I just returned from a visit to our Kenya partners. Kenya was one of the Global Nutrition Report’s (GNR) star performers in 2017 in terms of stunting reduction – with levels nationally of 26%. But the rates vary wildly by the 47 counties: Kitui and West Pokot are both above 45% and Kilifi and Mandera are in the high 30’s (see the 2014 Kenya Demographic and Health Survey, p. 162).
At the same time, Kenya is experiencing an upsurge in overweight, obesity and other risk factors for diet-related non-communicable diseases (NCDs). The country is in full “double burden” mode with undernutrition and other manifestations of malnutrition such as obesity and diabetes running in parallel, often in the same communities or families.
In this context, a focus on improving diets makes sense because it is core to preventing all forms of malnutrition. Improving the consumption of nutritious safe food is the ultimate “double duty” action—one that addresses undernutrition as well as the diet related NCDs.
What is driving the phenomenon of the double burden? The usual suspects–urbanisation, income growth, increasing availability and glorification of cheap junk food– are probably to blame. We have to guess, because the last nationally representative individual food intake survey was conducted in 1994 (although this 2016 WFP survey of diet diversity via food frequency is very useful).
Are there causes for optimism that Kenya can counter this double burden? Yes, several.
First, the central government is just about to elevate nutrition to the Presidential level through the new National Food and Nutrition Security Policy Implementation Framework, which has been signed by all 47 County Governors. This is excellent because we know that attention and leadership from the very top of government pushes nutrition up the political and development agenda, with results in terms of funding, staffing and awareness across society.
Second, one of President Kenyatta’s 4 big priorities for his new term is Food Security and Nutrition. On closer inspection of the speech I find reference to diversifying production, improving water for agriculture and improving vegetable, fruits and fish production, and generating jobs. Coupled with commitments on universal health care and to improving the enabling environment for businesses to provide jobs for young people, this sounds promising. And it is really needed: a recent Save the Children Cost of Diet study in Turkana county found that the cost of a nutritious diet was 10 times the monthly cash transfer funded by the Government with help from DFID (and the highest cost was for adolescents due to their higher nutrient requirements). Now we look for government policies, legislation, tariffs, taxes and spending that support these promising goals.
Third, the Kenyan nutrition community, admittedly from my limited interactions, seems committed and coherent. I met senior government representatives including the Principal Secretary, Ministry of Health, Mr. Julius Korir, Dr. Peter Cherutich, the Director of Preventive and Promotive Health Services and Ms. Gladys Mugambi Head of Nutrition and Dietetics and Scaling Up Nutrition (SUN) Focal Point, as well as representatives of the UN community, researchers from CIAT, development partners, and business leaders. It was encouraging that everyone in the nutrition sector is so alert to the ravages of climate change and the uncertainty it generates in food production and consumption.
From a GAIN perspective our dynamic new Country Director Leah Kaguara is leading a short, sharp country strategy development process. GAIN works to improve the consumption of nutritious safe food required for healthier diets. So naturally a key strategic question we will have to answer is “should we work with partners in the most deprived areas where there are few businesses to bring together with government, and few markets to shape?” This is an important question and one that, at least for me, does not have an easy answer. Why?
First, do the counties with the highest prevalence of stunting actually have the largest number of stunted children? The counties where the largest number of stunted children are located may not be the most remote or deprived counties (see Andy Sumner’s work on the location of poverty): it is possible that these areas may have fairly well developed markets with availability of healthy foods better than others.
Second, just because markets are thin in some areas, does that mean they cannot be developed? For example, if a stronger cold chain is developed (such as through our PLAN programme) in order to reduce food price volatility by improving food storage, can that bring small and medium sized companies into the value chain?
Third, are we assuming that small enterprises are not present in poor and remote areas? Our experience with the Marketplace for Nutritious Foods suggests otherwise. (And let’s not forget that farmers are businesses.)
Fourth, county governments employ many people, and the workplace programmes we run with businesses could be adapted to public sector employment. Does the Ministry of Health, for example, make it easy for its employees to eat nutritious and safe food?
Finally, even in areas where humanitarian work is the main activity, small businesses can be crowded in, witness the World Food Programme’s programme for Syrian refugees which uses blockchain technology and vouchers to be redeemed with participating small vendors.
You can tell what my prior views are, but my colleagues and I will keep an open mind. Nevertheless, what is clear, even from my short trip, is that there are “many Kenyas” in terms of nutrition outcomes, governance, identity, capacity and programme coverage. Understanding context is always a vital principle, and in Kenya it is no exception.
There are green shoots everywhere, but we need to be under no illusions that tackling this double burden of malnutrition in Kenya will require a massive collective effort – by government, citizens, health professionals, businesses, and donors – to turn around. While Kenya is on track to meet global World Health Assembly targets – for under 5 stunting, wasting, overweight, and exclusive breastfeeding – for other critical indicators such as women’s anemia, adult obesity and adult diabetes it is off course (see the 2017 Kenya country profile from the Global Nutrition report).
Improving the quality of diet is a no-regrets “double duty” action to reduce malnutrition in all these forms. So we need to get behind the President’s commitment to improve food security and nutrition—and to hold the government, and other stakeholders, accountable for progress towards meeting that commitment.