CS-SUNN takes the nutrition conversation from policy rooms to the local government, where officials say better coordination could turn scattered interventions into a sustained response
By Bunmi Yekini
The meeting in Epe was not about unveiling a new health centre or handing out food. It was about something less visible, but potentially more consequential: getting nutrition written into the local government’s plans, and, importantly, its budget.
The Civil Society Scaling Up Nutrition in Nigeria (CS-SUNN) team had travelled from Abuja to Epe Local Government as part of an advocacy drive aimed at moving nutrition financing closer to the communities where malnutrition is experienced.
The team had hoped to meet the council chairman, Princess Olayemi Surah Animashaun. She was unavailable, but the meeting did not lose its purpose. Around the table were people who could influence what happens next: the Council Manager, the budget officer and the Medical Officer of Health amongst others.
Kunle Ishola, a senior programme officer with CS-SUNN, explains the reason for the meeting.
“Over the years, the focus of nutrition has actually been at the national and state level,” he said. “CS-SUNN is taking it to the next level, which is going down to the grassroots when it comes to nutrition financing.”
Nutrition cannot remain an activity that departments pursue when an opportunity or programme comes along. It needs to appear in the budgets of the different departments that influence what people eat, how children grow and whether families have access to basic services.
That means health, agriculture, education, water, sanitation and hygiene, information, women affairs, economic planning and budget cannot work in isolation.
Ishola calls it the multisectoral approach. And Epe, one of four Lagos local government areas selected for the first phase of the initiative alongside Ikeja, Ikorodu and Lagos Island, may now be preparing to put that idea into practice.
Nutrition has had an identity problem for years.Mention it and the conversation often moves quickly towards agriculture, food production, crops and farming. But having food available does not automatically mean that people are eating adequately or that children are growing properly.
The health sector later became a natural home for nutrition, but that too had limits.
“Health only focused majorly on health facilities,” Ishola said.
That explains why nutrition has increasingly been treated as a responsibility shared across sectors, with the Ministry of Economic Planning and Budget providing what Ishola describes as a neutral coordinating space.
A child’s nutritional wellbeing can be affected by whether there is enough food at home, whether a mother has access to health services, whether a family has clean water, whether a child attends school and what happens to women who are responsible for much of the feeding and care within households.
No single department controls all of those things.
“So no single department can run nutrition effectively,” Ishola said. “It needs the conglomerate, the coordination function of other departments to make a holistic approach.”
That is the gap CS-SUNN is trying to close in Epe.
The organisation wants nutrition budget lines established across relevant departments and wants the newly established Local Government Committee on Food and Nutrition to meet regularly and coordinate the local response.
The need is difficult to reduce to a single number because malnutrition does not present itself in just one form. The 2024 Nigeria Demographic and Health Survey puts national stunting among children at about 40%, underweight at 27% and wasting at 8%.
Ishola said state-level figures also point to a serious burden in Lagos, although local government-specific data are not readily available.
“If the state figures are high, that means that of the local governments too are also high,” he said.
Dr Adeleke Awolesi Emmanuel, the Medical Officer of Health for Epe Local Government and chairman of Lagos State’s Medical Officers of Health, put the Lagos stunting figure at about 30%.
For Epe, however, the absence of a precise local government figure is itself part of the problem.
It is difficult to plan precisely for a problem that is not being consistently measured at the level where interventions are supposed to happen.
But officials in Epe are already seeing the consequences.
Awolesi said the Local Government Committee on Food and Nutrition has an important role to play in ensuring that vulnerable people are not missed.
“It is saddled with the responsibility of ensuring that no child is missed within our communities and not just children, also women,” he said.
The committee’s mandate extends to other vulnerable groups, including older people.
Perhaps the most significant discovery for the CS-SUNN team was that Epe already had pieces of the response in place.
The Council Manager, Mrs Shofolu Olufumilayo Alice, explained that the local government already supports women and children with health-related interventions.
The council refers residents with health challenges to the Federal Medical Centre in Epe and bears the cost of treatment in some cases.
It also provides food packages for mothers and children quarterly.
The local government has been engaging communities on maternal and child health, while officials have also worked with Community Development Associations to reach people in areas that government workers cannot always reach directly.
“We cannot do it alone,” Shofolu said.
The community associations, she explained, help carry information back into their neighbourhoods after meetings with local government officials.
It is a practical arrangement: government provides the programme, community leaders help carry it to places government may struggle to reach.
CS-SUNN’s intervention, therefore, is less about replacing what Epe is doing than bringing the activities under a more deliberate structure.
Awolesi acknowledged this.
“Many of these things our Executive Chairman has been doing,” he said. “We will just organise it like the committee wants and we will be able to achieve more and better.”
That may sound like an administrative adjustment. But in public health, organisation can determine whether an intervention survives beyond the enthusiasm of an individual office holder or a particular programme.
For Ishola, the response from Epe was better than he expected.
The budget officer indicated that the council could create nutrition budget lines with the chairman’s approval. The Medical Officer of Health welcomed the advocacy because, he said, the issue had already been under discussion but officials had lacked a clear way to organise it.
Then came another commitment: Epe officials said they would begin preparations for the first meeting of the Local Government Committee on Food and Nutrition.
For CS-SUNN, that meeting could be the beginning of something bigger.
The goal is not simply to have another committee that exists on paper.
It is to get agriculture asking what its work means for nutrition; health looking beyond treatment; education considering the nutritional wellbeing of children; water and sanitation becoming part of the nutrition conversation; and women affairs recognising its role in protecting mothers and children.
And then there is the money.
A programme that is not reflected in a budget can easily become dependent on occasional interventions, donor support or the personal interest of whoever happens to be in office.
A budget line changes the conversation.
It makes nutrition something the local government has deliberately planned to spend money on.
The real test, however, will not be inside the council secretariat.
It will be in Epe’s communities.
Shofolu said the local government intends to put greater effort into reaching rural communities, where existing nutrition and food-related interventions can be strengthened.
That is where community structures become important.
The local government already relies on Community Development Associations to help disseminate information. CS-SUNN wants the coordination at the administrative level to translate into better action at community level.
Ishola left Epe encouraged by what he heard.
“I have never hoped better than the hope given to us today by the stakeholders we met in the local government area,” he said.
But the significance of the visit will ultimately be measured by what happens after the visitors leave.
For a local government already doing some of the work, the challenge is to move from separate activities to one coordinated response, with nutrition no longer treated as something that can be fitted in when there is room, but as part of what the council plans to deliver.
That is the change CS-SUNN hopes to see begin in Epe and eventually spread across Lagos State.