Nutrition at the Centre
Zambia: Situation Analysis
Dr. Phoebe A Bwembya
Helen Chirwa
August, 2013
Zambia: Social – Economic status of Eastern province
Contents
1.0 General Background
2.0 Eastern Province
2.1 Crop Marketing
3.0 Initiatives addressing nutrition
3.1 Background to the SUN Campaign
3.2 Current gglobal focus for the SUN
3.3 Zambia’s response to the Sun Campaign
3.4 Donor support to the SUN Campaign
3.4 Donor Support to Nutrition
3.5 Challenges to addressing nutrition in Zambia
4.0 WASH Activities
4.1 CARE‘s involvement in the SPLASH Project
4.2 UNICEF initiatives in water and sanitation
4.3 Donor support to WASHE
5.0 Food Security and Agriculture
5.1 CARE’s involvement
5.2 Donor support to the Agriculture Sector
5.3 Nutrition, food security, agriculture and WASH
6.0 Challenges in the delivery of services
7.0 Structures for service delivery
8.0 Health Services in target districts
9.0 Key Literature for reference
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1.0 General Background
Zambia with a total land area of 75 million hectares (752,000 square Km) has a population of 13 million people (CSO, 2010). Fifty-eight per cent (42 million hectares) of the land has medium to high potential for agricultural production. Rainfall ranges between 800mm to 1400mm per annum. It is estimated that 14% of total agricultural land is currently being utilized. The country is divided into three major agro-ecological regions: Regions I, II and III. Zambia has potential to expand agricultural production given the vast resource endowment (land, labour and water) that the country possesses.
2.0 Eastern Province
This report focuses on the target area selected for the project. This area is located in the Eastern Province of Zambia; and lies in Region II, agriculture zone. The Region receives between 800 to 1000mm of annual rainfall. It is sub-divided into Region IIa and IIb. Region IIa also covers the Central, Lusaka, Southern and Eastern fertile plateaux of the country. Crops grown in this Region include Maize, Cotton, Tobacco, Sunflower, Soya beans, irrigated Wheat, Groundnuts and other minor arable crops. Region IIa is also suitable for flowers, Paprika and vegetable production. Region IIb consists of sandy soils, commonly found in Western province. This region is suitable for production of cashew nut, rice, cassava, millet, vegetables and timber. It is also suitable for beef, dairy and poultry production. Almost all rural communities in Zambia rely on agriculture for their livelihood. However, the actual percentage of people depending on agriculture in the selected districts and the average land holding per household will need to be determined by CARE during the field survey. (The 2011 rapid assessment is attached).
The 2011 rapid assessment conducted in Eastern Province by CARE identified maize, rice, cotton, sunflower and groundnuts as the majorand soy beans as the minor crops produced by households. Rice is extensively grown in three districts (Lundazi, Mambwe and Chama) of Eastern Province.
2.1 Crop Marketing
Maize: The marketing of maize grain is mainly through the Food Reserve Agency (FRA) of the Ministry of Agriculture and Livestock (MAL) and to a lesser extent by informal traders. Informal traders usually participate early in the maize market; and generally offer farmers a lower price than FRA (about ZMK 30 compared to ZMK 65 per 50kg bag). In comparison, the FRA enters the maize market season late and also delays in paying for their crop. This disadvantages rural households, as they are most of the year pressed for cash for household needs, including money for school going children, health services, and purchasing agriculture inputs. Marketing of maize is also hampered by the poor road infrastructure, which contributes to high transportation costs. At the regional level, the government supported price of about US$300/ton is higher than the maize price in many Southern African countries.
Cotton: Itis widely grown mainly by small scale farmers in the province. Several cotton companies such as BEECHARD, Cargil, Dunavant, Olarm, Eustina and Chipata Cotton offer smallholder farmers inputs, extension support, transport for the produce, and a market for their cotton. Payments are immediate, allowing farmers to meet pressing needs, such as educational fees for school going children. However, farmers complain of poor prices set by private companies (pegged at ZK2.00/kg for 2013). As many farmers produce about 400kg per year (from one hectare), the produce only brings into the household a meager gross income of ZK810.
Sunflower and groundnuts (oil crops): Many households do not grow adequate quantities of these crops to profitably enter the market. Sunflower provides an opportunity for value addition through local extraction of oil and byproducts such as sunflower cake. Sun flower cake is yet to be adopted for livestock supplementary feeding in local communities. It is important to identify barriers that prevent communities from using the sunflower cake. Local people may be trained on how the cake can be utilized within the community. However, women through informal trading do export the cake to Lusaka and other Copper-belt towns. Formal markets for groundnuts are limited and production trends show a steady decline with regard to land area for the crop. Use of groundnuts for IYCF is commonly practiced at community level. Production of commercial products containing groundnuts requires further research to remove the afflotoxins generally associated with local nuts.
Livestock: There are no formal livestock markets in the selected area. Small scale producers heavily rely on informal community markets. Some households raise small livestock such as chickens and goats. Chicken are consumed but eggs are left to hatch to increase numbers. Chickens provide a ready source of income in rural areas, as they can easily be sold to cater for household needs, such as soap, salt or transport to get to nearby centres for services. A market for milk exists in nearby town centres. It may be necessary to conduct a mini-survey to determine the percentage of households raising livestock. Empowering rural communities through promotion of small livestock is an area that can be explored by CARE.
Horticulture: Horticultural crops are sold locally in the community and in the nearby districts. In Mambwe, vegetables have a potential market at local lodges within the district. Producers of horticultural crops depend on community and nearby district town marketsfor selling their produce. Generally, all households produce local vegetables such as pumpkin (leaves), bean (leaves) and okra for home consumption. Some families grow other vegetables such as onion, cabbage, spinach, and carrots in dambos. These vegetables may be consumed at home or sold to nearby communities. Depending on availability of water for home gardens, it may be possible to encourage production and consumption of vegetables rich in iron (e.g. spinach), Vitamin A (e.g. yellow sweet potatoes and carrots).Type of crops to promote can be identified during the field survey. The field survey will also inform the type of nutrition education for the specific communities.
Rice: Locally, COMACO, government workers, Roman Catholic Church, private businessmen (exchange second hand clothes – “salaula” for local produce) are the main participants in the rice market.
Soyabeans: Some household produce soya beans. If properly processed, soya beans could be used as the main component in the production of a local product for complementary or supplementary feeding.
Cotton: Cotton has a strong out-grower scheme in Eastern Province. Farmers organized as cooperatives or farmer associations engage in cotton farming. Many of the cotton farmers have poor marketing skills.
Credit: Formal savings and credit schemes do not exist in the local communities. Loan shark schemes (locally known as Kaloba), charge high interest rates, as much as 100% per short period of one month. Legal loan facilities or credit schemes in local communities is an area requiring attention to enhance community productivity and welfare.
Population statistics: If more than one district will be targeted, create a separate column for each district. If data are not available from census, refer to MOH/MOA/MOE data. If our unit of intervention is sub district – then we might also want to look for sub district total population and extrapolate the rest of the data from the district data.
Table 1: Population statistics for the selected project districts
District / Population / % Under 18 / Under-5 stunting / Pop growth rate / % women / Population DensityChipata / 452,428 / 54.7 / 53.6 / 2.1 / 50.9 / 67.6
Lundazi / 314,281 / 55.9 / 56.9 / 2.9 / 51.4 / 22.4
Chadiza / 107327 / 58.3) / No data / 2.5 / 50.2 / 41.7
Sources: Central Statistics Office 2010 Census of Population and Housing, NNSS 2009.
Table 2: Some statistics on women aged 15-49 years and children below 24 months in the selected project districts
National Data / Data Source with Year / Target Area Data (usually district level) / Data Source with YearTotal population / 13.2 million / CSO 2012 / 107,327 Chadiza / CSO-2012
Population of women of reproductive age
(a) 15-49 years expressed as a % of total population / 6.2% / CSO, MoH, TDRC, UNZA and Macro Inc (2009) Zambia Demographic and Health Survey, 2007.
Population of children under 24 mos.
And also expressed as a % of total population / 6 % / Census 2010
% of Rural Population / 47 % / Census 2010
% of population classified as “marginalized”, if any / Generally, there are no marginalized populations in Zambia. Classification is by socio-economic status.
% of population below poverty line -“poor”. Use MGD definition*. / Sixty percent of the population lives below the poverty line and 42% are considered to be in extreme poverty. /
Women’s literacy overall
-For lowest poverty quintile
-For rural areas / Only 3% women have completed secondary level education / Eastern province has 31% of women who are un education / UNICEF
DHS
Education levels
Location / No education % / Primary % / Completed Primary % / Some secondary % / Completed %
Urban / 55 / 37.8 / 13.5 / 25.0 / 6.6
Rural / 20 / 52.1 / 11.6 / 7.7 / 0.8
Education: Quintiles
Highest / 5.9 / 31.9 / 11.8 / 27.9 / 9.5
Lowest / 29.4 / 55.8 / 9.8 / 4.1 / 0.3
*The MGD definition is “living on less than $1.25 per day”.
3.0 Initiatives addressing nutrition
National Initiatives or Programs Addressing Nutrition Using short paragraphs, please, describe the current momentum in the country to address nutrition. Include major government programs (and how well they are working, their coverage), coalitions or networks of coordination (and CARE’s involvement), donors who are supporting efforts in nutrition, etc.
3.1 Background to the SUN Campaign
Two years ago, the United Nations General Assembly under the Scaling Up of Nutrition (SUN) has recommended implementing 13 high impact interventions as an important step to reducing malnutrition. These are: (1) exclusive breastfeeding for the first six months, (2) complementary feeding starting at six months, (3) vitamin A supplementation, (4) hygiene, (5) zinc supplementation, (6) multi‐micronutrient fortification, (7) de‐worming, (8) iron supplementation, (9) iodized oil utilization, (10) salt iodization, (11) staple fortification, (12) prevention and treatment of moderate under‐nutrition, and (13) treatment of severe under‐nutrition without complications with RUTFs (United Nations General Assembly, 2011). These interventions have been recommended based on evidence from studies that demonstrated the positive results in addressing under‐nutrition. Through published evidence in the Lancet series, these interventions are also endorsed as being important for maternal and child survival (Bhutta et al, 2008).
3.2 Current gglobal focus for the SUN
Recently, there is has been more focus promoting ten interventions:(1) Peri-conceptual folic acid; (2) maternal balanced energy protein supplementation; (3) maternal calcium supplementation; (4) multiple micronutrient supplementation in pregnancy; (5) promotion of breastfeeding; (6) appropriate complementary feeding; (7) vitamin A administration (6 – 59 months); (8) zinc supplementation in children aged 6–59 months; (9) management of severe acute malnutrition (SAM); and (10) management of moderate acute malnutrition(The Lancet, Executive Summary, June, 2013). Current proposed interventions heavily support supplementation, offer limited support for sustainable development, and does not take into consideration promotion of nutrition practices within context.
3.3 Zambia’s response to the Sun Campaign
Zambia has acknowledged the high malnutrition rates in the country and has signed to the campaign for scaling up nutrition SUN) interventions. A number of documents focusing on the problem have been prepared, e.g.
(1)The Food and Nutrition Policy outlines specific areas of attention for nutrition programs (MOH, 2006).
(2)The NFNC has prepared a multi-sectoral National Food and Nutrition Strategic Plan for 2011-2015, which outlines strategic areas for addressing malnutrition. The Plan outlines 11 strategic areas, of which eight are key and the first one focuses on the First 1000 Days programme for scaling up nutrition (SUN). The plan also outlines key interventions to be implemented in line with the SUN campaign and in keeping with national frameworks, such as National Development Plans and Vision 2030. Please note the 10 interventions do not address under nutrition within the Zambian context. The current focus is to localize the interventions in line with national plans and aspirations.
(3)The Vice President represented Zambia in London on June 8, 2013, during the G8 summit. This is an important step that shows leadership in addressing malnutrition in the country.
(4)During the G8, Zambia through the Vice President reaffirmed its commitment to reducing malnutrition by pledging additional funding of 20% towards nutrition and $30 per child.
(5)A number of bilateral and multilateral donors are also interested in supporting the reduction of malnutrition in Zambia. Already, DFID, Irish AID and SIDA have demonstrated their commitment through financial support to the First 1000 Days Programme.
(6)USAID project (ZAMNACS) recently launched in Eastern province is supporting the supplementation of HIV positive individuals in selected communities. It is not yet clear if activities of this project will be extended to Lundazi and Chadiza (selected sites for this project).
In localizing the SUN interventions, Zambia has selected 14 districts in which to scale up nutrition activities. Lundazi is one of the two districts in Eastern Province where SUN activities will be implemented.
3.4 Donor support to the SUN Campaign
DFID, Irish AID and SIDA are providing funds for three years to a consortium (CARE international, Concern International, and Nutrition Association of Zambia) to support the SUN activities in Zambia. Care International as the lead agency will play a key role in the managements of the funds as well as supporting the government to implements SUN activities in 14 selected districts with the highest stunting levels in the country. (The SUN Proposal is attached)
Infant and Young Child Feeding: IYCF is one of the strategies being applied in order to reduce stunting in Zambia. The national Food and Nutrition Commission (NFNC) provides leadership for IYCF in the country. The MOH and partners such as Zambia Systems Strengthening Integrated Programme (ZISSP) and the Breast Feeding Association of Zambia (BAZ) train IYCF volunteers, including mother support groups. Trained volunteers support care givers in communities. Intensified IYCF promotion has contributed to achieving 62 % exclusive breastfeeding for the first six months. There are no IYCF activities in Eastern Province. IYCF is an activity that CARE may support in the selected districts.
UNICEF in partnership with government has been implementing Community Management of Acute Malnutrition (CMAM) in selected districts of the Eastern Province. CMAM activities are not present in the selected project districts. Limited availability of locally produced products or commercial complementary feeds has hampered expanding implementation of CMAM to more communities that require support.
Children’s Clinic: The Government of Zambia through the Ministry of Health promotes routine children’s clinic visits to ensure children receive health and growth checks and are fully immunized. The government also supports the child health week (CHW), a bi-annual event conducted in all health facilities to intensify provision of services such as Vitamin A supplementation, de-worming, iron supplementation and growth monitoring and promotion (GMP). CHW also provides an opportunity for retreating mosquito nets. Problems associated with child health week include high numbers of clients turning up for services leading to staff being overwhelmed; logistical challenges to ensure that the right supplies timely reach the specific facility, and delays in reporting data on services. UNICEF and the government usually provide the financial and logistical support for the CHW.
The School Feeding Programme: Also referred to as Food for Education provides meals for school children while they are at school. Food for Education is an umbrella term encompassing several activities that use food as a resource to promote education. The objectives of the programme are to increase enrolment, reduce dropouts and stabilize attendance, improve attention span and learning capacity, and stimulate parents’ participation in education of their children. Food insecure locations are targeted to improve attendance and other school indicators (GRZ/WFP 2007-2010 Programme Document). In Zambia, the programme targeted 18 drought-stricken districts, with high food-insecurity, high percentage of out of school children and low educational indicators (Vulnerability Assessment Committee Report of 2002).
The Government, with assistance from WFP has been implementing the School Feeding Programme since 2003. The food basket provided by the WFP to support SFP comprises High Energy Protein Supplement (HEPS), fortified with micronutrients and sugar. The ration per child is 100 grams of HEPS and 10 grams of oil per learning day. The ration is prepared into porridge and served to children by parents at school. Partners of WFP include UNICEF, MOH, MCDSS, Donors, NGOs, community members and PTAs.
3.4 Donor Support to Nutrition
What support is the government receiving from major international entities such as WHO, UNICEF, World Bank, USAID, DFID, etc? What nutrition (including IYCF, maternal nutrition, PMTCT), maternal or child health, or related activities are they supporting? What are the gaps in funding or technical support?
DFID: DFID supports the Republic of Zambia in keeping with the country’s national development plans and United Kingdom priorities focusing on poverty reduction, wealth creation, governance, female empowerment, reproductive, maternal and new-born health, human resource capacity building, health and nutrition. DFID is the major donor for the SUN fund in Zambia. Opportunities for supporting nutrition by DFID in Zambia exist through: