How Institutional Reform Can Strengthen Nutrition Accountability: The Experience of Benin

The nutrition situation in Benin is alarming and is characterised by persistent undernutrition along with increasing obesity rates. According to the 2006 Demographic Health Survey (DHS), the prevalence of stunting among children under five years of age was 43.1%, with wasting and underweight rates of 8.4% and 18.4%, respectively. More recent national-level estimates of stunting, wasting and underweight among children aged 6 to 59 months were 37.0%, 4.7% and 17.3%, respectively (AGVSAN 2009). In 2006, anemia (<11.0 g/dl) was present in 78.1% of the children in this age group. Among women of reproductive age (15-49 years), the prevalence of chronic energy deficiency (BMI <18.5 kg/m2) was 9.2%, and the prevalence of obesity (BMI >30 kg/m2) was 5.8%. Corresponding estimates from AGVSAN 2009 show 9.0% chronic energy deficiency and 7.0% obesity in women of reproductive age. In addition, anemia (<11.0 g/dl for pregnant women and <12.0 g/dl for non-pregnant) was present in 61.3% of women of reproductive age (DHS 2006).

This nutrition situation resulted not from an absence of action, but rather from a dissipation of efforts in the nutrition sector and a dearth of leadership within it, resulting in the lack of visibility of the sector. This contributed to the poor performance of several food and nutrition programmes/interventions over the past decades. In response to this, the Government of Benin began a reform programme in 2007 and committed resources for the formation of a Core Group for Nutrition,[1] which facilitated a multi-stakeholder  dialogue that yielded the so-called ”Guedevy Consensus” and later the Strategic Plan for Food and Nutrition Development (PSDAN). The latter was approved by the government in May 2009. The critical component of the plan was the formation and positioning of the Council on Food and Nutrition (CAN), which was created in June 2009 and placed at the highest political level: under the Office of the President of the Republic.  It is a multi-sectorial, multi-stakeholder platform for the co-ordination of all food and nutrition activities in the country. The staff of the Permanent Secretariat, the operational unit of CAN, was recruited in 2012 through an independent and competitive process.

The PSDAN is operationalised through a results-oriented Food and Nutrition Programme (PANAR), which has five sub-programmes that integrate nutrition-specific interventions, targeted at the first 1000 days post-conception, into the National Food Security Programme. The PSDAN now serves as an overall framework for all nutrition initiatives in Benin and all nutrition stakeholders have an obligation to align their activities with this.

The cost of the PANAR programme is estimated at 72 billion XOF (109.5 million Euros) over the first 10 years and the government’s commitment to it is represented by the fact that over 20% of PANAR is being financed by the national budget (4 billion XOF per year). Efforts to mobilise additional resources are ongoing and a platform of stakeholders, including the government and the private sector, has been instituted to assist in this.

Under the framework of the PANAR, a four-year Community Nutrition Project (PNC) was launched in 2012. It is funded by the Japan Social Development Fund through the World Bank. Its objective is to improve the nutrition of 16,800 children from 160 villages with high malnutrition rates, in 10 out of the 77 districts of Benin. It is implemented by a team of NGOs (one international and five national). The PNC studies what works in the community management of moderate and severe acute malnutrition using resources co-ordinated by local authorities. The PNC operates as a pedagogical project, with lessons and positive results documented through a permanent monitoring and evaluation set-up (Plan Benin 2013) and incorporated into a larger Food, Health and Nutrition Multi-sectorial Project. This new national initiative will be implemented over the next four years in 40 districts by the CAN Permanent Secretary, using NGO community facilitation expertise, under the leadership of local authorities at the district level. The World Bank has allocated 14 billion XOF for this work.

To improve understanding of the nutrition sector, the CAN is mapping all institutions that intervene in the sector of food and nutrition in Benin. In October 2014, it will host a regional workshop on the cost of a national nutrition plan of action, a community scorecard impact assessment and tracking nutrition expenses. Participants from 10 French-speaking countries will receive support to develop and refine tools and plans of action, which they are expected to implement in their respective countries.

The creation of the CAN is a great advancement in the institutional landscape of nutrition in Benin. It has formalised regular meetings of the platform of nutrition stakeholders that are committed to mobilising funds for the implementation of the PSDAN through the PANAR. By dedicating a special budget line to planned nutrition activities, the Government of Benin has gained more confidence from partner institutions and various actors working in the field of food and nutrition.

[1] The Core group was co-ordinated by Joseph Hessou and assisted by Léopold Fakambi, two leading figures in the Benin nutrition sector.

References

INSAE and Macro International Inc. 2007. Enquête Démographique et de Santé (EDSB-III) - Bénin 2006. Maryland.

INSAE, PAM and UNICEF. République du Bénin. Analyse Globale de la Vulnérabilité, de la Sécurité Alimentaire et de la Nutrition (AGVSAN). Rome, PAM. 2009

Plan Bénin. 2013. Evaluation participative à mi-parcours du BEN 0081 : Projet de Nutrition Communautaire au Bénin (PNC). Rapport d’évaluation de Plan International Bénin inédit, Cotonou.