In response to high levels of malnutrition and food insecurity, the Government in Yemen has brought the agriculture, food security and social protection sectors together to implement a long term integrated and multi-sectoral action plan for combating malnutrition.
SUN Yemen country team Dr. Mutahar Al-Abassi Vice Minister – National Coordinator for SUN-Yemen
Mr. Abdullah Al-Shatter Deputy Minister-Assistant National Coordinator for SUN-Yemen
The Ministry of Planning and International Cooperation in Yemen has led the development of an integrated multi-sectoral response plan for nutrition by engaging all relevant sectors and stakeholders including agriculture and fisheries, and development partners. Together with a team of consultants, a causal analysis has been undertaken to identify the key determinants of child malnutrition, to complete a trajectory analysis, to set
priorities for interventions and to cost a five year (2015-2019) multi-sectoral action plan (USD 1.2 billion).
What is the scale of the problem in Yemen?
- Chronic malnutrition rates are amongst the highest in the world 47%
- Very few women breastfeed their children (exclusive breastfeeding rates are extremely low) 11.6%
- Yemeni children often have a diet low in nutrients in the first years of life (low dietary diversity)
- Undernutrition contributes to 34% of child deaths in Yemen
- Food insecurity is the highest in the Middle East and extremely high when compared to the overall size of the economy
Developing and costing a multi-sectoral action plan
Child under-nutrition is pervasive and persistent in Yemen with 47% of children chronically undernourished (stunted) and 13% of children affected by acute malnourishment (wasting). The Global Hunger Index 2009 ranks Yemen 74 out of 84 countries analysed (up from 80 out of 88 countries in 2008), with a score of 27 out of 100 (down from 29.8 in 2008), indicating an ‘alarming’ stage of food insecurity. While other countries in the Middle East and North Africa have seen a significant improvement in ranking, Yemen’s score has not changed
significantly between 1990 and 2009 . Numerous factors have been identified as contributing to the poor state of food security in Yemen, including lack of income to access food, and inadequate national safety nets. The latest estimates indicate that prior to the political crisis in 2011 levels of poverty have risen from 42% of the population in 2009 to 54.5% in 2012.
About 41% of the Yemeni population are food insecure, though there are no marked differences in malnutrition
levels amongst food secure and insecure families, Food insecurity, however, is not the only reason for high rates of malnutrition among vulnerable population groups in Yemen. In Yemen there are no significant differences in malnutrition rates (stunting and wasting) among food secure and food insecure populations (CFSS 2014). Rather, malnutrition is the result of a multi-dimensional and complex interplay of immediate, underlying and basic causes.
Considering the severity of the nutrition situation, development partners and the government in Yemen have been intensely engaged in developing a long term integrated multi-sectoral action plan for combating under-nutrition. The Ministry of Planning and International Cooperation (MoPIC) has led the process for developing this plan by engaging all relevant sectors and stakeholders.
The Yemen country SUN team has engaged with a team of international consultants from Maximising the Quality of SUN (MQSUN) to undertake a causal analysis to identify the key determinants of child under nutrition, conduct a trajectory analysis, set priorities for interventions and cost a five year (2015-2019) multisectoral action plan totaling US$ 1.2 billion.
Common planning and results
MoPIC has worked closely with the SUN Movement Secretariat to finalise the multi-sectoral plan. A team
of international consultants from MQSUN has been engaged to assist the Yemen SUN team to finalise the
planning documents through specific areas of support i.e. causal analysis, identification of key determinants
of malnutrition that influence child nutritional prevalence trajectory analysis, draft intervention impact
projection, priority interventions and costing of these interventions.
The planning and development of the common results framework were guided by the findings of the causal analysis which highlight the key food security related determinants that influence child nutrition. These
include minimum dietary diversity among children – particularly non-staples and products of animal origin,
household consumption of iodized salt, livestock ownership, indebtedness, etc. Low dietary diversity
combined with poor care and feeding practices contribute to the high prevalence of non-linear growth and stunting rates found in Yemen. The comprehensive food security survey of 2014 found that only 12.4% of children under two consume an adequately diverse diet. The regression analysis showed that children who consumed at least 4 of the 7 food groups had a lower risk of wasting.
Based on the causality analysis, key intervention areas were identified through a technical consultation in
Amman on 19-20 March, 2014. The purpose of the meeting was to create awareness and buy-in of the relevant sector for the sectoral interventions (health, agriculture, water, education, fisheries) for an integrated national nutrition approach. The intervention packages identified include both nutrition-specific and nutrition-sensitive activities. During the planning process a consensus was developed among the sectors and stakeholders that the plan should focus on large-scale programmes related to nutrition-specific interventions, in addition to diversification of agriculture products, improved food availability and utilisation, improvement of water and sanitation services, increased production and availability of fisheries products that have an indirect but substantial impact on child under-nutrition.
Participating sectors were engaged in building consensus on the Common Results Framework for nutrition. This entails agreeing on an intervention package based on causal analysis and agreed common results; articulation of a nutrition focus on the respective sector such as ‘nutrition gardening’ instead of ‘home gardening; identification of nutritional objectives through reflection on availability, access and utilisation of means and services; and identification of key target groups i.e. women and children under five and priority geographical areas and timeframe covering the period of 2015-2019. All sectors were engaged in preparing a costed national nutrition multi-sectoral plan.
The agriculture and fisheries sectors worked closely with the High Council for Food Security Group which was
established in 2013. The priority areas for the National Food Security Strategy and Multi-Sectoral Nutrition
Action Plan were aligned in order to address the prevailing under-nutrition of the most vulnerable groups.
What are the key investment priorities and considerations to addressing malnutrition in Yemen?
- Ensure dietary adequacy and diversity
- Improve maternal and child health services
- Improve coverage and access to adequate water and sanitation services
- Education opportunities for girls the overall size of the economy
Identifying common target areas
The agriculture, food security and social protection sectors have agreed on the principle of programmatic and geographic convergence in that all sectors will work together in 145 out of a total of 333 districts with a high burden of under-nutrition, which contributes to 75% of the total national burden of under-nutrition. Within these 145 districts, each sector came up with a number of common target districts using their sector specific criteria which include food security, water and sanitation services availability, poverty, school enrolment, in addition to high stunting (over 40%) and wasting (over 10%) rates.
Both the agriculture and fisheries sectors have a key role to play in ensuring a supply of nutritious foods
while also increasing awareness about locally available nutrient dense foods. Nationally there is significant
dependency on imported food stuffs. Production of fruit and vegetables, which can provide vitamins and minerals, is often replaced by oat production, while the fisheries sector focuses mainly on the external
market rather than the domestic market. Twenty-four costal districts with the highest stunting prevalence
out of the 145 targeted districts were selected for improvement in the fisheries sector.
Specific interventions include increasing production and storage of sea food, promotion of sea food as part of dietary diversity, increasing income generation activities by provision of small loans to fishermen families.
In Yemen under-nutrition affects people across the wealth spectrum. While not explicitly highlighted in this national framework it is anticipated that existing national systems will be strengthened to address the
underlying and basic causes of under-nutrition, in particular the Social Welfare Fund (SWF), the Social Fund for Development (SFD). The social welfare fund supports the most vulnerable in the Yemen population with a money transfers every three months. The social fund for development works closely with the World Bank providing direct technical and financial support to various ministries. The MoPIC, World Bank and SWF are discussing the possibility of including nutritionspecific criteria into the 1.5 million targeted population unconditional cash transfers programme which would help to address the nutritional needs of the vulnerable population.
Addressing the challenges
The SUN Yemen team faced some challenges in the beginning of the process. It took time to build consensus on planning for common results, alignment with the newly emerging political situation and new Government, and capacity constraints in coordination and multi-sectoral planning. These challenges were addressed with the help of United Nations partners and the SUN Movement Secretariat.
As Yemen moves towards implementation, transforming these planning documents into action will be the real challenge especially implementing the nutrition-sensitive interventions. In the current situation mobilizing financial resources for this plan will be a huge challenge for the Government and the SUN Donor Network.
Case Study Bibliography
- 2009 Global Hunger Index. The Challenge of Hunger: Focus on Financial Crisis and Gender inequality. IFPRI Brief 62 November 2009
- http://www.worldbank.org/en/country/yemen/ overview
- Comprehensive Food Security Survey for Yemen 2014 United Nations World Food Programme (WFP) and the United Nations Children’s Fund (UNICEF)
- MQSUN (Maximising the Quality of SUN) is a consortium of leading organisations working on nutrition funded by the UK Government Department For International Development (DFID). The project aims to provide DFID with technical services to improve the quality of nutrition-specific and nutrition-sensitive programmes. The group are committed to providing services in:
- expanding the evidence base on the causes of under-nutrition
- enhancing skills and capacity to support scaling up of nutrition-specific and nutrition-sensitive programmes
- providing the best guidance available to support programme design, implementation, monitoring and evaluation
- increasing innovation in nutrition programmes
- knowledge sharing to ensure that lessons are learned across DFID and beyond
- Qat is a mild narcotic plant that releases a stimulant when chewed. Qat cultivation in Yemen is increasing by around 12% each year, according to Yemen’s Ministry of Agriculture and Water Resources, and displacing the production of other crops such as fruit, vegetables, and coffee. http://www.foreignaffairs.com/ articles/139596/adam-heffez/how-yemen-cheweditself-dry
- The regression analysis which was performed by MQSUN was a very important step in the process of preparing the national framework document. Understanding the key drivers of malnutrition in the Yemen context was very helpful in bringing in the country team towards a collective understanding as to the underlying
causes of malnutrition and most importantly the subsequent response to malnutrition
- The regression analysis also presented some counterintuitive findings which required the country team to sit and explore some of the contextual issues and practices which are particular to the Yemen context. This exercise was particularly useful in understanding the role of adolescent girls as caregivers in the home and as a result the potential impact of schooling on nutrition indicators at household level
- Through the process of the regression analysis, the costing process and the trajectory analysis, the various sectors and ministries now have a much better grasp of what it means to include nutrition objectives in the planning of interventions which do not necessarily have a nutrition objective.