Keeping Moyale from the tipping point: Promise amid disaster

Thanks to an early famine intervention program implemented in the district of Moyale, Kenya, Concern Worldwide was able to improve nourishment for many children in the community. Kirk Prichard, Concern advocacy officer, and Concern Kenya acting country director Wendy Erasmus report.

You see a lot of heartbreaking events unfold when you work in an emergency: malnourished children lying in stabilization clinics; once-proud pastoralists newly dependent on food assistance for survival; scores of cattle carcasses littering the parched plains of northern Kenya; camels who have survived the harshest desert conditions for millenniums, uncharacteristically dying.

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Pastoralists, now entirely dependent on food assistance, participate in a community meeting about their future plans. Photo: Kirk Prichard, Concern Worldwide
And though these images continue to upset us, it is the stories of success that move us the most — like the stories that emerged from the district of Moyale, where Concern launched an early intervention in 2010 in response to the impending crisis it had been tracking for months.

Moyale is in the far north of Kenya, right on the border of Ethiopia and a few hundred kilometers from Somalia. This is the exact region where the current drought has had its most devastating impact, killing up to 40 percent of cattle, which are the lifeblood of these pastoralist communities. Reports indicate that 80 percent of the surviving livestock have left the north entirely in search of pasture. And it is now estimated that more than 75 percent of the population in the northern areas is “food insecure” and in need of emergency rations.

Despite being located in the epicenter of the drought, Moyale tells a different story. Statistics aren’t the best way to describe a very human tragedy, but they illustrate a compelling point.

For example, in Moyale, the rate of “global acute malnutrition” (GAM) among children under five is 13.7 percent: a threshold of 15 percent indicates a humanitarian emergency. In neighboring Marsabit and northwest Wajir, GAM rates are at 27 percent, almost double the international emergency threshold.

Simply put, children in Moyale are better nourished and thereby healthier and more resistant to illness and death than their neighbors.

What has made this difference in parts of Moyale, an area that has similar economic, agricultural and climate conditions as its neighbors? Early indications suggest that it is in part due to disaster risk reduction programming and early interventions by Concern.

Almost a year ago (in October 2010), the first warning signs of a looming disaster in Moyale began to appear. When these warnings were first issued, Concern’s nutrition team immediately got to work with a network of local partners to begin scaling up nutrition programs. They launched a large-scale “early intervention” to prevent the situation from deteriorating into a widespread catastrophe.

In other words, instead of waiting until large numbers of children became severely malnourished, Concern designed a program to prevent malnutrition levels from reaching emergency thresholds in the first place.

IMG_3686Beneficiaries of Concern’s emergency livelihoods program in northern Kenya. Photo: Kirk Prichard, Concern Worldwide
Here’s how it worked.

Concern worked with the Ministry of Health to hire and train more than 120 community health workers (CHWs): these CHWs traveled to the remote arid and semi-arid pastoral lands of Moyale to find and screen children at risk of severe acute malnutrition — children who showed signs of moderate malnutrition, but whose condition was not yet life-threatening. The Concern-trained CHWs identified all moderately malnourished children that they found during the screenings and outreach, and admitted them into a supplementary feeding program, whereby they received rations of special highly nutritious food and were referred to health facilities for checkups. Concern also provided the families of these children with food rations. Concern’s intervention effectively prevented these children from becoming severely malnourished, and therefore more difficult — and expensive — to treat. Training these CHWs to screen and refer children for treatment cost just $25 per worker, and they are improving the lives of children in their communities every day.

In addition to training and providing technical supervision of Community Health Workers, Concern partnered with the Kenyan Ministry of Health to set up and provide technical support for 25 health clinics and approximately 20 outreach sites to improve health and nutrition coverage in communities throughout Moyale District and prevent malnutrition. To date, among an estimated total population in Moyale of more than 55,000, Concern-supported nutrition services have screened 7,000 children and pregnant and breastfeeding women, and treated 4,190 for moderate acute malnutrition. Of those treated, 89 percent of children under five and 85 percent of mothers recovered and were “cured,” and there were no deaths.

The Concern-supported outreach sites were particularly important in these pastoralist communities because the population is nomadic, moving from place to place many times a year with their herds in search of water and pasture. Communities may seek help at a health facility, but then move on and be unable to return. Outreach services ensure that assistance reaches those who may not be able to access services in the same facility multiple times.

Concern also worked with local partner organizations to assist families with little access to food and at high risk of hunger. Concern and partners provided vulnerable families with livelihoods support, agricultural training and support, and education to boost their income and food security. This early, integrated, multi-sector response helped prevent the most vulnerable from tipping over the edge into crisis.

Investments in scaling up nutrition, preventing hunger and improving the capacity of the poorest to manage their natural resources and improve their access to food have huge potential. Recent studies on undernutrition published in the Lancet, the world’s leading medical journal, and reinforced by the United Nations “Scaling up Nutrition” Movement, provide clear evidence of the direct links between proper child nutrition and healthy physical and mental development.

We are extremely proud of the work Concern has done in Moyale. But the fact that so many people in neighboring districts are facing extreme hunger is unacceptable: it highlights how much hard work remains to be done before we are able to scale up nutrition interventions to reach those at risk quickly and effectively. Investment in long-term development and emergency preparedness is a big part of the solution. We know that development and disaster risk reduction programs save lives — and cost much less than disaster relief. Early, integrated, multi-sector interventions that focus on preventing malnutrition rather than only on treating malnutrition are also vital. But despite their obvious impact and benefit, funding for these types of programs is quite scarce.

There is a saying that we’ve often heard here in Kenya: “Drought comes from God, but famine comes from man.” The current crisis in the Horn of Africa has many underlying factors: dramatic spikes in food prices, extreme changes in weather patterns, severe drought, entrenched extreme poverty, lack of income opportunities and poor water and health infrastructure. Regardless, in 2011, a regional food crisis affecting over 12 million people should not be happening. Preventing massive suffering from hunger and malnutrition is within our power — and it is our collective responsibility.