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Dear Nigerian twitterati, I feel compelled to contribute to the intense debate concerning the value or stupidity of the Nigerian Home Grown School Feeding Program. I hope to lay out what I do know, based on some of the best available evidence.
There are fundamental concerns I cannot address. For example, I may not be able to convince you if you already believe that social welfare programs are evil or stupid. Also, If your preferred positions are guided by your politics, I may not also be able to help. That said . . .
We know from nationally representative surveys that more than 20% of Nigerian children are malnourished. In the Northeast and Northwest, the prevalence is as high as 50%. bit.ly/2qoldY6
Children under 5years old are most affected by malnutrition. Affected children are much thinner than they should be, or much shorter, or both. The complications of malnutrition are lifelong!
In particular, children who live close to settlements where Boko Haram has struck in the past 5 yrs have a substantially increased risk of being acutely malnourished. bit.ly/2CUG10I
Malnutrition among children leads to increased risk of severe infections, hospitalization and death. bit.ly/2P1AiNT
Malnutrition underlies between 77% and 100% of cases of diarrhea, lower respiratory tract infections, measles - major killers of children <5.
Children who live beyond 5yrs also face consequences of malnutrition. Cognitive development is impaired. The kids go to school and can’t concentrate, can't learn as well as they should. bit.ly/2PA8Jeb
There are also consequences into adulthood. For instance, working memory may be poor. The impact persists till middle age! This is one of the reasons children from poor households fail to keep up with their peers into adulthood, on average. bit.ly/2ESPRTm
School-feeding programs are a means to augment the dietary intake of vulnerable children. They offer a way to address some of the effects of malnutrition children may have suffered, and help prevent new malnutrition.
School feeding programs consistently lead to increased intake of calories and vitamins among children. Essentially, they do what they're meant they do. #Effective
School feeding programs also lead to increased enrollment and attendance in school. bit.ly/2RnhEN6
Studies in Jamaica also show that kids who benefit from school feeding programs also do better in school, overall. They perform better in Math and their verbal fluency improves! bit.ly/2RnhEN6 AND bit.ly/2EVS4h9
Targeting school children is great because 1) they're reachable while in school, 2) there is an opportunity to correct chronic and recent malnutrition, 3) the school systems benefit too - school attendance improves, children can get more out of school bit.ly/2JuIOPD
One major concern is this: The studies found small average effects - the kids attended school 5 - 6 days more if they were enrolled, gained only about 1kg per year. This likely depends on the individual child's weight before school feeding commenced.
The greatest gains were in Maths scores - which became much much better. Over millions of kids, however, these small effects mean A LOT! bit.ly/2EQqykW
The ideal beneficiaries of a school nutrition program are kids around the country who are at risk of being malnourished, or who are mildly malnourished. Kids with moderate or severe malnutrition must be cared for by health workers.
Why not feed kids with mild malnutrition only? To do this, we would have to hire nurses, station them at schools and have them examine every pupil, conduct regular measurements to determine the child’s nutritional status. Possible, but fraught with its own challenges!
If we select a few kids and then provide them with food, we may or may not cut costs. We may however expose the vulnerable kids to stigma from their peers. Instead, feeding all children in low income areas will ensure that as many less-privileged kids as possible are reached.
I should also mention that the homegrown school nutrition program (@NHGSFP) is one of several promoted @NEPAD_Agency & @_AfricanUnion are promoting among member countries - to eradicate hunger in Africa.
The World Food Program (@WFP) has also been at the forefront of funding and implementing school feeding programs.
How can we evaluate the school-feeding program, even if the FG didn't provide for it? We can use data from the multiple rounds of national surveys conducted every 5 years, compare intervention localities with others, and make sense of the impact of the program.
So, we will know (with some uncertainty) if this works in a few years!
In 2005, @WFP spent about $63 per child per year in some of the African countries it's had school feeding program bit.ly/2PxDpfZ. Nigeria is spending ~$57 per child per day or less ($0.19 per child * 300 days).
My hunch is that the program can be delivered more cheaply. Using program data, it should be possible to determine whether there is waste in the system and where.
Why not improve the economy, fix income inequality, eradicate poverty? These are excellent questions that demand concerted effort from the government. The potential complications of childhood malnutrition are long-term, perpetuating adverse consequences throughout adulthood.
Why not improve primary healthcare with this money? This one is really difficult to argue against because PHC is fundamental. A good school health program is one of the features of a solid primary healthcare, and school nutrition is one of the arms of school health.
Why not improve the quality of education? The need to improve the quality of education is also critical. School feeding program is a health and nutrition program with educational benefits.
We also need to improve gender equity, ensure access to clean potable water, and keep our environment clean. sciencedirect.com/science/articl…
My point is that we should do all we can to improve primary healthcare, improve the quality of education, as well as prevent childhood malnutrition. Not this or that. All! This should be our demand!
Is the diet appropriate for addressing malnutrition? When you’re dealing with kids that are not getting sufficient calories, or who are getting their calories solely from high energy carbohydrates, fruits, veggies, legumes, especially are helpful additions!
Food is of good quality if it includes a large number of food groups. The greatest benefits Nigerian kids can derive from the school feeding program is to increase their access to healthy calories and diversify the food groups they eat.
More fruits, more vegggies, unprocessed tubers, dairy, fish, meat, for eg.
I cannot speak to the exact content of the meals beyond what I have seen in photos. It is very likely that the meals are more nutritious than what kids from most low-income households are otherwise exposed to.
One cannot also rule out unscrupulous elements who do not adhere to the program's guidelines.
Aside from the children who immediately benefit, the program creates a local value chain in small villages and towns across the country. Local contractors including men and women hired on farms, who sell food, who cook, etc.
I do have issues with the opacity with the selection of beneficiaries - are entire schools, villages selected, on what basis? From the pictures I've seen, I do think that whichever way the kids are being selected, many appear to be the correct kids to target.
I am also concerned about lack of information about evaluation? Are we reaching the right kids? Is there a mechanism for independent stakeholders and researchers to take a critical look at what is being done?
To reiterate, we have to strengthen primary healthcare, ensure children have life-long follow-up, such that we can improve the prevention and early detection of diseases and risk factors such as malnutrition.
We also must improve the quality of education, ensure teachers are well paid regularly, and address the process deficiencies that abound in the system.
Thank you!
Error: Here I meant that Nigeria is spending ~$57 per year.
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