Country government

Sierra Leone

Nutrition for Growth (N4G) commitment

Reported progress

Assessment

Financial commitments
London 2013

Increase the government’s financial allocation to nutrition and food security and create a specific budget line for nutrition in budgets for the Ministries of Health and Sanitation, Agriculture, and other relevant ministries.

Reported progress

Since the launch of the SUN Movement in 2012 and the commitment made on behalf of the government at the Nutrition for Growth in 2013, government has made substantial efforts to support the drive for scaling up nutrition actions. According to the last budget tracking survey report on nutrition (2018), government of Sierra Leone expenditure on nutrition sensitive actions was Le263.47 billion (US$33.22 million) after weighting (uniform 25%) and before adjusting for inflation. In 2017, it was Le226.68 billion (US$30.7 million). In nominal terms, total nutrition sensitive expenditure grew by 16% from 2017 to 2018 but contracted by 3% from 2017 to 2018 in real terms. From 2017 to 2018, inflation increased from 12% to 16%, hence affecting the value of the money in leones. However, it is worth taking note that investment has been made around improvement in the human resource for nutrition as follows:

1. From only 25 staff in 2013 to 94 by 2020 nationwide. These include clinical nutritionists in all government hospitals, senior nutritionists in regional headquarters towns, and public health nutritionists in all 16 districts with 5 per district, except 2 that have 4 nutritionists.

2. The staff strength has allowed the implementation of five core programmes - Maternal, Infant and Young Child Nutrition (MIYCN), Integrated Management of Acute Malnutrition (IMAM), Clinical services, Micro-nutrient, and Nutrition Surveillance.

3. Provision of an entire building to house the national staff with various rooms and a conference hall.

4. Advocacy for the creation of a budget line for nutrition-specific programming from the national revenue under the Ministry of Health is ongoing and the issue has been tabled with the parliamentary caucus on nutrition.

Assessment
On course
Basis of assessment

At least half of the individual commitment components are assessed to be on course

Impact commitments
London 2013

1. Reducing the prevalence of stunting from 25.7% to 11.7% in under-2 children.

2. Reducing wasting from 6.9% to 2.0%.

3. Increasing exclusive breastfeeding from 32% to 70%.

Reported progress

1. According to the most recent data available, the 2019 Demographic Health Survey reported the prevalence of stunting among children under the age of two years to be 24.1%.

2. For wasting, the prevalence among children under the age of five years is about 5.1%. It is important to note that the initial data used for setting targets for the commitment was based on the 2010 SMART survey and the most recent data is from 2017 so it is not being considered here for this reporting.

3. Exclusive Breastfeeding for children less than six months was reported to be 54.0% (Demographic and Health Survey 2019). Although the 70% target was not reached, there has been an improvement considering the baseline of 32% to 54% from the most recent national survey.

Assessment
On course
Basis of assessment

At least half of the individual commitment components are assessed to be on course

Policy commitments
London 2013

1. Finalize and endorse 5-year Nutrition and Food Security costed plan by July 2013.

2. Prioritize fundraising to ensure successful implementation of the Nutrition and Food Security costed plan.

3. Establish legal frameworks and enforce the Code for the Marketing of Breast Milk Substitutes and food fortification.

Reported progress

1.The Multi-Sector Strategic Plan to Reduce Malnutrition in Sierra Leone has been revised and launched by the Vice President. The plan specifies national nutrition targets and costed actions that guide collective implementation and required resources from 2019 to 2025.

2. Fundraising activities were prioritized before the Covid-19 breakout in Sierra Leone but this will no longer be implemented due to funding constraints. However, with support from the UN Nutrition under the REACH project, a concept note is being developed for a joint programme for nutrition. The concept note will be used to raise funds for the implementation of the agreed interventions. Other SUN partners especially the UN Agencies and CSOs are supporting the implementation of the National Multistakeholder Strategic plan for the reduction of malnutrition in Sierra Leone.

3. The legal framework for the establishment and enforcement of the Code for marketing of breast milk substitute is in its final stage in parliament. The plan is for the bill to be enacted before World Breastfeeding Week.

Assessment
On course
Basis of assessment

At least half of the individual commitment components are assessed to be on course

Program commitments
London 2013

Scale up community support networks for nutrition and food security.

Reported progress

Community structures such as community health workers and mothers support groups are the main links for community interventions. A policy for CHWs was developed to be operationalized from 2016 to 2020. Initially, a total of about 14,000 CHWs were trained and equipped to carry out community health services including nutrition screening for identification and referral of malnourished children. However, that figure dropped to 13,660 mainly due to low incentives and lack of commitment. The Ministry of Health has now reviewed the policy with a condition that all CHW workers should be able to read and write. A total of 8,700 CHWs and peer supervisors have been recruited and are currently undergoing training nationwide with 32 Master Trainers.

Mothers support groups that were established were scaled up from 14,300 in 2017 to 16,000 in 2019. They provided counselling sessions for mothers on maternal, infant and young child feeding, as well as mid-upper-arm circumference screening for identification of children with acute malnutrition. These structures are still in the communities but a good number of them are not functional due to lack of incentives to motivate them. The Directorate of Food and Nutrition is encouraging partners to support the MSGs by creating livelihood structures that can bind them together while they perform their duties to young mothers and their children.

Outreach services are being strengthened to scale up service uptake in rural communities.

For improvement in nutrition surveillance in terms of timely reporting and data quality management, CHWs will be trained on the use of the Rapid-pro tool for routine data collection including nutrition indicators. This is intended to be used nationwide.

In the context of Covid-19, refresher trainings were provided for mothers to do self-screening of their children.

Assessment
On course
Basis of assessment

At least half of the individual commitment components are assessed to be on course