How aggressive advocacy, social media help in fight against malnutrition

On their second visit to receive their rations of power food, the twin girls looked filled-out. Their health was returning. On their first visit, they had looked like they belonged in a war-ravaged country: their cheekbones were too obvious for infants; their sagging, papery skin hung loosely over the bony frame; over their ribcage the […]

On their second visit to receive their rations of power food, the twin girls looked filled-out. Their health was returning.

On their first visit, they had looked like they belonged in a war-ravaged country: their cheekbones were too obvious for infants; their sagging, papery skin hung loosely over the bony frame; over their ribcage the skin sunk with each breath, outlining the shape of bones beneath.

Hassana and Hussaina were not in a war zone; they were in the city of Nigeria. Precisely, at a health centre in Kwali area council of Abuja on a Wednesday in October.

They were evidence of the long-denied presence of severe acute malnutrition ravaging children in the country’s opulent glitzy capital. And a horde of bloggers, Tweet warriors and Instagrammers had picked that Wednesday to besiege the health centre.

“If you want to reach a lot of young people, your best target is social media,” said Chioma Kanu, a programme officer for the Civil Society Legislative Advocacy Centre.

“If you are talking about a holistic approach to address severe acute malnutrition and we haven’t even touched the people who can actually tweet and get information out to the general public and policymakers and lawmakers then we haven’t really commenced.”

The horde was in the community to be the eyes of the public—to show even the country’s capital wasn’t spared of malnutrition. They pulled out their phones and cameras and began clicking away. The hashtags followed, flooding the information super way. Interest in news search for malnutrition soared that October in Nigeria, a Google Trend analysis shows. Borno topped the locals for the keyword. Abuja came in the sixth position. And the movement sparked interest in the related query “severe acute malnutrition”.

“We have been living in a lot of denials, we feel that there really isn’t any issue in Abuja, that we don’t have severe acute malnutrition,” said Kanu.

“But if you come here, you will see children that are two years old looking like two-month-old babies. You would have thought it was a war-torn zone, but, hey, it is Abuja.”

Eyes of the public

A nurse ran a tape around the middle-upper arm of the twin sisters for a circumference check. That determined how the girls were categorized according to one of three colours—green for normal, orange for moderate malnutrition, and red for severe malnutrition.

The twins fell firmly in the red band. A batch of ready-to-use therapeutic food was dispensed to their mother Habibat for the second time. Three weeks later, she would say her twins were improving.

Acute malnutrition in the FCT stood at 5.5% then, according to the National Nutrition and Health Survey that year 2018. The average for the entire north-central stood at 4.9%, but the national average was 7%.

The survey found a trend showing children in their first year of life were most affected.

CISLAC was part of a coalition under the Children’s Investment Fund Foundation to bring investment, interventions and funding into malnutrition.

Organisations like UNICEF and Save the Children had been on about malnutrition, using donor dollars to support primary health centres to manage acute malnutrition within communities. CISLAC would in all work in 11 northern states, but the venture in Kwali was its last. It was three-pronged: train health workers and caregivers to use local goods, use social media influencers to amplify awareness, and advocate federal lawmakers for increased funding to fight malnutrition.

Work plans

Some of the work was to train facility staff to teach caregivers on using local foods to beef up child nutrition. Staff identified malnourished children throughout the 10 wards of Kwali.

In Wako ward, Elizabeth Gantata held sway in charge of the health centre. Wako has attracted residents displaced by the crisis in the northeast as well as seasonal farmers from Sokoto, Zamfara, Katsina.

“Many women don’t have an idea of what and what to give their children, so most of these children end up being malnourished,” says Gantata. “That’s why they are many.” A typical day sees at least 10 children.

Habibat and other mothers face the nurses during a food demonstration. A table is packed with food samples: oranges, watermelon, green vegetables, sweet potatoes, beans, eggs, maize, palm oil, groundnut, soybean. They are all grown locally, and routinely sold off to travellers plying the expressway into Abuja.

“It is not that they don’t have the food. They have the food but ignorance on how to handle this,” says Gantata.

“See out demonstration table. All the foods needed are there. We farm it, but unfortunately, some of us prefer to take it to market just because we need money to take care of other things.”

Social learnings

“The internet has provided a platform where a lot of people can be reached via the power of social media,” said Patience Adejo, one of the social media influencers affiliated to Nigeria Health Watch who visited the Kwali centre in 2018.

“Using this platform, I see a lot of reach beyond traditional media. Just with a hashtag, there is a high possibility of getting many to see what is happening in terms of nutrition in Nigeria and how they can come in.”

And with the internet not bound by time, it never forgets.

The site at Kwali is not the first time social media and youth power would be engaged to turn the course of malnutrition.

A separate intervention by Scaling Up Nutrition sought to bring the voices of young people into the malnutrition discourse and turn up its volume. It curated 15 topics—obesity, anaemia, nutrition in the school curriculum, food safety, dietary practices—for dissemination via discussion boards, publications, bulletins, campaigns, webinars and blogs.

 It also appointed Maryam Ahmed a youth leader and ambassador embedded with Civil Society Scaling Up Nutrition in Nigeria to provide technical support on young engagement and content development targeting young people.

Ahmed was overweight as a child and still battling with it. In her adult years, she has committed to diet and exercise—and helping other young people deal with being overweight, the converse side to the malnutrition problem in Kwali.

Her agenda was nutrition—in blogs, articles, social media campaigns, conferences.

The project lasted only months. But a third of respondents who took part in its close-out survey said they were previously “uninformed” about youth and nutrition. Another 58% said campaigns and activities on youth and nutrition increased their knowledge at the end of the programme.

The programme used the social media advantage, garnering 233,893 Twitter impressions and nearly engagements. The campaign on Facebook reached over 2,000 and nearly 700 engagements.

At least it got media outlets to spotlight “youth and nutrition” in their publications—from Daily Trust and Leadership for print to NTA and AIT for television, and Vision Fm, Kiss FM and Armed Forces Radio for radio.

It came down to the combined discipline of diet and exercise for Ahmed.

“It has really helped me with my weight and I’m almost at the stage of the BMI which will show that I am a normal weight,” she said.

Galvanising support

The social media horde was meant to disrupt the flow of awareness about malnutrition in the country. That was the immediate goal; the long-term goal was to galvanise support to secure more funding for malnutrition.

Lawmakers and legislative committees were put on target. So was the ministry of budget and economic planning, before its merger with the finance ministry. Lawmakers to make an appropriation, and the budget office to push for a cash-backed release.

In one instance, an entire legislative committee was flown to Ghana for a retreat on malnutrition funding, the distance chosen to keep them contained, focused and to “have their maximum attention”.

The lawmakers returned with increased support for nutrition financing.

“The key goal was increased financing for nutrition but sensitisation and awareness creation was also deployed so that we achieved both the supply- and demand-side objective,” said Mohammed Murtala, programme manager at CISLAC looking back on the end of the intervention.

“Within that period, we noticed a significant increase in the willingness of the states, and at the federal level, to even increase nutrition funding,

“From 2012 to 2016 when malnutrition issues began to emanate, there was little or no funding being released.

“From 2017 up toll 2020, when we did massive awareness and advocacy engagement, we began to notice a gradual improvement in terms of the government taking ownership in funding nutrition intervention.”

The 2017 federal budget included N1.2 billion in counterpart funding for UNICEF to procure RUTF. N800m was released, but RUTF never came up in the 2018 budget. By 2019, the budget included N10 million to procure local alternatives to RUTF. In 2020, the budget for alternatives to RUTF rose to N10.5 million. By 2021, the allocation was N10,1 million to “develop and procure” alternatives to RUTF.

But not all states followed suit. Kano, Bauchi and Gombe made allocations and releases for counterpart funding to procure RUTF but that’s about it.

And that’s a serious challenge in states that wholly relied on whatever funding came from UNICEF or some other donor partner. A second challenge is a political will to take ownership.

After 2018, Unicef support went into phasing out, while states were encouraged to step up to the plate—to take care of their nutrition funding.

“Most of the policy and framework that states used are donor-driven. The annual work plans, state governments are not even willing to develop their annual work plan,” says Murtala.

“The coalition, which CISLAC is part of, built capacity to develop these work plans rather than wait for UNICEF to hand them over a work plan that they should use. Most states were able to build work plan, but following up on how far they have gone, most haven’t done anything.”

Finance is also a limitation, that strikes at weak sustainability. Every intervention succeeds only as far as smooth cooperation with the government allows—and that means organizing workshops and seminars. The government budget goes into conferences, workshops and seminars for nutrition, without actually procuring what’s required by children like Hassana and Hussaina.

Many centres for community management of acute malnutrition have run out of RUTF, facing depleted or no funding at all.

“If we had an ongoing project in that regard, I’m sure when we engage them further, they would release funds to protect RUTF and other programmes for infant and young child feeding,” says Murtala.

“The people who have been trained over time have a high level of capacity, but the major problem is financing.”

Strategic advocacy helps interventions. And when it comes to (mal)nutrition, leveraging the voice of young people, pushy influencers and the power of social media to lay bare and shame helps project causes.

But going through the data with a fine toothcomb will require some clustering and further analysis to see who exactly is listening, what really social media metrics say about people and nutrition—how to better harness impact. That could spell a difference for the Hassanas and Hussainas.

The piece is with support from the Solutions Journalism Network and Nigeria Health Watch