The Liberia Product Access Initiative: moving towards better nutrition

Liberia faces a severe problem with childhood malnutrition. One in three children under the age of five is stunted (their mental and physical growth is limited from poor nutrition), and 6% are acutely malnourished (they have rapid and severe weight loss). Undernutrition is a major public health crisis in the country, appearing in three main forms: wasting (low weight-for-height), stunting (low height-for-age), and being underweight (low weight-for-age). Of these, wasting is the most neglected, receiving little financial support and political attention.

Liberia is facing a severe nutrition crisis, with a substantial portion of its young children experiencing malnutrition, which can lead to long-term health, cognitive, and economic consequences. 

Although there have been efforts to tackle malnutrition through the regular supply of ready-to-use therapeutic food (RUTF) for children, there has been a marked decline in the number of children receiving RUTF in recent years. On top of this, micronutrient deficiencies are widespread; 13% of young children are lacking vitamin A, which is crucial for a healthy immune system and good eyesight.

Additionally, more than half of all children under five and nearly 40% of women are anaemic, which significantly reduces productivity and quality of life.

The bleak picture of malnutrition in Liberia was exacerbated by recent events: the growing impact of climate change, the outbreak of Ebola and the Covid-19 pandemic. These challenges, compounded by the extremely limited domestic resource allocation to nutrition programmes, have led to severe economic hardships for millions of underserved population especially women and young children living in underserved communities.

To understand why fewer children were accessing wasting treatments and other essential nutrition interventions, The Power of Nutrition (TPoN), UNICEF, Irish Aid and the Ministry of Health (MoH) teamed up to implement TPoN’s unique Access Initiative programme. The programme consists of independent assessment surveys, conducted by The University of Liberia School of public health with randomly selected communities of Urban Montserrado and Grand Bassa Counties.

This September, a dissemination workshop was held in Monrovia, Liberia, bringing together the partners of the initiative to discuss the key outcomes from the surveys. The workshop focused on evaluating efforts to improve nutrition, especially among vulnerable groups like pregnant women, young children under five, and adolescent girls. This blog summarises the discussion and explores its implications for the future of nutrition in Liberia.

From the findings, three clear barriers to accessing treatment for wasting became apparent:

1. Lack of knowledge: Many mothers and caregivers were unaware of the availability and importance of RUTF.
2. Stock-outs: Even when caregivers were aware of the treatment, often supply shortages made it difficult for families to obtain it.
3. Access issues: Challenges in both reaching treatment centres and the availability of services once there, contributed to low uptake.
   
   

Evaluating the findings - what did we learn?

The dissemination workshop provided an opportunity for nutrition stakeholders to review these findings and discuss ways to improve the current situation. The surveys were designed and conducted so we are able to identify areas of both high and low coverage of services, helping provide a clearer picture of where our efforts are needed the most.

From the survey results and through the workshop, we developed five key recommendations to improve nutrition services in Liberia:

1. Inclusive programme design: It’s crucial to involve local health authorities, mothers, caregivers, community health assistants and volunteers in designing interventions to improve buy-in and ensure that nutrition products are used appropriately.
2. Timely distribution: Ensuring that nutrition products reach the target populations promptly is essential for effective treatment.
3. Integration with other services: Combining nutrition services with other primary healthcare interventions like routine immunisation, counselling, and social behaviour change communication can enhance their effectiveness and efficiency in the delivery of essential nutrition services.
4. Awareness of programmes: Educating communities about locally available nutritional foods can help reduce reliance on external supplies and promote sustainable nutrition practices.
5. Training and capacity building: Providing refresher training for frontline health workers and community volunteers can improve service delivery and ensure better outcomes.

Moving forward: strengthening nutrition systems

During the workshop, there was a strong emphasis on using the data collected to advocate for better resource allocation and policy development. The Director of Nutrition at the Ministry of Health, Dr. Bedee Duworko Gbozee, highlighted the importance of continuing independent data collection to identify gaps and challenges in service delivery. She also stressed the need for accountability among stakeholders and the government to ensure that nutrition programmes receive the necessary support and funding.

Conclusion: a collaborative path to better nutrition

The lessons from implementing the PAI programme in Liberia have helped create a similar programme in Ethiopia. This is being done with the Ethiopian Public Health Institute (EPHI) and local universities, using real-time data to understand the challenges (supply and demand side) related to malnutrition in low-income communities. A joint scientific paper comparing the situations in both Liberia and Ethiopia is now being prepared.

The PAI dissemination workshop was a crucial step towards strengthening Liberia's health and nutrition systems. The SUN Liberia (Scaling Up Nutrition) will share the PAI evidence brief with the office of the Vice President as part of their advocacy efforts to mobilise additional support and financing for Nutrition towards implementing these valuable recommendations. By bringing together government bodies, international organisations, and local communities, Liberia is paving the way for more effective and equitable nutrition interventions. With ongoing collaboration, commitment, and investment, there is hope for a healthier future for all Liberians, especially the most vulnerable.

By focusing on these recommendations and fostering a collaborative approach, Liberia can improve its nutrition programmes and better serve those in need, ultimately reducing the rates of undernutrition and improving the overall health of its population.

Header image: credit UNICEF Liberia, Newborn at WHO clinic, Margibi.