Radio SudFM Senegal correspondent, Marie Rosalie Ndiaye, interviews USAID Chief Nutritionist, Shawn Baker

Radio SudFM Senegal correspondent, Marie Rosalie Ndiaye, interviews USAID Chief Nutritionist, Shawn Baker, September 8, 2022. You can listen to it in French here, or read the English translation.

Radio SudFM: We are with Shawn Baker. Hello. You are the Chief Nutritionist of USAID, the United States Agency for International Development. So, Mr. Baker, since February we have been witnessing a war between Russia and Ukraine. What do you think are the economic consequences of this conflict?

Shawn Baker: Thank you. And first of all, thank you for inviting me to this interview. We are very concerned about Russia's war against Ukraine and the price spikes around the world, and the impact on fertilizer. But we also must understand the context. On the side of the U.S. Government, we feel very lucky that since the last global food crisis during 2007-2008, we already implemented a major initiative called Feed the Future. Even with an on-going war whose consequences throughout the world are felt very strongly, we firmly believe that without the foundation established by the Feed the Future program, the consequences would be even more serious. And what I see here in Senegal, despite the consequences of the impacts of this food crisis, we see that there are certain achievements. We see the strength of the Senegalese Government's commitment to the fight against malnutrition going back decades, and the programs set up in partnership with the Government of Senegal, its partners and the American Government have created a solid foundation for the population to be more resilient in the face of these crises.

Radio SudFM: And concerning this inflation, one of the consequences of this war, but also the scarcity of certain food products, especially cereals. Do you think Senegal should reorient its agricultural policy?

Shawn Baker: In fact, even before the war, I think we see very fundamental reasons for a reorientation of agricultural policy or, really a diversification of agricultural policy. And I think the war and its aftermath highlights this need even more. And if I can really put this in the context of the objectives of my mission, which is focused on nutrition. Let’s consider the impacts on women and young children, because it is true that food is more expensive now. But the impacts are felt the most among children from 6 to 23 months who need, in addition to breast milk, a very nutritious and healthy diet. And pregnant and nursing women always need a good diet, not only for their own well-being, but also for the well-being of their children. In Senegal even before the war, during this critical age of 6 to 23 months, on average, there were only 10% of children of young children – only 10% who had a minimum acceptable diet. Some programs – including one of the programs I was talking with yesterday, “Kawalor” – have shown that by working with the health system and with the agricultural system, we can make nutritious food much more accessible and affordable.

At baseline, in 2018, in the intervention zone of the “Kawalor” program, only 3.8% of children had a minimum acceptable diet, a proportion that increased almost six-fold when we repeated the study in 2022. Well, but what does that mean? I am a technician. I often speak in technical language, but I am also a grandfather, and my granddaughter is Senegalese. And you can see clearly if you take care of young children the difference between a child who was breastfed and fed properly the impacts on her health, the energy she has, the sharp mind she has. And it's really the difference between a healthy child with a future and children who are at risk of disease. And these diseases can be fatal, or even if the children manage to survive malnutrition, their cognitive and physical development are damaged. Professionals may speak about this situation in technical language, but I think that everyone who cares for children sees the real impact of what happens when a child is given adequate nutrition compared to those who are not well nourished.

Radio SudFM: Today, if the situation persists, do you fear a famine?

Shawn Baker: This is a very important question. I think we must also put the current crisis created by Russia's war against Ukraine and therefore the rise of food insecurity around the world in the context of multiple other crises. The world is in the process of emerging from the greatest pandemic for 100 years, the impacts of the Covid pandemic destabilized many systems. In Africa, whether it is the Horn of Africa or here in West Africa, there are already food insecurity crises often caused by changes in climatic conditions and, in addition, now the soaring prices created by the war against Ukraine, growing insecurity which further aggravates an already very worrying situation. We, on the side of the U.S. Government, side feel very honored by the generosity of the American Congress, which has voted to increase the budget of USAID to help deal with this situation. And to give you a very concrete example of our great concern about the consequence of this war, it is a spike in acute malnutrition rates. What is acute malnutrition? These are children who are too thin, and these children who are too thin are at great risk of mortality. It's really during a food crisis when the populations most at risk are children. And UNICEF has projected that in the 15 countries most affected by the various crises, there will be an increase of more than 260,000 children suffering from severe acute malnutrition.

What this means is they will need support with therapeutic foods, and other services. So in addition to our so-called “daily” work, which is estimated at about $500 million a year, we were able to make an exceptional investment with UNICEF of $200 million. Knowing that our resources alone are not adequate, our Administrator launched an appeal to mobilize additional resources. We have already mobilized $50 million more from private donors, foundations, and by September 21, we hope to double this amount to handle the current crisis. But also, we know that even if peace returns in the near term, the consequences of this situation will continue. And so, we have to be there in the long term, and not only in an emergency situation, but also in development settings. And to come back to Senegal, for example, even though Senegal has made enormous progress in the fight against malnutrition, there are still cases of acute malnutrition that require treatment. And there too, I was very happy to see signs of progress, how Senegal systematically integrates into the health system detection and treatment of child malnutrition. And I think we're well prepared to handle any increase in acute malnutrition rates here in Senegal.

Radio SudFM: Do you have figures for acute malnutrition here in Senegal?

Shawn Baker: Here in Senegal, before turning to acute malnutrition, I want to look at an indicator which is more long-term and also put that in the context of progress that Senegal has already made, but also where there is room to improve. If we look in general at one of the indicators that we use in the field of nutrition, it is stunting, children who are too short for their age. In the sub-region, these rates vary from 30 to 40 to 50%. In Senegal, that figure hovers around 18%. So really, Senegal is seen as a model of having made exceptional progress with this indicator. For decades, USAID has accompanied Senegal in its policy and programs to fight malnutrition. The creation of the National Nutrition Development Council is seen as a model, which brings together all the nation's forces, be it the health or agriculture sector to join the fight. So there has been a lot of progress and 18% is good. Now, it is still surprising that despite this progress, even before the Covid, there were around 9% of children who suffer from either severe or moderate acute malnutrition and require treatment. The good news is that the government is assuming its responsibilities and has a system in place to detect these children and provide the necessary services. You asked for other figures and that is one of the current challenges. Because during Covid, there was a pause in data collection, so often we don't have up-to-date data, which is not the government's fault.

It's the reality of the situation that field data collection was suspended in most countries to avoid any risk of disease transmission. But as I said, I think Senegal has made a lot of progress. But we also see that this progress has stagnated somewhat for several years, and we are particularly concerned about infant and young child feeding. Nationally, there are only 10% of children aged 6 to 23 months who are receiving a minimum acceptable diet, during this critical period, when in addition to breastmilk, infants and young children very nutritious foods. And I think that's where you need a special focus. And that comes back to your question of the agriculture system, and the importance of greater diversification of commodities. It is not only cereals that are important, but also needed are more horticultural products, more fish, small ruminants, nutritious foods such as cowpeas, etc. But also, it is important that the health sector is committed to improve promotion of good food practices. And there is also a very active private sector here in Senegal, which can produce, process, local products that are more available, more affordable, more nutritious so that families have more capacity to feed their children well.

Radio SudFM: Tell us about the program “Feed the Future”. Your takeaways.

Shawn Baker: Going back to where I started our conversation, for Feed the Future, it's true that the current situation is very worrying, but I think it would be much more worrying if we had not put in place Feed the Future. The broad objectives of Feed the Future are to hunger, poverty and malnutrition. I was able to engage with different partners involved in the implementation of Feed the Future here in Senegal, and I think one of the programs that really exemplifies the very positive aspects of Feed the Future is "Kawalor”. At the center of this program I would say was putting women at the heart of development. Really, the platform was mostly focused on women's groups. Around the world, the evidence is very clear that the more women have access to resources, have decision-making power, and have access to necessary information, the more there will be positive impacts on the life of the family and especially, from my perspective, children’s nutritional status. So, at the heart of this Feed the Future Kawalor program was really how to empower women, to give them better access, and it worked. I already spoke about the improvements in infant and young children feeding. There have also been very significant improvements in the rate of breastfeeding.

The baseline survey had shown - and why I come back to exclusive breastfeeding, is that we know during the first six months, the essential source of nutrition for the child, is breast milk, breast milk, breast milk. Of course, breastfeeding is the social norm in Senegal. But there are certain aspects of the practice that are not optimal, for example, delayed initiation of breastfeeding. Global guidance is to initiate within one hour after childbirth, the first milk is very nutritious and this is also good for the health of the mother. And often – I think you find that everywhere in the Sahel - we know it's hot, we have the impression that the baby is thirsty, ‘I have to give water, I have to give more.’ However, breast milk meets all the water and nutrient needs of the child. So, we are very focused on exclusive breastfeeding for the first six months, because it's very powerful for children’s health. In the zone of influence of “Kawalor” the baseline survey in 2018 showed around 21% of children aged 0 to 6 months were benefitting from exclusive breastfeeding.

And this rate more than doubled over the program period, to almost 59%. So, it's really remarkable progress and I think it gives examples that are relevant elsewhere in Senegal. The rates in general in Senegal are not bad, more than 40%. But there is a long way to go. It is an essential action, where with a prioritized behavior change strategy, we can see spectacular progress. In certain partner countries, we have reached rates of around 87%, for example. So, I think that all the means are in place to accelerate action.

We also had some data that was very interesting – coming back to women’s empowerment of women - the percentage of women who said ‘I'm a partner in decision-making’ dramatically increased, the percentage of women who controlled land and controlled what they could grow and who grew fruits and vegetables - all increased dramatically. It created a virtuous cycle, where women have more resources, more knowledge on what to do with these resources, how to feed the family. And that has benefits for everyone, creating a virtuous cycle of positive impacts.

Radio SudFM: Do you have any future projects on nutrition and prospects for Senegal?

Shawn Baker: I think we're in a period of reflection, and for me, it was a great pleasure to be here in Senegal and to talk with our partners at the government level, our implementing partners. The National Council for the Development of Nutrition is also evaluating the impact of nutrition programs across the country and developing new strategies. So, we are in the process of evaluating what we have already done. How can these lessons learned be applied on a large scale and what will be the next chapter of our support for the government of Senegal in its ambitions to end malnutrition. So, to give you very specific projects right now, it's difficult because we are in this period of reflection, just like our partners at the government level. That being said, there is a new initiative that our health office has launched - health in urban settings. Which, for me, provides very important opportunities. Because we know that malnutrition is often thought of as a phenomenon in rural areas. But we see more and more with the rate of urbanization in Senegal, that there are also problems of health and malnutrition in urban areas. It will support the Ministry of Health and private providers on how to improve access to essential services, including nutrition services.

Radio SudFM: Shawn Baker, Thank you.

Shawn Baker: No, it's me to thank you. It's really nice to be back in Senegal and to have this opportunity to discuss with you.