KATSINA - It is the start of the rains in northern Nigeria, and farmers are out sowing their fields. They know that the next three months will be the belt-tightening lean season, when households need to be prudent to get by, but hardship will give way to the harvest in September.
For the women gathered at a small healthcare centre in Daura, in the northwestern state of Katsina, hunger has come early, and is visible in the ginger-coloured hair and the slack skin of their children.
Hajiya Ladidi's two-year-old daughter, Kadija, is severely malnourished and enrolled in an outpatients therapeutic programme (OTP) at Gurjiya, one of six run by Save the Children in the Daura Local Government Area. Business has been bad for her husband, an onion middle-man who buys from local farmers and sells to traders heading south. He has another wife, a total of nine children to feed, and the stored grain from last year's harvest ran out in May. [ http://www.irinnews.org/Report/93701/GLOBAL-Food-and-nutrition-jargon-buster ]
Katsina, on the border with drought-affected Niger, has a global acute malnutrition rate of 8.1 percent among children aged under five, according to a preliminary survey at the beginning of this year by the UN's Children Fund (UNICEF). That figure is almost certain to worsen as the lean season sets in, and prices of the staples millet, maize and sorghum rise.
Nigeria is the key food producer in the Sahelian region, but across the northern states there are now 383 sites like those in Gurjiya, providing Community Management of Acute Malnutrition (CMAM): a dramatic expansion from the 30 at the launch of the programme in 2009.
The women at the Gurjiya health centre, waiting to have their children measured and checked, understood the community mobilizers' exhortation to feed their families with nutritious food, the problem was to find the money to do so. Khadija's mother needs US$2 a day to keep her household fed, and that is a struggle, she told IRIN.
"In the villages you will just find millet, which is a carbohydrate," said Ramatle Bello, the OTP officer at Gurjiya, which has 200 children on its books. "They could use beans, eggs or milk, but they are not doing so because they prefer to sell those items to make money."
UNICEF runs the bulk of the OTP sites in Nigeria, and provides the nutrition-rich Ready-to-Use Therapeutic Foods (RUTF) central to the CMAM programme. Mothers bring their children for weekly check-ups to the government-owned health centres, where they receive antibiotics and health lectures. But it is the 8-week course of high-energy RUTF that changes the fortunes of their children, and when IRIN visited Gurjiya, none was available.
[ http://www.irinnews.org/Report/72897/GLOBAL-Birthplace-of-a-nutrition-revolution-a-blender-in-Malawi ]
There have been sporadic shortages throughout this year, with UNICEF, Save the Children, and Action Against Hunger - partners in the European Union ECHO-funded programme - borrowing from among each other to try and provide a level of service. There had been a cumulative total of five weeks of low RUTF stocks, and Bello was worried: "Without RUTF there is no CMAM."
She said some women with too far to walk had to borrow the 30 US cents for a motorbike taxi to the health centre, or had other children at home to take care of. If the shortages persisted, they would stop coming: "It is really affecting this programme."
In the first five months of this year, 69,000 children were enrolled in CMAM in 11 northern states. The largest number by far - 19,000 children - are in Katsina, a city which 300 years ago was at the heart of commerce in the north. According to one aid worker, the extent of the needs means even more sites could be opened in the state, "but we'd be overwhelmed. The challenge is even bigger than we thought."
Stanley Chitekwe, UNICEF's chief of nutrition, says need is squeezing supplies. "Monthly consumption is increasing and the [RUTF] pipeline is becoming very sensitive. We're not even managing with buffer stocks, whatever comes we push to the states."
Logistical delays in clearing RUTF through Lagos port were also holding up delivery, and a solution being explored is to use one of the RUTF suppliers in neighbouring Niger, if there are surpluses there. "Hopefully, they will move faster," he added.
Alhaji Aliyu Usman, the director of the Primary Health System in Daura, said the supply "hiccups" did not "invalidate the importance" of the work of the past three years, but what he wanted to see was technical collaboration and the investment to allow Nigeria to produce its own RUTF.
According to USAID's FEWS NET food security outlook for May, "abnormal increases in food prices" are anticipated between July and September across northern Nigeria. Boko Haram-related insecurity, last year's production shortfalls, transport costs, and an outflow of grain into Niger, are among the causes; the impact will be even more poor households struggling to meet their daily nutritional needs. [ http://reliefweb.int/node/500035 ]
While climatic conditions are playing a role, it is affordability rather than production that determines food insecurity in Katisna. "There is a paradox of hunger amidst plenty," Abimbola Williams, Save the Children's newborn and child survival adviser, told IRIN. "There can be surplus production within the state, but hungry children just a few kilometres away."
Nigeria's last demographic and health survey, in 2008, found that stunting in children aged under five topped 53 percent in the northwest; by comparison, the southeast was 22 percent. Just under a third of the population of the northwest were assessed as extremely poor based on assets owned; the only region worse-off was the northeast, with 47 percent of their people on the bottom rung of the ladder. [ http://www.neuroaro.com/sites/default/files/downloadables/Nigeria%20DHS%202008%20Full%20Report.pdf ]
"Across the north, people depend on farming for income and feeding," said Hussaini Abdu, director of Action Aid in Nigeria, "and a drop in rains means a drop in production." The land cultivated, with limited access to credit, fertilizer and improved seeds, has rarely been productive enough to tide a household over all-year round.
Traditionally men have migrated during the dry season to the towns and cities to look for work, but with an average of 42 percent of males in the north having never attended formal schooling, "they can't make any income, and it just deepens the poverty," said Hussaini.
Aid agencies are rethinking their strategy - in particular towards intervening earlier, before the stage of severe malnutrition. Save the Children are looking at cash transfers, "to see how the very poor can be supported during the hunger months," Denis Onoise, the field manager of Save the Children in Katsina told IRIN.
According to one aid worker, who asked not to be named, "CMAM targets only severely malnourished children, but the majority of acute malnourished children and moderately malnourished are not accessing the services. Treatment of severe malnutrition can be mainstreamed through the primary health care system, but moderate malnutrition is more difficult to manage as it's resources intensive."
The hesitancy of the local authorities in the past to acknowledge the extent of the crisis has been an additional problem, aid agencies say. The existence of malnutrition in the north was seen as an embarrassment for a regional super power like Nigeria, made even more awkward by the fact that Daura and Katsina are the homes of two former heads of state.
The usual response by the state authorities to food deficits had been to swing open the doors on their food reserves, "but the surplus never gets to the poor - it goes into politically-connected hands, and some of it winds up being sold across the border," the aid worker said. Nigeria is the only country in the Sahel not to have declared an emergency.
"Malnutrition has always been here [in the north], but it wasn't seen by duty-bearers as a critical issue, people took it for granted," the aid worker added. "The government needs to accept and engage; the most important thing is ownership. Nigeria is rich, it has the resources, so it's just willingness."
But according to Rabia Manam Daura, the head of the Katsina state primary health care programme, "the government is ready" to look at prevention. "There has to be a plan, we need capacity-building, communications and advocacy - money is the only problem."