Today, we drove the 150 miles from Fada N’Gourma to Ouagadougou – the last leg before flying out tomorrow morning. On arriving in Ouagadougou, Nicholas Kristof and the “Win-a-Trip” winners visited a center for supporting people living with HIV. Over the course of the past week, Shawn Baker and I have accompanied Nick through four countries – Mauritania, Senegal, Niger and Burkina Faso. We’ve been in numerous villages, and we’ve spoken in depth with many people – mostly women – about the challenges of their lives and the solutions to help improve their lot.
In pursuit of HKI’s mission to prevent blindness and reduce undernutrition, we focus on two major program areas in Africa – fighting malnutrition (particularly micronutrient deficiency), and controlling certain tropical diseases, such as trachoma and onchocerciasis. During this past week, we have seen some successful programs in each of these areas. During these days, I’ve been reflecting on HKI’s approach to reducing malnutrition.
HKI employs a five-pronged strategy. First, we support vitamin A supplementation (VAS). In Niger, for example, we have achieved and sustained near universal VAS coverage of children under 5 years of age. The child showing the onset of nutritional blindness subsequent to a bout of measles whom we met this week (in Dogon Doutchi) was a case from neighboring Nigeria (where the VAS program is far weaker).
Second, we focus on behavior change to promote essential nutrition practices, such as exclusive breastfeeding for the first six months, optimal feeding for infants and children over six months, and seeking care for sick children. Looking at one aspect, exclusive breastfeeding, we see that progress is slow – but there are definitely improvements. In Niger, for example, exclusive breastfeeding has increased 8-fold in recent years (albeit from a very low starting point). The impact is visually palpable: exclusively breastfed children are healthy, plump and alert.
Third, we seek to diversify diets to ensure that women and children consume micronutrient-rich foods, such as fresh leafy vegetables and eggs. While we are still awaiting hard evidence of the impact, a casual observer in the village of Zona-Tenga in Burkina Faso will note that the infants consuming this produce are robust and active.
Fourth, we seek to fortify foods at an industrial scale, particularly wheat flour and cooking oil, which are consumed by a large segment of the population. Our visit to the flour mill in Nouakchott, Mauritania, is an example. HKI has been working with public and private sectors throughout West Africa to fortify foods. Over 45 million West Africans now consume fortified wheat flour, and over 50 million consume cooking oil fortified with vitamin A.
Finally, we work on bio-fortified crops. These crops are naturally bred or genetically modified to enhance their micronutrient content. In Africa, HKI is working to adapt — through conventional plant breeding — and disseminate orange fleshed sweet potatoes (OFSP). During our visit in Zona Tenga, we saw a nursery full of OFSP cuttings, just waiting for the next rainfall to be planted in fields. This crop is not only adapted to the local farming system, but it appeals to people’s culinary preference – and of course, it is rich in vitamin A.
HKI works closely with local governments to plan and implement the work together. We also work closely with local non-government organizations. Through capacity building, local governments and local NGOs will take ownership of the work. But we also have a huge and dedicated workforce – some 400 throughout Africa. Much of the credit for HKI’s success goes to them.