capacity has been built to the extent that all the surrounding states implementing CMAM were trained by Gombe State staff.

2. Gombe should be the model state for CMAM in the North. But the 15 centres are only operating on skeletal services by administering therapeutic food, which is still being provided by UNICEF since total withdrawal would do more harm than good. Gombe currently has over 300,000 malnourished children. So even if the 15 centres are fully operational, it would still be inadequate.

I find it rather ironic that with glaring evidence of malnutrition in the state, the government is yet to own and commit to the programme.

To make it work, government would have to:

a. Trace the money earmarked in the 2010 budget for the scale-up of CMAM.

b. Reactivate the committee responsible for CMAM monitoring and supervision. It has been dormant for over a year.

c. Approve and release the supplementary fund needed to procure more therapeutic food in preparation for UNICEF’s withdrawal.

d. Local government areas to provide supplementary drugs as all the centres are out of stock.

And to play our part, Save the Children would:

a. Facilitate the reactivation of the CMAM committee.

b. Support the committee and nutrition officer to advocate for the purchase of therapeutic food in the 2013 budget.

c. Support the Maternal, Newborn and Child Health (MNCH) coalition to advocate to chairmen of the 11 local government areas to provide the supplementary drugs required at the centres.